•• According to Form 200-5/a – a medical examination paper – of prisoner G.B., the prisoner needs an echoscopy of his abdominal cavity and a colonoscopy. By the date of our visit, none of the indicated medical measures were carried out. •• According to the results of a doctor’s consultation on 29 October 2014, prisoner V.B. needs a visit to a neurologist. The prisoner did not have a chance to visit a neurologist by the time we monitored the institution. •• According to a doctor’s consultation on 8 July 2014, prisoner D.T. needed to have his waist scanned with MRI (micro resonance imaging). The patient was registered in the appropriate database but the MRI was not performed. •• Prisoner T.G. was asking for a neuropathologist’s consultation for 6 months in vain. The prisoners we interviewed in the Institution no. 17 complained of rare visits by a gastroenterologist. According to their statements, they have to wait 3 to 4 months to see the gastroenterologist. Due to prevalence of gastrointestinal diseases in prisons, long intervals between the visits of gastroenterologists negatively impact the health of prisoners. 2.5.4.2.  MEDICAL REFERRAL Primary healthcare teams at penitentiary institutions are the ones who decide whether specialized medical services are needed. Accordingly, they are the ones to request patient referral. Patients are registered electronically. After a request for referral gets registered, it is then processed by the Medical Department of the Ministry of Corrections. If the request is well-founded and complies with the national guidelines (plus international guidelines where necessary), it will get approved and assigned a list number. After a request is approved, depending on the number of the request in the list, a medical services provider is contacted and the patient is referred to the provider. If a request is rejected, the rejection is registered in the system and the relevant primary healthcare team is informed about the reasons of rejection. Only those patients are put on an electronic queue whose medical services are preplanned. Urgent cases are not subject to a queue. There are separate electronic queues for eastern and western parts of Georgia and they are regulated independently. Referrals to outpatient clinics and inpatients clinics are regulated separately as well. According to explanations obtained from the representatives of the Medical Department of the Ministry of Corrections, scheduled referrals are impeded by barriers such as prisoners injuring themselves, going on hunger strike or arbitrarily stopping a treatment course. Another problem in regard to medical referrals is the 96 NATIONAL PREVENTIVE MECHANISM OF GEORGIA