Identifier
Created
Classification
Origin
07TBILISI2450
2007-10-01 09:53:00
CONFIDENTIAL
Embassy Tbilisi
Cable title:  

PROBLEMS REMAIN IN PRISON HEALTH CARE

Tags:  PHUM PREL GG 
pdf how-to read a cable
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DE RUEHSI #2450/01 2740953
ZNY CCCCC ZZH
P 010953Z OCT 07
FM AMEMBASSY TBILISI
TO RUEHC/SECSTATE WASHDC PRIORITY 7783
INFO RUEHZL/EUROPEAN POLITICAL COLLECTIVE PRIORITY
C O N F I D E N T I A L SECTION 01 OF 03 TBILISI 002450 

SIPDIS

SIPDIS

DEPARTMENT FOR EUR/CARC

E.O. 12958: DECL: 07/24/2017
TAGS: PHUM PREL GG
SUBJECT: PROBLEMS REMAIN IN PRISON HEALTH CARE

REF: A. TBILISI 724

B. TBILISI 1042

C. TBILISI 1612

Classified By: Ambassador John F. Tefft for reasons 1.4 (b) and (d).

C O N F I D E N T I A L SECTION 01 OF 03 TBILISI 002450

SIPDIS

SIPDIS

DEPARTMENT FOR EUR/CARC

E.O. 12958: DECL: 07/24/2017
TAGS: PHUM PREL GG
SUBJECT: PROBLEMS REMAIN IN PRISON HEALTH CARE

REF: A. TBILISI 724

B. TBILISI 1042

C. TBILISI 1612

Classified By: Ambassador John F. Tefft for reasons 1.4 (b) and (d).


1. (U) Summary: Health care in Georgian prisons continues
to be problematic due to overcrowding, lack of professional
medical staff, and unclear delineation between Ministries of
Health and Justice over which ministry is responsible for
medical care. Despite increased prison capital expenditures
and the opening of two new wings at existing prisons,
unsanitary conditions and poor medical care continue to
contribute to inmates' deaths. The GoG has identified prison
improvement as one of its top priorities, but overall efforts
so far have not been enough to address the problem. End
Summary.

--------------
Who's on First?
--------------


2. (U) On August 3, Poloff met with Sandro Urushadze,
Advisor, Georgian Ministry of Labor, Health and Social
Services, (MOH),to discuss the delineation of
responsibilities between the Georgian MOH and the MOJ for
prison doctors, and plans for outsourcing prison health
care. The MOH and the Ministry of Justice (MOJ) share
responsibility for prison health care. MOH is the only
authority to certify doctors and provide professional
licensing. MOJ prison doctors receive their salaries from,
and work for, the MOJ. Historically there has been much back
and forth between the two ministries as to how these
functions are really shared. Control over prison hospitals
was transferred from the MOJ to the MOH in 2004-2005 upon the
recommendation of the Council of Europe; however, there were
no mechanisms to implement this change. According to the
Georgian Young Lawyers Association (GYLA),the Joint Reform
Commission of the MOJ and the MOH which was set up in April
2006 failed to take any effective corrective measures. In
July, the MOJ created a working group whose responsibility
was the assessment and inventory of the Medical Service
within the penitentiary system. Also, in mid-July, President
Saakashvili created the Interagency Coordination Council
against torture, inhumane treatment and violation of human
rights. Influential MP Giga Bokeria chairs the committee.

Ostensibly, prison health care would also be discussed in
this forum. The Council has met several times, but has yet
to craft a comprehensive plan.

--------------
The Tonic of Outsourcing
--------------


3. (U) The current plan of the MOH is to outsource prison
health care by using civilian health care providers.
Previously, MOJ had its own medical cadre which provided
health care. Now the focus will be on outsourcing these
tasks to civilian health care providers. Their first step is
a health care assessment to determine how to best allocate
resources. This assessment is being conducted with the
International Red Cross (ICRC) during September and October
and involves interviewing 700 prisoners in order to establish
a methodology to allocate resources.


4. (U) Urushadze envisions that each prison will have its own
cadre of core staff on site, but some tuberculosis patients
(TB) and those with serious mental disorders will be
transferred to Gldani prison, when it opens later this fall.
The Gldani prison is designed to house 4000 prisoners and
offer 100-150 hospital beds in its medical unit. If patients
require something beyond routine care, they will be
"outsourced" to a local civilian hospital. Urushadze added
that there are doctors who work in other prison systems
besides MOJ prisons: Ministry of Internal Affairs (MOIA) and
Ministry of Defense (MOD) have their own prisons, and own
medical staff.

--------------
The Doctor's In, but is He Qualified?
--------------


5. (U) On September 17, Poloff met with the Public Defender's
Office (PDO) Spokesman Giorgi Giorgadze and Dr. Levan
Labauri, Patients' Rights Center. Per Dr. Labauri, health
care in prison is part of the overall health responsibility
of the MOH. According to Dr. Labauri, there are 15 or more
laws on health and patient's rights, and chapters of
different parts of legislation on health care, but these are
not observed. By law, each prison which houses over 100
inmates should have on its staff a general practitioner, a

TBILISI 00002450 002 OF 003


dentist, and a psychiatrist. Only one of the prisons
currently meets this criteria. In the eyes of the PDO,
prisoners are being discriminated against because these
provisions are not being observed. There are conflicting
laws which deal with the certification of doctors. According
to Article 37 of the Constitution, doctors are not required
to be licensed. Conversely, prison health care providers who
work for MOIA and MOD work under the rubrique of a Limited
Company (LTD) arrangement which regulates licensing and
requirements. Thus, MOJ health care providers are not
working under a governing body or legal framework.

