THE RIGHT TO HEALTH IN PRISON: RESULTS OF A NATIONWIDE SURVEY AND REPORT 4.5 Although prisons in Malaysia sought to improve the delivery of healthcare by appointing ‘Panel Doctors’ (at the time of the survey), the number of doctors placed at the prisons were severely disproportionate to the number of prisoners. For instance, in a prison105 with 4,612 prisoners (at the time of the survey), only 2 doctors were available. Also of concern is the lack of female doctors to treat female prisoners. 4.6 The Commission found that most prison doctors were not adequately trained to do the work they face because they were only trained in the delivery of primary health care, without sufficient experience in diagnosing and treating communicable diseases, drug abuse and more importantly, mental health. 4.7 The Commission cautions that the failure to employ sufficient and qualified doctors in prisons would mean that the health problems may be left unattended leading to unnecessary suffering, sometimes with fatal consequences. Dual Loyalty 4.8 If the prison doctor serves dual roles, functioning as both medical specialist and at the same time is directly subordinated to the prison director rather than being part of a civil healthcare structure, he or she will have a very difficult and sensitive role to fulfil.106 In terms of medical ethics, doctors should never be involved in security or disciplinary matters of any kind.107 4.9 Dual loyalty may be defined as “clinical role conflict between professional duties to a patient and obligations, express or implied, to the interests of a third party such as an employer, an insurer, or the state.”108 The dual loyalty faced by medical doctors in prison is between their patients (prisoners) and the prison administration. Kajang Prison Custodial and Non-Custodial Measures: The Prison System Criminal Justice Assessment Toolkit. Accessed via https://www. unodc.org/documents/justice-and-prison-reform/cjat_eng/1_Prison_%20System.pdf on 29/2/16 107 Principles of Medical Ethics relevant to the Role of Health Personnel, particularly Physicians, in the Protection of Prisoners and Detainees against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. Adopted by General Assembly resolution 37/194 of 18 December 1982. Accessed via http://www.ohchr.org/EN/ProfessionalInterest/Pages/ MedicalEthics.aspx on 29/2/16 108 Dual Loyalty in Prison Health Care by Jörg Pont, MD, Heino Stöver, PhD, and Hans Wolff, MD, MPH. Accessed via http:// www.ncbi.nlm.nih.gov/pmc/articles/PMC3487660/#bib1 on 29/2/16 105 106 64