5.  The applicant was born in 1974 and is currently serving a sentence in Jelgava Prison. 6.  On 3 November 1987, at the age of thirteen, he was examined in a neuropsychiatry centre and diagnosed with conduct disorder that had resulted from early central nervous system damage. He was registered with a psychiatrist, but did not pay any visits to the psychiatrist. 7.  On 21 February 1991 at the age of seventeen, he was again examined in a neuropsychiatry centre with the same diagnosis. It was recommended that he undergo an inpatient medical examination, but he failed to arrange such an examination. 8.  On 11 December 1997 the applicant was arrested. 9.  Following hearings from 6 to 23 September 1999, on the latter date the Zemgale Regional Court (Zemgales apgabaltiesa) convicted the applicant of aggravated murder and robbery and sentenced him to fifteen years’ imprisonment. 10.  On appeal and having examined the results of the first inpatient forensic psychiatric examination of the applicant (see paragraphs 23 and 24 below), the Criminal Chamber of the Supreme Court (Augstākās tiesas Krimināllietu tiesu palāta) upheld the ruling of the first-instance court. 11.  On 28 December 2000, after initial hearings in connection with a charge of theft which had been brought against the applicant, the Jelgava Court (Jelgavas tiesa) ordered the second inpatient forensic psychiatric examination of the applicant in view of concerns about his mental health (see paragraphs 25 and 27 below). 12.  Further hearings took place between May and December 2001. On 19 February 2002 the Jelgava Court ordered the third inpatient forensic psychiatric examination of the applicant in view of his behaviour during the trial (see paragraphs 28 to 31 below). The experts conducting the examination were specifically asked to consider if the applicant had been suffering from a mental illness after February 2001. During this examination, a primary arachnoid cyst in the applicant’s brain was discovered (see paragraphs 28 to 31 below). 13.  On 11 September 2002 the Jelgava Court ordered the fourth inpatient forensic psychiatric examination. The examination results showed that the cyst had doubled in size (see paragraphs 32 and 33 below). 14.  Following hearings from 24 to 28 December 2002, on the latter date the Jelgava Court convicted the applicant of aggravated theft and sentenced him to three years’ imprisonment, which term was less than the statutory minimum of six years’ imprisonment for the crime owing to his state of health, but found that he had full mental capacity. The sentences handed down in the first and second sets criminal of proceedings were combined to a total of fifteen years and ten months’ imprisonment. 15.  On 14 February 2003 the Zemgale Regional Court admitted an appeal brought by the applicant against the ruling of the first-instance court and scheduled the first appellate hearing for 1 April 2003. During that hearing the applicant suddenly felt ill. An ambulance was called to his aid and pain-relieving injections were administered to him. On the same date, the proceedings were stayed owing to the deterioration of the applicant’s state of health. On 7 May 2003 the applicant was informed that the appellate proceedings would commence when his state of health improved. 16.  On 22 January 2004 the Zemgale Regional Court upheld the applicant’s conviction but reduced the total term of imprisonment to fifteen years. It appears that no appeal on points of law was lodged. 17.  During his pre-trial detention and for the first years of his sentence the applicant was mainly held in two prisons, both of which were located next to each other in Rīga – Matīsa Prison and Central Prison. On 1 November 2008 these prisons were merged into one Rīga Central Prison (Rīgas centrālcietums). 18.  On 2 November 2006 a request by the applicant to serve his sentence in Jelgava Prison was granted and he was transferred to serve his sentence there. 19.  At various times the applicant was admitted to a prison hospital, which provided somatic and psychiatric inpatient care for sentenced and remand prisoners from all of the prisons in Latvia. The hospital was located on the premises of Central Prison in Rīga. On 1 November 2007 the hospital in Central Prison was closed. 20.  On 26 June 2008 the applicant was recognised as being Category 3 disabled. 21.  