Report on the results of the monitoring visit to the Zbarazka Specialized Tuberculosis Hospital No. 63

On 17 December 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 based on Article 24 of the Criminal Executive Code of Ukraine — Visiting penitentiary institutions, a monitoring group from the Kharkiv Human Rights Protection Group and the NGO “Protection of Prisoners of Ukraine” carried out a visit to the state institution “Zbarazka Specialized Tuberculosis Hospital No. 63” of the branch of the State Institution “Public Health Centre of the State Criminal-Executive Service of Ukraine” in the Chernivtsi, Ivano-Frankivsk, Zakarpattia, and Ternopil regions (hereinafter — the hospital, the institution, the facility). A planned visit was conducted without prior notice. While preparing for the visit, the monitors used materials from appeals made by convicts and their relatives.

The visit was conducted as part of the project “Reducing the suffering of prisoners 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 carried out by the following monitors:

• Andrii Didenko — assistant to the People's Deputy of Ukraine Yaroslav Yurchyshyn, programme coordinator of the Kharkiv Human Rights Protection Group, experience in monitoring visits since 2014;
• Serhii Zuikov — assistant to the People's Deputy of Ukraine Kostiantyn Kasai, member of the public council under the Ministry of Justice of Ukraine, member of the NGO “Protection of Prisoners of Ukraine”, has many years of experience in monitoring visits;
• Hanna Skrypka — member of the public council under the Ministry of Justice of Ukraine, lawyer for the NGO “Protection of Prisoners of Ukraine”, specialises in citizens' appeals, has experience in monitoring visits;
• Oleh Tsvilyi — member of the public council under the Ministry of Justice of Ukraine, head of the NGO “Protection of Prisoners of Ukraine”, has extensive experience in monitoring visits, specialises in issues of torture and cruel, inhuman treatment.

General Information

A closed-type institution for the treatment of women suffering from tuberculosis. Women who are ill or suspected of having tuberculosis are transferred to the hospital from various penitentiary facilities in Ukraine.

Head of the hospital — I. B. Nytka.

The institution is designed for 130 beds and consists of the following departments:

• Department for convicts with non-tuberculosis-related diseases, which provides medical care to persons serving sentences at the State Institution “Zbarazka Correctional Colony No. 63”, at which the hospital is established, with 30 beds;
• Department for patients with drug-sensitive tuberculosis with bacillary excretion, with 50 beds;
• Department for patients with drug-resistant tuberculosis with bacillary excretion, with 50 beds.

Vacant positions: infectious disease specialist; phthisiatrician; cytomorphologist; medical assistant (feldsher); senior nurse; nurse; laboratory medical assistant; junior nurse (3 positions); head housekeeper; disinfector.

The hospital provides opioid substitution therapy to patients with drug dependencies; as of 1 December 2024, 11 people are in the programme. As of 1 December 2024, 546 people had been tested for HIV, 2 of whom tested positive.

All newly identified patients were placed under dispensary supervision, received tuberculosis chemoprophylaxis, and were consulted by an infectious disease specialist. Patients were prescribed ART. The hospital conducted 135 HCV tests, with 27 positive results, and 150 HBV tests (1 positive result).

24 people started and completed treatment for viral hepatitis C; 18 of them underwent treatment effectiveness monitoring, and HCV was not detected. Currently, 7 people have confirmed HCV. They will begin treatment on 1 January 2025. Patients are provided with rapid tests for HCV (400 units) and HBV (600 units).

Work of the Medical Consultation Commission (MCC) regarding the application of Article 84 of the Criminal Code of Ukraine to convicted patients:

• Over 11 months, 6 MCC meetings were held and sent to the Zbarazka District Court for consideration regarding release from further service of sentence; three people were released due to illness from further service of sentence, and three were refused.
• Documents for 15 patients were prepared and sent for consideration to the Central Medical Consultation Commission of the National Public Health Centre of the State Criminal-Executive Service of Ukraine.

