3.9.4.4. Independence and Competence of a Doctor; Confidentiality and Informing a Prisoner In accordance with Recommendation no. R(98)7 of the Committee of Ministers of the Council of Europe, doctors who work in prison should provide the individual inmate with the same standards of health-care that is delivered to patients in the outside community. The health needs of the inmate should always be the primary concern of the doctor. Clinical decisions and any other assessments regarding the health of detained persons should be governed only by medical criteria. Health-care personnel should operate with complete independence within the bounds of their qualifications and competence.306 It is a contravention of medical ethics for health personnel, particularly physicians, to be involved in any professional relationship with prisoners or detainees the purpose of which is not solely to evaluate, protect or improve their physical and mental health.307 The issues related to independence and qualifications of medical personnel remain problematic in 2016. For ensuring the independence of the medical personnel employed in the penitentiary health care system, it is necessary that the medical personnel should not the subjects of the Ministry of Corrections of Georgia. Furthermore, even within the penitentiary health care system, it is important to make efforts towards enhancing the degree of professional independence and qualification. It is important to ensure continuous professional training of medical personnel and enhancement of various training modules and set up an effective mechanism for assessment and supervision of sustainability of training outcomes. It is important to review the legal framework governing penitentiary health care for ensuring the rigorous observance of the principles of professional ethics to a maxim degree by the medical personnel of the penitentiary system. It is a contravention of medical ethics for health personnel, particularly physicians, to be involved in any professional relationship with prisoners or detainees the purpose of which is not solely to evaluate, protect or improve their physical and mental health.308 In 2016, certain subordination of the medical personnel to the administration of a penitentiary establishment remains a problem as it violates the principle of confidentiality and obstructs the process of provision of medical services. In terms of professional independence of medical personnel, it is particularly important to ensure in long term perspective, integration of the penitentiary health care with the public health care. As regards the short term perspective, it is imperative to ensure strict supervision over observance of the principles of professional ethics by the medical personnel and adequate response to breaches. 306 Council of Europe, Recommendation no. R (98) 71 of the Committee of Ministers to Member States Concerning the Ethical and Organisational Aspects of Health Care in Prison, adopted by the Committee of Ministers on 8 April 1998 at the 627th meeting of the Ministers’ Deputies in Strasbourg), paras. 19-20. 307 The United Nations Principles of Medical Ethics, 1982, principle 3, available only in English at: http://www. un.org/documents/ga/res/37/a37r194.htm [Last visited on 18.03.2015]. 308 The United Nations Principles of Medical Ethics, 1982, principle 3, available only in English at: http://www. un.org/documents/ga/res/37/a37r194.htm [Last visited on 18.03.2015]. 144 HUMAN RIGHTS SITUATION IN CLOSED INSTITUTIONS