Report on the visit to the penitentiary hospital Dej

1. On May 24, 2002, two representatives of APADOR-CH visited the penitentiary hospital Dej.

2. Background

As compared to the previous visit (April 2001), progress has been made in point of the medical and guard staff necessary for the good running of the hospital. Thus, in April 2001, the surgery ward was only for easy surgery because there was only one surgeon; now there are three. Out of the 16 officers and non-commissioned officers that the guard and treatment service needed in 2001 13 were hired (4 officers and 9 non-commissioned officers). In point of equipment, there is approval for and expected to arrive: an ultrasound (as a substitute for the Doppler ultrasound which is too expensive), the "Elisa" line for tracing HIV, hepatitis B and C and tumors, as well as an ambulance equipped with everything necessary for emergencies. In December 2001 the hospital managed to buy a van (without medical equipment) for the transportation of the detainees in better conditions to Cluj for specialty consultations. Obviously the ambulance remains a priority.

The doctors in the hospital are concerned about the fact that the circulation of the requests for release from prison for health reasons, mainly of detainees with terminal diseases takes too long. The detainee files the application to a court that orders a medical expertise. The hospital sends to the Forensic Medical Institute all the documents as well as its opinion. The Forensic Medical Institute does not have a deadline for submitting its conclusions to the court. Hence, if the expertise of the Forensic Medical Institute is not ready at the deadline for judging the application of the detainee, the court will fix another date for the trial. The procedure can repeat until the submittal of the expertise of the Forensic Medical Institute to the court. Detainee Zolti Janos has generalized ganglion cancer, in an advanced phase. In the penitentiary system, the hospitals do not have specialists and the necessary equipment or the medicine. Although the situation of the detainee is more than clear, the forensic-medical expertise was almost one month late, while the doctors in Dej could not help him at all. Consequently, APADOR-CH requires the GDP that, either directly or through the Justice Ministry, to have discussions,and possibly to sign a protocol with the Forensic Medical Institute to shorten as much as possible the drafting of the forensic-medical expertise especially in the case of detainees with terminal diseases or with major health problems.

In 2001, the discussions were about the intention of the GDP to draft an internal regulation for the hospitals in its network. According to the hospital management there are already some concrete proposals, the facility in Dej having already forwarded a complete draft regulation, applicable to the ordinary penitentiaries too, as regards the hygiene-sanitary aspect. APADOR-CH supports the idea of such a regulation separately. In the association opinion, the separate regulation should include at least the following provisions:

For the penitentiary hospitals

Banning the immobilization of the sick detainees by cuffing them (including during the way to the medical consultation/to the hospitals or transfers; naturally, the banning of chains even if as a general rule they are not used). For immobilizing very agitated detainees medical bandages should be used;

The drastic limitation of the cases that are considered breaches of the Internal Rules and Regulations; the potential punishments should be restricted only to warnings, scolding and maximum withdrawal of the right to one visit only (the hospital of Dej already does this); the disciplinary measures should not be included and neither should they be mentioned in the detainee's file;

Giving up the compulsory 6:00 wake up which is not justified in any way in the case of sick detainees;

For the medical wards in the penitentiaries

Banning the consultations made by the prison doctors to the penitentiary officers, except for the emergencies;

Banning any mention in the medical chart of a detainee of the word "simulating"; nobody can guarantee that the "person simulating" would not really get ill or that because of this "label" he/she risks not to get in time the necessary medical assistance;

No detainee will be sanctioned in any way if he/she asked to be taken to the medical ward and the doctor or the nurse said it was not the case;

Banning the immobilization of the sick detainees with chains and/or cuffs. The cuffs can be used only in the case of sick detainees who are very agitated, only with the doctor's approval and only for the duration of their transportation to and from hospitals/civilian clinics. During the time in hospital the sick detainees can be immobilized only with bandages and only at the request of the civilian doctor;

During the time in civilian hospitals or penitentiary infirmaries, the disciplinary measures for breaches of the Internal Rules and Regulations will be identical with that in the penitentiary hospitals;

The obligation of the doctors/nurses in all the penitentiary system units to write down in the registries and medical charts all the wounds, concussions, traces of hits of any detainee in any moment of detention; non-observance of the obligation would be punished by disciplinary measures; if omission of such registration hides the truth in a criminal case the doctor/nurse should be subject to a criminal investigation for accessory to the crime (torture, mistreatment, abusive investigation etc).

