REPORT on the visit to the Bucharest Penitentiary Hospital (Jilava)
The hospital has 952 beds, 842 for patients, 85 for duty service (healthy detainees employed in services) and 25 for women in transit at the Jilava penitentiary, situated next to the hospital.
The hospital has various departments: surgery, anaesthesia, post-op, TB, psychiatry, internal medicine, chronic diseases, skin and venereal diseases and a maternity. #7 doctors and 128 assistants are in charge of medical issues and a staff of 121 are responsible for guard and treatment.
45 deaths were registered in 1999, including the persons transferred to civilian hospitals, but found in the penitentiary hospital’s files.
The hospital is provided with two vans used to transport the patients, two Dacia rescue cars and an old TV van. The rescue cars are too small and poorly equipped. The hospital badly needs a bigger, better-equipped ambulance.
The hospital management appoints room chiefs. There are various explanation for the use of this obsolete system that is no longer employed – at least on paper – in any penitentiary: the flow of patients and the varying state of health of each detainee, function of the evolution of their disease. APADOR-CH does not believe that a room chief (or "delegate") is necessary, whether elected or appointed. This situation creates differences and leads to suspicion among detainees, which is not desirable. The most disputable thing is that the chiefs of minors’ rooms are adults, a widely spread practice in the penitentiary system. APADOR-CH considers that the room chiefs (or "delegates") must disappear. Besides the relations of subordination resulting from the status of "chief" of other detainees – especially in the case of juveniles – most detainees think that the room chiefs are informers and do not actually represent the detainees.
The hospital does not have an animal farm or plots of land used for agriculture as most penitentiaries do, so that they have to buy all the foodstuffs.
A detainee can be subjected to a specialised examination only on the basis of a court order, irrespective of who asked for the examination (the detainee, investigation bodies). The first specialised examination is conducted at the local level by a commission of the Forensic Institute, which proposes the release or the continuation of detention. The decision is up to the court. The court’s decision can be challenged before the Forensic Institute, which orders a counter-examination. The result of this second examination is submitted again to the court, that makes the decision. Finally, the last legal resort is the Forensic Institute management, which orders a new examination, on the basis of which the court makes the final decision. The Forensic Institute commissions include a specialist from the penitentiary hospital or, at the local level, the doctor of the penitentiary where the inmate is detained. The APADOR-CH representatives understood that the doctor’s role in the penitentiary system is to confirm or deny whether the detainee’s illness can be treated within the penitentiary system.
The suspension of punishments for health reasons varies from one to three months and even longer. The detainee is under obligation to undergo treatment at a specific hospital. If the detainee is not cured by the end of this period, he/she will have to follow the whole procedure described above, only this time at large.
The whole procedure is cumbersome and lengthy; during this time, the detainee’s state of health can deteriorate and a medical intervention can become useless, even if the most renowned specialist in the field treats him.
APADOR-CH considers that this procedure should be simplified and solved in an emergency procedure. The role of a court order is unclear as long as the detainee is not taken out of the system. The decision to conduct a specialised examination should be exclusively up to the doctors in the penitentiary system and outside it, and the doctor who treats the patient should have the final say. The association believes that the court’s decision whether to approve the suspension of punishment on health reasons should be consistent with the conclusions reached during the examination. The judges do not have the qualification to assess a medical decision.
The penitentiary hospital does not have isolation rooms. Usually, punishments consist in suspensions of the right to receive visits and to make phone calls. The right to receive parcels is not suspended; this is a praiseworthy decision that should become a general practice for the whole penitentiary system, at least until the quality and quantity of the food served in the penitentiary system comply with the standards.
The association’s representatives learned from the hospital management that that the Minister of Justice issued Order no. 2963/15 December 1999 regulating the procedure of the incident report, the composition and competencies of the disciplinary commission, etc. The issue that was raised consists in the fact that the detainee is heard by the commission only if the suggested punishment is serious enough – at least isolation. In other words, the detainee cannot defend himself before the commission in case of minor punishments (suspension of certain rights, warning, etc.). APADOR-CH considers that this limitation of the right to defence is unacceptable regardless of the deed committed, especially as each incident report followed by a punishment is taken into consideration in case of a future violation of the regulations or before the parole board. Although this order solves some problems, the association believes that it represents a step backward because of the provision described above and asks that it be repealed.
