Report on the results of the monitoring visit to the Dnipropetrovsk Specialized Tuberculosis Hospital No. 89

On 27 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 on the basis of Article 24 of the Criminal Executive Code of Ukraine — Visiting execution of sentences institutions, a group of monitors from the Kharkiv Human Rights Protection Group and the NGO “Protection of Prisoners of Ukraine” carried out a visit to the state institution “Dnipro Specialized Tuberculosis Hospital No. 89” of the branch of the State Institution “Public Health Centre of the State Criminal-Executive Service of Ukraine” in the Dnipropetrovsk and Donetsk regions (hereinafter — the hospital, the institution, the facility).

A planned visit was conducted without prior warning. During the preparation for the visit, the monitors used materials from complaints submitted by the convicted persons and their relatives.

The visit was conducted within the framework 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 — Danish Institute Against Torture.

The visit was carried out by the following monitors:

• Andriy Didenko — Assistant to the People’s Deputy of Ukraine Yaroslav Yurchyshyn, programme coordinator of the Kharkiv Human Rights Protection Group, with experience in monitoring visits since 2014;
• Serhiy 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”, possessing many years of experience in monitoring visits.

General Information

The Head of the Dnipropetrovsk Specialized Tuberculosis Hospital No. 89 of the branch of the State Institution “Public Health Centre of the State Criminal-Executive Service of Ukraine” in the Dnipropetrovsk and Donetsk regions (hereinafter — the Hospital) is O.V. Yurchenko.

The tuberculosis hospital consists of the following units: an administrative building with a consultative-diagnostic block, an outpatient clinic with a quarantine, diagnostics and distribution ward and a pre-trial detention ward, a clinical diagnostic laboratory, a pharmacy and pharmacy warehouse, an intensive care unit, 4 wards for the treatment of patients with active tuberculosis, an MIO office, and auxiliary premises.

The wards for the treatment of patients with active tuberculosis are organised to ensure the separation of patient flows in accordance with the requirements of tuberculosis infection control, namely:

• Intensive care unit — 8 beds, MBT (+), contagious form of TB;
• First ward for patients with drug-resistant tuberculosis with sputum positive for bacteria and preserved sensitivity to fluoroquinolones — 75 beds, MBT (+), contagious form of TB;
• Second ward for patients with drug-resistant tuberculosis with sputum positive for bacteria and resistance to fluoroquinolones — 57 beds, MBT (+), contagious form of TB;
• Third ward for patients with drug-resistant tuberculosis with sputum negative for bacteria and preserved sensitivity — 45 beds, MBT (-), active form of TB;
• Fourth ward for patients with drug-resistant tuberculosis with sputum negative for bacteria and resistance to fluoroquinolones — 45 beds, MBT (-), active form of TB;
• Outpatient clinic with a quarantine, diagnostics and distribution ward and a pre-trial detention ward — 10 beds, MBT (+), contagious form of TB.

Staffing table: total for the institution — 96.5 positions, of which: doctors — 34 positions, mid-level staff — 44 positions, junior staff — 18.5 positions.

Vacant positions: medical statistician — 0.5 positions; hospital nurse — 0.25 positions; worker in the maintenance of the healthcare facility — 1.5 positions; junior medical nurse — 0.5 positions; paramedic — 1 position; dietary nurse — 0.5 positions; junior medical nurse — 0.5 positions.

As of 27 December 2024 (since the beginning of 2024), 17 convicted persons have died in the hospital (DSTL No. 89). In 2023 — 16 convicted persons.

In the institution, 4 convicted persons died (in 2023 — 6).

The total number of deaths in 2024 is 21, in 2023 — 22.

Among those who died in 2024:

• acute cerebrovascular accident — 1;
• cirrhosis of the liver — 2;
• acute cardiovascular failure — 7;
• HIV + tuberculosis — 5;
• tuberculosis — 6.

Information regarding all lethal cases was provided to the Prosecutor’s Office and the Police.

