Due to medical demographics, in certain regions the general population encounters difficulties for common treatments and has to travel, sometimes long distances, for specific healthcare. In such cases prisoners are overlooked by the healthcare system. In the sixty-one institutions inspected, only eighteen institutions were able to offer specialised consultations onsite (in most cases dermatological consultations). The law needs to ensure equality for prisoners, in particular for certain specialised treatments, notably those to which access for the poorest persons is already difficult outside of prisons. It would thus be appropriate to take poor conditions of detention into account, which worsen the prisoner’s state of health, and social difficulties before imprisonment, to which lateness in access to treatment is attributable. 7.4 Limited Rights for Imprisoned Patients Although the principle of freedom to choose one’s doctor is valid (Medical Code of Professional Ethics [code de déontologie médicale]162, Social Security Code [code de la sécurité sociale]), it does not apply to prisoners since they are obliged to use the medical unit doctors both for specialist and general consultations, as stated under article D.365 of the CPP163. Consent to treatment is not requested at the time of examination of new arrivals and screening for tuberculosis. This is not the case for the pre-release consultation, which is only offered (article 53 of the Prisons Act). Article D 364 of the Code of Criminal Procedure provides that “if a prisoner engages in an extended hunger strike, they cannot be given medical treatment without their consent, except when their state of health seriously deteriorates and only by decision and under medical supervision”. This article is not in line with the Tokyo protocol164 (1974). At time of removal from prison for consultations and explorations, the head of the institution has to decide the level of the escort in writing according to statutorily defined criteria165. This liberty of assessment is rarely applied. Thus the presence of the prison escort during the consultation leads to violation of medical secrecy by breaking the one-to-one conference. Similarly, the wearing of leg-cuffs by the patient during clinical examinations, in bed or sitting down, has led to the condemnation of France for violation of article 3 by the ECtHR166. A strict interpretation of article 803 of the CPP167 needs to be applied. The fundamental rights of hospitalised persons are set out in the Hospitalised Patients’ Charter (Charte de la personne hospitalisée). Chapter 7 of the latter specifies that: “persons in police custody and hospitalised prisoners have the same rights as other hospitalised patients within the limits provided for by law168 with regard, in particular, to communications with the outside and 162 Article 6 of the medical code of professional ethics: "the doctor shall respect the right of every person to freely choose their doctor" (article R. 4127-6 of the Public Health Code). 163 "Prisoners can only be examined and treated by a doctor of their choice, except in case of a decision by the regional director of the Department of prison services with territorial jurisdiction. They shall then take financial responsibility for the costs incumbent upon them for this treatment". 164 As far as the specific case of hunger strikes is concerned, the World Medical Association's Declaration of Helsinki and Declaration of Tokyo of the World Assembly of Prison Medicine specify that if prisoners are capable of forming conscious and rational judgements, hunger strikers shall not be artificially fed. 165 Circular concerning the organisation of prison escorts for prisoners going to medical consultations, AP 2004-07 CAB/18-11-2004 NOR: JUSK0440155C. 166 Decision of 23rd November 2003. 167 "Nobody can be subject to the wearing of handcuffs or leg-cuffs except if they are considered to be dangerous for other people or for themselves, or likely to run away. In these two scenarios, all useful measures shall be taken, under conditions compatible with security requirements, in order to avoid a handcuffed or leg-cuffed person being photographed or subject to audio-visual recording.” 168 The special terms of R 112-30 to R112-33 of the CSP specify that prisoners cannot come and go as they please within the hospital. 112