Report on the results of the monitoring visit to the Stryzhavska Multidisciplinary Hospital No. 81 in the Vinnytsia region

On 27 August 2024, in accordance with the Optional Protocol to the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, taking into account the provisions of the Standard Minimum Rules for the Treatment of Prisoners and the decisions of the European Court of Human Rights, and on the basis of Article 24 of the Criminal Executive Code of Ukraine — Visiting penitentiary institutions, a group of monitors from the Kharkiv Human Rights Protection Group and the NGO “Protection of Prisoners of Ukraine” conducted a regular visit to the state institution “Stryzhavska Multidisciplinary Hospital No. 81 of the branch of the State Institution ‘Health Care Centre of the State Penitentiary Service of Ukraine’” (hereinafter the hospital, the institution, the facility).

The visit was carried out as part of the project “Reducing Prisoners’ Suffering in the Context of the War in Ukraine”, funded by the government of Denmark in partnership with DIGNITY — The Danish Institute Against Torture.

The visit was conducted by the following monitors:

• Didenko Andrii Andriiovych — assistant to the People's Deputy of Ukraine Yaroslav Yurchyshyn, has experience in monitoring visits since 2014;
• Zuikov Serhii Yuriiovych — assistant to the People's Deputy of Ukraine Kostiantyn Kasai, member of the Public Council under the Ministry of Justice of Ukraine, has extensive experience in monitoring visits, specialises in the research of medical assistance provision;
• Tsvilyi Oleh Volodymyrovych — member of the Public Council under the Ministry of Justice of Ukraine, has extensive experience in unannounced visits to penitentiary institutions, specialises in the research of issues related to torture and ill-treatment.

To evaluate the information obtained during the monitoring visit, the following were used: the previous report and recommendations, NPM reports (National Preventive Mechanism under the Commissioner for Human Rights of the Verkhovna Rada), reports from prisoners and their relatives, national legislation of Ukraine, and the regulatory acts of the State Penitentiary Service of Ukraine and the Ministry of Health.

The visit took place without prior notice. As part of the visit, discussions were held with convicted patients, including on conditions of anonymity, regarding the observance of human rights, conditions of detention, and the proper provision of medical care, as well as with the staff and management of the institution. The monitors had access to the necessary documentation.

During the monitoring visit, violations of national legislation requirements and non-compliance with international recommendations in the field of prisoner treatment were identified, which lead to violations of the rights of convicted persons.

Date of the previous visit: 27 July 2022

General Information

The institution functions as a multidisciplinary hospital. The facility houses individuals who have been transferred for treatment from penitentiary institutions of varying security levels.

The institution is located at the following address: Vinnytsia region, Vinnytsia district, urban-type settlement Stryzhavka, Alei Street, 62, 23210.

The Stryzhavska Multidisciplinary Hospital has a capacity of 100 beds and includes the following departments: therapeutic with 30 beds (of which 10 are endocrinology, 5 beds for palliative care); surgical with 20 beds; infectious with 30 beds; ophthalmological with 20 beds (serving ophthalmological patients from correctional colonies throughout Ukraine).

The staffing level for doctors is 91.42%, and for middle-ranking medical staff, it is 96%. The overall staffing level in the hospital is 77.77%.

Vacant positions: dentist — 0.5 positions; psychiatrist — 1.0 position (total vacant doctor positions — 1.5); middle-ranking staff: ward nurse — 4.0 positions, nurse — 1.0 position, medical assistant — 1.0 position (total vacant middle-ranking staff positions — 6.0). Total vacant positions — 7.5.

Registered in the outpatient department are prisoners with disability groups: Group I — 0; Group II — 2 persons; Group III — 10 persons.

Work of the Medical Advisory Commission (MAC) regarding the application of Article 84 of the Criminal Code of Ukraine to sick prisoners in 2024:

1. Number of those released under Article 84 of the Criminal Code of Ukraine — 4 persons;
2. Number of cases reviewed by the MAC — 14;
3. Number of materials sent to court — 14; granted — 5, refused by the court — 0;
4. Number of deaths during court consideration — 3.

