CAT/OP/PRT/1/add.1 IV. Healthcare A. Generic observations and concerns 54. The Subcommittee recommends the State party to ensure that all inmates receive adequate medical attention from doctors, that medication is not used as a form of control to compensate for shortage of staff, and that informed consent for treatment is systematically sought. 55. The implementation of this recommendation is being put into practise. Administration of drugs to inmates must be previously prescribed by physicians, which inform them, during consultations, about the medicine to be administered, its name, purpose, dosage, and its intake duration, among other elements. Any additional clarification requested by inmates is given by the nursing services when administrating the therapy. Medication intake is witnessed and the drugs are placed in individual containers whose content is poured directly into the hand of each inmate. 56. With regard to the Porto prison, it should be clarified that prisoners on hunger strike are always seen by a doctor before the hunger strike starts and are subject twice a day to a check of their vital signs and level consciousness by the nursing staff. Whenever these patterns are altered, even if slightly, those prisoners are immediately seen by a physician at any time of day or night. 57. Psychiatric medication is always prescribed by a doctor, which explains to inmates their action and side effects. The explanation of these effects to psychiatric patients with discernment problems, such as patients with psychoses and/or psychotic episodes, is often difficult and non-administration may pose risks to their lives or to third parties. Medication is never administrated to compensate shortage of staff. 58. The Subcommittee recommends to expand the provision of medical devices and supplies such as defibrillators to be used in medical emergencies and the associated training for staff to all places of detention in order to ensure help can be provided promptly. 59. The provision of medical devices and supplies, including defibrillators, is subject to the availability of financial resources for this purpose. However, it should be mentioned that the Porto prison has all the necessary devices and the personnel is trained for any medical emergency, including the use of defibrillators. Furthermore, medical personnel has training in advanced life support and nurse staff has training in basic life support with and without defibrillators. 60. An effort has been made in this direction, defibrillators had been installed and the associated training given for staff, but it has not yet been possible to reach all places of detention. B. Medical screening and examination 61. The Subcommittee recommends that all newly arrived detainees, as soon as possible and no later than 24 hours following the entry into a place of detention, be given a thorough medical examination, including a full body examination, in order, inter alia, to detect any signs of injuries sustained prior to the person’s admission. In addition, the results of such examinations should be appropriately and comprehensively recorded in a specifically designated and confidential register, and in cases of suspicion of torture and ill-treatment, reported accordingly, as described in Rules 33 and 34 of the UN Standard Minimum Rules for the Treatment of Prisoners (Nelson Mandela Rules). 62. Medical examinations should be carried out regularly, and always in keeping with the principle of medical confidentiality: no person other than medical personnel should be present during the examination. Guards should remain out of hearing and normally out of sight, except in the rare case where the medical staff may, for reasons 8