CASE OF LITVINOV v. RUSSIA
No violation of Article 3 - Prohibition of torture (Article 3 - Degrading treatment) (Substantive aspect);Violation of Article 13 - Right to an effective remedy (Article 13 - Effective remedy)
Branko Lubarda;Dmitry Dedov;George Nicolaou;Helen Keller;Helena Jäderblom;Johannes Silvis;Luis López Guerra
6. The applicant was born in 1964 and, until his arrest, lived in St Petersburg. 7. On 26 June 2010 the applicant was arrested on suspicion of aggravated kidnapping and extortion committed within an organised criminal group and with the use of firearms. He remained in detention throughout the investigation and trial. 8. On 22 June 2012 the Leningrad Regional Court found the applicant guilty as charged and sentenced him to nine years’ imprisonment in a high-security correctional colony. 9. The Supreme Court of Russia upheld the sentence on appeal on 8 November 2012. 10. The parties provided the Court with extensive medical evidence, including the applicant’s clinical records, medical certificates, expert reports, and opinions by various medical specialists. 11. The evidence shows that the applicant had a long history of heart and kidney diseases. In 2007 he suffered a stroke, closed craniocerebral injury and cerebral contusion. The following year he suffered a myocardial infarction and was admitted to a hospital for in-patient treatment. A medical examination carried out by the hospital revealed a deterioration in the functioning of his kidney. He was prescribed a basic drug regimen, which was supervised by a cardiologist and a nephrologist. Upon discharge from the hospital, his state of health was considered satisfactory. 12. After the applicant’s arrest he was taken to a temporary detention centre in the town of Vsevolzhk, and six days later, on 2 July 2010, to temporary detention facility no. IZ-47/1 in St Petersburg (“facility no. IZ47/1”). On admission to the detention facility, the applicant underwent a general medical check-up performed by the prison doctor, who concluded that he was “somatically healthy”. Eleven days later he underwent an electrocardiogram, which revealed hypertrophy of the left ventricle of his heart and myocardium insufficiency. The prison doctor recommended in-patient care. 13. On 16 July 2010 the applicant was transferred from the detention facility to hospital no. 2 of medical ward no. 78 of the Federal Service for the Execution of Sentences (“prison hospital no. 2”). An electrocardiogram and blood and urine tests were performed in the hospital, leading to diagnosis of third-stage hypertension, third-stage arterial hypertension, coronary disease, firstdegree angina pectoris, sclerotic kidney, fourth-stage chronic kidney disease, and chronic renal insufficiency of the second degree. He was prescribed drug therapy comprising enalapril, aspirin, spironolactone and other medication. 14. On the day following his admission to the hospital, the applicant made a written refusal to receive injections of hypotensive medication, arguing that they could lead to a sharp drop in his blood pressure. 15. The applicant’s clinical records show that he received drug treatment for hypertension in the hospital. His blood pressure and body temperature were regularly monitored. 16. On 13 August 2010 the applicant was discharged from the hospital and transferred to facility no. IZ-47/1. The discharge certificate indicated that his treatment had not produced the expected results, with the applicant’s arterial blood pressure remaining at a high level. It recommended a consultation with a cardiologist and a nephrologist in order to adjust his treatment. 17. Two months later, on 13 October 2010, the applicant was taken to hospital no. 1 of medical ward no. 78 of the Federal Service for the Execution of Sentences (“prison hospital no. 1”), where he was examined by several doctors, including a cardiologist and a nephrologist. He underwent several medical examinations, which revealed that his angina pectoris had progressed to the third stage. He was also diagnosed with firstdegree encephalopathy of mixed genesis. His antihypertensive drugs regimen was adjusted accordingly. The doctors recommended regular monitoring of his blood pressure, creatinine and urea levels. The applicant was certified as having a third-degree disability on 2 December 2010. 18. In December 2010, the applicant’s wife, anticipating his discharge from the hospital, complained to the head of the Regional Department of the Federal Service for Execution of Sentences in St Petersburg and Leningrad Region and to the Investigative Committee of the Leningrad Region that the applicant’s medical treatment had been inadequate and about his impending transfer from the hospital to a temporary detention facility. On 18 January 2011 the Investigative Committee dismissed the complaint. The complaint to the Regional Department of the Federal Service for Execution of Sentences was also unsuccessful. 19. On 3 December 2010 the applicant was sent back to facility no. IZ47/1. He was seen by a therapist. His treatment continued as prescribed in the hospital. 20. On 14 December 2010 an independent cardiologist, Dr F., chosen by the applicant’s wife, issued a report assessing the quality of the applicant’s treatment in detention. He observed that the applicant’s health, and in particular his heart condition, had deteriorated while in detention. He noted that after the arrest the applicant had not been given medication or appropriate dietary nutrition. Serious emotional conditions aggravated by the incarceration had also contributed to the deterioration of his health and increased the risk of a stroke, fatal heart attack or kidney failure. Dr F. recommended dietary nutrition, basic treatment and regular monitoring of the applicant with a view to adjusting his drug therapy if necessary. These and the subsequent recommendations of Dr F. were submitted to the authorities by the applicant’s lawyer or wife and appear to have been included in his medical file. 21. On 14 January 2011 a prison doctor ordered the applicant’s medical examination. A week later the applicant underwent a biochemical blood test and a urine test. His diagnosis was re-confirmed and the doctor recommended continuing his treatment with hypotensive drugs. 