Report on the Results of a Monitoring Visit to Shepetivka Multidisciplinary Hospital No. 98
On 7-8 November 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 United Nations Standard Minimum Rules for the Treatment of Prisoners and decisions of the European Court of Human Rights, and pursuant to Article 24 of the Criminal Enforcement Code of Ukraine — “Visiting Penal Institutions,” a group of monitors from the Kharkiv Human Rights Protection Group and the NGO “Protection of Prisoners of Ukraine” visited the state institution “Shepetivka Multidisciplinary Hospital No. 98 of the Branch of the State Institution ‘Health Care Centre of the State Criminal Enforcement Service of Ukraine in Khmelnytskyi Oblast’” (hereinafter — the hospital, the institution, the facility).
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 visit was conducted by the following monitors:
- Andrii Andriiovych Didenko — Assistant to a People’s Deputy of Ukraine, Yaroslav Yurchyshyn, with experience in monitoring visits since 2014;
- Serhii Yuriiovych Zuikov — Assistant to a People’s Deputy of Ukraine, Kostiantyn Kasai, Member of the Public Council under the Ministry of Justice of Ukraine, with many years of experience in monitoring visits;
- Oleh Volodymyrovych Tsvilyi — Member of the Public Council under the Ministry of Justice of Ukraine, with extensive experience in monitoring visits, specialising in issues of preventing torture and cruel treatment;
- Hugues de Suremain — Expert of the working group of international partners of Ukraine on prison reform.
General Information
The institution is a multidisciplinary hospital of a closed type for the treatment of persons held in penitentiary facilities.
The Acting Head of the Hospital is O. V. Rohozha.
The facility has a capacity of 110 beds and consists of the following departments:
- Therapeutic department with 40 beds (including 5 beds for palliative care);
- Surgical department with 40 beds;
- Dermatological department with 30 beds (serves dermatological patients from correctional colonies across Ukraine).
Staffing levels for doctors are at 93.5%, and for nursing staff at 100%. The overall staffing level in the hospital is 93.5%.
Vacant positions: medical statistician — 1.0 post, general practitioner (therapist) — 0.5 post, neurologist — 1.0 post, surgeon — 1.0 post, Head of the Surgical Department — 1.04 posts, dermatovenereologist — 0.5 post, outpatient clinic therapist — 1.0 post, narcologist — 0.5 post (total vacant doctor posts — 6.5). Nursing staff positions are fully filled. Total vacant positions — 6.5 posts.
During the first 9 months of 2024, medical staff performed rapid HIV tests on 705 persons, hepatitis C tests on 122 persons, hepatitis B tests on 122 persons, and COVID-19 tests on 175 persons. The hospital provides opioid substitution therapy to patients dependent on narcotic substances. 34 persons are receiving therapy.
Work of the Medical Advisory Commission (MAC) regarding the application of Article 84 of the Criminal Code of Ukraine to convicted patients in 2024:
- Number of persons released under Article 84 of the Criminal Code of Ukraine — 5;
- Number of cases reviewed by the MAC — 6;
- Number of materials submitted to the court — 6: approved — 5; rejected by the court — 0;
- Number of deaths during court proceedings — 1.
Since the beginning of the year, 11 convicted persons have died. The outpatient clinic has registered convicted persons with disability groups: Group I — 2 persons; Group II — 15 persons; Group III — 23 persons.
The facility has established an infection control committee, which includes medical staff from the Shepetivka Correctional Colony No. 98, to ensure compliance with sanitary and anti-epidemic regimes and the prevention of tuberculosis and COVID-19. In the first 9 months of 2024, no active forms of tuberculosis were detected.
Facts Discovered During the Visit
During the monitoring visit, violations of national legislation requirements 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 accordance with the order on the distribution of convicted persons and persons in custody requiring inpatient medical care to health care facilities of the Health Care Centre of the State Criminal Enforcement Service of Ukraine, men and women requiring palliative care from penal institutions and pre-trial detention centres in the Khmelnytskyi, Kirovohrad, Odesa, Mykolaiv, and Kherson regions are sent to the Shepetivka Multidisciplinary Hospital No. 98.
However, the hospital lacks a palliative care unit for providing inpatient palliative care, 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 lacks a license to conduct economic activities in medical practice for the necessary medical specialties, 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 palliative patients.
