them, accompanying them during their stay at the hospital and bringing them back to the institution. Prisoners are thus transferred according to rules which are precise (although they differ slightly between institutions) and tend towards diversity rather than uniformity. They distinguish between a maximum of four alternative security procedures. The first procedure involves the prisoner being taken to hospital by three prison officers: the head escort, who, in principle, is a senior prison officer (premier surveillant), the driver of the vehicle and another prison officer, without handcuffs or fetters117. The second procedure is identical except that the prisoner is handcuffed (usually behind their back). The third consists of adding fetters to the previous scenario. In the fourth procedure, a police or gendarmerie vehicle accompanies the prison vehicle for heightened security. These four levels of security are often reduced to three, by the merging of two of the described procedures. In practice, the rules therefore encourage adaptation of the use of physical restraint (‘making fit’ jurists would say) to the risk presented by the person transported to hospital, and to the risk of escape in particular. In other words, in this case the rules do not give priority to uniformity, but to adaptation of prison treatment to the individual. However, in reality little differentiation is to be seen: in almost all cases in almost all institutions inspected, removal from prison for hospital treatment always takes place handcuffed and fettered, in other words applying the highest level of security. In other words there is no adaptation of security measures to individuals and, in particular, to their level of physical fitness; strict uniformity prevails. Whatever the age and pathology for which they are taken out of prison, the precautions taken are identical. Occasionally seriously ill or disabled prisoners are not handcuffed. “On the schedule of removals from prison for the first week of inspection”, notes a report from the Contrôleur général concerning a remand prison, “the inspectors observed that the use of handcuffs alone was planned for three prisoners” that is to say in about one case out of five. This means that none of the prisoners was dispensed from physical restraint, in addition to the restraint imposed by the escort. However these provisions themselves are only indications: it is up to the senior prison officer, the head of the escort, to assess the measures to be taken at the time of removal from prison. This assessment invariably tends towards increasing the security measures “provided for”. In addition, although a form is always supposed to be filled in listing the means of restraint used after the event, in several institutions this form is not completed. The need thereof has not been felt, since practices are indeed uniform (and entirely acknowledged). The drawbacks of such systematic treatment are clear when it is recalled that hospitals are public places in which ordinary people come and go, that casualty departments, where prison ers removed from prison are often taken, are crowded places twenty-four hours a day and that handcuffs and fetters may cause discomfort or worse if they are poorly adjusted or if the journey is long. The cases referred to the inspectorate mention journeys endured with discomfort or difficulty as well as the deep humiliation caused by appearing in public closely accompanied by two persons in uniform, on one either side, and a noisy rattle of chains, which is a source of terror for the persons present. Admittedly, hospitals sometimes have dedicated access routes or separate waiting areas, but this is not always the case. Contact with third parties (apart from medical staff) is practically unavoidable, as is the associated risk, in small towns, of bumping into acquaintances (there is no difference on this point with police custody medical examinations carried out in hospital). The Committee for the Prevention of Torture defines any use of restraint 117 It is recalled that fetters are chains which join the ankles together, in order to impede running. 54