Since the beginning of the year, 13 prisoners have died. In the hospital — 8 prisoners, in Ministry of Health institutions — 2 prisoners, in the State Institution “Stryzhavska Correctional Colony No. 81” — 3 prisoners.

The hospital provides opioid substitution therapy (OST) to patients dependent on narcotic substances. 104 people are receiving substitution maintenance therapy.

Preliminary Remarks

1. In the wards of the inpatient departments, beds are placed directly against each other; the requirements regarding the floor area norm per convicted person in a medical facility are not being met;
2. Sanitary facilities are not equipped with doors, which violates the right of convicted persons to privacy;
3. The hospital has not created proper conditions for transporting patients to the operating theatre, which is located on the third floor; there is no lift in the surgical department. The facility has no conditions for the recovery of individuals after surgical interventions: there are no handrails or internal ramps;
4. Departments are not provided with access to drinking water: there are no containers for boiled water;
5. Most cells are not equipped with supply and exhaust ventilation, which does not ensure proper ventilation of the cells and may lead to the spread of infectious diseases among detained persons;
6. The infectious isolation ward, like the infectious department as a whole, is not equipped with a shower room. Thus, sick prisoners are deprived of the right to maintain hygiene, or their washing must take place in general shower rooms. Because of this, the principle of isolation for patients with infectious diseases is not observed;
7. Some mattresses and pillows need replacement;
8. For the current year, the injury registration log lacks photographs of existing bodily injuries, as provided for in Clause 3, Section 1, Chapter II of the Joint Order of the Ministry of Justice of Ukraine and the Ministry of Health of Ukraine dated 15.08.2014 No. 1348/5/572 “On Approval of the Procedure for Organizing the Provision of Medical Care to Prisoners”;
9. Medical examinations are conducted in the presence of other prisoners;
10. Shower cubicles are not equipped with curtains, which prevents prisoners from exercising their right to privacy during hygiene procedures.

Facts Discovered During the Visit

1. According to the order on the distribution of prisoners and persons in custody requiring inpatient medical care to health care facilities of the Health Care Centre of the State Penitentiary Service of Ukraine, men and women who require palliative care from penitentiary institutions and pre-trial detention centres in the Vinnytsia and Zhytomyr regions, in the city of Kyiv, and in the Kyiv region, are sent to the Stryzhavska Multidisciplinary Hospital No. 81.

At the same time, the hospital lacks a palliative care department for providing palliative care in inpatient conditions, in accordance with Clause 4 of Section IV of the “Procedure for Providing Palliative Care”, approved by the order of the Ministry of Health of Ukraine dated 04.06.2020 No. 1308.

According to the “Procedure for Providing Palliative Care”, the main components of palliative care are medical, social, spiritual, and psychological support for the patient. At the same time, the hospital does not have a licence to conduct economic activities in medical practice for the necessary medical specialities, which fails to meet the proper organisational, personnel, and technological requirements for the hospital's material and technical base to carry out psychological support for a palliative patient.

2. According to Clause 2, Clause 3 of Chapter III, Section II of the “Procedure for Organizing the Provision of Medical Care to Prisoners”, approved by the joint order of the Ministry of Justice of Ukraine and the Ministry of Health of Ukraine dated 15.08.2014 No. 1348/5/572 (hereinafter — the Procedure), a general practitioner (or a family doctor), a psychiatrist, and a dentist must participate in the preventive medical examination.

At the same time, the positions of psychiatrist and dentist in the hospital are vacant, which indicates that the primary and preventive medical examination is incomplete, as a result of which prisoners and detainees do not receive proper medical care.

