CAT/OP/ESP/1 58. The Subcommittee recommends that the State party take the required steps to standardize the provision of medical care across detention centres, including access to specialists where necessary. C. Injuries and the Istanbul Protocol 59. Although there is a form that includes a section for an inmate’s account of events and another for a detailed description of injuries, these forms are often not processed properly. For example, at Soto del Real prison, little attention is paid to the inmate’s account, whereas at Picassent and Bilbao (Basauri) prisons, all the reports examined contained both sections. When there is reason to believe that the injuries have been caused by public officials, some centres transmit the reports to the judge for action. 60. The Subcommittee was informed that follow-up on cases of injuries sustained by persons deprived of their liberty is hindered by the fact that the injuries and the events that caused them often are not correctly recorded in the injury reports. The Subcommittee believes that this can lead to the concealment of ill-treatment, or even torture, especially when it is committed while a person is being held in solitary confinement, thereby making it difficult to effectively investigate such cases. 61. In addition, the Subcommittee observed that, in almost all cases, doctors send their injury reports in unsealed envelopes to the prison authorities, who are then responsible for conveying them to the judicial authorities; this is true even in cases where prison doctors report to the autonomous community health department, such as at San Sebastián prison. The Subcommittee notes that the Office of the Ombudsman issued a number of recommendations in this regard in its 2014 study of injury reports concerning persons deprived of their liberty. This situation undermines inmate trust, since inmates fear being the object of reprisals if they lodge a complaint. 62. The Subcommittee found that health-care professionals at all the centres were not familiar with the Istanbul Protocol and had little knowledge or understanding of how human rights relate to health. 63. Therefore, the Subcommittee recommends that all doctors who are in contact with persons deprived of their liberty be trained in the application of the Istanbul Protocol. It also recommends that inmates’ accounts of how their injuries occurred be explicitly recorded in the injury reports. 64. The Subcommittee reminds the State party that, under paragraph 122 of the Istanbul Protocol, a doctor should: assess possible injury and abuse, even in the absence of specific allegations by individuals, law enforcement or judicial officials; document physical and psychological evidence of injury and abuse; and correlate the degree of consistency between examination findings and specific allegations of abuse made by the patient or with his or her explicit consent or cooperation. 65. The Subcommittee held meetings with the chair of forensic medicine and the director of the Institute of Forensic Medicine, which serves the country’s central judicial bodies. These officials are required by law to respond promptly to judicial requests. They are aware of the Istanbul Protocol but instead apply a protocol that was developed by forensic doctors in 1997. Furthermore, the Subcommittee was informed that the Institute of Forensic Medicine has developed – and has begun to use – a protocol on the provision of medical care to persons in incommunicado detention (“Guía de trabajo para la asistencia a personas detenidas en régimen de incomunicación”) even though it has not yet been approved by the chair of forensic medicine. 66. In addition, the Subcommittee has received complaints about a lack of privacy during prisoners’ visits with forensic doctors in which it is alleged that prison officials are always present during such visits. 67. Accordingly, the Subcommittee recommends that the State party address this issue with all due deference to inmates’ right to confidentiality. It further recommends GE.19-17184 11