RECOMMENDATION TO THE MINISTER OF CORRECTIONS AND THE MINISTER OF LABOR, HEALTH AND SOCIAL PROTECTION: •• By mutual collaboration, develop a plan for full integration of penitentiary healthcare into the national healthcare system 2.5.5.  INDEPENDENCE AND COMPETENCE OF PRISON DOCTORS; CONFIDENTIALITY; PATIENT AWARENESS According to the Recommendation of the Committee of Ministers of the Council Europe, doctors who work in prison should provide the individual inmate with the same standards of health care as are being delivered to patients in the community. Clinical decisions and any other assessments regarding the health of detained persons should be governed only by medical criteria. Health care personnel should operate with complete independence within the bounds of their qualifications and competence.146 A doctor shall not be involved in an activity whose purpose is not protection of the priosner’s health.147 As we found out as a result of our monitoring in 2014, there are issues related to independence and competence of the penitentiary healthcare personnel. Thus, in the Institution no. 3, the monitoring group witnessed how a prisoner stated he had swallowed sharp-tinned metal screws sized 4-5 centimeters each but the doctor on duty could not independently decide to call an X-ray specialist or an echoscopist to locate the screws in the intestines and determine the actual or possible injury to the prisoner’s health. The doctor on duty tried to contact the chief doctor who was not in the institution at that time. Because the prisoner was under an imminent threat, the monitoring group obtained the prisoner’s consent to inform the deputy prison director about the incident. It was only then that the chief doctor was contacted and a permission to call an X-ray specialist was obtained. The monitoring group has gotten an impression that prison doctors are unable to independently make decision in specific cases – something that puts their independence and competence under a question mark. In deciding whether to refer a prisoner to a medical facility, the penitentiary healthcare personnel depend on the will of the prison director and the Chairman of the Penitentiary Department because these two have the right to reject a prisoner’s transfer to a hospital. It is necessary to eliminate the possibility of such undue interference by non-medical staff in the provision of medical services by amending the Order of the Minister of Corrections no. 55 dated 10 April 2014 accordingly. As a result of our monitoring during 2014, we revealed that it is a routine practice to place prisoners in solitary confinement cells as a measure of discipline on the basis of a doctor’s recommendation. Moreover, it is not always clear whether the doctor’s 146 Recommendation no. R (98) 7 of the committee of ministers to member states concerning the ethical and organisational aspects of health care in prison (Strasbourg 1998, 20 April), paras. 19-20 147 United Nations Principles of Medical Ethics (1982), Principle 3 is available only in English at http:// www.un.org/documents/ga/res/37/a37r194.htm [last viewed 18.03.2015]. 106 NATIONAL PREVENTIVE MECHANISM OF GEORGIA