3. In violation of Clause 41 and Clause 69 of the recommendations of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (hereinafter — the Committee) (CPT/Inf(93)12-part), the position of psychiatrist in the hospital is vacant, which does not ensure proper prevention, diagnosis of mental disorders, treatment, supervision, care, medical and psychological rehabilitation of persons held in the hospital and correctional colony who suffer from mental disorders.

At the same time, in July 2024, two suicide cases were recorded in the institution. During confidential conversations with prisoners, the monitoring group was informed that in one of these cases, the prisoner had recently finished treatment in the substitution maintenance therapy (SMT) programme shortly before committing suicide.

Furthermore, the lack of a psychiatrist on the hospital staff indicates that drug-dependent individuals are not properly provided with rehabilitation after completing treatment in the SMT programme, cognitive-behavioural therapy (CBT), etc. This indicates a violation of the right to health protection and medical care (Article 49 of the Constitution of Ukraine).

In addition, in its report on the results of the visit to Ukraine in 2023, the Committee reiterates its recommendation to further strengthen the provision of psychological assistance in institutions, as well as to develop the training and role of penitentiary psychologists, especially in terms of therapeutic clinical work with prisoners.

In this context, efforts must be made to recruit clinically trained psychologists, who should be part of the medical team and, in their work, should not combine two different roles, i.e., risk assessment and therapeutic clinical work. (CPT/Inf (2024) 20) point 85).

4. The hospital provides substitution maintenance therapy to patients dependent on narcotic substances. 104 people are receiving substitution maintenance therapy. At the same time, during the visit, prisoners who had previously stopped treatment in the substitution maintenance therapy programme for various reasons approached the monitoring group with complaints about the accessibility of the specified treatment for them in the hospital facility.

This violates their right to choose methods of treatment in accordance with Article 38 of the Law of Ukraine “Fundamentals of Legislation of Ukraine on Health Care” and contradicts the principles of effective treatment of drug addiction, the first of which is accessibility, where every person in need of treatment should be given such an opportunity.

In addition, the Committee, in its report on the results of the visit to Ukraine in 2023, notes that being admitted to a penitentiary institution is an opportunity to resolve a drug-related problem, and therefore it is important that appropriate assistance is offered to all interested persons, and access to SMT programmes in institutions should be easily available. (CPT/Inf (2024) 20) point 86).

5. In violation of the requirements of the Instruction on completing the primary registration documentation form No. 003-6/o “Informed voluntary consent of the patient to diagnosis, treatment, and surgery and anaesthesia, and to the presence or participation of educational process participants”, approved by the order of the Ministry of Health of Ukraine dated 14.02.2012 No. 110, it was established that there was a lack of signed informed voluntary consent forms for diagnosis and treatment from patients who were in the hospital.

This may indicate the absence of voluntary consent from patients for the application of diagnostic, preventive, and treatment methods, which is a violation of Article 43 of the Law of Ukraine “Fundamentals of Legislation of Ukraine on Health Care” and Clause 47 of the Committee’s recommendations (CPT/Inf(93)12-part).

6. During the visit, the monitoring group identified a prisoner with bodily injuries who refused to report the circumstances of their receipt and did not express any complaints in this regard. Members of the monitoring group reported this fact to the medical staff of the outpatient department, to which they received the response that the hospital's medical staff only records bodily injuries after the prisoners in need of such services apply to them. Such inaction on the part of the medical staff contributes to the occurrence of cases of ill-treatment in the institution.

At the same time, in violation of the requirements of Clause 3, Section 1, Chapter II of the Procedure and the Instruction on filling out the primary accounting documentation form No. 511/o “Certificate of recording bodily injuries”, approved by the order of the Ministry of Health of Ukraine dated 14.02.2012 No. 110, medical workers do not properly complete the certificates.

In particular, point 8, where the circumstances of receiving bodily injuries are stated, is not filled out. The lack of proper recording of bodily injuries does not comply with Clause 60 of the Committee’s recommendations (CPT/Inf(93)12-part), which states that medical services in places of detention can contribute to the prevention of violence against persons held in custody by systematically registering bodily injuries, and, if necessary, by informing the relevant authorities.

