ESSEX PAPER 3: INITIAL GUIDANCE ON THE INTERPRETATION AND IMPLEMENTATION OF THE UN NELSON MANDELA RULES Medical Assistance in Urgent Cases The first sentence of Rule 27(1) requires prisons to ‘ensure prompt access to medical assistance in urgent cases’. The Essex Group emphasised that the determination of urgency should be made by a clinician, not the prison administration. The Essex Group acknowledged that in situations in which health-care staff are not present, a nonmedical person may have to take a decision on what to do. However, they noted that even in such situations it should still be possible to telephone a health-care specialist so that the decision and any subsequent action is informed by the advice of a health-care specialist. The experts noted that ‘urgency’ does not only imply a life-threatening situation. Rather, it refers to the situation in which if the prisoner was in the community, he or she would need to go to the accident and emergency/emergency room of a hospital. The experts noted that this rule applies to both physical and mental health. The second sentence of Rule 27(1) provides that ‘[p]risoners who require specialized treatment or surgery shall be transferred to specialized institutions or to civil hospitals’. The Essex Group pointed out that this sentence is broader than the first which only focuses on ‘urgent’ cases. This sentence addresses situations in which prisoners may need to be taken out of the prison if necessary in order to access specialist care. This may relate to the nature of the health complaint or the identity of the patient (for example, access to a paediatrician for a child or young person). Specialist care also includes mental health facilities. Rule 27(2) provides that ‘[c]linical decisions may only be taken by the responsible health-care professionals and may not be overruled or ignored by non-medical prison staff’. This Rule makes clear that if the clinician determines that the prisoner needs to go to hospital, the prison administration cannot overrule or ignore this decision in any situation, including non-urgent cases. The Essex Group also noted that this provision should be read together with Rule 26(1) as requiring a record to be made and maintained of the chain of decision-making as a means of protection against abuse and to ensure accountability. Isolation and Segregation on Grounds of Public Health The Essex Group noted that tuberculosis (TB) or other highly contagious diseases and threats of epidemics may require quarantine for medical reasons, as captured in Rule 30(d). It states that ‘in cases where prisoners are suspected of having contagious diseases, providing for the clinical isolation and adequate treatment of those prisoners during the infectious period’. The Essex Group recalled that Rule 30(d) should not be read to require the isolation or segregation of prisoners infected by HIV.265 Where isolation is deemed necessary this must only be for public health reasons and based on national health protocols. The World Health Organization has set out that, Only a medical doctor can decide on the need for isolation. The beginning and end of quarantine measures are strictly medical decisions. The duration of isolation should be The European Court of Human Rights has ruled that the segregation of prisoners with HIV, in the absence of a reasonable and objective justification, may amount to a violation of Article 3 in conjunction with Article 14 of the ECHR, see: Martzaklis and Others v. Greece, Application No. 20378/13 (ECHR, 9 July 2015) 265  Penal Reform International and the Essex Human Rights Centre | 72