‘Lack of palliative care and shortage of doctors’ — report on the results of a monitoring visit to Lviv Penal Institution No. 19
Lviv Penal Institution No. 19 has a 400-year history. The institution performs the functions of a pre-trial detention centre. The institution has transit cells, as well as a maximum-security sector for those sentenced to life imprisonment.
During the visit, the monitoring group reviewed documentation relating to the colony's operations and medical records, and inspected utility and residential premises, doctors' offices, the X-ray room, the operating theatre, wards, and other areas of the hospital and medical unit for compliance with the requirements of Ukrainian legislation and international standards. The monitors visited the hospital premises, the duty unit, paid cells for pre-trial detainees, transit cells, and cells for housing women.
General Information
Located on the premises of the institution is the Psychiatric Unit of the Lviv Multi-disciplinary Hospital No. 19, a branch of the State Institution ‘Health Care Centre of the State Penal Service of Ukraine in Lviv Region’.
According to official data provided by the head of the institution, the staff consists of 288.5 full-time positions, with 217.5 currently filled. Over the course of the current year, 353 people have arrived at the facility. On the territory of the colony, 11 units of the Social and Psychological Service are operational, and 3 units are mothballed. At the time of the visit, 832 people were being held in the institution, 69 of whom were in the social rehabilitation section. The cost of maintaining one prisoner per day is 46.76 hryvnias. During the current year, 14 people were released on parole. 52 people are employed under employment contracts, and 103 convicted persons are employed under civil law contracts. The average monthly salary is 4,102.28 hryvnias. No one has been released from the institution due to a serious illness. During 2023, 7 cases of bodily injury were recorded in the institution, 2 of which occurred upon arrival. This year, 78 long-term visits and 159 short-term visits have been conducted. There are 3 psychologists working in the institution. There are 37 people registered as prone to self-harm, 4 people as prone to escape, and 94 people identified as malicious offenders.
During the monitoring visit, the premises where men and women in transit to penal institutions are held were inspected; the mother and child rooms and paid cells for prisoners were also visited. During these inspections, full confidentiality and interaction with prisoners and convicted persons were ensured.
During the visit to each premise, there was an opportunity for confidential communication with prisoners, which allowed them to speak openly about their issues.
During the communication, no significant complaints or statements were received from convicted persons regarding the conditions of detention in the pre-trial detention centre or instances of ill-treatment during the visit.
Lviv Multi-disciplinary Hospital No. 19, a branch of the State Institution ‘Health Care Centre of the State Penal Service of Ukraine in Lviv Region’
Acting Head of the Lviv Multi-disciplinary Hospital — Roman Bilianskyi.
Lviv Multi-disciplinary Hospital No. 19, a branch of the Health Care Centre of the State Penal Service of Ukraine in Lviv Region, has a capacity of 125 beds. The hospital consists of the following departments:
- therapeutic unit with 40 beds (20 therapeutic, 10 neurological, 5 female psychiatric, 5 palliative);
- surgical unit with 40 beds (30 surgical, 10 oncological);
- psychiatric unit with 45 beds based at Penal Colony No. 40 (43 beds for men, 2 for life-sentenced prisoners).
Outpatient department: 1 ward-cell for somatic patients with 5 bed spaces. The tuberculosis unit consists of 4 ward-cells with 15 bed spaces.
In the hospital, in accordance with the order of the Health Care Centre of the State Penal Service of Ukraine dated 26.09.2022 No. 62-OD, the referral of convicted patients was suspended during January 2023 due to the need to bring the hospital premises into a proper sanitary condition. In February 2023, the referral of convicted persons for inpatient treatment was resumed.
The following positions are vacant according to the staffing schedule: hospital head — 1.0; deputy hospital head — 1.0; department head — 2.0; general practitioner (family doctor) — 1.0; surgeon — 0.50; anaesthesiologist — 0.50; psychiatrist — 1.0; X-ray laboratory technician — 1.0; laboratory assistant — 1.0; nurse — 1.0; anaesthetist nurse — 1.0; junior nurse for patient care — 1.50; junior nurse (orderly) — 2.0; housekeeper — 1.0.