At the time of this visit, the penitentiary hospital accommodated 716 patients (47 women and 15 minors – 10 in the TB department and 5 in psychiatry) The most crowded departments were the TB ward (about 320 persons for a capacity of 400) and psychiatry (156 detainees and140 beds). The number of TB patients has decreased substantially once the Targu Ocna TB penitentiary hospital has become functional. It should also be mentioned that the TB department was overcrowded because of a group of patients that had just been admitted the previous night in order to be examined by the Forensic Institute.
At the beginning of this visit there were about 20 detainees in the yard. They were in pyjamas, despite the gusty wind. The hospital management said that the number of robes detainees should wear during the walks was too small. Moreover, the APADOR-CH visit coincided with the very first walk in months. Obviously, sick people do not go out for walks unless the weather is fine. But February was a warm month; still, none of the detainees were taken out for walks. Most patients could not even remember the last time they had been out. The penitentiary management tried to blame their failure to observe this elementary right on the small staff who have to guard the detainees and accompany any detainee transferred to a civilian hospital. APADOR-CH considers that, on the one hand, the number of staff is the responsibility and concern of the General Directorate for Penitentiaries, and should not prejudice the assistance granted to sick detainees; on the other, safety measures taken when sick detainees are taken out for walks are too strict. The walking grounds are surrounded by a high wire fence, impossible to escalate by a healthy man, let alone a sick one. Actually, there have been very few attempts to escape from the penitentiary hospital. Given the above-mentioned elements, APADOR-CH considers that the sick detainees can be guarded by a small number of staff during the daily walk.
The airing system is faulty so that the kitchen is damp. The daily menu consisted of tea, biscuits and margarine for breakfast, vegetable soup and potatoes with meat by-products for lunch and rice with milk for dinner. The diabetics were also supposed to get milk for breakfast, potatoes with meat (instead of by-products) for lunch and mash potatoes with margarine for dinner. The diet for TB patients was the regular one, only higher quantities of food. Obviously, the 62kg meat by-products (legs, spine, pig heads), the 16 kg lard and the 5.2 kg meat (for diabetics) did cover the 100 gr. meat (?!) provided by the standards, but do not meet quality standards, as "meat" consisted mainly of lard and cartilage.
The penitentiary hospital does not have a detainee commission to monitor the quantities of food taken from the pantry to be cooked and distributed. APADOR-CH admits that the presence of sick people in the kitchen could cause problems. That is why they suggest that the penitentiary should resort to the healthy detainees working in the hospital, in order to instate a minimal control over the quantity and quality of food. Many of the detainee’s suspicions would thus be eliminated.
Some detainees complained they had been given beans with bugs and cabbage with maggots. The hospital management admitted to the beans, but denied ever having served cabbage with maggots.
a) The TB ward has 14 rooms. In Room 105 there were 49 detainees and 51 beds. There was no TV or radio set. The detainees could listen to the loudspeaker or read "Curierul National" daily newspaper as the only pastimes. The lavatory consisted of two seatless toilets, one of them broken, and a trough with four taps, two of them out of order. The 49 detainee had not been taken out in months and had absolutely nothing to do the whole day.
In Room 106 there were35 detainees and 34 beds, as a detainee transferred from another penitentiary had just been brought in the night before. He was supposed to be moved to another room immediately.
In Room 108 there were 13 detainees and 16 beds. Hygiene was just as precarious as in the two previous rooms.
APADOR-CH stresses that the patients need special conditions: hot and cold water every day, the opportunity to take showers more often than other detainees, disinfected toilets, etc.
The TB patients take showers once a week by rotation. The tiled shower room is provided with eight showers. Unfortunately, despite the efforts to improve sanitary conditions, the ceiling was deteriorated by the dampness.
According to the detainees and doctors, about half of the number of TB patients in detention caught the disease in the penitentiary system. The precarious hygiene documents in most of APADOR-CH’s reports is thus confirmed.
b) The psychiatric ward consists of 8 rooms. In Room 205 there were 19 patients and 16 beds. One of the detainees – Titus Cionga – had been admitted to hospital on 24 January 2000 and, after more than a month of oral medication, he had a fit following which he had to be handcuffed (on 7 March) and treated with injections. The detainee said he had been cuffed round the clock for a long time (two months, according to him), that he had to beg in order to be allowed to go to the toilet and the only occasion when one of his hands was uncuffed was during the meals. (The other detainees in the room confirmed that he used to relieve himself in bed.)
