CASE OF AMIROV v. RUSSIA
Violation of Article 3 - Prohibition of torture (Article 3 - Degrading treatment;Inhuman treatment) (Substantive aspect);No violation of Article 3 - Prohibition of torture (Article 3 - Degrading treatment;Inhuman treatment) (Substantive aspect)
Dmitry Dedov;Luis López Guerra
6. The applicant was born in 1954. He lived in the Republic of Dagestan and was the mayor of Makhachkala between 1998 and 2013. He is currently detained in correctional colony no. 6 in Orenburg Region (“the correctional colony”). 7. In June 2013 the applicant was arrested and placed in custody pending criminal proceedings against him. He suffered from several illnesses, including a urinary condition, a rectal prolapse, hepatitis C, and type 2 diabetes. He was confined to a wheelchair and had to use catheters and enemas to urinate and defecate. 8. On 12 August 2013 he lodged an application with the Court complaining that he was not receiving adequate medical assistance in detention. Four days later the Court indicated to the Russian Government under Rule 39 of the Rules of Court that he should be examined by medical experts. 9. On 27 November 2014 the Court delivered a judgment in the case, finding, inter alia, that there had been violations of Articles 3 and 34 of the Convention on account of the authorities’ failure to provide the applicant with adequate medical care or to comply with the interim measure indicated (see Amirov v. Russia, no. 51857/13, §§ 75, 93, and 94, 27 November 2014). 10. Relying on Article 46 of the Convention the Court held that the authorities should admit the applicant, at that time detained in remand prison no. 4 in Rostov-on-Don, to a specialised medical facility where he should remain under constant medical supervision and should be provided with adequate medical services corresponding to his needs; alternatively, the authorities could place him in a specialised prison medical facility, if the facility could guarantee the requisite level of medical supervision and care. (see Amirov, cited above, § 118). 11. After 27 November 2014, the date of the Court’s judgment in the applicant’s first case, he continued being detained in the remand prison pending the completion of his trial. 12. According to the information from the Government, in 2014 the applicant’s cell was re-equipped to take account of his needs as a wheelchair user. Handrails were installed near his bed and the toilet, and the furniture was put at a lower level in order to be accessible. Wheelchair ramps and a lift were installed in the detention facility. A room for personal-hygiene procedures needed by the applicant was located opposite his cell with all the necessary equipment. 13. In 2015 he was examined by various doctors, such as a general practitioner, a neurologist, a surgeon, a urologist, and a proctologist. He underwent basic medical tests and received the treatment he had been prescribed. The prison doctors found his overall condition to be satisfactory. 14. The applicant’s lawyers noticed, however, that his state of health had worsened. They solicited medical opinions on the treatment required. 15. On 14 July 2015 Dr W., a specialist in neurology, examined the applicant. He noted progressive muscular dystrophy, the development of leg convulsions, and urinary problems. An immediate admission to a specialised hospital for long-term treatment and urological surgery was recommended. The doctor said that further detention in prison would put the applicant’s life at risk. 16. On 30 October 2015 the applicant was examined by a forensic expert, Dr N., who confirmed the deterioration of his medical condition, and noted the development of bedsores. The doctor suggested that the applicant’s state of health might warrant early release on medical grounds and stated that he needed constant medical care. 17. On 22 January 2016 Dr N. assessed the quality of the medical care in the remand prison. He noted the absence of exercise therapy, physiotherapy, and massage, and was concerned that the prison premises were not sterile enough for hygienic procedures. 18. In the meantime, on 27 August 2015 the Military Court of the NorthCaucasus Circuit found the applicant guilty of having organised an act of terrorism and an attempt to murder an investigator in his case. He was sentenced to life imprisonment in a high-security correctional colony. The Supreme Court of Russia upheld the conviction and sentence on 24 March 2016. 19. On 1 April 2016 the applicant was sent to serve his sentence in the correctional colony. 20. He spent the first two weeks of his detention in an ordinary cell in the quarantine wing. According to a letter from the chairman of the Committee for Civil Rights sent to the applicant’s lawyer on 20 April 2016, the cell was not adapted to the needs of a wheelchair prisoner. The applicant depended on his fellow inmates, who assisted him in his daily needs, including helping him to perform enemas on himself. 21. Every day the applicant was taken, handcuffed and blindfolded, to the prison yard for exercise. 22. On 2 April 2016 he was examined by several prison doctors: a tuberculosis specialist, an infectious-diseases specialist, a dentist and a general practitioner. The latter recorded his illnesses, ordered blood and urine tests, and prescribed treatment, comprising of a special diet and drugs. He noted that the applicant needed regular catheterisation and enemas. Examinations by specialists in endocrinology, ophthalmology, gastroenterology, neurology, cardiology, urology, and surgery, and exercise therapy were recommended. 23. The applicant was regularly visited by the prison general practitioner in the quarantine wing and underwent blood and urine tests. The doctor was satisfied with his medical condition and the results of his treatment. 24. On 14 April 2016 the applicant was moved to medical unit no. 56 and placed in cell no. 12. He shared its space of 14 sq. m with one cellmate. The applicant was provided with a wide bed, a sink installed at a low level, and a medical couch, which he used during self-catheterisation procedures. Enemas were carried out in a separate room twice a week with the assistance of the medical unit staff. The custodial authorities continued handcuffing and blindfolding him while he was escorted to the yard. 25. On 11 May 2016 he was examined by several doctors: a general practitioner, an endocrinologist, a neurologist, and a urologist from the civilian hospital in Sol-Iletsk. According to the medical records kept by the doctors, his medical condition was acute. No recommendations for inpatient treatment or urgent medical measures were made. The endocrinologist ordered tests of his thyroid-gland hormones, which were carried out on the same day. The neurologist prescribed exercise. The latter prescription was endorsed by a prison doctor on 19 May 2016. 