would take place or not. The Report viewed this as a shortcoming of the procedure of providing prisoners with medical services. The Public Defender therefore issued a recommendation to cancel this rule and vest the Chief of the Medical Department of the Ministry of Corrections with the right to decide on prisoners’ medical referral, upon consultation with the Chairman of the Penitentiary Department. Unfortunately, the Rules approved by Order 55 of the Minister of Corrections grants the decisionmaking power to prison directors if a prisoner is to be transferred to penitentiary medical facilities, and to the Chairman of the Penitentiary Department if a prisoner is being transferred to a civilian hospital. Both prison directors and the Chairman of the Penitentiary Department may refuse to transfer prisoners to the aforementioned medical facilities. Further, the Rules do not specify, in case of refusal, what additional measures should be taken to provide the prisoner with timely and adequate healthcare services. We believe these shortcomings must be made good, by inserting appropriate changes in the Rules governing medical referrals. One of the recommendations indicated in the Public Defender’s 2013 Report to the Parliament was not to make a prisoner wait for his/her turn on the list if he/she had been incompletely examined in an outpatient clinic or has been examined but requires additional tests or examination shortly after the visit to the outpatient clinic. We believe the Order of the Minister of Corrections no. 55 must regulate this issue so that there is a legal ground for transferring those in need to medical facilities without having to wait for their turn on the list. 2.5.4.3.  EQUIVALENT AND QUALITY MEDICAL SERVICES According to the European Prison Rules, medical services in prison shall be organised in close relation with the general health administration of the nation. Health policy in prisons shall be integrated into, and compatible with, the national health policy. Prisoners shall have access to the health services available in the country without discrimination on the grounds of their legal situation. Prisoners should have access to all necessary medical, surgical and psychiatric services including those available in the country.145 Unfortunately we did not see any steps towards substantial integration of the penitentiary healthcare with the national civilian healthcare system in 2014. These two healthcare sectors – penitentiary and civilian – are developing separately, each on its own. Standards applicable to the civilian healthcare system have not been fully implemented in the penitentiary healthcare system yet. Although in organizing the prison healthcare system consideration should be given to the differences and difficulties inherent in the penitentiary system, implementation of the basic civilian healthcare standards in the penitentiary as soon as possible is of crucial importance for raising the penitentiary health services to a level equivalent to civilian health services. Furthermore, an effective mechanism for controlling the quality of medical 145 The European Prison Rules, Rules 40.1 – 40.5. NATIONAL PREVENTIVE MECHANISM OF GEORGIA 101