CASE OF PATRANIN v. RUSSIA
Violation of Article 34 - Individual applications (Article 34 - Hinder the exercise of the right of petition);Violation of Article 3 - Prohibition of torture (Article 3 - Degrading treatment;Inhuman treatment) (Substantive aspect);Violation of Article 13 - Right to an effective remedy (Article 13 - Effective remedy)
Dmitry Dedov;Elisabeth Steiner;Julia Laffranque;Khanlar Hajiyev;Mirjana Lazarova Trajkovska;Paulo Pinto De Albuquerque
6. The applicant was born in 1976 and is detained in correctional colony no. 2 in the Tatarstan Republic. 7. Since 1999 the applicant has been suffering from progressive multiple sclerosis. He was designated with Category 1 disability as a result of that condition. 8. On 22 February 2012 the applicant was arrested on suspicion of active membership of an organised criminal group between 1995 and 2005 and the murder or attempted murder of several people in 1999. 9. The applicant’s health deteriorated significantly and rapidly in the detention facility, where his health complaints were not addressed in any way, as the facility did not have any medical specialists. In August 2012 the prison authorities recorded that the applicant’s movement was impaired and that he was unable to walk without a cane. 10. In September 2012 the applicant suffered an epileptic seizure which resulted in paralysis of the left side of his body. Several days later an investigator authorised a forensic medical examination of the applicant to determine whether he was fit to stay in a detention facility. A medical examination, based, inter alia, on the results of an MRI exam performed by civilian experts from the Tatarstan Republic medical institute, led to the conclusion that the applicant was suffering from “a serious condition preventing his detention”. In particular, experts diagnosed him with progressive multiple sclerosis, left-sided hemiplegia (paralysis) in the cerebral spinal form, acute right-sided hemiparesis (muscle weakness of the right side of the body) with the persistent astheno-depressive syndrome, memory deterioration, partial atrophy of the visual nerves, symptomatic epilepsy with polymorphic partial motor and generalised attacks three to four times a month, arterial hypertension of the first degree, and light myopathy of both eyes. On 25 September 2012 the applicant was released from detention. 11. On 29 May 2013 the Supreme Court of the Tatarstan Republic found the applicant guilty as charged and sentenced him to ten years’ imprisonment, to be served in a correctional facility under a strict regime. The trial court, however, decided that the applicant should not be placed in custody pending appeal proceedings. On 3 September 2013 the Supreme Court of the Russian Federation upheld the judgment on appeal. 12. On 17 September 2013 the applicant asked the Supreme Court of the Tatarstan Republic to order a medical examination for him with a view to confirming that he was not fit for detention. The request was not processed. 13. The applicant was taken into custody on 8 October 2013. He was placed in a prison hospital in correctional colony no. 2 in the Tatarstan Republic. 14. In November 2013 the applicant underwent an MRI test and was examined by several doctors, including by a neurologist, from the prison hospital in correctional colony no. 2. Their decision issued on 23 November 2013 indicated that given the negative prognosis for and the severity of the applicant’s condition, he should be sent for a forensic medical examination to determine whether he could be released early on health grounds. The doctors relied, inter alia, on the results of the MRI examination, which had shown that in comparison to the results of the previous MRI exam in September 2012 the applicant’s illness had progressed significantly and demonstrated further negative dynamic. The applicant was informed by the prison administration that they would seek his immediate release on health grounds. 15. However, a week later the applicant was notified that an additional expert examination was to be performed. Two medical experts visited the applicant, spoke with him and informed him that his condition did not warrant release. On 20 January 2014 the applicant was served with a copy of an opinion by the two medical experts who had concluded that he did not suffer from any condition listed in Government Decree no. 54 of 6 February 2004 on illnesses warranting release on health grounds, as his condition had not yet reached the crucial stage which required early release. 16. Relying on a number of medical certificates and reports issued by medical specialists from civilian medical facilities, who had either treated him following his release from detention in September 2012 or had studied his medical history in 2013, the applicant argued that he was unable to care for himself and that he required constant assistance, care and medical treatment which the Russian penal system was not able to provide. In particular, a report issued in September 2013 by a neurologist from the Tatarstan Republican hospital indicated that the applicant had no movement on the left side of his body and could only partly move the fingers of his right hand and his right leg; he could not walk or sit without assistance; and he required assistance even if placed in a wheelchair. Another report indicated that the applicant was suffering from urethral dysfunction leading to involuntary urination, an additional element calling for constant care. The civilian doctors concluded that the stage of development of the applicant’s illness was 9 (with death expected to occur according to that scale at stage 10). 17. Having provided copies of his complaints to various Russian authorities, the applicant submitted that his requests for an independent medical examination to determine whether he could remain in detention, as well as his complaints about the lack of proper medical assistance, had gone unanswered. 18. The applicant argued that he spent his entire day in bed. Prison doctors, who had no proper training to deal with patients in his condition, came to see him only once every few days. He had not been bathed for months. He could not eat or drink unaided, so he received food once a day. He suffered from severe pain, as he could not defecate and the medical personnel only gave him an enema once every two weeks. He did not receive any treatment, and had not been seen in detention by specialists such as a neurologist. 19. On 12 February 2014 the Court, in response to the applicant’s request under Rule 39 of the Rules of Court, decided to indicate to the Government that the applicant should be examined immediately by medical experts independent of the penal system, including by a neurologist and an epileptologist. The experts were to be asked whether the treatment and physical care the applicant was receiving was adequate for his condition, whether his current state of health was compatible with detention in the conditions of a correctional colony or a prison hospital, and lastly whether the applicant’s current condition required him to be admitted to a specialised hospital or released. The Russian Government were also asked to ensure the applicant’s immediate transfer to a specialised hospital if the medical experts concluded that he required to be admitted to such a hospital. 