As of 27 December 2024, 9 convicted persons had been reviewed at the meetings of the Medical Advisory Commission (hereinafter — MAC) (in 2023 — 12). The conclusions of the MAC were prepared in accordance with regulatory requirements. All documents were submitted to the court without violating deadlines. Of the 9 individuals (in 2023, out of 12) whose documents were in court, 2 were released under Article 84 of the Criminal Code of Ukraine and discharged from the hospital (in 2023 — 4), 6 died while their cases were being considered by the court (in 2023 — 8), and 1 case remains in court.

Facts discovered during the visit

During the visit, shortcomings were identified in the operation of the Dnipropetrovsk Specialized Tuberculosis Hospital No. 89 that lead to violations of the rights of convicted persons and detainees during the provision of medical assistance in the hospital and its outpatient clinic, in particular:

1. In violation of the requirements of the tenth paragraph of point 2 of Section XVII of the Internal Regulations of Execution of Sentences Institutions, approved by Order of the Ministry of Justice of Ukraine dated 28.08.2018 No. 2823/5 (hereinafter — IR ESI), two convicted persons who perform the duties of duty orderlies are kept in the hospital’s inpatient outpatient clinic (hereinafter — OPC) around the clock.

During a confidential conversation, one of them (convicted person K.) reported that he is entrusted with performing various tasks, including caring for the seriously ill, cleaning the premises, and that he occupies a sleeping place in one of the inpatient wards.

The second convicted person, K., reported that he is the senior duty orderly for the OPC and the quarantine, diagnostics and distribution ward (hereinafter — QDDW). He is entrusted with tasks related to maintaining order and control over other convicted persons in the inpatient unit and providing newly arrived convicted persons in the QDDW with bedding.

To confirm this, the monitoring group was provided with the Arrival Log of Convicted Persons to the SI “Dnipro Correctional Colony No. 89”, in which the convicted person K. made entries regarding the issuance of bedding sets to newly arrived convicted persons.

Thus, the institution’s management and medical staff delegated to the duty orderlies the right to organise constant supervision of the convicted persons in the inpatient unit and the QDDW, to control their compliance with the internal daily routine, etc.

This violates Article 96 of the Criminal Executive Code of Ukraine (hereinafter — CEC of Ukraine), point 4 of Section II of the IR ESI, and the requirements of point 2 of Section 1 of the Regulations on the quarantine, diagnostics and distribution ward, approved by Order of the Ministry of Justice of Ukraine dated 04.11.2013 No. 2300/5.

At the same time, the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (hereinafter — the Committee) has repeatedly recommended ending the practice of using convicted persons as assistants in medical units and as orderlies. (Report of the Committee on the results of the visit to Ukraine in 2005 (point 132. CPT/Inf (2007) 22), in 2013 (point 151. CPT/Inf (2014) 15), in 2017 (point 86. CPT/Inf (2018) 41).

2. In violation of the requirements of point 5 of Chapter 5 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), not all patients undergoing inpatient treatment in the hospital have primary accounting documentation form No. 003/o “Medical card of an inpatient patient”, approved by the Order of the Ministry of Health of Ukraine dated 14.02.2012 No. 110, opened for them. All data regarding treatment and diagnostics in the hospital, including those obtained during the examination of the convicted patient, along with the prescription sheet, must be entered into this card.

3. In violation of the requirements of the Instructions for filling out the primary accounting documentation form No. 003-6/o “Informed voluntary consent of the patient to the provision of diagnostics, treatment and the performance of an operation and anaesthesia and the presence or participation of participants in the educational process”, approved by the Order of the Ministry of Health of Ukraine dated 14.02.2012 No. 110, the absence of informed voluntary consent for diagnostics and treatment, signed by patients who were in the hospital, was established.

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

4. In accordance with point 3 and point 4 of Chapter 1 of Section II of the Procedure, in the event of detecting bodily injuries on a convicted person, the medical professional who discovers such injuries shall draw up a certificate in triplicate, which shall detail:

• information (written statement, oral or written explanation of the convicted person regarding the circumstances of receiving bodily injuries (date, time, place of occurrence, methods of causing injuries, information about the person(s) who, in the opinion of the convicted person, caused 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 convicted person, the nature of the injuries, their size and location;
• the medical professional’s assumptions based on the information provided by the convicted person and medical indicators, as well as the justification for their correlation.