As of 1 December 2024, 1 death was registered at the State Institution “Zbarazka Correctional Colony No. 63”; the patient was undergoing inpatient treatment in the department for convicts with non-tuberculosis-related diseases. As of 1 December 2024, there are 18 disabled persons registered at the hospital (Group I — 2, Group II — 6, Group III — 10). Over 11 months, documents for 8 patients were prepared and sent to the Medical and Social Expert Commission (MSEC), including re-examinations (5 — Group III, 2 — Group I). One person was recognised as disabled for the first time (Group III).

Facts established during the visit

During the monitoring visit, violations 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 persons:

1. In violation of the requirements of paragraph 10 of clause 2 of Section XVII of the Internal Regulations of Penitentiary Institutions, approved by the order of the Ministry of Justice of Ukraine dated 28 August 2018 No. 2823/5, there are two convicts in the hospital who perform the duties of orderlies. Thus, the institution’s management and medical staff have delegated to the orderlies the right to exercise constant supervision over convicts in the inpatient facility, control their compliance with the daily schedule, etc.

At the same time, the Committee has repeatedly recommended ending the practice of using convicts as assistants in medical units and as orderlies. (Report of the Committee on the results of the visit to Ukraine in 2005 (paragraph 132, CPT/Inf (2007) 22), in 2013 (paragraph 151, CPT/Inf (2014) 15), in 2017 (paragraph 86, CPT/Inf (2018) 41)).

2. In accordance with clause 3 and clause 4 of Chapter 1 of Section II of the Procedure for organising the provision of medical care to persons sentenced to imprisonment, approved by the order of the Ministry of Justice of Ukraine and the Ministry of Health of Ukraine dated 15 August 2014 No. 1348/5/572 (hereinafter — the Procedure), in case of detection of bodily injuries in a convict, the medical worker who discovered such injuries shall draw up a certificate in triplicate, which must detail:

• information (written statement, oral or written explanation of the convict regarding the circumstances of receiving bodily injuries (date, time, place of occurrence, methods of infliction, information about the person(s) who, in the convict’s opinion, inflicted them), as well as other information regarding the receipt of bodily injuries);
• an exhaustive description of medical indicators characterising the state of health of the convict, the nature of the injuries, their size and location;
• the medical worker’s assumptions based on the information provided by the convict and the medical indicators, as well as the justification for their correlation.

The medical worker shall attach photographs of the convict’s existing bodily injuries to the certificate. Two copies of the certificate shall be attached to the materials of the personal file and the outpatient medical record (form 025/o), and the third copy shall be issued personally to the convict.

The medical worker must immediately, but no later than 24 hours from the moment of discovering such injuries, inform the prosecutor and the administration of the penitentiary institution by phone, email, and written notification. In cases where the convict reports that the bodily injuries were inflicted by officers of the rank-and-file and/or command staff of the State Criminal-Executive Service of Ukraine or by employees of other law enforcement agencies, the State Bureau of Investigation must also be informed.

Information about the fact of discovering bodily injuries shall be entered by the head of the medical unit or the on-duty medical worker into the register of facts of discovery of bodily injuries in convicts, the form of which is provided in Appendix 3 to this Procedure, which is kept in the relevant health care institution of the State Criminal-Executive Service.

At the same time, during the visit, the monitoring group established facts of improper recording of bodily injuries. Thus, during the inspection of the Logbook of X-ray examinations for the period from 26 September 2024 to 17 December 2024, 8 cases of recorded injuries were found, including foreign bodies in the form of needles in fingers, chest contusions, and other injuries, information about which was not entered into medical documentation.

Thus, medical workers did not draw up certificates in accordance with the Instructions for filling out primary accounting document form No. 511/o “Certificate of recording bodily injuries”, approved by the order of the Ministry of Health of Ukraine dated 2 February 2024 No. 186, did not enter information about the fact of detecting bodily injuries into the register of facts of detection of bodily injuries in convicts, and did not properly notify the Prosecutor.

Such actions by the medical staff may indicate the concealment of facts of infliction of bodily injuries on convicts or negligent performance of their duties. This not only violates the rights of convicts to proper medical care and the recording of injuries but also makes it impossible to conduct a timely investigation into such cases and hold the guilty persons accountable.

Furthermore, the lack of proper recording of bodily injuries does not comply with paragraph 60 of the Committee’s recommendations (CPT/Inf(93) 12-part), which states that prison medical services can contribute to the prevention of violence against persons held in custody through the systematic registration of bodily injuries, as well as, if necessary, through informing the relevant authorities.

