THE PENITENTIARY HEALTHCARE SYSTEM AND TORTURE PREVENTION MECHANISMS their institution is open only one day a week. Prisoners have been complaining of unavailability of prescribed medications at their institutions. Prisoners are often irritated about the so-called generic drugs. Pursuant to Article 11(1) of the Georgian Law on Drugs and Pharmaceutical Activity, a generic drug is an international non-patented pharmaceutical product. Generic pharmaceutical products are used to replace patented (original) medications since they have the same treatment effect as their original counterparts. According to the World Health Organization (WHO) definition, a generic drug is a pharmaceutical product, intended to be interchangeable with an innovator product, that is manufactured with a license from the innovator company and marketed after the expiry date of the patent or other exclusive rights.74 The effectiveness of generic pharmaceutical products depends on their composition and equivalency. A generic pharmaceutical product, like to an original drug, contains an active agent and a supplement. It is the latter that is responsible for how fast and in what quantity the active agent is released from a pill or a capsule. Effectiveness of generic drugs depends on these factors. A minor change in the supplementing substance or the pill casing may greatly affect the drug quality. If the supplementing substance in a generic pharmaceutical product differs from the substance used in the original drug, the two drugs may not be interchangeable in terms of therapeutic effect or may have different therapeutic effects. That said, prisoners must be provided with adequate information about generic pharmaceutical products. If prisoners are unhappy complaining about the treatment effect of generic drugs, these drugs must be examined clinically to determine their therapeutic equivalency. During our routine and special monitoring visits, we found out that some medications listed as available were not actually available in the relevant institution. For example, in December 2012, when the trustees of the Public Defender were visiting the Center for the Treatment of Tuberculosis and Rehabilitation as well as the Penitentiary Institution No. 8 within the monitoring, the local personnel could not show the monitoring group some of the medications that were on the list of available medications; however, the medical personnel did explain they had replacement drugs. To avoid any misunderstanding and disappointment amongst the prisoners, we suggest that all of the drugs formally listed as available in a particular penitentiary institution be actually available at all times. To this end, it would be appropriate that the medical personnel estimate potential consumption of drugs in advance and submit a request for sufficient quantity of drugs to make sure that their institution does not experience shortage until the requested drugs are delivered to the institution. Medical referrals The Ministry of Corrections offers prisoners healthcare services in 52 civilian clinics. These clinics are selected by a simplified rule, after a market research, taking into account geographic accessibility and the current need for medical services, on the basis of a Government resolution.75 A legal basis for medical referrals is the Code of Imprisonment (Article 121) and the Order of the Minister of Corrections and Legal Assistance no. 38 dated 10 March 2011 approving the “Rules of transferring sick prisoners from pretrial detention facilities and institutions for sentenced prisoners to general hospitals, the Penitentiary Department’s Center for the Treatment of Tuberculosis and Rehabilitation and to the Institution for the Treatment of Remand and Sentenced Prisoners.” 74 See http://www.who.int/trade/glossary/story034/en [last accessed 10.03.2014]. 2013 Medical referral implies the redirecting of patients to specialized medical clinics both within and outside the penitentiary system. With a view of making the referrals effective, transparent and fairly managed, in May 2013, the Medical Department and the IT Department of the Ministry of Corrections jointly developed a special electronic software. On 1 September 2013, the Personal Electronic Health Record (PEHR) software was launched in penitentiary institutions. The software has automated implementation of standard procedures and data management. One of the modules of the software is responsible for the management of medical referrals. 75 Resolution of the Government of Georgia No. 2163 dated 26 December 2013. NPM Report 31