As Israel's Health Ministry awaits final results from the autopsy of a Palestinian detainee who died in Megiddo Prison on Saturday, human rights organizations and even the Israel Medical Association aren't waiting. They say that, regardless of the findings, it's time to take responsibility for prisoners' health away from the Israel Prison Service and give it to an outside body.
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The Health Ministry Monday declined to comment on Arafat Jaradat's death, saying that it will decide whether to launch a probe into his medical treatment in prison only after receiving the autopsy report.
With the sole exception of psychiatrists, prison doctors aren't directly subordinate to the ministry, which gets involved only if medical negligence is suspected. Instead, they answer to the prison service an arrangement that both human rights organizations and the IMA say can create a conflict of interest between a doctor's obligation to his patient and his obligation to his employer. These groups argue that prison doctors should cease being part of the IPS.
One potential conflict of interest, according to Physicians for Human Rights' Anat Litvin, is over referrals to hospitals. Litvin says a senior IPS official told her organization "that the medical team feels it failed if they sent a prisoner or detainee to the emergency room but the hospital ultimately decided not to hospitalize him because this means manpower, a vehicle and expenditure for medical services that were apparently unjustified. From a medical standpoint, that's an extremely problematic position. It's even possible that, sometimes, prisoners aren't getting hospital treatment because of these considerations."
A report that PHR issued about a year ago, jointly with the Public Committee Against Torture in Israel, said that prison doctors also sometimes refrain from reporting injuries caused by abuse during investigations. That violates international conventions Israel has signed, which require a doctor to report any signs of torture or abuse he observes during treatment. Even when the prisoners themselves claim to have been tortured, this often isn't documented or reported, the report said.
In response to that report, in January 2012 the Health Ministry set up a standing committee to which doctors can report such suspicions. Some countries have successfully removed prison doctors from their prison service's authority, Litvin added. In Great Britain, for instance, "moving responsibility for prison medicine to the public health system improved the ability to recruit doctors, who then brought the standards of medical treatment under normal conditions with them to prison."
The Health Ministry seems likely to oppose that solution, because it has lately been divesting itself of direct responsibility for medical services. For example, it recently turned over responsibility for school nurses to an outside contractor.
Litvin believes other models could be explored, "such as transferring responsibility to the health maintenance organizations. The goal is to end doctors' subordination to IPS management."
The IMA concurs. "It's true that every doctor has a conflict of interests between the patient and the system in the HMOs, and also in the army," said Prof. Avinoam Reches, who heads the IMA's Ethics Board. "But in the case of the IPS, the problem is severe, because the treatment is given to people who have no freedom of choice whatsoever."
Litvin said the recent case of "Prisoner X" an Australian-Israeli dual citizen, whom foreign media have identified as Ben Zygier, who reportedly committed suicide in Ayalon Prison underscores the problem. "There were some who claimed that Zygier received psychiatric drugs without [the doctors] seeing him," she said. "It's not clear how that was done from a medical standpoint, but the case underscores how, under the existing situation, medicine is subordinated to the demands of security."
Dr. Ze'ev Wiener, a psychiatrist who volunteers with PHR, also had harsh words
for the current system. "The IPS management is liable to apply pressure, usually unseen, on [doctors] to change their decisions at the expense of the prisoner's health," he said.
The Health Ministry responded that "at this stage, no examination whatsoever is being conducted into making prison doctors directly subordinate to the ministry."