3. In violation of the first part of Article 115 of the Criminal Executive Code of Ukraine, the departments of the hospital violate the requirements regarding the standard of living space per convict in inpatient treatment conditions (not less than 5 m²). Thus, in Ward No. 2 of Department No. 3 for convicts with non-tuberculosis-related diseases, which provides medical care to persons serving sentences at the State Institution “Zbarazka Correctional Colony No. 63”, where 4 convicted persons were held, the area of the premises according to the living space measurement report is 18 m². Thus, the actual area per convicted person was 4.5 m². A similar violation was established in Ward No. 1.

4. In the shared bathrooms of the hospital wards, the monitoring group discovered a violation of Article 8 of the Convention for the Protection of Human Rights and Fundamental Freedoms, which guarantees the right to respect for private life. Specifically, there are no partitions in the bathrooms, which deprives convicts of the possibility to ensure privacy while using them.

5. In Ward No. 2 of Department No. 8, the monitoring group recorded a violation of the temperature regime. During the inspection, the air temperature in the living quarters was 12 °C, whereas according to clause 1 of Section XXII of the Internal Regulations of Penitentiary Institutions, in the cold season, the temperature in the living quarters of penitentiary institutions must be maintained at a level not lower than 18 °C.

6. In violation of the requirements of the Standard of provision of bedding, special clothing, and special footwear (inventory property) for convicts undergoing treatment in medical and prophylactic institutions, institutions with the rights of medical facilities, and medical units at penitentiary institutions and pre-trial detention centres, approved by the order of the Ministry of Justice of Ukraine dated 20 February 2012 No. 280/5, convicted persons do not receive hospital property (hospital suit, robe, and slippers). Convicts are in the inpatient facility in their everyday clothes, sometimes with their own bed linen.

7. In violation of the requirements of the Instructions for filling out primary accounting document form No. 003-7/o “Informed consent of a person for a psychiatric examination”, approved by the order of the Ministry of Health of Ukraine dated 15 September 2016 No. 970, the absence of informed consent for a psychiatric examination, signed by the patient, was established in the medical documentation (medical record No. 025/o or No. 003/o).

8. In violation of the Measures and Means for preventing infection when providing care to patients, approved by the order of the Ministry of Health of Ukraine dated 3 August 2020 No. 1777, Department No. 3 for convicts with non-tuberculosis-related diseases, which provides medical care to persons serving sentences at the State Institution “Zbarazka Correctional Colony No. 63”, is equipped with only one isolation ward for infectious patients, which makes it impossible to separately accommodate patients with dangerous infectious diseases from each other and other convicts simultaneously.

9. In violation of paragraph 8 of clause 5 of Chapter 2 of the Procedure, there is no isolation ward in the inpatient facility for persons with mental disorders for convicts who pose a danger to those around them.

10. During the inspection of the disciplinary isolation cell (DICO) area, the monitors established that upon placing a convict in the disciplinary isolation cell, it is practiced to attach a medical certificate to the file, which contains the state of health and according to the conclusion of which the convict can be held in the DICO/CTP based on their health condition. The facts revealed prove that the institution’s employees possess confidential information regarding the health status of convicted persons who are in the DICO area.

This violates the requirements of Article 39-1 of the Law of Ukraine “Fundamentals of Health Care Legislation of Ukraine” regarding the right of persons to confidentiality of health status. At the same time, the Committee has repeatedly emphasised that the obligation of prison doctors to certify the fitness of convicts to undergo disciplinary punishment is unlikely to contribute to the development of positive relations between doctor and patient.

In principle, medical personnel should never participate in any part of the decision-making process regarding the application of any form of solitary confinement, except in cases where this measure is applied for medical reasons. On the other hand, medical personnel must be very attentive to the condition of convicts who are in solitary confinement. Medical personnel must be informed immediately about every such placement and must visit the convict immediately after placement, and then regularly, at least once a day, and provide them with prompt medical care and treatment if necessary. Medical personnel must inform the institution’s administration if the health of the convict is seriously threatened by solitary confinement. (CPT/Inf (2024) 20) paragraph 104).

