1.1 Obiski v zavodih za prestajanje kazni zapora in mladoletniškega zapora 1.1 Visit to prisons and juvenile prisons Zdravstveno varstvo Health care ZPZK Koper – Nova Gorica zdravstveno oskrbo še vedno zagotavlja Zdravstveni dom Nova Gorica, pojasnjeno pa je bilo tudi, da do sprememb v zdravstvu pri njih ni prišlo. Health care in Nova Gorica Unit of Koper Prison was still provided by Nova Gorica community health centre; it was explained that no major changes occurred in health care. Pregled v delu zdravstvenega varstva in zdravniške oskrbe v ZPKZ Ljubljana je opravil doc. dr. Milan Popovič, dr. med., specialist splošne kirurgije (izvedenec). Priporočila, predlogi in zaprosila DPM v tem delu so rezultat njegovih ugotovitev. DPM je bilo pojasnjeno, da odvisniki prejemajo Methadone in Suboxone kot nadomestilo za droge in razna pomirjevala. DPM je UIKS zaprosil za podatek o oceni uspešnosti obstoječe metode zdravljenja odvisnosti od drog v zavodu in ali so bile kdaj predstavljene in ponujene še kakšne druge možnosti za zdravljenje te odvisnosti. UIKS je odgovorila, da obravnava odvisnosti v zaporih poteka v skladu s Strokovnim navodilom obravnave odvisnosti od prepovedanih drog, ki ga je Generalni urad UIKS pripravil v sodelovanju s Koordinacijo centrov za preprečevanje in zdravljenje odvisnosti od prepovedanih drog. UIKS je tudi pojasnila, da k obravnavi odvisnosti pristopajo z različnimi modeli in da je substitucija le del nizkopražnega programa, ki predstavlja nižjo nevarnost okužbe s hepatitisom B, C in HIV, obolevnostjo in umrljivostjo, in da omogoča boljšo kakovost življenja odvisnika v času zdravljenja. Za zaprte osebe skrbijo zdravniki splošne medicine, zaposleni na Oddelku za nujne medicinske pomoči (NMP) Zdravstvenega doma v Ljubljani, locirani v zgradbi UKC. Dva psihiatra, ki prihajata enkrat do dvakrat na teden, skrbita za psihofizična stanja in posebej za stanja odvisnih od raznih psihoaktivnih snovi. V ZPKZ enkrat tedensko dela tudi stomatolog. The examination of health and medical care in Ljubljana Prison was conducted by our expert, Dr Milan Popovič, specialist in general surgery. The recommendations, proposals and requests of the NPM in this section are the result of our findings. It was explained to the NPM that drug addicts were taking Methadone and Suboxone as substitutes for drugs and various sedatives. The NPM requested from the Prison Administration of the Republic of Slovenia an assessment of the success rate of the present treatment of drug addiction in the relevant prison and if any other forms of treatment had ever been provided. The Prison Administration of the Republic of Slovenia responded that the treatment of addiction in prisons was conducted in accordance with the Expert instruction on treating drug addiction, which the Head Office of the Prison Administration of the Republic of Slovenia prepared in cooperation with centres for the prevention and treatment of addiction to illicit drugs. The Prison Administration of the Republic of Slovenia also explained that different models were used in the treatment of addiction and that substitution was only part of a low-threshold programme which presented a lower risk of hepatitis B and C and HIV infection, prevalence and mortality, and that it enabled a better quality of life for addicts during treatment. General practitioners employed at the unit for emergency medical aid of Ljubljana Community Health Centre at Ljubljana University Medical Centre treat prisoners. Two psychiatrists who visit the prison twice weekly attend to the prisoners’ psycho-physical condition and particularly the condition of prisoners addicted to different psychoactive substances. A dentist works in the prison once a week. Ugotovljeno je bilo, da je zdravstveno zavarovanje zaprtih oseb v zavodu še vedno glavni in kronični problem. Nekatere od teh oseb nimajo urejenega niti osnovnega zdravstvenega zavarovanja, drugim, ki imajo zdravstvene izkaznice, pa le-te ne veljajo, ker nimajo poplačanih stroškov osnovnega zdravstvenega zavarovanja. V primerih neodložljivega zdravljenja pri teh osebah zdravljenje poplačajo iz hišne blagajne. Zaradi tega se večkrat pojavijo konflikti, v katerih sta najbolj izpostavljeni medicinski sestri, ki ju zaposluje Ministrstvo za pravosodje. UIKS je pojasnila, da se s problemom zdravstvenega zavarovanja srečujejo na vseh zavodih za prestajanje kazenskih sankcij. Problem ocenjujejo kot velik, vendar ne kroničen, saj za tiste osebe, ki nimajo zavarovanja, zdravljenje plača zavod. Uspešno rešujejo individualne probleme z Zavodom za zdravstveno zavarovanje, skupno in sproti na podlagi navodila Generalnega urada pa rešujejo tudi probleme o postopanju za vse zavode za prestajanje kazni zapora. O težavah redno seznanjajo in opominjajo pristojno Ministrstvo za zdravje, kjer imajo tudi oni besedo pri pripravi sprememb Zakona o zdravstvenem varstvu in zdravstvenem zavarovanju. UIKS priznava, da prihaja do navedenih konfliktnih situacij med medicinskim osebjem in zaprtimi osebami, vendar pravi, da jih uspešno rešujejo z alarmnim