Country

Bulgaria

Detention issue

FRA research findings

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Legal instruments & key provisions

Legal instrument Key provision
Execution of Penalties and Detention in Custody Act (Закон за изпълнение на наказанията и задържане под стража)Prisoners, who have requested a medical examination, must be seen by a doctor within 24 hours. Prisoners with temperature, traumas or in another emergency condition must be seen by a doctor immediately at any time. At least once per year all prisoners must undergo annual prophylactic examinations, fluorography and laboratory tests, and receive all mandatory immunisations and re-immunisations. Prisoners who do not agree with their diagnosis or the prescribed treatment can request consultation with a specialist from another medical establishment at their own expense.

NATIONAL PREVENTIVE MECHANISM RECOMMENDATIONS

Year Recommendation Report
2017In 2017 the focus of the inspections conducted by the NPM was on communicable diseases. Pursuant to Article 140, paras 2 and 3 Execution of Penalties and Detention in Custody Act, all prisoners are provided with the possibility to make voluntary, anonymous or confidential consultations and tests for HIV/AIDS. HIV/AIDS tests are appointed also by the director of the hospital or the medical care centre. In those cases the prisoner may refuse to perform the test. In practice, this activity is not funded by the Ministry of Justice and the newly admitted inmates are not offered the opportunity to conduct HIV/AIDS tests. It is relied on tests performed by the Regional Health Inspections under the National Programme for Prevention and Control of HIV and Sexually Transmitted Infections in the Republic of Bulgaria 2017-2020. The prisons in Sliven and Stara Zagora have good practices. The Regional Health Inspections conduct HIV/AIDS tests once a month there. No HIV/AIDS tests have been made in the prisons in Varna, Vratsa, Pazardzhik, Plovdiv, Sofia and Lovech. In all prisons there is a designated medical staff member for combatting tuberculosis who works under the National Programme for Prevention and Early Detection of Tuberculosis in the Republic of Bulgaria. After the Programme was introduced, a down trend of instances of tuberculosis has been observed. Report details
2018The DGEP [Directorate General Execution of Punishments] reports annually shortage of specialists in the penitentiary medical centres and specialized hospitals, which is a poor healthcare quality indicator. This is due mostly to the shortage of specialists in the healthcare system in general, and to MoJ [Ministry of Justice] reluctance to improve the working conditions in the penitentiary healthcare system. Currently there is an available part-time psychiatrist working in the medical centre with the Sofia Prison, provided such is envisaged to be operating in every prison medical centre. Report details
2019‘The inspections in 2019 show that the prison health care system remains unreformed and the quality of the health care for inmates does not improve. The NPM is of the opinion that a structural reform of the health care in the penitentiary system is required, allowing for external referrals, in line with the European Prison Rules. […] Directorate General Execution of Punishments (DGEP) reports annually understaffing in the medical centres and specialized prison hospitals, which is a bad indicator about the quality of the health care. This fact is largely due to the lack of specialists in the healthcare system in general, on the one hand, and the unwillingness of the Ministry of Justice to improve the working conditions for the specialists in the system, on the other hand. Report details
2020According to the NPM, the most serious problem at prisons is medical care. It should be noted that the long-standing promises of the Ministry of Justice to reform the health system in the penitentiary system and amend the Execution of Punishments and Detention in Custody Act were not fulfilled in 2020 either. The NPM reiterates that such action is critical to identify the existing problems in the system and set out the actual possibilities to organise the health services for persons deprived of liberty. There has been no improvement in the health care for persons deprived of liberty. In 2020, 52 persons died in comparison to 36 in 2017. Medical specialists are continuing to leave the system. Over the past year, support was provided for the activities related to outpatient medical care and 20 medical specialists were hired under service contracts, general practitioners were selected ex officio in line with the National Framework Agreement. Report details
2021The quality of health care in places of detention remains unsatisfactory. The Ministry of Justice has not implemented the long-awaited changes in the Law on the Execution of Sentences and Detention (LESD) to reform the provision of health care. Systemic problems in the medical care of prisoners are identified, such as shortage of medical specialists in almost all prisons, neglect of complaints of prisoners, untimely release of prisoners to external specialists for diagnosis and treatment, rude treatment of medical professionals to prisoners, etc. Report details
2022“The quality of health care in penitentiary facilities remains unsatisfactory for yet another year. In the past 2022, the Ombudsman in her capacity as National Preventive Mechanism found deterioration in the medical care provided. The medical care of prisoners in the inspected facilities does not meet the legally established requirements and there are prerequisites for violating the rights of prisoners as patients and health insured persons. In some penitentiary facilities there is no medical specialist for months on end (e.g., the prison in the city of Plovdiv), and in others the appointed persons are on civil contracts, which in practice makes them relatively independent from the management of the penitentiary institution with the resulting constraints on their activities (e.g., the prison in Vratsa).” Report details
2022The lack of medical professionals in almost all prisons is a systemic problem, but other problems are also identified, such as the neglect of prisoners' complaints, untimely referral of prisoners to external specialists for diagnosis and treatment, rough treatment of prisoners by medical professionals etc. Report details
2022Main recommendations: […] To carry out a thorough analysis of the reasons for the lack of medical staff in penitentiary facilities […] The medical specialists of the prisons to comply with the requirements of Ordinance No 2 of 22 March 2010 and should examine the chronically ill prisoners […] Report details
2023The quality of medical care provided continues to be unsatisfactory. This is due to insufficient medical staff in detention facilities, which results in difficult or denied access to medical specialists and services for prisoners. A large proportion of the medical staff employed in places of detention is employed on a civil contract. The ex officio choice of a general practitioner by the respective regional health insurance fund creates the possibility for prisoners to enjoy rights as insured persons, but the lack of doctors in prisons who are there on a daily basis limits their health rights. Report details
2023Key recommendations: […] Continue efforts and seek new opportunities to ensure a longer presence of medical professionals in places of detention [...] Arrangements should be made for the payment of medicines from prison funds where it is found that there is a shortfall in the personal accounts of prisoners [...] Prisoners with established mental disorders should be placed in an appropriate medical environment, under the supervision of qualified professionals […] Report details