At least twice a week, and as often as they consider useful, a doctor visits each punishment wing in order to examine all prisoners there. Outside of UCSA working hours, a doctor is on call from the Urgent Medical Aid Service call centre (centre 15). Information on any placements in punishment wings is usually provided directly or by telephone. In order to preserve a trace of the passing on of this information, certain institutions inform the medical service by means of fax and hand over the daily list of prisoners placed in punishment, solitary confinement and confinement cells by the same means. On each visit, the doctor stamps the punishment wing register. Generally speaking, examination of the register makes it possible to prove that doctors have come in accordance with the statutory obligation of two visits per week. However, this is qualified by the two following reserves: On the one hand, it is not always established that the visit was made by a doctor and not by a nurse. Thus, in one institution inspected in 2012, the individual record of medical care and treatment in the punishment wing mentioned twelve visits by a member of staff of the UCSA over a period of fourteen days, but only two visits by a doctor, the others having being made by a nurse. The frequency of visits by the doctor was not therefore in compliance with legal obligations. On the other hand, the examination provided for by law is sometimes reduced to a cursory visit by a doctor, which ends with a signature of the register. The practice of certain UCSA staff consists of remaining in the background and leaving it to the warder to ask each prisoner whether they wish to be seen, from the security door of the cell and with the grating closed. One person encountered in the punishment wing of a long-stay prison thus declared to the inspectors that, despite having declared a health problem – a problem connected to the action having led them to the punishment wing – they had only been able to have the benefit of an initial examination eight days after their placement: on the preceding days the health staff had not entered their cell. When doctors consider that maintenance in a punishment cell is likely to compromise a person’s health, they draw up a medical certificate, which they send to the director of the institution, the latter then has to order suspension of the measure and removal of the person from the punishment wing. The medical report is binding upon the director of the institution. Similarly, in accordance with the circular of 9th June 2011213 “the sanction can only be recommenced in compliance with a medical opinion”. In this respect, the medical practices ascertained vary greatly from one institution to another. In general, removal of prisoners from the punishment wing by medical order appeared to be rare in the institutions inspected – sometimes coming after an episode of a suicidal nature or giving rise to a more medically-oriented approach to the prisoner (placement in the SMPR, hospitalisation in a mental health institution) – and bore no relation to a perception on the part of certain warders, which propagates the idea of “impunity” of prisoners with medi cal “complicity”. Conversely, during the inspection of one large long-stay prison it was ascertained that punishment cell sanctions were only rarely enforced. However, contrary to widespread belief within this institution, the early lifting of these punishment cell sanctions did not arise from medical certificates of incompatibility, but from the initiative of the heads of detention themselves, after having informed the medical department of their fears of the risk of suicide attempts. 213 Circular JUSK 1140024C. 119