in all circumstances, all births and gynaecological examinations, without exception, must take place free from handcuffs and restraints and with no prison staff in attendance." This report also provided an opportunity to underscore that respect for medical confidentiality, the patient's right, is an absolute duty for the physician who must abide by it. Where attendance of prison staff may, under exceptional circumstances, prove necessary during an appointment, means must be taken to ensure that the patient's privacy is respected (by communicating in writing or using curtains or screens, etc.). An express reminder of the principle of respect for medical confidentiality must be given to medical and prison staff alike. In 2017, similar recommendations were issued to several heads of institutions concerning cases which had been referred to the CGLPL by post. One referral received in 2017 is particularly edifying in this regard: "Dear Madam, In October 2015 I had written to you about a problem I encountered during a transfer to the hospital for medical reasons. The otolaryngologist had refused to allow my handcuffs to be taken off during the examination. You took action and nothing of this sort happened again. I have just experienced the problem again yesterday, but in a more violent way (…). This time it was the warders in charge of the transfer who refused to take my handcuffs off in the presence of the stunned practitioner, even though I had asked them to do so. Two of them remained in the room throughout the appointment, and medical confidentiality was not respected as a result. I told them that I was going to contact my lawyer, but this had no effect on their attitude (…). I am 66 years old and I have never had an incident report drawn up against me during more than seven years in prison. These humiliating attitudes are becoming ever more common [in the institution], I have already written to you about this in my previous letters (…). I'll admit that I fear reprisals as writing to you is seen in a very bad light". Talks were held with the heads of institutions following inspections. Accordingly, in one longstay prison, it had been found during an inspection in 2016 that a memo required a warder to be present during medical treatment. A recommendation had been issued for the purposes of repealing it. The management of the relevant hospital had proposed organising discussions on this subject with the nursing staff. During talks with the management of this institution in 2017, it was found that the memo in question had been repealed. The job description for the warder assigned to the health block now provides that the employee only attend the appointment where requested by the practitioners or advised by the institution's management. In this context, a reminder is given of the importance of honouring the principle of discretion set out particularly in the professional practices guide on health block surveillance. Similar to the on-site verification conducted at the Fleury-Mérogis remand prison in 2016, these examples are characteristic of the difficulties encountered in applying the principles enshrined in law, which the CGLPL has nevertheless reiterated countless times, in practice. The Chief Inspector will continue to pay close attention to these questions, which are fundamental for ensuring that the dignity of detainees during external movements for medical reasons and medical confidentiality are respected under all circumstances. 90