- 70 Moreover, discussions held with senior medical staff in the establishments visited revealed that they had the distinct impression of exercising no real influence over the management of the institutions, even as regards matters in which a medical opinion was essential. To sum up, it appeared that the objective of good management underlying sections 55 to 60 of the 1992 Act was not being met. In this respect, the CPT cannot overstate the importance of ensuring that all decisions relating to treatment policy and practice are preceded by close consultation with the medical and nursing authorities of the establishment concerned and ultimately rest with a body comprising suitably qualified individuals. c. legal guarantees relating to involuntary hospitalisation 217. The aforementioned 1992 Act on the modernisation and organisation of the health system inter alia amended the rules on admission of patients to psychiatric institutions. It enhances safeguards for patients in the context of involuntary hospitalisation and covers hospitalisation orders, possibilities of appeal, and review of placement. These provisions of the Act deserve to be described in full. 218. Under the new Act, patients can be hospitalised without their consent only where all the following conditions are met: the patient must be suffering from a mental disorder; the patient must be incapable of taking decisions which affect his health; it must be established that failure to hospitalise the patient would either be detrimental to his treatment or cause deterioration in his state of health. In addition, a patient suffering from a mental disorder may be hospitalised in order to prevent his inflicting bodily harm on himself or others. 219. According to the terms of section 96, involuntary hospitalisation is carried out at the request of the spouse, a parent or relative or any person having charge of the patient, or the guardian where the patient is legally incapacitated. Where there are no such persons, and in urgent cases, hospitalisation can be requested ex officio by the public prosecutor attached to the district court of the place where the patient is permanently or temporarily resident. Committal applications should be made to the competent public prosecutor and accompanied by medical opinions from two psychiatrists or, where a second psychiatric opinion cannot be obtained, by the opinion of a psychiatrist and of a doctor specialised in a related field. Upon admission, the patient must be informed of his rights, and in particular of his right of appeal, by the hospital director or by a representative of the director. A written record must be made of the fact that the patient has been informed of his rights, and it must bear the signatures of the person responsible for informing the patient and of the person escorting the patient. Where placement is ordered ex officio by a public prosecutor, or where the patient has refused to undergo the medical examinations required for obtaining the aforementioned opinions, the patient is sent to a public psychiatric hospital for the purpose of conducting the requisite examinations and issuing expert opinions. The patient's transfer must be carried out in a manner which preserves his dignity and personal integrity. Patients may not be held for more than 48 hours for the purpose of conducting the medical examinations.