stikalom (zvoncem), ki ga lahko medicinsko osebje uporabi v vsakem trenutku, ko se počutijo ogrožene, in z neposredno bližino pravosodnega policista, ki lahko v trenutku, ko zasliši zvonec, vstopi v ambulanto ter vpokliče (prenosna postaja TETRA) tudi vse preostale pravosodne policiste v zavodu. Bolniška soba je manjša soba z dvema posteljama, ki ji pripada še higienski prostor. Vsaka postelja ima pripomoček za mobilizacijo težje pokretnega pacienta. Na stenah ni morebitnih ventilov za dovajanje kisika in zraka, kar izvedenec ocenjuje kot pomanjkljivost. Izvedenec je čakalnico ocenil kot neprimerno in utesnjeno za oskrbo življenjsko nevarnih stanj. Manjka nujno potreben ležeči voziček, saj je zanašanje na bližino UKC lahko v nasprotju s časom, ki je potreben za nujno intervencijo. V primeru nenadne motnje zavesti ali nekega drugega smrtno nevarnega stanja je treba pacienta položiti na ležeči voziček, da se mu lahko pristopi z vsake strani. UIKS je pojasnila, da je v ordinaciji pregledna postelja, ki je fiksna in trenutno zadostuje, in da se nujni in nenadni primeri za oskrbo življenjsko nevarnih stanj rešujejo v prostoru dogodka. Prenove prostorov se ne morejo lotiti, saj nimajo potrebnih finančnih sredstev. DPM je ugotovil, da ZPKZ Ljubljana – Odprti oddelek Ig splošnega zdravnika, psihiatra in zobozdravnika obsojencem še vedno zagotavlja v ambulanti ZPKZ Ljubljana. DPM ni prejel nobenih pritožb obsojencev glede zagotavljanja zdravniške oskrbe. V času obiska nihče od obsojencev ni prejemal terapije, urinski testi pa se opravljajo le občasno. It was established that the health insurance of prisoners was still the main and topical issue in the prison. Some prisoners did not even have basic health insurance and health insurance cards of other prisoners were not valid because their basic health insurance had not been covered. In the case of the immediate treatment of such persons, the treatment was covered by the prison’s budget. Conflict frequently occurred due to this issue, in which the two nurses employed by the Ministry of Justice were most exposed. The Prison Administration of the Republic of Slovenia explained that health insurance was an issue in all prisons. The problem is assessed as great, but not chronic, because the prison covers treatment for prisoners with no insurance. Individual problems with the Health Insurance Institute of Slovenia were being successfully resolved, and on the basis of the instruction from the Head Office, issues on procedures in all prisons were also being jointly and promptly resolved. The problems were regularly reported to the Ministry of Health, with which they also participate in drafting amendments to the Health Care and Health Insurance Act. The Prison Administration of the Republic of Slovenia admitted to the occurrence of conflict situations between medical staff and prisoners, but wrote that these were successfully resolved with an alarm switch (bell) which the medical staff could use at any moment when threatened, and by the immediate presence of a judicial police officer who enters the infirmary upon hearing the alarm and calls (TETRA mobile station) other judicial police officers in the prison. The patient’s examination room consists of a smaller room with two beds and hygienic premises. Every bed has a device for moving patients with severe mobility difficulties. No valves for supplying oxygen and air were on the walls, which the expert assessed as a deficiency. The expert also assessed the waiting room as unsuitable and stifling for the treatment of life-threatening conditions. A mobile patient table was urgently needed, because reliance on the close proximity of Ljubljana University Medical Centre may not suffice in the case of urgent intervention. In the case of sudden disturbances of consciousness or any other life-threatening condition, the patient must be put on a mobile table that enables approach from each side. The Prison Administration of the Republic of Slovenia explained that a fixed examination bed was located at the infirmary, which currently sufficed and that the treatment of urgent and sudden cases of life-threatening conditions was being addressed at the location of the occurrence. The renovation of the premises could not be undertaken because of the lack of funds. The NPM established that a general practitioner, a psychiatrist and a dentist for prisoners of Ig Open Section of Ljubljana Prison were still provided by the infirmary of Ljubljana Prison. The NPM received no complaints from prisoners relating to the provision of such medical care. No prisoner was undergoing a treatment at the time of the visit; urine tests are conducted occasionally. 46 poročilo o izvajanju nalog DPM v letu 2014 DržavnI preventivnI mehanizEm po Opcijskem protokolu h Konvenciji OZN proti mučenju in drugim krutim, nečloveškim ali poniževalnim kaznim ali ravnanju IMPLEMENTATION OF THE DUTIES AND POWERS OF THE NPM IN 2014 National Preventive Mechanism under the Optional Protocol to the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment 47