Organisation of health care
Ministry in charge
Ministry of Justice
Every prison facility has a health care unit
The main care provided in prison is pharmaceutical treatment, general medicine and psychiatric care.
Specialized medicine and hospitalization are provided by the public hospitals (National Health Service) and the São João de Deus Prison Hospital1.
Hospitals do not have units dedicated to prisoners. The latter are cared for within the services, under the supervision of prison officers.
Access to health care
Health care is free
The prisoner may choose an external doctor. The costs are then at his or her own expense. This request must be addressed in writing to the warden of the establishment (article 60 of the Regulations).
A medical examination is performed upon admission
A clinical assessment must be made within 24 hours of entering prison. A nurse collects the information necessary to open the medical file. A doctor is required to consult within a maximum of 72 hours (article 53 of the Regulations).
This consultation includes screening for contagious and transmissible diseases (article 61 of the Regulations).
A medical file is opened upon admission
During the admission consultation, the nurse opens a medical file containing personal information on the state of health of the prisoner. The individual clinical file accompanies the prisoner during his or her prison journey, even in the event of a transfer. It is accessible in the event of the prisoner’s return to prison.
The medical file can be dematerialized.
Prisoners can access health care units after
a written request
Medical examinations are carried out on a confidential basis
Portuguese law provides for the confidentiality of medical interviews (article 32 of the Code for the enforcement of punishment).
Persons having access to data relating to the health of the prisoner are bound by professional secrecy, even after the end of their duties (article 57 of the Regulations).
Observers report frequent non-compliance with confidentiality rules. Health workers appear to be insensitive to this clause.
Access to care must be ensured in continuity and quality. The prisoner’s access to health care must be identical to that of any free citizen (article 32 of the Code for the enforcement of punishment).
Drugs are distributed by the nursing staff. Medication is prepared by pharmacists and/or pharmacy assistants. The prisoner takes his or her medication under the nurse’s watchful eye [^29].
[^29]: Directorate General for reintegration and penal services , “Report on activities and self-assessment, 2017”, 2018, p. 72.
A transfer to the hospital is decided by the Directorate General of Prison Services (DGRSP). In the event of a medical emergency, the warden of the institution may decide, alone, on this transfer. The DGRSP must be notified as soon as possible (article 34 of the Code for the enforcement of punishment).
Physical health care
Infectious diseases are most prevalent in Portuguese prisons. As of December 2017, 2,017 prisoners were affected by HIV or hepatitis (B and C). Hepatitis C affects 58.3% of this group1.
Preventative measures for epidemic and contagious diseases are implemented. The warden may, on the advice of the medical service, remove a contagious person. Each prison develops and submits a plan for health promotion and disease prevention to the Directorate General. This plan focuses in particular on reducing risk behaviour. A doctor (or other qualified person) carries out regular inspections of prisons. Recommendations are submitted to the warden. These recommendations concern the food which is distributed, hygiene and cleanliness of the facility, sanitation, heating and ventilation. If the warden of the institution ignores the recommendations, the physician may refer the matter to the Directorate General (DGRSP) (article 37 of the Code for the enforcement of punishment).
Mental health care
Persons suffering from mental disorders are detained in facilities within prisons or in psychiatric hospitals.
Since 1998, the São João de Deus Prison Hospital has had a psychiatry and mental health department. It provides clinical assistance, outpatient care and hospitalization of patients. The service has 18 beds for men and 8 for women. Santa Cruz do Bispo - Men Prison has a psychiatric ward with 73 individual cells, nine dormitories and a double cell for prisoners with mental disorders. 137 people with mental disorders were serving their sentences in psychiatric hospitals in December 2017[^32]. [^32]: Directorate General for reintegration and penal services, “Report on activities and self-assessment, 2017”, 2018, p. 49.
Prison wardens at Caxias Prison Hospital and in the psychiatric wing of Santa Cruz do Bispo Prison are trained in the care of people with mental disorders.
Persons who are addicted to drugs can benefit from a substitution program (methadone, subutex, antagonists, suboxone). In December 2017, 1,062 people were receiving substitution treatment. The programmes are implemented in collaboration with the national health service.