Photographs of the existing bodily injuries of the convicted person shall be attached to the certificate by the medical professional. Two copies of the certificate are attached to the materials of the personal file and the outpatient medical card 025/o, and the third copy is given to the convicted person personally.

The medical professional must immediately, but no later than 24 hours from the moment of detection of such injuries, inform the prosecutor and the administration of the execution of sentences institution about the fact of the discovery of bodily injuries in a convicted person via telephone, email, and written notification. In cases where the convicted person reports that the bodily injuries were caused by persons 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 detection of bodily injuries is entered by the head of the medical unit or the on-duty medical professional into the log of recording facts of detection of bodily injuries in convicted persons, the form of which is provided in Appendix 3 to this Procedure, which is stored in the respective healthcare facility of the SCES.

At the same time, during the visit, the monitoring group established facts of improper documentation of bodily injuries. Thus, during a selective check of the X-ray Examination Log, cases of convicted persons with injuries who were referred for X-ray examination were discovered. In particular, on 16.12.2024, a convicted person, Z., was referred with a diagnosis of bruising, information about which was not entered into the medical documentation.

Furthermore, the monitoring group established that on 30.09.2024, a convicted person, T., arrived at the institution from the Dnipropetrovsk Multidisciplinary Hospital No. 4 with multiple superficial incised wounds on both cheeks, information about which was also not entered into the medical documentation.

Thus, the medical staff did not draw up certificates in accordance with the Instructions for filling out the primary accounting documentation form No. 511/o “Certificate of documentation of bodily injuries”, approved by the Order of the Ministry of Health of Ukraine on 02 February 2024 No. 186, information about the fact of detection of bodily injuries was not entered into the log of recording facts of detection of bodily injuries in convicted persons, and the Prosecutor was not duly notified.

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

In addition, the lack of proper documentation of bodily injuries does not comply with point 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 through the systematic registration of bodily injuries, as well as, if necessary, through informing the relevant authorities.

5. In violation of the first and second parts of Article 115 of the Criminal Executive Code of Ukraine, the hospital premises, in particular the OPC inpatient unit and the fourth ward, require repair work with the replacement of sanitary-technical equipment and the electrical network.

There is an unpleasant odour, poor sanitary conditions; the walls of some premises are covered with mould due to water leaks, significant clutter with personal belongings and rubbish exists, the floor and the bathroom are dirty, and bedding, pillows, and mattresses require replacement. The bathroom and shower in the hospital’s fourth ward do not meet elementary sanitation and hygiene rules.

The premises do not have a sufficient level of natural and artificial lighting and ventilation. In addition, the institution’s administration has introduced a practice of cutting off electricity in the hospital’s wards, due to which the convicted persons are forced to remain without light for 15 hours a day and are deprived of the opportunity to use electrical appliances, which contradicts point 2 of Section II of the IR ESI, which provides for the right of convicted persons to use them.

In some wards, beds are placed close to each other, which does not ensure personal space for the convicted persons and contradicts the requirements of the State Building Norms of Ukraine V.2.2-10:2022 “Healthcare Institutions” and violates rule 18.1 of the European Prison Rules.

The bathrooms are not equipped with toilet bowls and do not have sufficient partitions to ensure privacy, which is a violation of rule 19.3 of the European Prison Rules. In violation of the requirements of rule 22.5 of the European Prison Rules and the Provision Standards, the premises are not equipped with drinking water tanks.

This does not comply with point 53 of the Committee’s recommendations (CPT/Inf(93)12-part) and points 13, 14, and 15 of the UN Standard Minimum Rules for the Treatment of Prisoners (the Mandela Rules).

6. In violation of the requirements of the Standards of property entitlement for bedding, special clothing and special footwear (inventory property) for convicted persons undergoing treatment in medical-preventive institutions, institutions with the rights of medical facilities and in medical units at execution of sentences institutions and pre-trial detention centres, approved by the Order of the Ministry of Justice of Ukraine dated 20.02.2012 No. 280/5, convicted persons do not receive hospital property (hospital suit, robe, and slippers). The convicted persons stay in the inpatient unit in everyday clothes, sometimes with their own bedding.

