VII)  Health care 3) Presence of a prison guard during examination The Health Care Services Act 63 stipulates that a officer of the Prison Service may be present within eyeshot during provision of health care to prisoners. He or she may be present within earshot only in cases of risk to the life, health or safety of the medical worker or another specialist worker, or property. This provision is controversial as it assumes that, as a rule, physician-patient meeting will have a witness (the prison guard within eyeshot). Such a legal regulation is unsatisfactory, not only with respect to medical confidentiality but also in view of prevention of ill-treatment (see below). Paragraph 51 of CPT Standards stipulates that all medical examinations of prisoners (whether on arrival or at a later stage) should be conducted out of the hearing and – unless the doctor concerned requests otherwise – out of the sight of prison officers. 64 CPT Standards thus stipulate a higher degree of confidentiality in contact with physicians than Czech legal regulations. In addition, I believe that the Health Care Services Act as well as the CPT Standards insufficiently regulate the entire range of situations that commonly occur. The presence of an officer of the Prison Service must be considered with regard to two different situations. Health care is provided to convicts primarily in health care facilities of the Prison Service. 65 If this is not possible 66, then it is provided in civilian health care facilities 67, i.e. outside the guarded premises of prisons, which naturally carries a risk of the prisoner’s escape. In prison health care facilities, the aforementioned problem can be addressed using cameras that monitor the medical office’s premises and transmit the video (not audio) feed to a Prison Service offices so that he or she may intervene if needed (e.g. if the prisoners attacks the physician); at the same time, such an arrangement preserves physician-patient confidentiality to the maximum degree. However, the situation (especially in terms of security) is more difficult in case of civilian health care facilities due to the fact that civilian facilities are not secured and guarded. Here, the security reasons permit certain infringement of the right to medical confidentiality on the part of a Prison Service officer (consisting in him or her always being in the eyeshot). 68  69 For this reason, I further address only the situation where a prison guard is present during medical examination in a Prison Service’s health care facility. 63 Section 46 (1)(g) of the Health Care Services Act. 64 EUROPEAN COMMITTEE FOR THE PREVENTION OF TORTURE AND INHUMAN OR DEGRADING TREATMENT OR PUNISHMENT (CPT). CPT Standards [online]. CPT/Inf/E (2002) 1 – Rev. 2004 [retrieved on 20 November 2015]. Available at: http://www.cpt.coe.int/lang/cze/ cze-standards.pdf. 65 66 Section 23 (1) of the Imprisonment Rules. Typically e.g. when the physician is not present or in case of a more demanding medical procedure that cannot be performed in Prison Service facilities for objective reasons. 67 Section 23 (3) of the Imprisonment Rules. 68 As currently stipulated in the Health Care Services Act. 69 For the sake of completeness, I note that pursuant to Section 50 (1)(b) of the Health Care Services Act, a medical worker has a right to deny provision of medical services if his or her life would be directly threatened or if his or her health would be seriously at risk (e.g. due to the prisoner’s assaulting the medical worker). /29/