As regards the penitentiary hospitals, APADOR-CH asks the Justice Ministry and the General Directorate of Penitentiaries to make urgent demarches with the National Military House of Health Insurance to give up the "compulsory monthly number of discharges" (in the case of the Dej hospital, this is of 200 a month, that is, exactly the maximum capacity). If failing to attain this "limit " the hospitals do not receive the necessary funds. This bizarre regulation (of March 2002) represents a real danger for the quality of the medical act. Constrained by the "ceiling", doctors can be in the situation of discharging patients who are not completely cured, risking falling ill again. Until March 2002, the ceiling imposed by the NMHHI -itself debatable - referred only to the number of entries. There were enough cases when a detainee had various diseases, each pertaining to different wards and entailing consultation and various treatments. Naturally, moving the detainee from one ward to another (for instance from surgery to ophthalmology) was considered discharge. Following this new regulation a detainee who was treated for various diseases and leaves the hospital is considered only one discharge. APADOR-CH shares the opinion of the Dej hospital penitentiary director that the basic criterion should be the quality of the medical act (number of full/partial healing, unsolved cases, deaths etc) and not the number of discharges (or of entries for that matter).

A relatively minor problem at the Dej hospital but with impact on the mood of the patients is the small number of TV sets and the rare occasions to have a relaxing activity. As the hospital has been in negotiations for the past two years for taking over a wing of the building which is not used and belongs to the Court (so to the Justice Ministry, too) some space can be arranged, either in the current space or in the one that is to be taken over, for a club for the patients. The few activities with the detainees (including the religious services) take place in the hall or in the small spaces for supervision (individual counseling). A club for the detainees, equipped at least with a TV set could partially solve these problems.

Last but not least, although the access to the only public phone in the hospital is more relaxed than in the normal penitentiaries (the detainees who are ill can call once a week and approval for the call is received in a day) the duration of the call is of 5 minutes (maximum 10) even if no other detainee is scheduled for the phone. More than that, the room where the phone is (in the visit ward) is very small (4-5 square meters) and the supervisor, who stays inside, hears everything the detainee is talking. APADOR-CH insists that the secret of mail should be observed also in the case of telephone calls.

3. Detention conditions

3.1. Effective

At a capacity of 210 places, out of which 26 for the healthy detainees who do work for the hospital there were 133 sick detainees, out of whom 12 preventive and 121 with final convictions. The hospital does not receive women detainees (all the women detainees who are ill are taken to the hospital penitentiary of Jilava). There was no underage in the hospital on the visit day. A special case was that of an offender in whose case the Baia Mare Court transformed a fine that was not paid in days in prison and he arrived at Dej with cirrhosis, in a very serious condition, practically about to die. Eventually he was "lucky" because he was treated and saved from death. But the matter of principle remains namely the vision of a judge who sent to prison for a mere petty offence a person obviously unable to perform his term.

The medical staff includes 11 doctors, a pharmacist, two biochemists and 37 nurses (growing number as compared to last year). Also growing is the number of staff for guard and treatment (over 50). A young healthy detainee is permanently attending the needs of the patients in the Intensive Care Ward.

3.2. The food ward

Although it had several camp kettles the food -because of the relatively low number of detainees - is cooked only on the gas stove. The menu on the APADOR - CH visit day included:

In the morning: tea, margarine and crackers - for everybody; tea, margarine and cheese - for diet;

At noon: potato soup and stew with meat -for everybody; potato soup and pasta with meat - for diet;

In the evening: vegetable stew without meat - for everybody; beans without meat - for diet (the diabetics had potato stew without meat).

The quantities of meat and meat products on that day were 43.5 kg beef and 2,3 kg pork.

The dishes for lunch looked good. In addition, it was one of the rare cases when the association representatives actually saw meat (beef) in sufficient amounts, in the detainees' food.

Unfortunately some confusion has been created about the extra food given to the patients: at the food ward the two representatives of the association were told that there were two additional portions every day (at 10.00 and 17.00 hours) for all the patients. During the visit day the two additional portions turned into one (at 10.00 hours) and eventually it looked like only the underweight, diabetics and those with TB were getting this supplement (the hospital has wards of consultations, general practice, ophthalmology, otorhinolaryngology, intensive care and surgery). It was unclear whether is about one or two supplements and who received them.

Another problem somehow bizarre is about the quantity of meat for the detainees: on the days when the dish includes beef (as on the visit day) a 44 kg plus 2/3 kg of pork are used, whereas on the days with "only pork" the quantity of meat is 16-17 kg.

In the "basement" (the food warehouse) the association representatives found big quantities of onion and potatoes in an advanced stage of degradation (both the onion and the potatoes were sprayed with lime solution). "We cannot throw them away; we will use them for cooking" was the answer of the officers. Also in the "basement" there were about 20 kg corn flour in bags of 1 kg, with the expire date of March 2002 (the corn flour would have been for the officers mess).