7. In ward No. 1 of the women's department and ward No. 2 for the treatment of persons sentenced to life imprisonment, the monitors recorded the presence of installed video surveillance cameras. At the same time, according to Clause 8 of Section VII of the “Procedure for the Use of Technical Means of Supervision and Control in Correctional and Educational Colonies of the State Penitentiary Service of Ukraine”, approved by the Order of the Ministry of Justice of Ukraine dated 26 June 2018 No. 2025/5 (registered with the Ministry of Justice of Ukraine on 02 July 2018 under No. 766/32218), the use of video cameras and portable video recorders is prohibited in premises (cells) where medical examinations (check-ups) of prisoners and personal searches involving undressing are conducted.

This fact indicates that institution employees are obtaining confidential information regarding the health status of convicted persons during medical examinations, manipulations, or procedures. This violates the requirements of Article 39-1 of the Law of Ukraine “Fundamentals of Legislation of Ukraine on Health Care” regarding the right of individuals to the secrecy of their health status and Clause 9 of Section I of the Procedure for organizing the provision of medical care to prisoners.

8. In violation of Article 115 of the Criminal Executive Code of Ukraine, most of the hospital's ward-cells violate the requirements regarding the floor area norm per prisoner in inpatient conditions (not less than 5 m²). The total area of ward No. 6 in the ophthalmological department, where 6 beds are located, is only 29.1 m² according to the building plan.

In some wards of the therapeutic, infectious, and ophthalmological departments, beds are placed directly against each other, which does not provide prisoners with personal space and violates Rule 18.1 of the European Prison Rules.

In ward No. 2 for the treatment of persons sentenced to life imprisonment, the monitors recorded that the window was equipped with frosted glass.

In its report on the results of the visit to Ukraine in 2020, the Committee had already drawn attention to this and recommended taking measures to review the design of windows in cells in order to allow prisoners to see what is outside the cell. (CPT/Inf (2020) 40) point 48).

Furthermore, in some wards, facts were established constituting a violation of Article 8 of the Convention and the requirements of Rule 19.3 of the European Prison Rules, regarding the violation of the right of prisoners to privacy, namely, the lack of doors in sanitary facilities that would allow prisoners to have privacy.

9. A walk in the fresh air is allowed only for one hour a day. All other time, prisoners spend in the wards. At the same time, the Committee, in its report on the results of the visit to Ukraine in 2023 to the Lviv Multidisciplinary Hospital, expressed concern that patients were not offered any activities outside the ward, except for daily one-hour walks in the fresh air, which took place in small yards, and recommended taking measures in the hospital to improve the regime provided to patients and to consider the possibility of increasing the duration of walks in the fresh air. (CPT/Inf (2024) 20) point 89).

10. During conversations with patients from among those sentenced to life imprisonment in ward-cell No. 2, it was established that the medical staff continues the systematic practice of conducting medical examinations and medical manipulations in the presence of non-medical staff, namely, employees of the institution.

This violates the requirements of Article 39-1 of the Law of Ukraine “Fundamentals of Legislation of Ukraine on Health Care” regarding the right of individuals to the secrecy of their health status and Clause 9 of Section I of the Procedure for organizing the provision of medical care to prisoners. At the same time, the Committee criticises excessive security measures and considers such practices unacceptable, as they infringe upon the dignity of prisoners, hinder the development of proper relationships between medical staff and the patient, and possibly interfere with the establishment of an objective medical conclusion. (Report of the Committee on the results of the visit to Ukraine in 2012 (point 50, CPT/Inf (2013) 23).

In addition, in the mentioned ward, there is an unpleasant odour, unsanitary conditions; the premises need repair work; the walls, floor, and sanitary facility are dirty; bedding and mattresses need replacement. This does not comply with Clause 53 of the Committee’s recommendations (CPT/Inf(93)12-part).

