Correctional institutions professional treatment. On a visit to Göllersdorf correctional institution, the NPM observed that there are frequent requests for DAA but that these are often turned down. Said treatment was approved for just two detainees. The Federal Ministry of Constitutional Affairs, Reforms, Deregulation and Justice pointed out that in the case of those in the special institutions – more frequently than in other correctional institutions – possible interactions with existing medication have to be considered. For this reason, several patients were on a waiting list to receive treatment with DAA after a possible change of medication. Göllersdorf correctional institution The NPM recalls that detained persons have the right to the same medical care as those living in freedom. Failure to administer medication must then be medically indicated and objectively founded. During a visit to Vienna-Josefstadt correctional institution it could be seen that state-of-the-art treatment of detainees infected with HCV is guaranteed as a matter of principle through cooperation with Vienna General Hospital. The treatment of patients with a positive HCV diagnosis is determined and monitored by the General Hospital. The DAA therapy prescriptions from the General Hospital are approved by the medical superintendent of the Federal Ministry of Constitutional Affairs, Reforms, Deregulation and Justice regardless of the level of fibrosis. Vienna-Josefstadt correctional institution On the negative side, the approval by the medical superintendent takes several weeks. Even if HCV is a slowly progressing illness, certain circumstances such as cirrhosis of the liver can make a rapid start of treatment necessary. The NPM learned of a case where a patient with diagnosed cirrhosis of the liver was refused DAA therapy even though those responsible for approval had been informed about the urgency of treatment. In this sense, it was evident that the approval of HCV therapy by the medical superintendent has to be faster in urgent cases. Approval takes a long time The NPM also came to this conclusion on a visit to Graz-Karlau correctional institution. The on-site diagnosis and testing by the doctors was considered exemplary. In some cases, however, it takes more than a year until a decision is made by the general directorate on the approval of treatments. The procedure lacks any form of transparency. Those affected are left waiting a considerable amount of time for a reply. On the day of the visit, it was not possible for the visiting team to verify which approval criteria are used, how long approval takes and why those affected are forced to wait so long for decisions. Graz-Karlau correctional institution There is no rejection of the therapy requests either. Approval is simply “not confirmed” in the Electronic Patient Record Module, which results in some detainees waiting for approval for years. 116