7.2 The Need for Updating of the Protocols The third version of the methodological guide158 recommends updating of the protocols binding prisons and health institutions in order to standardise159 provision of healthcare, and continuity of treatment in particular, which needs to prioritise support from local facilities. This recommendation, which calls upon SAMU emergency medical services control, does not satisfy the prisons administration which, for reasons of security, wants doctors to come to the patient’s bedside. The inspectors thus frequently encounter prisons which had been backed up, for a certain length of time, by a local association providing medical treatment160 which then withdrew, either due to lateness in payment, or to excessive delays before medical action (time required for passing through security bars, lateness in accompaniment by the night graded officer etc.), and usually for both of these reasons. In a sample group of prisons inspected56, only one doctor was noted for the institution for night and day emergency duties. In fifteen institutions, the on-call obligation is only fulfilled by a doctor of the institution during the week and in the daytime, in all other cases the Centre 15 urgent medical aid service call centre is in charge of emergencies, in most cases (but not always) after having assessed the patient’s state of health by telephone with the latter. In addition revision of the procedures should make it possible to readjust staffing levels of medical teams, which suffer from uneven distribution according to the territory. Forty-eight protocols entered into between the administratively attached hospitals and prisons were analysed in the course of inspections161 between January 2011 and August 2013; twenty were signed between 1994 and 1996, thirteen in the course of the 2000s, fifteen have been updated since 2010. 7.3 Access to Specific Treatments, a difficulty shared with the Outside Certain specific treatments are not or are poorly provided in prison: dental treatment, ophthalmic care, physiotherapy etc. Matters relating to this question are often referred to the Contrôleur Général by prisoners and their families. Out of the sixty-one institutions inspected, two did not make use of the services of any dentistry practitioner. In eighteen institutions the dentistry surgery time was of between two half-days per month and six half-days per month, in twenty-three institutions it was between two and five half-days per week. These situations lead certain persons deprived of liberty to also be deprived of food, or to be forced, as best they can, to make themselves a gruel, which can be easily ingested without teeth. Only half of these institutions provided physiotherapy treatment. Article 46 of the Prisons Act specifies that “quality and continuity of health care are guaranteed to prisoners under conditions equivalent to those enjoyed by the population as a whole”. 158 Interministerial circular No. DGOS/DSR/DGS/DGCS/DSS/DAP/DPJJ/2012/373 of 30th October 2012. 72% had been revised at the end of 2011 according to the report of the Senate on the application of the Prisons Act no. 629. 160 For example SOS-médecins. 161 Sixty-one institutions. 159 111