11. In violation of Clause 37 of the Resolution of the Cabinet of Ministers of Ukraine No. 285 of 2 March 2016 “On Approval of Licensing Conditions for Conducting Economic Activities in Medical Practice”, the hospital lacks a document confirming free access to the buildings and premises of the medical facility for persons with limited mobility, the receipt of which is mandatory.

12. In accordance with the requirements of Clause 7, Part 1 of the Resolution of the Cabinet of Ministers of Ukraine of 22 December 2023 No. 1394 “Some Issues of Implementing the Programme of State Guarantees of Medical Services for the Population in 2024”, the National Health Service of Ukraine (NHSU) pays for medical services provided based on paper referrals for patients held in penitentiary institutions or pre-trial detention centres of the State Penitentiary Service, until the health care facilities of the State Penitentiary Service create the technical capability to issue electronic referrals.

However, due to the fact that prisoners do not have declarations concluded with a primary health care physician, they do not have the opportunity to receive necessary medical services at the expense of the NHSU, which leads to a violation of the requirements of paragraphs 4 and 5 of Article 4 of the Law of Ukraine “Fundamentals of Legislation of Ukraine on Health Care”.

13. During the inspection of the defibrillator's functionality, it was established that the expiration date of the electrodes had passed. At the same time, the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment recommended that medical services in all visited prisons (and all other penitentiary institutions in Ukraine) be equipped with equipment for saving lives by doctors (Report of the Committee on the results of the visit to Ukraine in 2017, (CPT/Inf (2018) 41) point 87).

14. In violation of the Procedure for organizing medical care at primary, secondary (specialised), and tertiary (highly specialised) levels using telemedicine, approved by the order of the Ministry of Health of Ukraine dated 19.10.2015 No. 681, the staff of the medical unit is deprived of the ability to make requests for telemedicine consultation and to receive advice for providing medical care to prisoners for technical reasons.

15. In violation of the requirements of the Norms of entitlement for bedding, special clothing, and special footwear (inventory property) for prisoners undergoing treatment in medical-preventive facilities, facilities with medical rights, and in medical units at penitentiary institutions and pre-trial detention centres, approved by the order of the Ministry of Justice of Ukraine dated 20.02.2012 No. 280/5, prisoners do not receive hospital property (hospital suit, robe, and slippers). Prisoners are staying in the inpatient facility in their everyday clothes, sometimes with their own bedding.

16. In violation of the requirements of Clause 7, Chapter 2, Section III of the Procedure for organizing the provision of medical care to prisoners, approved by the joint order of the Ministry of Justice of Ukraine and the Ministry of Health of Ukraine dated 15.08.2014 No. 1348/5/572 (hereinafter — the Procedure), sick prisoners are placed in ward-cells not based on an established diagnosis and the decision of medical staff to refer them to a specialised department of the hospital, but by the decision of the institution’s personnel.

17. In violation of the Measures and Means to prevent infection when caring for patients, approved by the order of the Ministry of Health of Ukraine dated 03.08.2020 No. 1777, the hospital is equipped only with isolation wards for prisoners sick with tuberculosis, which makes it impossible to simultaneously house patients with dangerous infectious diseases separately from one another and from other prisoners.

18. In violation of the requirements of the order of the Ministry of Health of Ukraine dated 16.12.2003 No. 584 “On Approval of Rules for Storage and Quality Control of Medicinal Products in Medical-Preventive Facilities” (hereinafter — Storage Rules), medicinal products are stored without taking into account the temperature regimes specified by the manufacturers. Thus, in the room where medicinal products, the storage conditions of which cannot exceed a temperature higher than 25°C, were kept, the temperature reached 27°C.

