THE PENITENTIARY HEALTHCARE SYSTEM AND TORTURE PREVENTION MECHANISMS Changing a queue number in the electronic database is impossible which makes it impossible, on its turn, to first serve the prisoners who need to be assisted the most. We believe this approach and the “first come – first served” principle will hinder timely provision of medical services to prisoners in need unless their medical condition falls within the urgent category.77 Furthermore, the way the electronic database functions excludes any chance of changing a patient’s number in a standby list, even if the patient’s health gets aggravated. In other words, if the patient’s condition does not qualify as urgency, the patient’s number in the queue may not be changed and the patient cannot be transferred to a hospital in a speeded up manner. It is essential to provide patients in need with required medical assistance promptly where there is a risk of developing a chronic form of a disease. With these reasons in mind, we think it is necessary to revise the current mechanism of the medical referral system for it to take into account the needs of individual prisoners. To this end, we would recommend splitting the electronic queue into two parts depending on whether the medical condition is acute or chronic. Alternatively, the way the electronic database functions has been functioning to date may remain unchanged but the Minster of Corrections may consider enacting a separate order about provision of urgent medical assistance to patients with acute forms of diseases. Acute diseases are characterized with clearly expressed symptoms and, therefore, local prison doctors could determine initial diagnosis by making locally available medical tests; with this diagnosis, the matter of medical referral can be decided thereafter. Another option is to categorize diseases by the degree of their impact upon vital human organs and by strength of pain after receipt of painkillers. We should admit, in the interests of fairness, however, that implementing the above-described alternatives will not make the existing situation essentially better unless the actual opportunities of medical referral are increased. Pursuant to information received from the Ministry of Correction, 10 prisoners are transferred to various medical establishments in eastern Georgia per work day on average; of this figure, two prisoners are transferred to hospitals and eight to outpatient clinics. The actual opportunities of medical referral also depend on the availability of the required attending personnel and vehicles and the number of patient vacancies in civilian medical establishments. According to the representatives of the Ministry of Corrections, the electronic database conductivity is negatively affected by patient cases involving self-injuries and urgent medical assistance, since these cases usually require prisoners’ transfer civilian medical establishments. Recommendations to the Minister of Corrections: QQ To approve new rules of medical referral entitling only the Chief of the Medical Department of the Ministry of Corrections to decide on the transfer of prisoners to penitentiary and civilian healthcare establishments after consulting with the Chairperson of the Penitentiary Department on security issues. These Rules should also contained detailed guidelines about emergency, urgent and scheduled transfer as well as peculiarities related to the functioning of the electronic database. QQ Taking into account how diseases develop in each individual case as well as the specific needs of individual prisoners, to ensure timely provision of medical services penitentiary and civilian healthcare establishments, on as needed basis; Medical infrastructure The primary healthcare system within the penitentiary consists of 37 units. The medical units of penitentiary institutions offer electric cardiography, ultrasound examination, X-ray, and sample-taking for general and biochemical blood tests and for lab tests on tuberculosis, hepatitis and HIV/AIDS. Dental services are available as well. 77 Pursuant to Article 3(S1) of the Law of Georgia on Healthcare, urgent medical assistance means assistance without which it will be impossible to avoid the patient’s death, disability or serious deterioration of health condition. 2013 QQ If a prisoner has not been examined completely at a civilian medical establishment or a prisoner needs additional medical examination in a short time period (several days) after his visit to such an establishment, to ensure that such prisoners are transferred to these establishment without having to wait for their turn in the queue. NPM Report 33