Titus Cionga had been sentenced to 18 years’ imprisonment for murder by the Timis Court, although the specialised examination had revealed that he had no legal capacity. In the opinion of APADOR-CH, he should have been admitted to a specialised institution. His diagnosis is schizophrenia on a retard background. The patient is violent (he broke the windows in two rooms), shouts at night and disturbs his inmates.
The association’s representatives agree that the detainee is a danger to himself and to others. Still, handcuffing him round the clock is not an acceptable solution, irrespective of the spell of time for which this measure is enforced. Obviously, there are other means to calm down a mental patient during a fit.
In Room 203 there were 3 minors and the room chief (the adult detainee) and 8 beds. The three taps in the lavatory ran incessantly.
The shower room was identical to the one in the TB ward (8 showers), but the ceiling was dry. The association’s representatives remarked an unusual situation: both shower rooms were also used to deposit the garbage.
c) The skin and venereal diseases ward
In the 6 rooms of this ward there were 44 patients. In Room 410 there were 3 detainees: two were HIV positive and the third had AIDS. The last had been sentenced to 4 years and 4 months for theft. He said his sickness had started in 1992 and was in a very advanced stage: his sight and vision were impaired, he could hardly eat and was "waiting to die". His medication consists only of vitamins.
One of the two HIV positive patients (sentenced to 8 years for fraud) complained about the poor quality of food – which had improved a little since they had begun to receive the regular diet – and about his constant fear that his treatment might be suspended (Crixivan is absolutely necessary to him). He said he had money and could be treated outside the penitentiary system. He applied for a suspension of his term in November 1999, but his application was sent by the hospital management without the medical report, therefore with zero chances to be examined. Only in February 2000 did the hospital send again the application with the medical report attached. The APADOR-CH representatives wish to know why it took almost four months to send some documents, especially as any delay could be deadly for an HIV positive person. The association’s representatives were told that I.T. is difficult to deal with, but hope that the delay in sending his application has nothing to do with this aspect. I.T. also said he had been allowed to speak on the phone only for few minutes at a time and inquired about the existence of regulations regarding the duration of phone calls. He also asked if DGP has any special funds for the treatment of HIV/AIDS infected patients. The APADOR-CH representatives request an answer from DGP on these matters.
The other HIV positive detainee was sentenced to 12 years’ imprisonment for robbery. Although the staff said that he was also difficult to deal with, his only complaint was that they were not allowed to smoke because… smoking can damage their health! Such argument seems cynical in the case of these detainees. The hospital director said that, if he allowed them to smoke, other patients would also ask for this favour. The APADOR-CH representatives consider that the other detainees, knowing what these three suffer from, would understand the situation and would not cause any troubles.
Conclusions:
- APADOR-CH notes a slight improvement in the situation at the Jilava penitentiary hospital, especially as the TB section is no longer overcrowded. The association urges DGP to find financial resources in order to provide the hospital with an appropriate rescue car, bigger and better equipped;
- APADOR-CH asks DGP for clarifications regarding the procedure established by means of the new order in terms of violations of internal regulations and the detainees’ hearings before the disciplinary commission;
- The association asks DGP to analyse whether the procedure of solving applications for suspensions of punishments on medical reasons could not be simplified;
- The association’s representatives noted that cultural-educational activities are practically non-existent in the penitentiary hospital. Sick detainees have nothing to do in their spare time; they are not even allowed to go out for walks every day. APADOR-CH agrees that the weather must be taken into consideration, as all detainees are sick people. That is why the hospital must be immediately provided with warm robes in order to allow detainees to go out more often. The association also notes that the hospital management invokes the small staff and the impossibility to guard the detainees during the walk, especially if a high number of detainees must be transferred to civilian hospitals, in which case the presence of two non-commissioned officers is required for each such detainee. APADOR-CH urges DGP to analyse if the rules related to the detainees’ supervision during the walks cannot be modified in the case of sick detainees by lowering the number of guards, especially as the walking grounds are surrounded by a wire fence that cannot be escalated;
- APADOR-CH asks the penitentiary hospital management:
Manuela
Stefanescu
Valerian Stan