2. According to Clause 2, Clause 3 of Chapter III, Section II of the “Procedure for Organizing Medical Care for 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 (hereinafter — the Procedure), a general practitioner (or a family doctor), a psychiatrist, and a dentist must participate in the preventive medical examination.
However, in the hospital’s outpatient clinic, which provides medical care to convicted persons serving sentences at the state institution “Shepetivka Correctional Colony No. 98,” the position of therapist is vacant, which indicates that initial and preventive medical examinations are incomplete, as a result of which convicted persons and detainees do not receive proper medical care.
3. In violation of Part 1 of Article 115 of the Criminal Enforcement Code of Ukraine, the hospital wards violate the requirements regarding the standard of living space per convicted person in inpatient conditions (not less than 5 m²). Thus, in Ward No. 6, which contains 15 beds and housed 11 convicted persons, the area of the premises according to the living space measurement act is 33.24 m².
Therefore, the actual area per convicted person was 3.02 m². A similar violation was found in Wards No. 4 and 5. Furthermore, it was established that in Wards No. 3, 4, 5, 6, 12, 14, etc., the actual number of beds exceeds the permissible number to ensure the standard of space per person provided by law.
This violation creates conditions for potential abuse by the hospital’s management and staff regarding compliance with the living space standard per convicted person in inpatient conditions and does not ensure proper personal space for persons in the hospital wards.
4. The monitoring group identified systemic violations, in particular, an insufficient level of natural and artificial lighting in the hospital wards (cells) and access to drinking water for convicted persons. During the conversation, convicted persons reported that they are forced to drink water from the central water supply system.
In patient wards, due to excessive window grilles and a lack of natural light, general lighting is kept on constantly. According to Annex Zh “Regulatory Indicators for Lighting Premises of Residential Buildings,” DBN V.2.5-28:2018 “Natural and Artificial Lighting,” approved by the order of the Ministry of Regional Development, Construction and Housing and Communal Services of Ukraine dated 03.10.2018 No. 264, the illumination of working surfaces in bedrooms and living rooms should be 150 LUX.
In Ward No. 6, there is unsanitary condition; 24.4 LUX of artificial and 2.5 LUX of natural lighting were recorded; in Ward No. 14 — 4.3 LUX of artificial and 1.1 LUX of natural lighting; in Ward No. 12 — 9.1 LUX of artificial and 6.6 LUX of natural lighting; in Ward No. 4 of the surgical department — 9.0 LUX of artificial and 0.7 LUX of natural lighting; in Ward No. 5 — 25.8 LUX of artificial and 12.2 LUX of natural lighting; in Ward No. 26 for life-sentenced prisoners — 17.6 LUX of artificial and 3.7 LUX of natural lighting.
5. In violation of the requirements of the Instructions for completing the primary accounting documentation form No. 003-6/o “Informed voluntary consent of the patient to diagnosis, treatment, surgery, 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 signatures of the doctors who provided information in the primary accounting documentation forms No. 003-6/o was established.
6. In violation of the requirements of Clause 3 of Section 1, Chapter II of the Procedure, medical staff do not properly compile reports detailing the nature of bodily injuries, their size, and location. In particular, in violation of the requirements of the Instructions for completing 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 02 February 2024 No. 186, they fill out form No. 318-OD “On approval of the card for primary recording of external injuries, instructions for its completion, and the form of the journal for recording detected bodily injuries,” which expired as of 30.04.2024.
Thus, the lack of proper recording of bodily injuries does not comply with paragraph 60 of the recommendations of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (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 appropriate authorities.
During the review of medical documentation, it was established that in outpatient medical records form 025/o, photographs of existing bodily injuries are not attached to the compiled reports, as provided for by Clause 3 of Section I, Chapter II of the Procedure. At the same time, the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (hereinafter — the Committee) in its report following the 2023 visit to Ukraine notes that any traumatic injuries detected during a medical examination should be photographed in detail, and the photographs, together with body diagrams, should be kept in the person’s individual medical record (CPT/Inf (2024) 20, paragraph 82).
7. In violation of the requirements of Clause 7, Chapter 2, Section III of the Procedure, convicted patients are placed in wards/cells not based on an established diagnosis and the decision of medical staff regarding referral to the appropriate hospital department, but by the decision of the institution’s staff.
8. In violation of the Measures and Means to prevent infection when providing patient care, approved by the Order of the Ministry of Health of Ukraine dated 03.08.2020 No. 1777, the hospital is equipped with only one isolation ward for infectious patients, which makes it impossible to simultaneously house patients with dangerous infectious diseases separately from each other and from other convicted persons.
