We note with satisfaction that the Minister of Corrections cancelled its Order 38 with its newer Order no. 55 dated 10 April 2014 approving the “Rules of transferring accused and convicted persons to general-profile hospitals, the Treatment Institution for Accused and Convicted Persons and the Center for the Treatment of Tuberculosis and Rehabilitation”. According to paragraphs 2 to 4 of Article 1 of the new Rules, a prison doctor drafts a reasoned request for transferring a patient to the Treatment Institution and Center and sends the request to the Medical Department of the Penitentiary Department. The prison doctor’s reasoned request shall be registered in the Medical Services Electronic Software (hereinafter, “the Software”). The prison doctor must inform the prison director about the request in writing. The Medical Department will examine the request within a reasonable time on the basis of the National Clinical Practice Recommendations (the Guidelines) and State Standard on Clinical Situation Management (the Protocol) approved or recognized by the Ministry of Labor, Health and Social Protection; where necessary, the request will also be examined against international guiding documents. If the request is granted, a patient who requires a scheduled medical service will be assigned a list number in the Software and a recommendation on his/her transfer to the Treatment Institution or the Center will be sent to the prison director and the prison doctor at least a day before the actual transfer. Paragraph 5 of Article 1 of the Rules determines how a waiting list is made. In particular, the Medical Department determines the list according to the location and the type of services requested (inpatient or outpatient). It is unfortunate that the Public Defender’s recommendation on improving the medical referral system for avoiding delayed provision of medical services as much as possible was rejected. In particular, we offered to take into consideration when constructing a waiting list the different grounds such as acute and chronic diseases, progress of the disease, aggravation of a patient’s health and other factors. We believe the electronic database of medical referrals needs to be improved because the current procedure of constructing the waiting list does not take into account patients’ individual needs and the patient’s number in the list depends not on clinical factors but on other criteria such as the number of waiting patients and the capacity of the relevant medical institution. A medical referral procedure for planned treatment is defective: it does not take into consideration a situation where the health condition of a patient on a waiting list is deteriorating but the condition has not achieved the intensity level warranting the provision of urgent medical services under Article 3(s1) of the Law on Health Protection. It should be noted that some diseases develop very quickly and it may be too late to provide the urgent healthcare service when a person’s life is in danger already. The medical referral procedure does not envisage the possibility of sorting patients with such diseases as a priority in determining their number on the list. The Public Defender’s 2013 Report to the Parliament also emphasized the circumstance that it depended on the will of a prison director and the Chairman of the Penitentiary Department – individuals who are not health professionals – whether a medical referral 100 NATIONAL PREVENTIVE MECHANISM OF GEORGIA