22. On 21 February 2011 Dr F. prepared a new report pertaining to the quality of the applicant’s treatment. He suggested that the applicant’s hypertension may have become drug-resistant and that a kidney tomography examination with a contrast agent was necessary in order to choose the correct treatment regimen. 23. A week later the applicant was taken back to prison hospital no. 2. A number of medical examinations and tests revealed that he was also suffering from renal hypoplasia and chronic latent pyelonephritis. 24. The applicant subsequently acquired an acute respiratory infection and was prescribed treatment for it. This led to a change in his hypertension therapy, primarily by decreasing the dosage and excluding certain drugs. His angina pectoris attacks became worse, and he was transferred to hospital no. 1 where his condition was brought under control. He was given, among other drugs, high dosages of anticoagulants. He was discharged from the hospital on 22 March 2011 on condition that he remained on the prescribed drug regimen and that his blood pressure and creatinine and urea levels were regularly monitored. 25. From 22 March to 14 April 2011 the applicant was held in facility no. IZ-47/1. The records submitted to the Court do not indicate what drugs or other treatment the applicant received during this period. 26. In the meantime, in March 2011 Dr F. studied the applicant’s clinical records and recommended that he undergo a coronary angiography examination, as well as haemodialysis to define the correct treatment and to prevent possible progress of his kidney disease. 27. On 14 April 2011 the applicant was taken back to hospital no. 2 with a view to adjusting his treatment. 28. Four days later Dr F., an independent nephrologist, Dr G., and the head of the prison hospital examined the applicant in the hospital. They recorded a further deterioration of his heart and kidney functions and suggested that his treatment with anticoagulants might be incorrect given the high risk of heart failure or internal hemorrhage. The doctors recommended that he undergo a coronary angiography examination and a renal tomography or Doppler ultrasound examination. 29. Another examination of the applicant by Dr F. and an independent cardiologist, Dr M., on 22 April 2011 led to the following opinion: the applicant had received adequate hypotensive therapy, which had nevertheless resulted in the aggravation of his hypercreatinemia. They observed that the coronary disease had started prevailing over the remaining diseases and suggested that the applicant’s therapy should be based on regular treatment with anti-aggregants, nitrates and statins. The doctors stressed that there was a high risk of the applicant’s condition deteriorating and leading to his death as a result of heart failure, a stroke or myocardial infarction, should prison medical personnel fail to perform a coronary angiography examination or surgery. 30. On 18 May 2011 the applicant was discharged from the hospital and transferred to temporary detention facility no. IZ-47/4 in St Petersburg (“facility no. IZ-47/4”). 31. On the following day the investigative authorities ordered the applicant’s expert examination. A medical commission was to answer several questions, including whether the applicant’s diseases posed a threat to his life and whether his further detention was compatible with his condition. According to expert report no. 200/K of 27 May 2011, the applicant was suffering from third-degree hypertension, third-stage arterial hypertension, chronic heart insufficiency of the second degree, first-degree chronic venous insufficiency, chronic coronary disease, second-degree angina pectoris, sclerotic kidney, second-stage chronic renal insufficiency, the initial stage of cerebral atherosclerosis, and dyscirculatory encephalopathy of the first degree. The commission stated that those illnesses required constant monitoring and adequate drug therapy. Any breach of his treatment regimen could induce life-threatening complications. The commission nevertheless concluded that the applicant’s condition did not warrant his release from detention. 32. At the end of May 2011 the applicant wrote a note refusing two injections and intravenous therapy and stating that he had lost trust in the attending medical personnel. On one occasion in June 2011 he refused to take a certain medicine, having noted that he had already taken similar drugs earlier that day. 33. On 1 July 2011 the applicant was examined by Dr F., who observed that the authorities had failed to give him necessary drugs and that the applicant’s relatives had had to step in and supply the prescribed medication. He nevertheless noted positive changes in his state of health. Dr F. again strongly insisted that the applicant needed to undergo a coronary angiography examination. 34. The applicant’s wife complained to the Representative of the Russian President in the North-West Federal Circuit of the applicant’s poor treatment in detention. The complaint was to no avail. She also complained to the St Petersburg Ombudsman. On 26 July 2011 the Ombudsman recommended that the applicant’s wife complain before the courts, apply for the applicant’s early release on medical grounds, or complain to the administration of the detention facility. 35. On 11 and 25 August 2011 Dr F. and a doctor from facility no. IZ47/4 examined the applicant. In their joint report they noted that for a considerable amount of time the applicant had not received even basic vital medication because none had been available in the detention facility. In particular, the applicant did not receive spironolactone, aliskiren, clopidogrel and isosorbide mononitrate. Only the latter drug was substituted with analogous medication. The applicant’s hypertension and coronary disease had deteriorated. The two doctors therefore recommended his admission to hospital. 