Background and aimsThe detainees’ right to healthcare is granted by laws, in accordance with EU directives and recommendations to which our country has consented. Prison population is a particularly vulnerable and marginalized group characterized by mortality rates different from the general population. This study aims at providing a picture of the causes of death, quality of healthcare and measures needed to reduce the number of in-prison deaths, including legal medicine expertise in view of sentence postponement/interruption.MethodsThe present paper is based on the statistical analysis of in-prison deaths casework recorded at the Forensic Medicine Institute of Cluj-Napoca and provided by territorially subordinated counties forensic services. The data collected cover over 15 years (2000–2014), a period long enough for significant retrospective statistical analysis.ResultsThe total number of deaths among the inmates was 113, the majority of male sex (110). Distribution by age groups shows a greater incidence among inmates aged 50 to 59 years (32 cases, 28.31%), followed by those in their 40s’ (30 cases, 26.54%) and 30s’ (25 cases, 22.12%). The most frequent pathological causes of death were cardiovascular (53 cases) followed by tumors (26 cases) and infectious diseases. A significant number of deaths were due to violent causes (14 cases-12,38%).ConclusionsSpecial problems are raised by the high number of deaths among prisoners, especially at a young age, while the high frequency of violent deaths from self- or non-self-inflicted traumatic causes requires supervision, monitoring and continuous analysis. Despite recent improvements, healthcare in prisons still poses some problems, mainly regarding diagnosis and treatment of heart diseases, neurosurgery and cancer.

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Background and aimApproaching the convicted patient is a topical issue in terms of alignment with EU provisions and recommendations, more so in the context of year by year increase in the number of convicts and consequently, prison patients. The prison patient exhibits increased vulnerability in regard to the rest of the convicts due to his/her medical status overlapping personality changes induced, while coping with a new environment. This represents a challenge for the physicians involved in the expertise process, which must act objectively within the limits and by the principles of professional ethics, while confronting a patient influenced by the prison environment.MethodsWe studied the existing legal and ethical framework concerning the expertise in view of sentence postponement/interruption on medical grounds and made a comparison between the theoretical information available and the “real life” situations encountered in our experience at the Institute of Legal Medicine Cluj-Napoca. Following this step we tried to establish some principles needed to optimize health care in the penitentiary system by detecting and sanctioning situations of deceptive behavior, doubled or not by simulation and over-simulation.ResultsConvicts present pathologies documented in medical records, but accuse new symptoms that could suggest a new pathological condition. During the expertise, convicted patients emphasize their symptoms and/or claim new symptoms unrelated to their documented medical condition. Convicts submit repeated requests for which treatment solutions within the NAP healthcare system had been already formulated.ConclusionThe patient must be properly informed about the steps to be taken and duration expected in performing a legal medicine expertise in pursuit of sentence postponement or interruption for the treatment of a medical condition that cannot be properly addressed within the NAP sanitary system. Information should come from authorized sources. Efforts to determine unauthorized sources (mainly “experienced” detainees with records of unsubstantiated demands) are surely beneficial.