NORWEGIAN PARLIAMENTARY OMBUDSMAN National Preventive Mechanism 14 15 USE OF RESTRAINT BEDS IN NORWEGIAN PRISONS assistance from the local accident and emergency unit for large parts of the day when the prison health service is closed. Very often, inmates are placed in restraint beds in the evening and remain restrained throughout the night. In practice, the accident and emergency unit is rarely contacted, even when an inmate is placed in a restraint bed. A review of the supervision logs showed that, in about half of the cases, a doctor was not consulted in advance, or notified as soon as possible, as set out in the guidelines.24 Several of the supervision logs revealed that inmates spent many hours in restraint beds without being supervised by medical personnel.25 ‘The inmate was placed in a restraint bed immediately after being admitted to the prison [...] on recommendation from the doctor.’ A restraint bed in a prison visited by the NPM. From the supervision log the role of medical personnel in relation to persons deprived of their liberty who are placed in solitary confinement, isolation or subject to other similar interventions.21 Medical personnel should ensure regular medical checks of the inmates’ physical and mental health, and report adverse e ­ ffects to health.22 The Health Personnel Act Section 4 states that medical personnel must perform their work in accordance with the r­ equirements of professional responsibility and diligent care. Medical personnel play a key role in relation to inmates placed in restraints, both because the decision is made on the grounds of self-harm and risk of suicide, and because being placed in restraints in itself poses a risk of injury. Inadequate supervision and medical follow-up of the inmates’ health while placed in restraint beds could be aspects of an evaluation that may result in the conclusion that a violation of Article 3 of the European Convention on Human Rights has taken place.23 The health risks posed by being placed in restraints means that a qualified and accessible health service with solid procedures for follow-up during and after the use of restraints is essential. For medical personnel to attend to their duties ­according to the Health Personnel Act, they must have in-depth knowledge of the risk of harm caused by the use of restraints. Half of the health services in prisons that have a restraint bed do not have dedicated procedures for their role and tasks when inmates are placed in restraint beds. Most prisons are also dependent on 21 The Mandela Rules, Rule 46 No 1, 2, 3. 22 The Mandela Rules, Rule 46 No 2. 23 Henaf v. France, application no. 65436, judgment of 27 November 2003, Section 47. Prison officers also reported that doctors from the accident and emergency units were not very aware of the risks associated with placing people in restraint beds. As a result the prison officers would wait until the next day to notify medical personnel when prison health service staff were available.26 In the majority of the cases, the doctors from the accident and emergency units do not have previous knowledge of the patients. ‘Tried admitting the inmate to hospital, but the hospital did not accept them.’ From the supervision log As example, we found a description in a decision that an inmate had repeatedly banged his head so hard against the floor in a police custody cell and subsequently in a security cell that he sustained visible head injuries. The inmate said that he wanted to die and asked to speak to a psychiatrist or a psychologist. Despite several telephone conversations with the accident and emergency unit, the doctor on call decided not to come and attend to the patient in question, but recommended over the phone to the corrections officer that the inmate be placed in a restraint bed. The accident and emergency unit did not follow up and attend to the patient while he was in restraints, despite being informed of the fact that he was vomiting due to his head injuries. In another case, an inmate with known and extensive trauma due to sexual abuse over many years, was placed in a restraint bed following an attempt to harm himself after being placed in a security cell. According to the administrative decision, the prison’s health service believed there was a major risk to life and health, and efforts were made to transfer the inmate to the specialist health service. After the health service closed, the inmate was assessed by a doctor from the accident and emergency unit, who ­concluded that the inmate did not wish to be in prison. The doctor confirmed to the inmate that he would remain in restraints until further notice. 24 Directorate of Correctional Service (2002). Guidelines to the Execution of Sentences Act and its Regulations, section 38.7. Revised version of 15 March 2019. 25 See, inter alia, the Parliamentary Ombudsman's report after its visit to Åna Prison, 13–15 November 2017 26 CPT/Inf (93)12-part Health care services in prisons, section 75: ‘Prison doctors and nurses should possess specialist knowledge enabling them to deal with the particular forms of prison pathology and adapt their treatment methods to the conditions imposed by detention.’