However, the existence of real proportionality between this restriction of a fundamental right and medical grounds, as required by article L. 3211-3 of the public health code 197, is not always established. In the absence of written procedures, the suspicion of disguised sanctions may legitimately weigh upon these practices. Very often, the framework of treatment is adapted according to day-to-day events. In reaction to individual acts, measures are taken which change daily life for the patients as a whole. As a nurse in a UMD explains: “A clash with a nurse will often lead to [a coercive framework] being built to the detriment of the others”. Indeed, some of the letters received by the Contrôleur général make it possible to shed light upon the existence of these collective sanctions within medical institutions. By way of example, one of these letters reported the instructions given by a doctor to the medical staff as a whole, in terms of measures to be applied to patients, following four incidents in which fires had been started, for which the person responsible had not been identified: “the unit no longer allows patients to go outside, including into the garden; no more tobacco or lighters and those that remain in the possession of patients are to be taken away; withdrawal of mobile phones, telephone calls and visits. For all patients until further notice”. When this issue was taken up with the director of the institution by the Contrôleur général, the former pointed out that “these kinds of conservatory measures [can be taken] when the security of patients and medical staff is endangered, which was manifestly the case. The measures taken concerning lighters, cigarettes and the closing of rooms were intended to prevent another fire in the unit.” In reply, the Contrôleur général emphasised that, although the removal of lighters and tobacco could be understandable as a precautionary measure, “withdrawal of mobile phones, prohibition of telephone calls and visits and denial of the right to go outside, including into the garden, do not appear to fall within the bounds of security measures. Indeed, these involve fundamental rights, restriction of which can only be enforced with regard to the patient’s mental condition and implementation of the required treatment, in application of article L.3211-3 of the public health code”. Although precautionary measures may be taken in the interests of patients and staff, no sanctions, and a fortiori no collective sanctions, should be applied against persons hospitalised without their consent. Health institutions are places of treatment and not of punishment. The inspectors also ascertained a general lack of openness and traceability with regard to decisions of placement of patients in seclusion rooms and under physical restraint, apart from any information which might be included in medical records, to which inspectors do not have access. Protocols governing placement in seclusion rooms and under physical restraint exist in most of the health institutions inspected. However, the inspectors were informed that ad hoc files are still not included in patients’ medical records. Moreover, the inspectors very often came up against difficulties in obtaining information concerning these placements. In one institution located in French overseas territories, the medical staff very clearly asserted that the seclusion room was used as a “punishment cell” in order to sanction certain patients. Moreover, one patient, who had been found not to be criminally responsible on the basis of article 122-1 of the penal code, found himself in this situation. He had 197 Of which the paragraph in question provides that “when a person suffering from mental disorders is subject to psychiatric treatment in application of the provisions of chapters II and III of this part, or is transported with a view to such treatment, any restriction upon the exercise of their individual liberties shall be adapted, necessary and proportioned to their mental state and to the implementation of the required treatment. In all circumstances, the dignity of the person shall be respected and their rehabilitation sought. 103