--------------
More Prisons--A Bitter Pill
--------------


6. (U) Despite reforms in Georgia's historically problematic
prison systems, there is little indication that prison health
care has significantly improved this year. According to the
PDO, the GoG focus on building more prisons has not yet
ameliorated the overcrowding problem, nor has it helped
resolve other health issues in the system. Some of the newer
prisons are already experiencing infrastructure problems, as
Dr. Labauri stressed. The OSCE Human Rights Representative
who works on prison reform issues, echoed that even with new
prisons, there are lingering structural problems.


7. (U) Two prisons have opened new wings with increased beds
this year, but this has not solved the overcrowding and
associated incidence of disease among inmates. Prison
mortality is still high, with over 70 deaths this year, most
attributable to prison conditions according to PDO. The PDO
questions the findings of the forensic reports for mortality
cases in prisons. Of some 90 mortality reports that were
completed, the PDO examined 35 and found that in 17 cases
deaths were due to diseases contracted while in prison.
Incidents of misdiagnosis from prison medical staff in
treating medical patients are common (ref C),with death
often attributed to cardiac attack rather than the true
underlying cause. Instances of TB in prison are high and are
exacerbated by overcrowding. The ICRC addresses TB in
prisons, but their program does not address strain resistant
types of TB. The rate of suicides in prison remain about the
same, but there are no suicide prevention programs or
psychiatrists to treat them.


8. (U) The current draft of the new Penitentiary code before
Parliament only cursorily addresses prison health care; the
PDO has made suggestions to Parliament's Health, Human Rights
and Legal Committees on how to better incorporate medical
provisions within the new Code.


9. (U) Dr. Labauri said that the NGO Empathy is getting good
results in the women and juvenile prisons where they have a
team of psychiatrists and separate treatment rooms to work
with patients. Dr. Labauri attributed much of the success to
the NGO's leader and the director of the women's prison
facility.

--------------
The Magic Elixir--Privatization
--------------


10. (U) On 17 September, Poloff met with Dato Kelbakiani,
Head of Social Services, Penitentiary Department, to discuss
improvements in prison conditions. According to Kelbakiani,
prison health care is part of the Georgian unified health
care system, but has separate coordination channels. Doctors
who serve in the prisons are certified in accordance with the
law on certification for doctors. At each prison, there are
the mandatory cadre of health providers, dentists and
psychiatrists.


11. (U) The current plan is to close Ortchala hospital prison
when Gldani prison opens this fall, unless it is needed for
overflow. Kelbakiani mentioned that with the help of
Norwegian Mission of Rule of Law Advisers to Georgia (NORLAG)
and Penal Reform International (PRI),that in Rustavi prison
they have implemented a psychological transition program for
prisoners who are to be released within the next six months.
Currently this program reaches 70 percent of the prisoners.
In Kutaisi prison they have implemented drug and alcohol
abuse treatments in conjunction with Atlantis programming.


12. (U) When asked, Kelbakiani could not provide statistics
on the number of prisoners who currently suffer from TB, nor
could he provide the number of those who suffer from the TB
resistant strain, but he said, "they are not so many." Per
Kelbakiani, the plan is to outsource medical care in prisons
as part of a larger medical privatization health care scheme.
Kelbakiani said now they are taking tenders from different

TBILISI 00002450 003 OF 003


Georgian insurance establishments for this purpose and will
make their decision by the end of the year. He added that
the government will pick up the tab for inmates' medical
insurance premiums and that a representative of the insurance
company would be on site to handle particulars, although he
did not spell out the plan in detail. He could not enumerate
the specifics of the plan nor a timetable for its
implementation. When Poloff asked how the new Penitentiary
Code would affect prison health care, Kelbakiani stated that
it would not directly affect his programs. The issue
historically, according to him, was not legislation but lack
of resources. He did tell Poloff that there were plans to
open new prisons in Javakheti and Adjara.

--------------
Prison Deaths High, but Rate Falling
--------------


13. (U) On September 28, Poloff spoke with Givi Mikanadze,
Deputy Minister, MOJ. He said that the GoG dedicated
1,081,000 GEL in 2007 towards prison medical care. Of the
1,081,000 GEL, 781,000 GEL was dedicated to purchasing better
medicines and 300,000 GEL was dedicated to inmate medical
care at civilian hospitals. He noted that in the last three
years there has been much discussion as how to best organize
health care within the prison system; currently they are
taking tenders to outsource this service. While he did say
that the total number of prisoners has increased, the rate of
deaths has not increased. He cited the following statistics:
so far in 2007,.038 percent of the prison population has
died, in comparison with .059 percent last year. He added
that MOJ is very transparent about prison mortality and
publishes these statistics monthly on the ministry's website.

--------------
Comment
--------------


14. (C) The delineation of the responsibilities between MOJ
and MOH continue to be blurred, each side pointing to the
other when faced with difficult questions about
responsibilities. Although the government's plan to ease
overcrowding was to build more prisons and open Gldani prison
(ref A,B),overcrowding is still cited as a major issue by
the PDO, OSCE, and Penal Reform International.


15. (C) Poloff will meet with representatives from Health and
Human Rights Parliamentary committees to advocate for better
delineation of health responsibilities between the ministries
in the penitentiary code draft. Additionally, post's Human
Rights Officer will attend future Interagency Coordination
Council meetings to discern government plans to improve the
situation.
TEFFT