KORPACHYOVA-HOFBAUER v. BULGARIA
Inadmissible
George Nicolaou;Guido Raimondi;Ledi Bianku;Nona Tsotsoria;Paul Mahoney;Yonko Grozev
1. The applicant, Ms Alisiya Yurieva Korpachyova-Hofbauer, is a Bulgarian national who was born in 1979 and lives in Wanfried, Germany. She was represented before the Court by her mother, Ms V. Shopova, who on 13 October 2014 was granted leave by the President of the Section under Rule 36 § 4 (a) of the Rules of Court to act on her daughter’s behalf in the proceedings before the Court. 2. The Bulgarian Government (“the Government”) were represented by their Agent, Ms D. Dramova, of the Ministry of Justice. 3. The facts of the case, as submitted by the parties and established by the Court, may be summarised as follows. 4. On 6 February 2012 the applicant, who suffered from a schizoaffective disorder, attacked her mother with a knife in their home. The police, who had been called by the applicant’s mother, arrested the applicant and took her to a centre for psychiatric health in Sofia. She remained there until 22 February, when the Sofia District Court ordered her to be transferred to Sveti Ivan Rilski State Psychiatric Hospital in Novi Iskar for two months’ compulsory treatment. The applicant appealed against that order, challenging in particular the court’s ruling as to the precise facility in which she was to be treated. Her mother, who was heard as a witness in the course of the appeal proceedings, also stated that she would prefer the applicant to be treated elsewhere, preferably as an outpatient. The Sofia City Court dismissed the appeal on 6 March 2012. 5. Sveti Ivan Rilski State Psychiatric Hospital, which is State-owned and operated, is situated at the outskirts of the town of Novi Iskar, at about one kilometre from the nearest neighbourhood, about eighteen kilometres from the centre of Sofia, and about four kilometres from Sofia’s ring road. It was created in 1949, using some of the premises of a nearby monastery, and consists of several buildings. 6. During the first week of her stay in that hospital, the applicant was placed under a “heightened security regime”, which meant she was not allowed to leave her ward unaccompanied. According to the hospital’s director, placing patients whose compulsory treatment had been ordered by a court under that regime was common practice as it allowed for an initial assessment of their condition. 7. After the first week the applicant’s regime was relaxed and she was allowed to move around the hospital grounds and take part in art therapy sessions. As her mental health improved – according to the Government as a result of the medication that she was given – her regime was relaxed even further, and between 15 and 17 March 2012 she was granted home leave. On 29 March 2012 her treatment continued on an outpatient basis, which meant that after that date she was only required to be present at the hospital during the day for medication and art therapy, but did not have to stay overnight. 8. The applicant’s compulsory treatment came to an end on 20 April 2012. 9. The applicant submitted that during the first week of her stay in Sveti Ivan Rilski State Psychiatric Hospital she had been assaulted by another patient. In the course of the hearing of the applicant’s appeal against the Sofia District Court’s order for her compulsory treatment, the applicant’s mother gave evidence that the applicant had told her that on 29 February 2012 a newly arrived patient had assaulted her in the shower, pushing her in the chest. She had however not sustained any injuries as a result, and had not called for help, apparently because she had felt scared. When her mother had visited her the next day, 1 March, the two had brought the incident to the attention of three members of the nursing staff, who had advised the applicant to call for help if such an incident were to occur again. On the basis of that evidence, the appellate court accepted that an incident with another patient had taken place. However, it noted that the proper way to deal with such matters was not to seek transfer to another hospital but to inform the nursing staff and ask them to take steps to avert future incidents, which was exactly what had happened. In the course of the same hearing the applicant said that the temperature in the hospital was too low for her to feel comfortable and that as a result she had a sore throat. 10. According to the applicant, conditions in the hospital were quite poor, characterised by insufficient funding and staffing levels, inter-patient violence, low temperatures in winter and frequent flooding. The hospital’s director had herself said in media interviews that the premises were old and impractical, with broken and mouldy walls and broken tiles, and that there had been cases of violence, including on one occasion against the director herself. 11. In support of her allegations, the applicant referred to a report by the Ombudsman of the Republic of Bulgaria drawn up after members of his staff had inspected the hospital on 26 June 2012 in their capacity as designated national preventive mechanism under Article 17 of the 2002 Optional Protocol to the United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (2375 United Nations Treaty Series 237), which entered into force in respect of Bulgaria on 1 July 2011. 12. The report began by noting that one of the hospital’s chief problems was its remoteness, which rendered access for patients’ relatives difficult, especially in winter. The other big problem was that the premises and the hygienic and material conditions did not live up to the applicable medical standards. The buildings were old and in a “deplorable” state of repair, despite partial renovation works carried out about a month before the inspection. The equipment was outdated and inadequate. As a result of a damaged dyke on the nearby Iskar River, the premises were flooded every year. The room in which food was being served to patients had leaks, mould on the ceiling and rusty equipment. 13. Patients were accommodated in rooms with three or four beds each. Each of the hospital’s wards housed about thirty-five patients and had two bathrooms and two toilets, found by the report to be “utterly insufficient”. Patients were allowed out of their rooms for one to one-and-a-half hours per day. Visits were permitted twice a week and had to take place in the yard, weather permitting. At the time of the inspection the hospital had one hundred and forty patients. Thirty-two of them were in the female ward, which was staffed by three medical doctors, one psychologist, eight nurses and ten orderlies. The hospital lacked almost all of the medical equipment required under the applicable regulations. It had never been audited, and did not properly record medical conditions other than the mental illnesses in connection with which the patients had been admitted. Patients who died in the hospital were not subjected to an autopsy, and patients who had to be restrained were not kept separate from other patients, as required under the applicable regulations. 14. In view of those findings, the report recommended that the hospital gradually be closed and transferred to new premises in Sofia. 15. In a letter to the Ombudsman dated 16 August 2014 in response to that recommendation, the Ministry of Health explained that the hospital’s possible relocation had been discussed on several occasions, but no decision had yet been taken. 16. Between 29 July and 1 August 2014 a team from the Ministry of Health audited the hospital, and on 18 August 2014 drew up a report. With regard to material conditions in the hospital, the audit report likewise noted that its premises were in a very poor state of repair and “dangerous for the health and lives” of patients and staff. It also noted that the buildings were regularly flooded, and that their foundations were not waterproof. Minor repair works such as repainting and a partial renovation of the roof had been carried out in 2012 and 2013. 17. The report, which also addressed the applicant’s situation, noted that the ward in which she had been kept had rooms with three or four beds each, and two bathrooms and toilets. The building, which had a local steam heating system, did not have proper isolation and could not be optimally heated. The nurses had kept records of room temperatures, taking the following readings at the time of the applicant’s stay: 17 degrees Celsius during the night of 23 February 2012, and 18 degrees Celsius during the nights of 25 February and 3 March 2012. The report also noted that in the applicant’s ward, patients were free to leave their rooms and move around. Those of them who, like the applicant initially, were placed under the “heightened security regime” were not allowed to leave the ward unaccompanied, in order to avoid acts of aggression, suicides or escapes, and were kept under constant supervision. 18. A report about the hospital aired by Darik Radio on 4 April 2011 and available online described derelict buildings with cracked walls, missing plaster and mould. According to that report, in winter temperature in some of the wards did not exceed 13 degrees Celsius. At the time of the journalist’s visit the hospital’s kitchen had been flooded. The poor state of the premises was also described in reports aired on 7 April 2011 by TV7 and on 24 January 2014 by Nova TV, also available online.