On 10 March 1998 the applicant underwent an outpatient forensic psychiatric examination (ambulatorā tiespihiatriskā ekspertīze) in a neuropsychiatric hospital in Jelgava (Jelgavas psihoneiroloģiskā slimnīca). This examination had been ordered by the investigative authority. The experts found that the applicant had antisocial personality disorder but recommended that the courts declare him to have full mental capacity (pieskaitāms). 22.  On 21 March 2000 the applicant underwent an outpatient forensic psychiatric examination at the prison hospital. This examination had been ordered by the appellate court in connection with the first set of criminal proceedings in view of the deterioration of the applicant’s health after the fight on 5 December 1998 (see paragraph 35 below). The experts did not reach any conclusions, but recommended an inpatient examination of the applicant because he had complained of memory impairment. 23.  On 28 June 2000 the applicant was admitted to a psychiatry centre (Psihiatrijas centrs) for one month for the purpose of an inpatient forensic psychiatric examination (stacionārā tiespsihiatriskā ekspertīze). He was examined by an ophthalmologist, a neurologist, a therapist, a narcologist and a psychologist. Several clinical tests, an ultrasound test and an electroencephalograph (“EEG test”) were carried out. The applicant told the doctors, among other things, that he had suffered memory impairment after the events of 5 December 1998 (see paragraph 35 below). 24.  On 27 July 2000 the experts issued their report, no. 51-2000. They found that the applicant had antisocial and borderline personality disorders. The examination had not revealed any particular memory impairment. No mental illness had been detected. The experts opined that there were no demonstrable changes in the applicant’s mental state which would have interfered with his ability to understand and direct his actions. He could participate in and follow the court hearings. It was recommended that the courts declare him to have full mental capacity. 25.  The applicant was admitted to the psychiatry centre again on 22 January 2001 for one month. During his stay at the centre he was examined by an ophthalmologist, a neurologist and a psychologist; several clinical tests and an EEG test were carried out. The latter showed minor negative dynamics compared to the previous EEG test results. Otherwise, the results of the second examination were identical to the first one. 26.  On 16 February 2001 the experts issued their report, no. 18-2001. The experts opined that any changes in the applicant’s mental state had not interfered with his ability to understand and direct his actions at the time of the offence. 27.  One of the experts who had conducted this examination gave evidence at the applicant’s trial in September 2001 before the Jelgava Court, stating that no trauma to the applicant’s head that could have influenced his mental health had been detected. She stated that the trauma that the applicant had sustained in 1998 had not affected his memory. 28.  The applicant was admitted to the psychiatry centre again on 18 March 2002 and remained there until 2 May 2002. He was examined by an ophthalmologist, a neurologist and a therapist; several clinical tests and an EEG test were carried out. The applicant was also subjected to an experimental psychological test. 29.  In addition, on 24 April 2002 a computed tomography (CT) scan on the applicant’s head was carried out and a primary arachnoid cyst stretching across the left temporal and frontal lobes measuring 4x5x7 cm was discovered. He was then examined by a neurosurgeon, who recommended mild dehydration for the next three months. After that period, he suggested another CT scan to determine a further course of treatment. 30.  On 30 April 2002 the experts issued their report, no. 53-2002. They opined that the applicant did not suffer from a mental illness but that he had an organic personality disorder, as well as a mild cognitive disorder. He suffered from sudden attacks of temporary and mild psychotic conditions. Therefore, at that time the applicant was not fit to participate in the court hearings – he had to be observed and treated in the prison hospital’s neuropsychology department. Another CT scan had to be performed after three months in order to decide on the need for neurosurgery. 31.  