7. In violation of point 8, part 5, Chapter 2 of the Procedure, there is no properly equipped isolation ward in the inpatient unit for persons with mental disorders who pose a danger to others due to ongoing repair work.

8. Two isolation wards for infectious patients are equipped in the hospital’s OPC inpatient unit. At the same time, these premises have a shared bathroom and washbasin, which does not ensure the isolation of patients with dangerous infectious diseases from each other and from other convicted persons, and contradicts the Measures and Means for preventing infection during patient care, approved by the Order of the Ministry of Health of Ukraine dated 03.08.2020 No. 1777.

9. The hospital has not organised the provision of substitution maintenance therapy (hereinafter — SMT) for persons with mental and behavioural disorders due to opioid use in accordance with the Procedure for conducting substitution maintenance therapy for persons with mental and behavioural disorders due to opioid use, approved by the Order of the Ministry of Health of Ukraine dated 27.03.2012 No. 200.

Drug-dependent persons are not provided with social-psychological support, cognitive behavioural therapy (CBT), relapse prevention, motivational interviewing, self-help groups, etc.

Thus, these individuals are deprived of the opportunity to receive SMT, which violates their right to choose methods of treatment in accordance with Article 38 of the Law of Ukraine “Fundamentals of Ukrainian Legislation on Healthcare”.

At the same time, the Committee in its report on the results of the visit to Ukraine in 2023 notes that entering 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; consequently, appropriate medical care must be available in all institutions.

The assistance offered to such persons must be diverse; substitution therapy programmes for persons with drug dependence must be combined with genuine psychosocial and educational programmes for persons with opioid dependence who are unable to stop using drugs.

Furthermore, access to SMT programmes in institutions must be easily accessible, and they must be managed also by penitentiary doctors, who must undergo special training on issues related to drug use. (CPT/Inf (2024) 20) point 86). Additionally, the medical drug “Naloxone” is absent in the hospital, which makes it impossible to provide emergency medical aid in cases of opiate overdose.

10. 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”, no conditions for the accommodation of people with disabilities have been created in the hospital.

11. Dispensary supervision is carried out for 10 persons with disabilities. Of them, group I — 1 person, group II — 0 persons, group III — 9 persons. 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 in the presence of information confirming a persistent impairment of bodily functions caused by diseases or the consequences of injuries that cause limitations in normal daily activities.

During the study of the medical documentation of the convicted persons, it was established that 2 persons with disabilities do not have an individual rehabilitation programme (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 a persistent impairment of bodily functions caused by diseases and the consequences of injuries, which cause limitations in normal daily activities.

12. In violation of point 37 of the Resolution of the Cabinet of Ministers of Ukraine No. 285 dated 2 March 2016 “On approval of Licensing conditions for the conduct of economic activity 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.

13. 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 (42 persons as of 27.12.2024) are undergoing PCR testing, due to which they are not receiving the necessary treatment, which may lead to a deterioration in their health condition and the spread of this infectious disease among convicted persons and detainees.

14. In violation of the Procedure for organising medical care at the primary, secondary (specialised), tertiary (highly specialised) levels using telemedicine, approved by the Order of the Ministry of Health of Ukraine dated 19.10.2015 No. 681, the hospital staff are deprived of the opportunity to submit requests for telemedical consultation and receive consultation for providing medical aid to convicted persons due to technical reasons.

15. In violation of the requirements of the Equipment Supply Table for a dentist’s and dental technician’s workstation, approved by the Order of the Ministry of Health of Ukraine dated 11.04.2005 No. 158, the hospital lacks a dental X-ray machine, which makes it impossible to conduct an in-depth dental examination of the convicted persons and does not ensure the timely provision of proper dental care.

16. There is no hot water supply in the doctors’ offices; the workstations of the medical staff do not meet the requirements of current legislation and violate Article 19 of the Law of Ukraine “Fundamentals of Ukrainian Legislation on Healthcare” and Article 13 of the Law of Ukraine “On Occupational Safety”.

17. During communication with convicted persons and hospital staff, and while inspecting the hospital premises, the monitoring group established that the medical staff continues the systematic practice of conducting medical examinations and medical procedures on convicted persons through bars.

At the same time, the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment regularly 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 personnel 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 2009, (point 129. CPT/Inf (2011) 29), in 2012 (point 50. CPT/Inf (2013) 23).