26. On 23 May 2016 the applicant was again examined by the endocrinologist, who noted, inter alia, the risk due to a low level of thyroid hormones. Another hormone test was prescribed for August 2016. 27. The applicant was examined by a medical board to establish whether he was entitled to early release on medical grounds. The board concluded that his medical condition did not warrant it. 28. From 6 to 8 June 2016 a commission of officials from the Russian Ombudsman’s Office, the Orenburg Ombudsman’s Office, the Orenburg prosecutor’s office, the Federal Service of the Execution for Sentences in Orenburg Region and medical unit no. 56 came to the applicant’s detention facility and examined the quality of his medical care. The commission concluded that it was adequate. 29. On 8 June 2016 the applicant was visited by an exercise-therapy specialist, who taught him exercises to support his health. It appears that this visit was a follow-up to previous visits by the specialist, in April and May 2016. However, the medical record does not disclose particular details of the recommendations made on those two previous occasions. 30. On 4 July 2016 two members of the Orenburg Regional Public Commission for Monitoring the Protection of Human Rights in Detention (Общественная наблюдательная комиссия Оренбургской области) inspected the colony. It appears that by the time of the inspection the applicant had been moved to another cell. The inspectors noted in particular, that the cell was divided into three sections by metal bars and housed six inmates. The applicant’s section measured 10.8 sq. m; it had a bath, a medical couch, a sink, and a bedside table with television set. The toilet was not partitioned from the rest of the cell and the applicant could be observed by his cellmate while using it. The correctional colony lacked wheelchair ramps, so the applicant could not freely access the yard or meeting rooms. He complained that the necessary drugs had had to be supplied by his relatives, owing to a lack of funds, which were to be allocated in the near future. Medical supervision was carried out by the general practitioner as regular examinations by other specialists had not been considered necessary. Allegedly owing to the applicant not having received medical massages, the applicant’s legs started convulsing. He was assisted by his cellmate, who helped him to get into bed. The applicant was not given a special diet. 31. On 11 August 25 October and 16 December 2016, and 19 April 2017 a special medical board of highly qualified civilian and prison doctors, and specialists in cardiology, endocrinology, neurology, and urology examined the applicant. They concluded that there was no need to admit the applicant to a specialist medical facility and that he could continue receiving treatment in the medical unit. The doctors were satisfied with the quality of medical care given to the applicant. 32. In the meantime the applicant’s lawyer complained to the Ombudsman of the Russian Federation of the applicant’s detention conditions and the poor quality of his medical treatment. The complaint was forwarded to the prosecutor’s office for the supervision of detention facilities in Orenburg Region. Having carried out enquiries, on 5 July 2016 the Office replied as follows: “It has been established that on admission to [the correctional colony the applicant] was placed in [a cell of the quarantine wing]. It was designed for two persons and measured 12 sq. m, which satisfied the requirements of the Execution of Sentences Act ... [The applicant’s] cellmate assisted him in his daily needs, which included hygienic procedures and moving around the cell. Accordingly, [the applicant] was not restricted in his rights ... The allegation that [the applicant] was not provided with special conditions [needed in his situation] is not true. His cell in the medical unit is furnished with a specially designed table, a bed and a sink, so he can easily access them and move freely about the cell. [The applicant] is assisted by the medical unit staff members and inmates in his movements within the medical unit, in particular when entering/leaving buildings in a wheelchair, and in his daily needs. As called for by [the applicant’s] disability and illnesses, he is examined by the prison doctors on a daily basis, he receives medical treatment as prescribed to the relevant medical standards, and he is provided with dietary nutrition. In May 2016 [the custodial authorities] provided him with a mattress [to prevent] bedsores. [The applicant] urinates with the help of a catheter which he inserts six to seven times per day (as recommended by [a urologist]). He defecates with the help of enemas performed every three days by medical staff from the medical unit. Detainees, who work in the medical unit, escort [the applicant] to a special room for that procedure and clean it afterwards. The regional medical standard “Procedures for simple medical procedures, desmurgy and immobilisation”, approved by an Order of the Ministry of the Health Care and Social Development of Orenburg Region on 5 March 2010 does not require catheterisation or enemas to be carried out in a sterile room. Sterile catheters and enemas tips are used by [the applicant]. In breach of Article 30 of the Penal Institutions Act (Federal Law no. 5473-1 of 21 June 1993), [the applicant] was escorted for walks handcuffed and blindfolded until 24 May 2016. Moreover, the inquiry, which had been performed earlier, revealed breaches of Article 101 § 7 of the Russian Code on the Execution of Sentences and Articles 10, 11, and 11.1 of the Social Protection of the Disabled in the Russian Federation Act (Federal Law of 24 November 1995 No. 181-FZ). [In accordance with the aforementioned Regulation, the applicant] should have been given the necessary devices (a wheelchair for mobility, an indoor wheelchair, a gel pillow to prevent bedsores, nappies for adults, and urinals). However, the custodial authorities have not provided him with those items. [Moreover,] the detention facility did not take measures to provide the exercise and sport therapy [for the applicant] indicated in his rehabilitation programme. In the light of the above, on 2 June 2016 the prosecutor’s office for supervision of detention facilities in Orenburg issued a formal order to the head of the correctional colony to rectify the identified shortcomings. The order has been ... complied with ... There are no grounds for a further intervention by the prosecutor ...”