CAT/OP/PAN/1 principles at least as protective as those outlined in the Nelson Mandela Rules (rules 50 to 52 and 60). V. Health 80. The Subcommittee noted that La Joya and La Joyita, which have a population of nearly 8,000 prisoners, receive medical care from the Virgen de la Merced medical centre, located a few blocks away. The Subcommittee was informed that the medical centre is open from 7 a.m. to 7 p.m. and that outside those hours, the 911 emergency number can be used if necessary. 81. The Subcommittee found that the medical centre has an emergency room in an acceptable condition, with advanced life-support equipment. The members of the medical and nursing staff, however, appeared unfamiliar with the equipment, suggesting that they had not received the training necessary to use it. 82. The Subcommittee recommends that the medical centre, in view of its potential patient population, provide medical service 24 hours a day, seven days a week, and that the medical staff be trained to respond to emergencies. 83. The Subcommittee received complaints from persons deprived of their liberty who stated that access to specialized medical care was lacking because of the difficulty of making arrangements for transfers to Santo Tomás Hospital. As a result, the Subcommittee found that there were inmates in the two prisons who had a wide range of conditions – some of which had been neglected for years – including badly healed fractures, colostomies, permanent urinary catheters, ventral and other hernias and tumours. 84. The Subcommittee recommends that medical arrangements to address these conditions be made without further delay, since, although these conditions are not immediately life-threatening, they may lead to further health problems and diminish a person’s quality of life. The failure to make those arrangements would amount to medical negligence, which could be a form of ill-treatment. 85. The Subcommittee welcomes the adoption of measures to reopen the secure ward, with beds for 25 prisoners, in Santo Tomás Hospital. The Subcommittee also welcomes the preparation of a room for patients with HIV/AIDS at the Virgen de la Merced medical centre, so that intravenous medicines can be administered to them at the centre itself, and the reopening of a short-stay room that would avoid unnecessary transfers. 86. The Subcommittee was informed by staff of the medical centre that, although the centre has the capacity to attend to up to 56 patients, the figure is always much lower; this information is consistent with statements made by persons deprived of their liberty, guards and inmate leaders. The Subcommittee noted that the medical centre records all medical activity in the patients’ histories and delivers a 60-day supply of medication to patients with chronic conditions. The Subcommittee received contrasting reports from detained persons, guards and staff on why detained persons do not return to pick up their medication. 87. The Subcommittee recommends that the number of consultations be increased substantially and, with a view to making the process transparent and clarifying responsibilities, that an effective system be set up for keeping records at all stages (from an inmate’s initial request for treatment to the involvement of leaders and inmates working on health issues, referral by the guard and admission to the medical unit). 88. At the Colón prison, on the floors visited and in the women’s facility, the prisoners were unanimous in complaining about the difficulty of gaining access to medical care, owing to the small number of daily consultations offered by the doctor. The Subcommittee noted with concern that the supply of medical care for a prison the size of the Colón prison is altogether inadequate. 89. The Subcommittee recommends that the lack of access to medical care be taken into consideration when the new prison in Colón is opened and that the system for providing such care be reorganized. 12 GE.18-12640