VII)  Health care VII)  Health care Health care in Czech prisons faces long term problems especially in the area of providing for available and good care, which is partially related to the lack of physicians motivated to work in prisons and the lack of strategy in prison health care. 52 1) Conception of health care in prisons So far, prison health care services have not been interconnected with the civilian health care system, which has been recommended in the White Book on Development of the Czech Prisons until 2015, as well as by the CPT or the Moscow Declaration of the World Health Organisation (WHO). 53 In my opinion, the Prison Service’s duty to provide health care services to the convicts (as well as officers and the employees of the Prison Service) needs to be revised. 54 Prison health care is, unsystematically, subsumed under the Prison Service, i.e. the Ministry of Justice, which is at variance with Act No. 2/1969 Coll., on establishment of Ministries and other central State authorities of the Czech Republic, as amended 55, as well as with the above-specified international standards. This categorisation results in a number of ethically problematic situations in the physician – patient relationship. The legal consequences are also observable in the absurd complaint system with respect to the provider of health care services, where complaints under Section 93 (5) of the Health Care Services Act are generally resolved by the head of the prison – a person without medical qualification who, moreover, requires the patient’s approval to inspect his or her medical files. I have repeatedly encountered cases where convicts refused to allow the head of the prison to inspect their medical files, which made the complaint impossible to resolve. the health care system needs a reform I have found a lack of medical staff in the prisons I visited. In one of the prisons, the position of the head physician was unoccupied for a long time, which had ramifications in ensuring the continuity of health care. Many heads of prisons noted problems in finding physicians. The recently increased salary incentive made only little difference. 56 The possibilities for ensuring availability of a physician for work with the convicts are very limited. It should be noted that convicts are often patients suffering of multiple medical conditions, often in combination with addictions and mental conditions, which increases the demands on medical staff. 52 MOTEJL, Otakar et al. Vězeňství (Prisons). Prague: Wolters Kluwer ČR, 2010, pp. 100-101. 53 WORLD HEALTH ORGANIZATION. Declaration on Prison Health as Part of Public Health [online]. Moscow: World Health Organization. [retrieved on October 2015]. Available at: http://www.euro.who.int/en/health-topics/health-determinants/prisons-and-health/publications/pre-2005/ moscow-declaration-on-prison-health-as-part-of-public-health. 54 This duty is stipulated by Section 2 (1)(l) of the Prison Service Act. 55 Cf. the definition of the competence of the Ministry of Health included in Section 10 (1) of the aforementioned Act. 56 The 2014 amendment of Regulation of the Government No. 564/2006 Coll., on salaries of employees in public services and administration, brought an increase of the pay grade of all physicians employed with the Prison Service. /26/