One of the experts who had conducted this examination gave evidence at the applicant’s trial in December 2002 before the Jelgava Court. It was her opinion that the applicant was suffering from a mental disorder, which was comparable to a mental illness. She explained that, prior to the third inpatient examination, it had been considered that the applicant had been fabricating his symptoms. According to her, the applicant ought to receive treatment – the number of epileptic seizures (lēkmes) he was suffering ought to be reduced, as every seizure damaged his brain cells. A lack of treatment could lead to dementia (plānprātība). It was her view that the applicant’s condition necessitated treatment under the supervision of a neurologist and regular examinations by a neurosurgeon, a psychiatrist and a psychologist. 32.  During this examination another CT scan revealed that the cyst had grown to the size of 10x10x5 cm. The doctors described it as “huge” and “visually impressive”. According to the neurologist and neurosurgeon, no particular treatment or surgery was necessary. It was recommended to monitor the applicant’s medical condition and, if necessary, to carry out another CT scan, EEG test and other examinations. The expert’s report, no. 109-2002 of 31 October 2002, concluded that the applicant did not suffer from a mental illness. It was recommended that he be declared to have full mental capacity. 33.  One of the experts who had conducted this examination gave evidence at the applicant’s trial in December 2002 before the Jelgava Court. According to her, the applicant’s head injury in 1998 might have caused the cyst to shift. She also testified that no treatment was necessary for the applicant, save for consultations with a neurologist. The expert asserted that an individual could live with such a cyst for many years, provided it was not affected by blows or other impacts. A cyst would not normally cause any disturbance provided that the individual did not suffer any injuries. The applicant ought to avoid any impacts to his head. 34.  Prior to 5 December 1998 the applicant had not complained to the prison medical staff of pain in his head or memory impairment. He had made other complaints such as, for example, of toothache, which had been addressed by admitting him to the prison hospital for treatment between 27 November and 4 December 1998. 35.  On 5 December 1998 the applicant was involved in a fight with other detainees in Central Prison in Rīga and received a blow to his head which caused a concussion and knocked him unconscious for a short while. The applicant was taken to the prison hospital on a stretcher and admitted to the neuropsychology department for examination. The applicant complained of headache and dizziness. The applicant had bruises on his neck and in the area of his back and chest. No damage to his central or peripheral nervous systems was detected after an examination by a neurologist. No fractures were detected on his head and chest after an X-ray examination. The applicant refused to receive pain relieving injections. He was discharged from the hospital ten days later. 36.  On 9 April 1999 the applicant consulted a psychiatrist and complained of headache, insomnia, hearing voices, anxiety, agitation and irritability. The applicant explained that the reason for his refusal to receive injections after the events of 5 December 1998 had been his fear of being poisoned. The doctor concluded that the applicant was fabricating his symptoms. 37.  During the forensic outpatient examination on 21 March 2000 the applicant complained of memory impairment. He also raised this complaint during the first and the second inpatient forensic examinations, in June 2000 and January 2001 respectively. Finally, during the third inpatient forensic examination in March 2002 he complained of constant headache. 38.  On 28 March 2003 the head of the medical unit of Matīsa Prison reported that the applicant’s medical condition had deteriorated and that medical treatment was necessary. 39.  According to the information provided by the Government, the applicant was admitted to the prison hospital for the following periods:
(i) between 3 and 20 January 2003;
(ii) between 20 February and 6 March 2003;
(iii) between 6 November and 4 December 2003;
(iv) between 8 and 29 April 2004;
(v) between 27 January and 17 February 2005;
(vi) between 26 May and 7 June 2005;
(vii) between 16 and 22 September 2005;
(viii) between 25 October and 11 November 2005; and
(ix) between 17 May and 21 June 2006.
