This file is a mirror of EUSKAL HERRIA JOURNAL by Basque Red Net.

1996 Report: Country by country: treatment of patients, legislative provisions, health-care service

Spain

Europe

Ministry responsible for prison establishments: Ministry of Justice and the Interior
Prison establishments: 87 (March 1995)
Total number of prisoners: 47,216 on 6 January 1995
Ministry responsible for health care in detention: n/a
Percentage of welfare budget allocated to health care: n/a
Number of doctors per 100 prisoners: n/a

Estimated number of sick prisoners

According to estimates made in the early nineties, 24% of prisoners were seropositive, and in 1990-91, 40% of seropositive prisoners also were infected with TB.

In 1992, 165 deaths were reported, including 105 attributable to Aids and ten to overdoses.

In 1994, at least two deaths were connected with incorrect diagnoses: J. Retolaza died from skin cancer while being treated for warts, and J. Ascensio died from tuberculosis while undergoing treatment for flu.

One prisoner at Nanclares de Oca Prison (Basque Autonomous Region) died on 5 October 1994 as a result of an asthma attack with cardiac arrest. Article 60 was still not applied to him despite the precariousness of his condition, which had been known for a long time.

Access to health care

Medical care is reported almost unanimously to be highly inadequate. Most prisons have a small sick bay, generally very poorly equipped. There are also four prison hospitals, two of which are for psychiatric patients.

The Caceres I women's prison has neither a sick bay nor a medical consulting room. Consultations take place anywhere, in corridors, the canteen, cells, or adminsitrative offices. Basque prisoners no longer have access to health care outside the prison - despite the legislative provisions - since the introduction of the policy of dispersion. They therefore depend exclusively on the health care provided by the prison administration.

Special treatments

Prisoners with Aids are frequently treated in sick bays where the nursing staff, in the absence of any infrastructure, are restricted to basic health-care provision.

In theory, seropositive prisoners and those with Aids are treated both by the prison's medical personnel and the public health service. It would appear however that doctors practising in prisons are reluctant to use the public health service. Patients are only transferred to outside establishments if their condition is very serious.

Prisoners suffering from Aids receive AZT treatment. The results of medical examinations are sometimes notified with unjustifiable delays, causing treatment to be interrupted in some cases for months.

In the view of the Citizens Against Aids Committee, infected prisoners do not receive the same level of health care as the rest of the population. The lack of appropriate means and facilities is sometimes responsible for the death of patients. Many prisoners have already died from Aids in Spanish prisons, and many more have died en route to hospital or a few days after being admitted to hospital. The spread of a number of infectious diseases in Spanish prisons has also increased the risk of infection.

Discriminatory treatment

Seropositive prisoners are not systematically confined in individual cells, however segregation may take place. Some prisoners are reported to have been placed in special wings housing other prisoners suffering from contagious diseases, particularly tuberculosis.

Patiens are not normally separated according to the type of disease from which they are suffering. Inmates at Navalcarnero complain that prisoners' health is not taken into account when they are assigned to cells. Tuberculosis or hepatitis sufferers share cells with uninfected prisoners, and bronchitis sufferers share cells with smokers.

Legislative provisions

Article 60 (2) of the prison regulations of 8 May 1981 provides for release on parole in cases of "serious illness accompanied by insurmountable pain". However, according to article 98.2 of the Penal Code, all detained persons must serve three-quarters of their sentence before they can be released on parole. Prisoners starting their sentences and remand prisoners would therefore appear to be excluded from the application of this article.

However, prison legislation requires prison authorities to fulfil their obligations in respect of the human rights and personality of prisoners, and to protect their physical integrity and health. In the view of the Director of Public Prosecutors, the onus on them to fulfil these obligations is greater when prisoners are in the terminal stage of illness; in the case of prisoners with Aids, the solution closest to the terms of the law is that they should receive, in prison, treatment appropriate to their illness. However, given the lack of available human and material resouces, prison establishments find it difficult to provide these people with the necessary treatment, and it was for this reason that the Director of Public Prosecutions concluded: "We do not contest that article 60 of the prison regulations should not, in the strictly legal sense, apply to these cases. However, is there any alternative?"

In this same conclusion, it is stated that the release of prisoners who have reached the terminal stage of Aids may be justified on humanitarian grounds, but that this release should not be granted automatically. Each case is studied separately and much weight appears to be attached to the good conduct of the prisoner and his probable conduct after his release.

The Supreme Court has made clear in a judgement the factors determining whether or not terminally ill prisoners should be released on parole. According to the Court, the purpose of parole is not only to enable these prisoners to die outside prison, but also to enjoy a final taste of freedom before dying.

On each occasion when parole is suggested, a social worker contacts the prisoner's family and members of the family are required to sign a "family declaration", whereby they undertake to provide moral support and assistance as well as health care. It would seem lastly that information concerning measures to be taken and procedures to be followed in order to obtain remission is not comunicated to the parties concerned.

Parole as stipulated in article 60 of the prison legislation is rarely granted.

Prevention

The Spanish prison service operates six priority programmes concerning STDs, health education, vaccinations, hygiene and the environment, drug dependence and the prevention of suicide.

On entry into prison, prisoners receive kits contatining condoms and hygiene products. These kits are automatically replenished every month. Condoms are also available in easily accessible places and in private visiting rooms. Information on how to use them is also provided.

Disinfectant products are also distributed free of charge accompanied by instructions for use. However, sterile syringes are not distributed.

Screening

On entry into prison all prisoners are given a general check-up which includes a medical examination and biological tests. Screening for STDs takes place systematically in all prison establishments.

Tests for HIV infection are offered. Serological tests are not compulsory, but seem to be increasingly accepted by new prisoners. There are however some reported cases where the HIV test was carried out without the consent of the person concerned.

Cases of pulmonary and extrapulmonary tuberculosis are common. All prisoners who test positive or show symptoms of the disease are given a chest X-ray.

The doctor is responsible for notifying the family of seropositive prisoners, while the medical service for its part is required to inform the General Directorate of Prison Services and the prison administration, which notifies services offering specialist treatment. If the person concerned is in detention awaiting trial, the examining magistrate is also informed.

Follow-up in the case of a positive result

Psychological counselling is offered to seropositive prisoners or those with Aids. In some cases, particularly in Barcelona, the doctor advises seropositive prisoners on the type of behaviour to adopt in order not to conatminate fellow prisoners.

Counselling may also be provided by the prison's medical personnel. Social workers also try to convince seropositve prisoners and drug addicts that they should undergo detoxication treatment.