9. In violation of Clause 8, Part 5, Chapter 2 of the Procedure, the inpatient facility lacks an isolation ward for persons with mental disorders for convicted persons who pose a danger to those around them.
10. During the visit, the monitors established that there are convicted persons in the hospital who perform the duties of orderlies. At the same time, the Committee has repeatedly recommended stopping the practice of using convicted persons as assistants in medical units and as orderlies (Report of the Committee following the 2005 visit to Ukraine (paragraph 132, CPT/Inf (2007) 22), in 2013 (paragraph 151, CPT/Inf (2014) 15), in 2017 (paragraph 86, CPT/Inf (2018) 41)).
11. In Ward No. 26, 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, Section VII of the Procedure for the use of technical surveillance and control equipment in correctional and educational colonies of the State Criminal Enforcement 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 (checks) of convicted persons and strip searches are conducted.
This fact indicates that institution staff 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 Ukrainian Legislation on Health Care” regarding the right of persons to privacy concerning their state of health and Clause 9, Section I of the Procedure for organizing medical care for persons sentenced to imprisonment.
Furthermore, on the outer doors of the aforementioned ward, personal cards are displayed providing information on a brief description of the crimes committed by the persons in the ward. In its report following the 2020 visit to Ukraine, the Committee noted that this practice should be stopped because it serves no reasonable purpose and, in addition to stigmatisation, has the effect of damaging the relationship between prisoners and prison staff, which can also be applied to medical staff (CPT/Inf (2020) 40, paragraph 52).
12. During the inspection of the disciplinary isolation unit (DIZO), the monitors established that when a convicted person is placed in a disciplinary isolation unit, it is practiced to include a medical certificate in the file, which contains the state of health and based on the conclusion of which the convicted person can be kept in a DIZO, PKT (chamber-type room), or PUNISHMENT CELL based on health status. The facts discovered certify that the institution’s staff possess confidential information regarding the health status of convicted persons who are in the DIZO area. This violates the requirements of Article 39-1 of the Law of Ukraine “Fundamentals of Ukrainian Legislation on Health Care” regarding the right of persons to privacy concerning their state of health.
At the same time, the Committee has repeatedly emphasised that the obligation of penitentiary doctors to certify the fitness of convicted persons to serve disciplinary penalties is unlikely to contribute to the development of positive relationships between doctor and patient. In principle, medical staff 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 staff must be very attentive to the condition of convicted persons in solitary confinement. Medical staff must be informed immediately of every such placement and must visit the convicted person immediately after placement, and then regularly, at least once a day, and provide prompt medical care and treatment if necessary. Medical staff must inform the institution’s administration if the convicted person’s health is at serious risk due to solitary confinement (CPT/Inf (2024) 20, paragraph 104).
In addition, this contradicts Clause 43.2 and Clause 43.3 of the European Prison Rules.
13. In violation of Part 1 and Part 2 of Article 115 of the Criminal Enforcement Code of Ukraine, the hospital premises require repair work with the replacement of sanitary and technical equipment and the electrical network. There is an unpleasant odour, unsanitary conditions, the walls of some rooms are covered with mould, there is significant clutter with personal belongings, the floor and the bathroom are dirty, and bedding, pillows, and mattresses need replacement.
The shared bathroom on the first floor of the hospital and the shower do not meet basic standards of sanitation and hygiene. In doctors’ offices and wards of the therapeutic department, located on the second floor of the building, there has been no water supply for over three months; the workplaces of medical staff do not meet the requirements of current legislation and violate Article 19 of the Law of Ukraine “Fundamentals of Ukrainian Legislation on Health Care” and Article 13 of the Law of Ukraine “On Occupational Health and Safety.” This does not comply with paragraph 53 of the Committee’s recommendations (CPT/Inf(93)12-part).
14. In some wards, beds are placed close to each other, which does not provide convicted persons with personal space and contradicts the requirements of the State Building Norms of Ukraine V.2.2-10:2022 “Health Care Institutions.” Furthermore, in some wards, facts of violation of Article 8 of the Convention and the requirements of Rule 19.3 of the European Prison Rules were established, regarding the violation of the right of convicted persons to privacy, namely — the absence of doors in bathrooms that allow convicted persons to have privacy.
