Prisoners Die from Pneumonia and TB in Georgian Prisons

Nona Suvariani, Tbilisi

Levan Labauri

Levan Labauri has involved the program funded by the UN for three years that aims to provide support to activities of the Georgian Public Defender’s Office. He often visits Georgian prisons within the scope of the program.

The commission was established by the Healthcare Ministry and Ministry of Justice two years ago. Although both ministries work hard to effort to improve the situation they have still not prepared an action plan, and have not even refined the concept of what they are seeking to accomplish.

“The commission has to introduce the conception as a foundation of all future activities. The members of the commission have not done anything for the last two years. We sent a letter to them in spring of 2008 and requested them to send their report about what activities that they have carried out during their existence. Their reply from the Healthcare Ministry was the following: the commission actively works on preparing the conception. They seem to have interviewed inmates of two prisons and inquired what the prisoners wished to change in their establishments. Finally, they defined that the information was not enough to set a goal of their activities…. Based on reality, the commission has demonstrated that it is incompetent in the field.   I doubt that the commission members are real specialists, though there might be some exceptions with some who really knows the problem and that we can actually deal with it. Anyway, the small number of good specialists cannot change the overall picture. The process that is on-going is chaotically. You can see 2005-2006 resolutions of Lado Chipashvili, former Ministry of Healthcare. According to those documents, the jail hospital was to be transferred to Hospital # 5 within three months. Two months later, he stated that all documents were signed and prisoners could be treated at ordinary hospitals. The conception is a serious document and it requires serious intellectual resources and now it appears that everything has been proceeding and without any consideration. Consequently, the crisis increased and each new government offers new initiatives.”

Levan Labauri thinks incompetent decision was made when Insurance Company “Aldagi” was authorized to carry out medical treatment of prisoners. Since then, the situation has not improved, and the reason why there is illness and so many deaths has not changed either.

There are special indicators in healthcare that evaluates the system. There seven or eight factors that is directly connected with the death rate.

“The Ministry of Justice counts and publishes information about the number of prisoner who died in penitentiary establishments. Scientifically measurement of death rate with percentage is not the proper way.  Consequently, the published figure is absurd. The death rate is calculated according to the following formula: how many prisoners died out of one thousand. Consequently, they have artificially created percentage calculation of death cases in order to prevent international experts from interpreting the provided data in a normal fashion.  Nobody understands the data even in Georgia. If the percent is high that means the death rate has increased. For example, if in 2007 the rate was 0.1 percent in 2008 it is 0.2 percent. It does not mean that situation has worsened because in 2007 the total number of prisoners might have been 10,000 but in 2008 it is 13,000. The number of prisoners might change throughout the year. It is obscure whether the 0.1 percent is estimated figure for the beginning of the year or it was fixed at the end of 2007. Take for instance, when there are prisoners with cancer in custody, and 90 percent of them die than that is not to be considered as a disaster.”

Levan Labauri spoke about the criteria according to which the death rate can be assessed. First of all, it is age factor. According to expert’s information the most number of prisoners who died in 2007 were under age of 21-30. It is very alarming data because the death inmates are young and more or less the most healthy population. Prisoners of the age of 41-50 take the second place in the death rate.

The factors that cause death among prisoners are poor nutrition and substandard living conditions. The organism can endure stress if it is in proper conditions that are guaranteed by good nutrition. It is important to supply prisons with safe and fresh drinking water.

“The problem was urgent in several custodies in 2006-2007 too. For example, the drinking water in Rustavi Prison # 6 was bad. When relatives brought food to inmates the prison personnel weighed the water too and consequently, they could not send to their relatives anything more. In Ksani Prison inmates were constantly sick because of the drinking water. Tens of condemned people were taken to Tbilisi. An epidemic situation was created, however, nobody ever though that it was necessary to investigate the cause of the crisis situation and find out why prisoners were getting sick.”

One more factor is sanitary-hygiene conditions. Levan Labauri thinks that abolishment of the Penitentiary Establishment # 5 partially resolved the problem. According to the general situation, the situation in Prison # 8 is relatively acceptable.