18. According to point 7 of Chapter III of Section II of the Procedure, convicted persons who work at food facilities (except for work related to the positions of salespeople, managers of food and clothing warehouses, storekeepers) and in the processing industry, in children’s homes, institutions of general secondary education, professional training units in special correctional schools, medical units (paramedic stations) and hospital facilities of the SCES (except for work related to the provision of medical aid), laundries, baths, rooms for long-term visits, dormitories, clubs, at water supply and sewage facilities, and sites for breeding and raising animals, 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, production facilities and organisations whose employees are subject to mandatory preventive medical examinations, the procedure for conducting these examinations and issuing personal medical books”, and for every convicted person of this category, a primary accounting documentation form No. 1-OMK “Personal medical book”, 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, is opened.

At the same time, the monitoring group recorded the absence of a personal medical book for some canteen workers and the absence of results of examinations in the medical documentation, which are conducted by medical specialists (including laboratory, clinical, and other tests) necessary for admission to work at food facilities.

19. The monitoring group established a dangerous state of the electrical networks in the hospital wards, which creates a threat to the life and health of the convicted persons and the institution’s staff and is a gross violation of the Fire Safety Rules in Ukraine, approved by the Order of the Ministry of Internal Affairs of Ukraine dated 30.12.2014 No. 1417, registered with the Ministry of Justice of Ukraine on 05.03.2015 under No. 252/26697 (hereinafter — Fire Safety Rules).

In particular, sockets and other electrical appliances used by the convicted persons are in an unsatisfactory condition, and electrical wires have exposed sections, which creates a significant risk of fire and could lead to dangerous consequences, including a threat to the life and health of persons located in the institution. In addition, in violation of the Fire Safety Rules, the hospital premises are not equipped with fire extinguishing and fire alarm systems.

21. During the visit to the hospital, complaints regarding the quality of food were received from the convicted persons. In addition, in violation of the requirements of point 14 of Section V of the Regulations on the organisation of food provision in the State Criminal-Executive Service of Ukraine for peacetime, approved by the Order of the Ministry of Justice of Ukraine dated 15.06.2021 No. 2160/5, the monitoring group established that food for the convicted persons is delivered from the institution’s canteen to the hospital ward in plastic buckets, rather than in marked thermoses.

Recommendations:

1. Take measures aimed at eliminating the identified violations of human rights and preventing torture, other cruel, inhuman or degrading treatment and punishment at the Dnipropetrovsk Specialized Tuberculosis Hospital No. 89 of the branch of the State Institution “Public Health Centre of the State Criminal-Executive Service of Ukraine” in the Dnipropetrovsk and Donetsk regions;
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 15.08.2014 No. 1348/5/572 and other normative-legal acts;
3. Provide the hospital staff with specialist doctors and medical personnel in accordance with needs;
4. Ensure the possibility of receiving substitution maintenance therapy based on a diagnosis of mental and behavioural disorders due to opioid use;
5. Fulfil the requirements of point 37 of the Resolution of the Cabinet of Ministers of Ukraine No. 285 dated 2 March 2016 “On approval of Licensing conditions for the conduct of economic activity in medical practice”;
6. Ensure the implementation of individual rehabilitation for persons who require it;
7. 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”;
8. Provide the hospital with necessary diagnostic equipment, including a dental X-ray machine;
9. Ensure the conduct of proper medical examinations for persons working with food products and the issuance of personal medical books;
10. End the practice of conducting medical examinations and medical procedures on convicted persons and detainees through bars;
11. Ensure the receipt of informed consent from patients for examination and treatment in the established form;
12. Ensure timely and proper documentation of bodily injuries in convicted persons;
13. Provide the hospital with hospital property (hospital suit, robe, and slippers);
14. Ensure proper medical care for persons suffering from viral hepatitis C;
15. Ensure the equipment of the necessary number of isolation wards for infectious patients;
16. End the practice of using convicted persons as duty orderlies in the hospital and the institution;
17. Ensure the proper operation of the telemedicine complex for submitting requests by doctors for telemedical consultation;
18. Eliminate violations of the Fire Safety Rules.