20. In response to the Court’s request, the Government provided the Court with a typed copy of the applicant’s medical history prepared by the detention authorities; certificates issued by the head of the applicant’s correctional colony and the head of the Service for the Execution of Sentences in the Tatarstan Republic; and a copy of the report drawn up on 25 December 2013 by a medical panel comprising the head, deputy head and senior inspector of the medical unit of the Service for the Execution of Sentences in the Tatarstan Republic and a deputy head of the prison hospital of correctional colony no. 2, where the applicant was detained. Relying on those documents, the Government argued that the applicant was receiving adequate medical assistance and that the medical panel of the Service for the Execution of Sentences in the Tatarstan Republic had concluded that “the degree of the manifestation of the applicant’s condition (multiple sclerosis) did not [reach the level] which could be described as bodily function impairment” warranting release in compliance with the Government’s decree of 6 February 2004 which laid down a list of illnesses calling for inmates’ early release. 21. The applicant commented on the Government’s information, insisting that the medical assistance afforded to him was virtually nonexistent. He relied on his medical record, and stated that prior to the application of the interim measure under Rule 39 of the Rules of Court he had been prescribed over twenty different drugs, of which, as indicated in the record, he had only received five. At the same time the applicant argued that the medical record was a forgery, as he had in fact only received one drug. Following the application of the interim measure he had been allowed to obtain certain medication from his wife to treat the epilepsy. He further submitted that the prison hospital where he was an inmate did not have the necessary medical equipment. He had usually been taken to another hospital for examinations, or a specialist with the proper equipment had been allowed to visit him in the prison hospital. The prison hospital only employed a neurologist, a specialist who, according to her own assessment, did not have the skill to treat the applicant’s complex condition. Despite the fact that the applicant’s condition was progressing and that the prognosis for him was negative, the authorities had not taken any steps to alleviate his sufferings and safeguard his life and limb. 22. The applicant submitted that since March 2014 he had developed new health problems, but the medical staff of the prison hospital had failed to address the ongoing deterioration of his health. In particular, he had begun suffering from kidney pain, but no nephrologist was available in the prison hospital. On 18 March 2014 the applicant was diagnosed with urinary tract infection, but no appropriate treatment followed. Several days later the applicant complained to an otolaryngologist of a purulent discharge from his left ear and severe pain. However, medical staff failed to comply with the otolaryngologist’s recommendations. 23. At the request of the applicant’s wife, on 18 April 2014 he was examined by a panel consisting of the deputy head of the prison hospital and several prison doctors. The commission found that the applicant did not suffer from bodily function impairment warranting his release. 24. On several occasions the applicant’s wife complained to the Prosecutor General and to the prison authorities, requesting an independent medical assessment. In their replies the authorities informed her that allegations of lack of adequate medical assistance had not been confirmed, and thus there were no grounds to order the applicant’s medical examination. 25. However, on 29 July 2014 a medical panel of the prison hospital, having confirmed the applicant’s earlier diagnosis, recommended his early release. In August 2014 the applicant’s wife lodged a motion for his release before the Privolzhskiy District Court of Kazan. 26. At the hearing held on 14 November 2014 the District Court heard the applicant’s attending prison doctor who stated that he had not and could not receive adequate treatment in respect of his multiple sclerosis in detention and that such treatment could only be provided in a specialised hospital, in particular in the Republican diagnostic centre of demyelinised illnesses. On the same day the District Court dismissed the motion for release. The applicant’s lawyer appealed. 27. In the meantime, on 15 December 2014 the applicant was transferred to correctional colony no. 9 in the Chuvashia Republic to continue serving his sentence. Three days later, following a visual medical examination, he was admitted to medical unit no. 21 in the colony which was to determine the issue whether the applicant’s condition called for his early release. According to the applicant, colony no. 9 did not employ a neurologist and had no means to deal with a patient of his health. 28. On 13 January 2015 the Supreme Court of the Tatarstan Republic quashed the decision of 14 November 2014 and sent the matter for a new examination to the District Court. 29. During the re-hearing on 19 February 2015 the Povolzhskiy District Court took note of the applicant’s transfer to a new colony and decided that it no longer had territorial jurisdiction to examine the applicant’s motion for release. The case was sent to the Tsivilsk Town Court in the Chuvashia Republic for further examination. 30. On 13 January 2015 a medical commission comprising three specialists from medical unit no. 21 issued a report finding that the applicant’s condition made him eligible for an early release. That report was filed with the Tsivilsk Town Court which on 26 February 2015 authorised the applicant’s release, having relied on the report of 13 January 2015 and statements by the head of medical unit no. 21. The latter had testified to the gravity of the applicant’s condition and the impossibility to provide him with adequate treatment or permanent general care and assistance in detention. The applicant was released on 11 March 2015 and taken by an ambulance to a hospital in Kazan. 31. The applicant provided the Court with expert opinions issued on 21 March and 5 August 2014 by neurologist M. from the Republican Medical Institute. Having examined the applicant and studied his medical file, the expert recorded negative dynamics in the applicant’s neurological condition, and found that he had not received the drugs necessary to treat his multiple sclerosis. The doctor recommended that the applicant undergo specific treatment in the Institute or in foreign hospitals, and noted that the lack of such treatment could lead to irreversible deterioration of the applicant’s health and eventually to his death. 32. The Government produced, in addition to the documents submitted by them in response to the Court’s Rule 39 request, a number of certificates signed by the staff and administration of the prison hospital, as well as by a fellow inmate. According to those certificates, the applicant was provided with the necessary care in the hospital. Medical staff fed him three times a day, washed his face and ears every morning, cut his hair and nails, changed his bedding, and showered him once a week. Nurses gave him enemas and changed his catheter bag as often as necessary.