3.3. The rooms

The rooms visited (nr.35 – 10 detainees for 20 beds; Intensive Care – 3 detainees plus the person that accompanies them permanently for 8 beds; nr. 21 – 10 detainees for 14 beds) are clean and have acceptable lavatories (a toilet, a sink and a showerhead). The detainees have hot water daily. All have said they were content with the quality of the medical assistance, the food and the accommodation, especially as compared to the penitentiaries wherefrom they came.

The exercise is of one hour a day, including on Saturday and Sunday.

3.4. Cultural-educational activities

Most of the rooms do not have a TV set, so that almost the only "entertainment" of the detainees is listening to the radio. The hospital has a radio station which retransmits the local station programs and which is also used for playing cassettes with sanitary education or about human rights. The socio-cultural office, with two staff members (plus the technician) does not have chess or rummy and the books in the library (about 3000 titles) do not seem to arise the detainees' interest. The magazine ("Speranta" - Hope) issued twice a month in Dej and, under different titles, once a month in other penitentiaries - in three copies that circulate from one room to another is not exactly a cultural activity with impact on the detainees. Apparently these "magazines" are the result of an order of the GDP and hence it is just something that has to be done.

An Orthodox priest comes part time to the hospital on Wednesdays, Saturdays and for the religious holidays but the services are done in the hall. It is also in the hall that the weekly meetings with the organization for religious education “Stinca veacurilor” are held and even more rarely with the representatives of the Roman-Catholic denomination. The two educators conduct individual counseling meetings with the detainees in the ….supervisor's booth with glass walls.

APADOR-CH understands that, due to the big fluctuation of the detainees it is very difficult to organize and develop long-term socio-cultural programs. However, it is very necessary that a club for the detainees with a few tables and chairs and a TV be arranged. In addition to the services, meetings and discussions, the club would partially supplement the lack of TV sets and especially would offer the detainees the possibility to participate in some activities in more decent conditions than in the halls. Similarly, purchasing chess and rummy could not be an insurmountable financial problem.

4. Special cases

Detainee Nicolae Maghiran, transferred from Margineni to Colibasi in December 2001, had both his legs amputated in time from up the hip. The disease also affected his hands and, as the Colibasi hospital does not have the necessary equipment, Maghiran had surgery at a civilian hospital in Pitesti, where the phalanxes of both his hands were amputated. The detainee, brought to Dej in May 2002 will again be subject to surgery on his hands because some of the fingers that were operated have now necrosis. However the next surgery is not a guarantee that his problem will be solved.

The APADOR-CH representatives consider that first the imprisonment and then the continued detention of half a man is unacceptable. The detainee who is to serve another ten months in prison has a family willing to take care of him. He said he had filed four applications for parole, out of which two in 2002 (on 17 of January and 28 of April) and received no answer.

Detainee Vasile Suciu (31 years) has a conviction of 20 years, of which he served almost 11. He does not use his left leg and uses crutches. The diagnosis is "post-thrombosis syndrome" and apparently there are no chances of cure.

Detainee Iordan Baba, convicted to 5 years and served 10 months, upholds and he lost his right eye in an accident in 1983 but that a piece of bone remained in the orbit and that causes repeated infections. The doctors of Dej say that he has gone through all the necessary investigations and no bone fragment was found. However, the infections come again and the cause and the treatment should be identified. The detainee is convinced that only the neurosurgery ward of the hospital in Targu Mures (where he had previous surgery) could solve his problem.

Conclusions:

APADOR-CH asks GDP to urgently finalize the takeover by the Dej hospital of that wing from the Court. Postponement of this is simply groundless as long as it is just a transfer within the same ministry (The Justice Ministry);

The association upholds that internal rules and regulations for the penitentiary hospitals and medical wards and infirmaries in the GDP should be drafted. APADOR-CH hopes that its suggestions will be considered and offers to cooperate with GDP for drafting this document;

APADOR-CH asks DGP to do all possible demarches to give up the "limited number of discharges" imposed by the National Military House for Health Inssurance underlining that this can impair the quality of the medical assistance;

The association asks the Dej hospital management to arrange a club for the detainees, with TV, to buy chess and rummy (or similar) and not to use deteriorated vegetables or expired products when cooking food.

APADOR-CH asks GDP to check if the parole applications of detainee Nicolae Maghiran reached the destination and do everything possible to solve his situation.

Manuela Stefanescu
Valerian Stan