19. In violation of the “State Sanitary-Anti-Epidemic Rules and Norms on Handling Medical Waste”, approved by the order of the Ministry of Health of Ukraine dated 08.06.2015 No. 325, the branch of the State Institution “Health Care Centre of the State Penitentiary Service of Ukraine” in the Vinnytsia region has not concluded an agreement with a specialised institution for the disposal of medical waste, in connection with which proper collection, sorting, and disposal of medical waste have not been organised in the hospital since the beginning of 2024.

20. In violation of the requirements of the Standards of medical care for HCV in adults, approved by the order of the Ministry of Health of Ukraine dated 15.01.2021 No. 51, not all persons with suspected viral hepatitis C undergo PCR testing, due to which they do not receive necessary treatment, which may lead to the deterioration of their health condition and the spread of the specified infectious disease among prisoners and detainees.

21. In violation of the requirements of the State Building Norms of Ukraine V.2.2-17:2006 “Buildings and structures. Accessibility of buildings and structures for persons with limited mobility”, conditions for maintaining people with disabilities have not been created in the hospital.

22. In violation of the Fire Safety Rules in Ukraine, approved by the Ministry of Internal Affairs of Ukraine dated 30.12.2014 No. 1417 (hereinafter — the Rules), the hospital premises are not equipped with fire extinguishing and fire alarm systems.

23. In violation of the requirements of Sub-clause 2.12 of Clause 2, Section III of the Rules, the door of the electrical switchboard in the hall of the ophthalmological department, which is located on the third floor of the hospital, was not locked.

24. The doctor's office and X-ray room are not provided with fire extinguishers, which is a violation of the requirements of Clause 3.6, Chapter 3, Section V of the Rules and a violation of Clause 10.18, Chapter 10 of the State Sanitary Rules and Norms “Hygienic requirements for the arrangement and operation of X-ray rooms and the conduct of radiological procedures”, approved by the order of the Ministry of Health of Ukraine dated 04.06.2007 No. 294, registered with the Ministry of Justice of Ukraine on 07 November 2007 under No. 1256/14523.

Recommendations:

1. Take measures aimed at eliminating the identified violations of human rights and preventing torture, other cruel, inhuman, or degrading types of treatment and punishment at the Stryzhavska Multidisciplinary Hospital No. 81 of the branch of the Health Care Centre of the State Penitentiary Service of Ukraine in the Vinnytsia region;

2. Staff the hospital with medical specialists according to needs;

3. Ensure the further referral of palliative patients to municipal health care institutions that have the appropriate organisational, personnel, and technological conditions for the proper care of such patients;

4. Comply with the requirements of Clause 37 of the Resolution of the Cabinet of Ministers of Ukraine No. 285 of 2 March 2016 “On Approval of Licensing Conditions for Conducting Economic Activities in Medical Practice”;

5. Ensure the accessibility of the institution’s buildings in accordance with the State Building Norms of Ukraine V.2.2-17:2006 “Buildings and structures. Accessibility of buildings and structures for persons with limited mobility”;

6. Ensure proper conditions for patients staying in wards with compliance with floor area norms per person and temperature regimes;

7. Ensure the timely and proper recording of bodily injuries in prisoners;

8. Ensure the proper disposal of medicinal products and medical devices;

9. Ensure that measures are taken for the proper storage of medicinal products;

10. Ensure the proper disposal of medicinal products and medical devices;

11. Provide the medical unit with hospital property (hospital suit, robe, and slippers);

12. Ensure the equipping of the necessary number of isolation wards for infectious patients;

13. Ensure proper medical care for persons suffering from viral hepatitis C;

14. Equip the fire prevention system in accordance with established requirements;

15. Ensure the proper functioning of the telemedicine complex for doctors to make requests for telemedicine consultation;

16. Ensure the possibility of receiving substitution maintenance therapy based on a diagnosis of mental and behavioural disorders due to the use of opioids;

17. Replace the pads for the external automated defibrillator;

18. Eliminate violations of the Fire Safety Rules.