CAT/OP/UKR/1 (c) Expand the available vocational training provided to children held in prison colonies.39 F. Healthcare 74. The SPT examined the overall provision of healthcare in places of deprivation of liberty, and welcomes the fact that health professionals were available at all the pre-trial and penitentiary institutions visited. 75. The SPT was greatly concerned that the setting and format for medical examinations and healthcare in several of the institutions visited were inappropriate as regards medical confidentiality. 76. The SPT recommends that when an examination is taking place any guards should be out of sight and hearing. Medical examinations and consultations should not take place through bars, or with the patient in handcuffs. Any special security measures should be determined on a case by case basis, in accordance with international standards,40 and the reasons recorded in the detainee’s medical file. 77. The SPT observed that extremely restrictive security measures were employed when transferring inmates or detainees to external healthcare facilities, especially those subject to life sentences. Additionally, the vehicles used were not adequate for transporting sick people. Procedures for the transfer of patients in need of urgent specialised treatment were extremely lengthy, potentially jeopardizing the health of the person concerned. 78. The SPT recommends that security policies for transfers of persons to external healthcare facilities be reviewed countrywide. Extensive security measures should only be applied in exceptional circumstances,41 and security measures should be decided on a case by case basis, and the reasons be recorded in the patient’s medical file. The administrative procedures for transfers should also be reviewed urgently with a view to shortening the transfer of patients in practice. 79. Medical registers in the different categories of places visited raised concerns regarding coherence and completeness. For example, some recorded the existence of traumas without providing any information regarding their origin. 80. The SPT recommends that the medical records system be updated and that efforts be made to establish a more coherent and complete form of recording information. The SPT reiterates its recommendation that all health professionals working with persons deprived of their liberty be given basic training in description and assessment of injuries and how to manage such situations, and that an independent expert body be established in accordance with the Istanbul Protocol. 81. The SPT frequently received allegations that inmates or detainees were obliged to pay for treatment and medicines, which in many cases they could not do. It believes that it is the responsibility of the State party to provide for the adequate healthcare of all persons deprived of their liberty free of charge.42 82. The SPT recommends that the State party urgently conduct a country-wide audit of the needs in all institutions, in order to facilitate the provision of sufficient medical supplies. 39 40 41 42 United Nations Rules for the Protection of Juveniles Deprived of their Liberty, Rule 43. European Prison Rules, Rule 51. European Prison Rules, Rule 53. European Prison Rules, Rule 39. 15