PRISONER LEGAL STATUS AMOUNTS TO SLAVES Georgi BANKOV, M.D. For 10 years now I’ve been watching the slow but painful evolution of healthcare in prisons. There has been some movement. Nothing, however, has been spared in the trial and error process. The beginning was chaos and then the sky saw the birth of its laws one by one. Some died; others are still shining, often not exactly synchronously. BHC is now in possession of a letter in which the Ministry of Justice admits to violating some laws. However, while they appear willing to cooperate, nothing has come of this yet. Again we are talking about medical care in prisons. Prisoners are being harmed by the Ministry. They are being deprived of a choice of GP, the right to informed consent, annual medical checks, and treatment. They are being serviced by illegal medical centres, while checks are not recorded. They are not guaranteed any occupational health and safety. Basically, their legal status amounts to slaves. They may live, and they may die. Severin’s case is indicative. He used to be your neighbourhood sturdy boy from Ruse. He had physical strength. “He used to carry two bags of cement at a time”, his former employer told us. His nickname was Rambo. However, he stole a few iron things. He had 5 children, and he was looking after them with the help of his mother and relatives. He ended up in jail for 2 years after stealing a manhole cover. He started work in a ceramic factory. “He wanted to help his children”, the prison officials informed us. For almost one year he worked more than his normal quota. He only had a few months left to serve. But on 29 December 2006 he died. He was 28. His eldest child was 9. Severin never had any health problems. The cause of his death turned into the quiz of the century. No one could tell for sure. “Cause of death undetermined”, says the official death notice. It is just as undetermined unofficially. According to the Ordinance for Medical Care in Legal Confinement Facilities, in cases of death, a forensic report is mandatory. This report in Severin’s case is, of course, missing and no one was able or willing to explain why. These documents are always top secret, even beyond national intelligence top secret. An investigation secret? It has been 10 months since he died. We made sure we got power of attorney from the deceased’s mother. She has at least the right to know what caused his death. What could count as a violation in the last year of the prisoner’s life? His health had not been checked in a legal medical institution. The prison’s medical centre does not meet the requirements of the Law for Medical Institutions in terms of staffing and equipment. It should be sealed and closed immediately by the Minister of Health who is responsible for control under this Law. The medical checks performed were not governed by the informed consent principle.
There is no written record whatsoever of the patient being informed and, subsequently, agreeing to checks and treatment, as required under the Public Health Law. The prisoner had not undergone the obligatory set of annual medical checks. Prisons juggle with figures, speaking of 100 or 200 per cent coverage of the inmate population with obligatory medical checks. In reality, however, there isn’t a single check performed in the thoroughness required by the Ministry of Health. The prisoner was apparently denied his right of choice of a GP. This is a subject we have been discussing since the very launch of health insurance reform. It was also dedicated substantial attention in the ombudsman’s report. The prisoner’s health condition was not checked before his starting the job. When starting a new job, there is also a thick Ordinance for applying preliminary and mandatory regular checks of the personnel and workers. The prisoner was not provided safe and healthy working conditions. The Bulgarian Ministry of Justice, the General Directorate, the Prison Production Government Enterprise, the Labour Inspectorate, and many others seem to think that prisoner labour is not subject to any protection under the Occupational Health and Safety Law. BHC has come to realise this through the progress of case proceedings on the death of a prisoner from Bourgas during work. The prisoner was not entitled to safety or indemnity in the event of work-related accidents or death. He was not even entitled to a pension. The prisoner was paid half of what he earned. Why the state withholds the remaining half remains unknown. Apart from this 50 percent, the government enterprise Prison Production has requested security guards and another 30 per cent from the employers for unknown reasons. Possibly to administer its own existence.... The prisoner lived in physical conditions bordering on inhumane treatment and torture. This latter point is a fundamental rule for Bulgarian prisons. I am not even going to comment on it. All lawsuits against Bulgaria with these charges as a rule end with a sentence against the state. It then pays all the penalties and court costs, and changes nothing. I would prefer it if criminals could just serve their sentences and have no grounds for suing the state, and hence indirectly me, for disgraceful and unfitting treatment. The only sanitary and epidemiological control in confinement facilities are those same medical centres. And what do they do? Nothing. They lack the required statute, expertise, willingness, and equipment. The responsibility for all of the above violations in the facilities and pertaining medical centres lies with their principal which is the Ministry of Justice. In this capacity it is authorised to optimise its structures in accordance with national laws. It has the rights, and it has the responsibilities.
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