Among infection diseases tuberculosis remains one of the main problems. 39 out of 101 sick prisoners died. Pneumonia occupies the second place in the death statistics.

“People die of pneumonia in our century only in Africa. The main reason of death is violence,  which means that all kinds of deaths that are not natural.”

The situation is urgent regarding the number and qualification of medical personnel. As a rule, it is proportional to the rate of death cases.

“Today, there are 21 medical trades in Georgia. One of them is judiciary medicine. Nowadays, the Ministry of Healthcare issued 70-75 licenses in judiciary medicine. Some of those 75 doctors died, others are in prison. In fact, there are only 40-45 doctors in total and most of them work in Tbilisi that creates a serious problem. Most of medical conclusions written in regions are terrible. Doctors in regions have poor qualification. Since 2004 judiciary medicine is under supervision of the Ministry of Justice that was completely unreasonable decision. Today, there are no independent experts in Georgia. Absolute majority of them depends on the Ministry of Justice, as there is no alternative. When the doctors were under supervision of the Ministry of Healthcare better conditions were provided for the improvement of their professional qualifications. Another problem is restricted autonomy of doctors. Representative of any law enforcement body cannot influence the doctor while he is making decision.

Gela Geladze, representative of the NGO “Democracy Institute”, that is monitoring Batumi Prison, stated that it is impossible to estimate real cause for deaths. Very often doctors do not operate the prisoners infected with AIDs, claiming “they are unsafe” to their personal health and well-being.

“Dentists also encounter serious problems. Prisoners often need their assistance. Now, they hardly manage to have painful tooth pulled out; there are no other methods of medical treatment provided for prisoners. The number of dentists is short. Several months ago old dentist chair was brought to the prison. However, a dentist was not hired anyway. Generally, it is difficult to hire doctors at custodies as they refuse to start work because of low salary and the location. Prisoners often ask for doctors and medical assistance.”

Levan Labauri was able to get hold of many conclusions where doctors could not identify basic anatomy organs. For example, a doctor wrote about a patient from Zugdidi: “Both appendixes are normal, however a person has only one appendix. Many doctors write about some unreal bones. There are cases when micro and macro morphological data do not coincide with each other.”

“Once we had such an occasion when I led a doctor to the prisoner who was injured. I pointed him to all bruises on his body and asked: Is it natural color? Nobody can persuade me that doctors are independent and are able to impartially make decisions. On the one hand doctors have low qualifications and on the second hand they are under repression by prison officials who control their decisions.”

An incident happened in Rustavi Prison. The doctor said in private conversation that the patient must be taken to the jail hospital but they I asked him whether he had applied to the prison administration with the request and he refused. How can I imagine that the doctor had wanted the patient to die?”

The expert underlines that all prisoners should be provided with the medical assistance that is available for the citizens that belong to the middle class.

The Law on Imprisonment states that if there are more than 100 inmates in the establishment all necessary conditions for stationary medical assistances should be provided.

There are two medical institutions for prisoners currently in Georgia; one of them is in Tbilisi and another one is in Ksani-establishment for the treatment of prisoners with tuberculosis. None of them have licenses. However, the State Regulation Agency within the Ministry of Healthcare should control the license requirements. To justify the situation that the establishments do not have licenses, the ministry of Justice mentions following arguments: An amendment is introduced to the Article 2 of the Georgian Law on Licenses and Permission and it states that if Ministries and its subordinate agencies carry out some activities they shall not be granted with license. It contradicts with the Article 37 Paragraph II of the Georgian Constitution which imperatively states that the state controls all medical organizations.”

The deficiencies of the penitentiary system are discussed within a report of the Public Defender. Some concrete facts are also mentioned there. Levan Labauri pointed out that it has become a tradition that recently the parliament accepts the reports of the Public Defender as ordinary notification, which represents disparaging attitude to the facts. Such reports should not only be made but reacted to, and this should be done by all means.