During communication with patients receiving treatment in the hospital, a patient, V., was identified in the therapeutic department, who was using an orthopaedic belt and struggling to move due to lower back pain. This patient reported that he sustained a spinal injury in January 2020 inside a vehicle used for transporting prisoners. After the injury, he was examined by doctors and underwent X-rays. A diagnosis of ‘fracture of the sacral vertebra and certain spinal pathology’ was made. He received conservative treatment. His health condition gradually deteriorated, and he now moves with great difficulty.
Upon reviewing the outpatient medical record, it was established that before the injury in January 2020, no spinal pathology had been observed in patient V. The personal file of the convicted person V. contains documents regarding the detection of bodily injuries in January 2020 — a spinal injury, confirmation of this injury via X-ray examination, inpatient treatment, and consultations with specialist doctors.
An examination of the medical record revealed that patient V. is in the hospital due to a spinal disease accompanied by pain syndrome, impaired limb innervation, and significant disruption of motor function and gait. In connection with this, the Medical and Social Expert Commission (MSEC) has been provided with patient V.’s documents to determine a disability group. The cause of the indicated painful changes was stated to be spinal disease. Data on patient V.’s health condition prior to January 2020, the injury in January 2020, and his health condition thereafter are absent from the inpatient medical record. This leads to a possible error in resolving the issue of the disability of the convicted person V. and its cause.
During the monitoring visit, violations of the requirements of national legislation and non-compliance with international recommendations in the field of prisoner treatment were identified, leading to violations of the rights of convicted and detained persons:
1. Violation of the rights of convicted and detained persons in the provision of medical care
Due to the lack of signed declarations between convicted persons and a primary care physician, they are unable to receive the necessary medical services funded by the National Health Service of Ukraine (NHSU), which leads to a violation of the requirements of paragraphs 4 and 5 of Article 4 of the Law of Ukraine ‘Fundamentals of the Legislation of Ukraine on Health Care’.
The hospital lacks separate offices for a gynaecologist, ultrasound specialist, and infectious disease specialist. These doctors conduct examinations of convicted patients in shared offices, which does not ensure confidentiality and may lead to a violation of the right to privacy during medical examinations.
2. Violation of the right of convicted persons to palliative care
In accordance with the ‘Procedure for the Provision of Palliative Care’, the main components of palliative care are medical, social, spiritual, and psychological support for the patient. The hospital lacks a licence for economic activities in medical practice for the specialties of medical psychology, psychiatry, and psychotherapy, which does not meet the necessary organisational, personnel, and technological requirements for the hospital's material and technical base for providing psychological support to palliative patients. There is no palliative unit in the hospital to provide palliative care in an inpatient setting. Such care is provided in the wards of the oncology unit using narcotic drugs, psychotropic substances, and precursors under the supervision of doctors until the patient's premature death. This indicates the absence of proper conditions for providing palliative care in an inpatient setting to those who require it. Patients are not referred to health care facilities that can provide such care. This leads to the deterioration of the physical and psychological state and spiritual suffering of the patient with life-limiting or life-threatening illnesses.
3. Violation of the right of convicted persons to psychiatric care
The monitoring group established that, in violation of the Law of Ukraine ‘On Psychiatric Care’, 3 people suffering from mental disorders are being examined and treated by doctors of other specialties due to vacant psychiatrist positions in the hospital, which does not ensure proper prevention, diagnosis of mental disorders, treatment, supervision, care, and medical and psychological rehabilitation of persons suffering from mental disorders. Furthermore, there is no isolation ward in the hospital for persons with mental disorders who pose a danger to others.