In addition, the above contradicts paragraphs 43.2 and 43.3 of the European Prison Rules.

11. According to the twenty-third paragraph of clause 6 of Section XXI of the Internal Regulations of Penitentiary Institutions, for the provision of medical care, the head of the medical unit (on-duty doctor) visits the DICO, punishment cells, and CTP (OK) daily and, if necessary, conducts examinations of convicts. At the same time, during the inspection of the Logbook of visits to the disciplinary isolation cell, the absence of a corresponding entry by a medical worker regarding a visit to the DICO on 13 October 2024, when the convicted person B. was there serving a penalty, was established.

12. 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 low-mobility population groups”, the hospital has not created conditions for accommodating people with disabilities.

13. Dispensary supervision is carried out for 18 persons with disabilities.

At the same time, in violation of the requirements of the Law of Ukraine “On the rehabilitation of persons with disabilities in Ukraine”, persons with disabilities do not receive proper diagnostic, treatment, and rehabilitation measures given the existence of information confirming persistent impairment of bodily functions caused by diseases or consequences of injuries that limit normal daily activities.

During the study of the convicts’ medical documentation, it was established that not all persons with disabilities have individual rehabilitation programmes (hereinafter — IRP). Furthermore, the recommendations of the IRP are not being fulfilled, due to which they do not receive proper diagnostic, treatment, and rehabilitation measures in the presence of information confirming persistent impairment of bodily functions caused by diseases and the consequences of injuries, which cause limitations to normal daily activities.

14. In violation of clause 37 of the Resolution of the Cabinet of Ministers of Ukraine No. 285 dated 2 March 2016 “On approval of Licensing conditions for carrying out economic activities in medical practice”, the hospital lacks a document confirming free access to buildings and premises of the medical facility for low-mobility population groups, which is mandatory to obtain.

15. In accordance with the requirements of clause 7 of Part 1 of the Resolution of the Cabinet of Ministers of Ukraine dated 22 December 2023 No. 1394 “Some issues of implementing the programme of state guarantees for medical care 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 Criminal-Executive Service, until the health care institutions of the State Criminal-Executive Service create the technical capability to issue electronic referrals.

However, due to the lack of concluded declarations with a primary care physician by the convicted persons, 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 Health Care Legislation of Ukraine”.

16. In violation of the Procedure for organising medical care at the primary, secondary (specialised), and tertiary (highly specialised) levels using telemedicine, approved by the order of the Ministry of Health of Ukraine dated 19 October 2015 No. 681, the hospital staff are deprived of the possibility to make requests for telemedicine consultations and receive consultations for the provision of medical care to convicted persons for technical reasons.

17. In violation of the requirements of the Equipment supply list for a dentist’s workplace and dental technician, approved by the order of the Ministry of Health of Ukraine dated 11 April 2005 No. 158, the hospital lacks a dental X-ray machine, which makes it impossible to conduct in-depth dental examinations of convicts and does not ensure the timely provision of proper dental care.

18. 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 January 2021 No. 51, not all persons suspected of having viral hepatitis C undergo PCR testing, due to which they do not receive the necessary treatment, which may lead to the deterioration of their health condition and the spread of the specified infectious disease among convicts and detained persons.

19. In violation of the Fire Safety Rules in Ukraine, approved by the Ministry of Internal Affairs of Ukraine dated 30 December 2014 No. 1417 (hereinafter — the Rules), the hospital premises are not equipped with fire extinguishing and fire alarm systems.

20. According to clause 7 of Chapter III of Section II of the Procedure, convicts who work at catering facilities (except for work related to the positions of sellers, managers of food and clothing warehouses, storekeepers) and the processing industry, in children’s homes, general secondary education institutions, vocational training units in special educational colonies, medical units (medical posts) and hospital facilities of the State Criminal-Executive Service (except for work related to the provision of medical care), laundries, baths, rooms for long visits, dormitories, clubs, at water supply and sewage facilities, and sites for the breeding and raising of animals, must undergo mandatory preliminary and preventive medical examinations in accordance with the Resolution of the Cabinet of Ministers of Ukraine dated 23 May 2001 No. 559 “On approval of the list of professions, industries, and organisations whose employees are subject to mandatory preventive medical examinations, the procedure for conducting these examinations and issuing personal medical books”. For every convict of the specified category, primary accounting document form No. 1-OMK “Personal Medical Book” must be opened, approved by the order of the Ministry of Health of Ukraine dated 21 February 2013 No. 150, registered with the Ministry of Justice of Ukraine on 23 April 2013 under No. 662/23194.