15. In violation of the “State Sanitary and Anti-Epidemic Rules and Norms for Handling Medical Waste” approved by the Order of the Ministry of Health of Ukraine dated 08.06.2015 No. 325, medical waste is disposed of by burning in the institution’s boiler room by a medical worker.
16. 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,” the hospital has not created conditions for the care of people with disabilities.
17. Dispensary supervision is carried out for 40 persons with disabilities. However, in violation of the requirements of the Law of Ukraine “On Rehabilitation of Persons with Disabilities in Ukraine,” persons with disabilities do not receive proper diagnostic, treatment, and rehabilitation measures, despite information confirming persistent impairment of body functions caused by illnesses and consequences of injuries, which cause restrictions on normal vital activity.
During the study of the convicted persons’ medical documentation, it was established that not all persons with disabilities have individual rehabilitation programmes (hereinafter — IRP). Moreover, IRP recommendations are not being implemented, due to which they do not receive proper diagnostic, treatment, and rehabilitation measures despite the existence of information confirming persistent impairment of body functions caused by illnesses and the consequences of injuries, which cause restrictions on normal vital activity.
18. 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 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.
19. In accordance with the requirements of Clause 7, 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 of Medical Service of the Population in 2024,” the National Health Service of Ukraine (NHSU) pays for medical services provided based on paper referrals for patients held in penal institutions or pre-trial detention centres of the State Criminal Enforcement Service, until health care facilities of the State Criminal Enforcement Service establish the technical capability to issue electronic referrals.
However, due to the lack of signed declarations with a primary care physician, convicted persons do not have the opportunity to receive the 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 Ukrainian Legislation on Health Care.”
20. During the check 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 life-saving equipment for use by doctors (Report of the Committee following the 2017 visit to Ukraine, (CPT/Inf (2018) 41) paragraph 87).
21. In violation of the Procedure for organizing 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 19.10.2015 No. 681, hospital staff are deprived of the ability to make requests for telemedicine consultations and receive consultations for providing medical care to convicted persons due to technical reasons.
22. In violation of the requirements of the Table of Equipping a Workplace for a Dentist and Dental Technician, 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 in-depth dental examinations of convicted persons and does not ensure the timely provision of proper dental care.
23. 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; convicted persons in the wards use faulty and damaged sockets, which could lead to electrocution of convicted persons or hospital staff and poses a threat to life and health.
24. In violation of the requirements of Sub-clause 2.12 of Clause 2, Section III of the Rules, the doors of the electrical switchboard rooms in the corridor on the second floor of the hospital were not locked.
Recommendations:
- Take measures aimed at eliminating the identified human rights violations and preventing torture and other cruel, inhuman, or degrading treatment or punishment at the Shepetivka Multidisciplinary Hospital No. 98 of the Branch of the Health Care Centre of the State Criminal Enforcement Service of Ukraine in Khmelnytskyi Oblast;
- Provide the hospital staff with the necessary medical specialists in accordance with needs;
- Ensure control over the proper maintenance of medical documentation in accordance with the Procedure for organizing medical care for 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 regulatory legal acts;
- Ensure the further referral of palliative patients to municipal health care facilities that have the appropriate organisational, personnel, and technological conditions for the proper care of such patients;
- Fulfill 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 Conducting Economic Activities in Medical Practice”;
- Ensure the conduct of individual rehabilitation for persons who need it;
- 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”;
- Ensure proper conditions for patients in wards, in compliance with space standards per person;
- Ensure the timely and proper recording of bodily injuries in convicted persons;
- Ensure the proper disposal of medicinal products and medical devices;
- Provide the medical unit with hospital property (hospital gowns, robes, and slippers);
- Provide for the equipping of the necessary number of isolation wards for infectious patients;
- Ensure convicted persons have agreements with doctors providing primary medical care in health care facilities of the Ministry of Health of Ukraine;
- Ensure the proper recording of preventive examinations;
- Ensure the provision of proper psychiatric medical care in accordance with the Law of Ukraine “On Psychiatric Care”;
- Stop the practice of doctors certifying the health status of convicted persons and detainees upon their placement in the disciplinary isolation unit (DIZO)/PKT (chamber-type room);
- Stop the practice of using convicted persons as orderlies in the hospital and the institution;
- Replace the pads for the external automated defibrillator;
- Eliminate violations of Fire Safety Rules;
- Ensure proper lighting in the premises where patients are kept.