36. On 19 September 2011 the applicant was examined by Dr G., who found that his kidney disease had progressed to stage three. The doctor stressed that an angiography examination at that stage of the development of the applicant’s illness posed a risk of irreparable damage to the applicant’s kidneys. However, the risk of heart failure was even higher, and therefore an angiogram was vital. 37. On 8 October 2011 the applicant was transferred to the Mariinskiy Hospital of St Petersburg for a coronary angiography examination. He underwent a number of tests in the hospital. A coronary angiography examination performed on 8 December 2011 revealed up to 75% arterial stenosis. The discharge certificate of 13 December 2011 prescribed the installation of a coronary stent. The surgery was to be performed in due course. 38. On 19 December 2011 the applicant was admitted to prison hospital no. 2, where he underwent various medical tests and examinations. 39. In a report prepared after the applicant’s examination on 20 January 2012, Dr F. and the head of the prison hospital stated that he had not received any statins. The absence of this drug had caused an increase in the applicant’s cholesterol level and deterioration in the lipid metabolism indices. In addition, the doctors observed that the applicant’s renal protective therapy had been insufficient and his blood pressure had not been monitored regularly. As a result, his kidney disease had progressed. 40. On 26 April 2012 in the course of the criminal proceedings against the applicant, the trial court ordered his expert examination with a view to updating the information about his state of health, particularly in the light of the results of his coronary angiography examination. In a report issued on 29 May 2012 experts confirmed that there was a high risk of heart complications, including lethal ones. They noted that the applicant’s state of health called for vascular surgery, drug treatment and the limitation of stress. 41. On 16 June 2012 the applicant was discharged from the hospital for a “breach of regimen”, namely his refusal to be examined by two doctors. He continued his treatment as an outpatient. 42. On 14 December 2012 the applicant was readmitted to prison hospital no. 1. 43. In January 2013 Dr G. and Dr F. again assessed the quality of the medical treatment provided to the applicant. They concluded that he had received adequate treatment, that he was in need of endovascular surgery and that his impending transfer to a correctional colony would be incompatible with his state of health. 44. The applicant spent another month in hospital no. 2. 45. On 18 March 2013 the applicant was sent to a correctional colony in the Mordoviya Republic to serve his sentence. 46. Meanwhile, on 1 April 2013 the applicant’s wife complained to the Prosecutor General, the Federal Service for the Execution of Sentences, medical ward no. 78 and other authorities of the continuous failure to properly diagnose and treat her husband. She received no response. 47. On 12 April 2013, after several weeks on the road, the applicant reached correctional colony no. IK-385/5 (“colony no. 385/5”). On admission he was seen by a doctor who confirmed his diagnoses and prescribed clinical blood and urine tests, an electrocardiogram, and examinations by a therapist, a cardiologist and a psychiatrist. Five days later, the applicant was prescribed basic drugs for coronary heart disease and hypertension. On 23 April 2013 he was examined by a psychiatrist, who did not find any acute pathology. 48. The applicant was admitted to prison hospital no. 21, where he spent the first two weeks of June 2013. He was seen by a doctor and again underwent various medical examinations, including blood and urine tests, electrocardiography and ultrasound tests. His diagnoses were confirmed and dietary nutrition and a specific drug regimen were prescribed. 49. From 13 August to 27 September 2013 the applicant was admitted to medical ward no. 13 of the correctional colony. A doctor monitored his health and adjusted his treatment regimen. 50. The applicant spent the entire month of October 2013 in transit between several detention facilities. At that time he contracted acute pharyngitis, which was successfully treated. 51. On 30 October 2013 the applicant’s health significantly deteriorated and he was admitted to the therapeutic department of medical ward no. 13. Tests revealed that he had kidney stones and a benign liver tumour. The applicant’s drug regimen was amended. His condition was considered to have been stabilised. 52. The discharge report issued to the applicant upon his discharge from the medical ward on 22 November 2013 indicated that he was to consult a heart surgeon and a nephrologist. 53. According to the applicant, following his discharge from the ward he was immediately sent to Saransk for the recommended examinations. The journey took over two weeks. 54. On 6 December 2013 a nephrologist and a heart surgeon examined the applicant and diagnosed him with second-degree chronic renal insufficiency, coronary disease, third-degree angina pectoris and atherosclerosis of the arterial vessels. Symptomatic treatment was prescribed for his kidney disease. A coronary angiography examination was also to be performed. In addition, the neurologist noted that the applicant’s state of health did not require haemodialysis. 55. On 24 January 2014 the applicant underwent a coronary angiography examination in Saransk Town hospital. It revealed up to 75% arterial stenosis with an unstable atherosclerosis plaque. Doctors authorised and immediately performed an urgent coronary angioplasty and a coronary stent was installed. The surgery was successful.