At the same time, the monitoring group was provided with falsified personal medical books of form No. 1-OMK issued to convicts from the household service staff, to which information about undergoing medical examinations at the Zbarazka Specialized Tuberculosis Hospital No. 63 of the branch of the State Institution “Public Health Centre of the State Criminal-Executive Service of Ukraine” in the Chernivtsi, Ivano-Frankivsk, Zakarpattia, and Ternopil regions had been entered, with the corresponding stamp and photograph.

At the same time, the personal medical book of form No. 1-OMK, the form and content of which are established by the order of the Ministry of Health of Ukraine dated 21 February 2013 No. 150, registered with the Ministry of Justice of Ukraine on 23 April 2013 under No. 662/23194, is an official document issued by an institution that has the right to issue such a document (which has a medical practice licence and an accreditation certificate), namely, the health care institution where the medical examination was conducted, and which grants the right to work to employees of certain professions whose activities are related to serving the population and may lead to the spread of infectious diseases. The Zbarazka Specialized Tuberculosis Hospital No. 63 of the branch of the State Institution “Public Health Centre of the State Criminal-Executive Service of Ukraine” in the Chernivtsi, Ivano-Frankivsk, Zakarpattia, and Ternopil regions does not belong to such institutions.

21. In violation of clause 6 of Chapter 3 of Section II of the Procedure, there are no recommendations, specifically the name, surname of the doctor, and signature, which are registered in the “Register of results of undergoing preventive medical examination”, the form of which is provided in Appendix 4 to the Procedure.

Recommendations:

Take measures aimed at eliminating the identified human rights violations and preventing torture, other cruel, inhuman or degrading treatment and punishment at the Zbarazka Specialized Tuberculosis Hospital No. 63 of the branch of the State Institution “Public Health Centre of the State Criminal-Executive Service of Ukraine” in the Chernivtsi, Ivano-Frankivsk, Zakarpattia, and Ternopil regions.

1. Ensure the hospital is staffed with medical specialists according to needs;
2. Ensure control over the proper maintenance of medical documentation in accordance with the Procedure for organising the provision of medical care to persons sentenced to imprisonment, approved by the joint order of the Ministry of Justice of Ukraine and the Ministry of Health of Ukraine dated 15 August 2014 No. 1348/5/572 and other normative legal acts;
3. Comply with the requirements of clause 37 of the Resolution of the Cabinet of Ministers of Ukraine No. 285 dated 2 March 2016 “On approval of Licensing conditions for carrying out economic activities in medical practice”;
4. Ensure the provision of individual rehabilitation to persons who require it;
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 low-mobility population groups”;
6. Provide the hospital with necessary diagnostic equipment, including a dental X-ray machine;
7. Ensure informed consent of patients for examination and treatment is obtained in the established form;
8. Ensure proper conditions for patients in wards with compliance with area standards per person;
9. Ensure timely and proper recording of bodily injuries in convicts;
10. Provide the hospital with hospital property (hospital suit, robe, and slippers);
11. Ensure proper medical care for persons suffering from viral hepatitis C;
12. Ensure the equipment of the necessary number of isolation wards for infectious patients;
13. Provide convicted persons with agreements with doctors who provide primary medical care in health care institutions of the Ministry of Health of Ukraine;
14. Ensure proper record-keeping of preventive examinations;
15. Ensure the provision of proper psychiatric medical care in accordance with the Law of Ukraine “On Psychiatric Care”;
16. Stop the practice of doctors certifying the health status of convicts and detainees upon their placement in the DICO/CTP area;
17. Stop the practice of using convicts as orderlies in the hospital and the institution;
18. Ensure the proper operation of the telemedicine complex for doctors to make requests for telemedicine consultations;
19. Eliminate violations of Fire Safety Rules.