4. Non-compliance with infection control and epidemiological surveillance for tuberculosis
On the day of the visit, 5 patients with an infectious form of tuberculosis were in the medical unit. Dispensary supervision is being carried out for 61 people with a diagnosis of tuberculosis (cat. 5.1). The medical unit does not comply with the requirements for the isolation of patients with tuberculosis; in particular, there are no partitions with doors or airlocks installed at the borders between clean zones and high-risk zones. The patient wards are used for more than one or two people (4 ward-cells for 15 bed spaces), the doors to the wards are not equipped with sealed thresholds or edge seals, and air recirculation via mechanical ventilation is not provided.
5. Violation of the right of convicted persons to proper dental care
The hospital lacks a dental X-ray machine, which makes it impossible to conduct in-depth dental examinations of the convicted persons and does not ensure the timely provision of proper dental care.
6. Violation of fire safety rules
The premises of the medical unit are not equipped with fire suppression systems or fire alarms. The doctors' office and X-ray room are not equipped with fire extinguishers. This does not ensure safe conditions for patients staying in the hospital and may pose a threat to their life and health.
7. Violation of the right of convicted persons to proper sanitary and hygienic conditions in a health care facility
The hospital premises do not meet the requirements of Article 22 of the Law of Ukraine ‘On Ensuring Sanitary and Epidemic Welfare of the Population’. The hospital premises require renovation: the walls have peeling paint and mould in places, and tiled wall panels are broken, which complicates the disinfection of the premises; there is no hot water supply.
In most ward-cells of the hospital, the standards for living space per convicted person in an inpatient treatment setting (no less than 5x2 m) are violated. The beds are placed tightly against each other. The ward-cells do not comply with the standards for proper natural lighting. Artificial lighting is also insufficient.
8. Violation of the rights of persons with viral hepatitis C
During 2023, 489 rapid tests were conducted in the medical unit to check for viral hepatitis C, and 64 people were suspected of having the disease. People suspected of having viral hepatitis C do not undergo PCR testing, due to which they do not receive the necessary treatment, which may lead to the deterioration of their health and the spread of this infectious disease among convicted and detained persons.
9. Violation of the right of convicted and detained persons to information about health status and treatment methods, and improper documentation
The absence of informed voluntary consent for diagnostics and treatment, signed by the patient, was established in inpatient medical records No. 003/o. This may indicate a lack of voluntary consent from patients for the application of diagnostic, preventive, and treatment methods.
There is no register for recording the results of preventive medical examinations at the Lviv Penal Institution No. 19, which indicates that preventive examinations are not being conducted properly.
During the current year, 9 cases of bodily injury were recorded in the register of bodily injuries of newly arrived persons. Upon studying the medical documentation, it was established that certificates and photographs of existing bodily injuries are missing from outpatient medical records 025/o.
In the outpatient department, the ‘Control card for monitoring an HIV-infected person’ (dispensary form No. 030-5/o) is not kept.
The visit was carried out by representatives of the NGO ‘Protection of Prisoners of Ukraine’ and the NGO ‘Kharkiv Human Rights Protection Group’. The monitoring group consisted of an assistant to the People's Deputy of Ukraine Kostiantyn Kasai, members of the Public Council under the Ministry of Justice of Ukraine Serhii Zuikov, Hanna Skrypka, and Oleh Tsvilyi, an assistant to the People's Deputy of Ukraine Yaroslav Yurchyshyn, the coordinator of Kharkiv Human Rights Protection Group programmes Andrii Didenko, and forensic medical expert Kostiantyn Zaporozhtsev. The visit was carried out within the framework of the project ‘Reducing Prisoners' Suffering in the Context of the War in Ukraine’, funded by the government of Denmark in partnership with DIGNITY — Danish Institute Against Torture. The purpose of the visit was to analyse human rights compliance in places of detention during the war, as well as compliance with the right to medical care for people undergoing treatment at Lviv Multi-disciplinary Hospital No. 19 of the State Institution ‘Health Care Centre of the State Penal Service’.
Date of visit: 11 July 2023