As concerns the applicant’s treatment for those periods the Government referred to the fact that: (a) the applicant had been examined by a neurologist, a neurosurgeon, an ophthalmologist, a psychiatrist, a radiologist and an otolaryngologist; (b) two CT scans of the applicant’s head had been carried out; and (c) the necessary clinical examinations had been performed. 40.  According to the Government, in 2007 the applicant had twelve consultations with the medical staff at Jelgava Prison. The applicant was admitted to the prison hospital on 15 October 2007 and remained there at least until 29 October 2007. During that period he was examined by a neurologist, a surgeon and an ophthalmologist and received some medication (for example, diazepam and piracetam). 41.  On 11 December 2007 and 12 June 2008 two more CT scans of the applicant’s head were carried out. The size of the arachnoid cyst remained largely unchanged. 42.  From 17 January to 17 February 2003, at the applicant’s request, the Inspectorate for Quality Control of Medical Care and Working Capability (“the MADEKKI”) examined the adequacy of the applicant’s medical treatment in prison. It was concluded that the applicant’s medical condition had deteriorated and that medical treatment was necessary, including dehydration. 43.  On 19 February 2003 the MADEKKI informed the applicant that it had advised the Prisons Administration to ensure further medical examinations were carried out and to arrange for him to have a consultation with a neurosurgeon. It appears that a CT scan of the applicant’s head was carried out on 28 February 2003 and a neurosurgeon examined its results. The MADEKKI concluded on 17 March 2003 that its recommendations had been implemented. 44.  From 10 January to 13 February 2004, at the applicant’s request, the MADEKKI examined the adequacy of the applicant’s medical treatment for the second time. It concluded that further medical examinations had been carried out but that the applicant had not had a consultation with a neurosurgeon in person. No surgery was needed. A further CT scan was recommended after six months. 45.  On 13 February 2004 the MADEKKI informed the applicant that it had advised the Prisons Administration to ensure further medical examinations were carried out and to arrange for him to have a consultation with a neurosurgeon. 46.  From 27 April to 25 May 2005, at the applicant’s request, the MADEKKI examined the adequacy of the applicant’s medical treatment for the third time. It was established that the applicant was being examined twice a year by a neurologist and an ophthalmologist. The conclusion was that further CT scans and consultations with a neurosurgeon were not necessary, as no damage to his health had been detected. 47.  From 7 November 2005 to 2 January 2006, at the applicant’s request, the MADEKKI examined the adequacy of the applicant’s medical treatment for the fourth time and found no shortcomings in the applicant’s medical care. 48.  On 8 March 2004, following a request by the applicant, the prosecutor’s office refused to order a forensic medical examination with a view to the possible release of the applicant on health grounds, as it determined that he had not fallen ill with a mental illness or another illness. It was noted that his medical condition was congenital. 49.  At the same time, Matīsa Prison’s governor asked the prosecutor’s office to order a forensic medical examination. In reply, the prosecutor’s office instructed the Prisons Administration to commission a medical panel to decide on the necessity of such an examination. It appears that they reached the conclusion that the forensic examination was not necessary because, at that time, the applicant was not suffering from any mental disorder. 50.  On 16 March 2005, following a repeated request by the applicant, relying on the previous year’s findings by the medical panel, the prosecutor’s office refused to order a forensic examination. 51.  On 13 May 2005, on the applicant’s complaint, a superior prosecutor explained that because the applicant’s medical condition had not deteriorated a forensic examination would not be ordered. 52.  On 26 August 2005, following a request by the applicant, the prosecutor’s office instructed the Prisons Administration’s medical unit to examine the applicant’s state of health and to decide if a medical examination was necessary with a view to the possible release of the applicant on health grounds. 53.  On 23 September 2005 the Prisons Administration informed the applicant that its medical unit had decided that a medical examination was not necessary because his state of health continued to be satisfactory. 54.  At the end of 2005, the applicant complained to the prosecutor’s office of the deterioration of his state of health. 55.  On the prosecutor’s request, on 15 June 2006, a medical examination of the applicant with a view to his possible release was carried out by medical staff of the Prisons Administration: three psychiatrists, one neurologist and one internist. They examined the applicant in person, his medical records and his medical condition and arrived at the conclusion that there were no grounds to initiate the applicant’s release under section 116 of the Sentence Enforcement Code. 56.  On 29 June 2006 the Prisons Administration informed the applicant that they did not have the authority to order a forensic medical examination. It was noted that the applicant’s state of health was satisfactory. 57.  On 14 July 2006 the prosecutor’s office once again confirmed to the applicant that there were no grounds to order a forensic medical examination.