Case of E.A. v Russia

Application no. 44187/04, 23 May 2013 (health treatment in detention and ill-treatment):

45.  The Court reiterates that under Article 3 of the Convention the State must ensure that a person is detained in conditions which are compatible with respect for his human dignity, that the manner and method of the execution of the measure do not subject him to distress or hardship of an intensity exceeding the unavoidable level of suffering inherent in detention and that, given the practical demands of imprisonment, his health and well-being are adequately ensured by, among other things, providing him with the requisite medical assistance (see Kudła v. Poland [GC], no. 30210/96, § 94, ECHR 2000‑XI).

45.  The Court reiterates that under Article 3 of the Convention the State must ensure that a person is detained in conditions which are compatible with respect for his human dignity, that the manner and method of the execution of the measure do not subject him to distress or hardship of an intensity exceeding the unavoidable level of suffering inherent in detention and that, given the practical demands of imprisonment, his health and well-being are adequately ensured by, among other things, providing him with the requisite medical assistance (see Kudła v. Poland [GC], no. 30210/96, § 94, ECHR 2000‑XI).

46.  Where complaints are made about a failure to provide necessary medical assistance in detention, it is not indispensable for such a failure to have led to a medical emergency or have otherwise caused severe or prolonged pain in order for the Court to find that a detainee was subjected to treatment incompatible with the guarantees of Article 3 (see Ashot Harutyunyan v. Armenia, no. 34334/04, § 114, 15 June 2010). Article 3 cannot be interpreted as laying down a general obligation to release a detainee on health grounds, save for in exceptional cases (see Papon v. France (no. 1) (dec.), no. 64666/01, ECHR 2001-VI, and Priebke v. Italy (dec.), no. 48799/99, 5 April 2001), or to place him in a civil hospital to enable him to obtain a particular kind of medical treatment. However, a lack of appropriate medical treatment may raise an issue under Article 3 even if the applicant’s state of health did not require his immediate release.

47.  The national authorities must ensure that diagnosis and care in detention facilities, including prison hospitals, are prompt and accurate, and that, where necessitated by the nature of a medical condition, supervision is regular and systematic, and involves a comprehensive therapeutic strategy aimed at adequately treating the detainee’s health problems or preventing their aggravation (see Dirdizov v. Russia, no. 41461/10, § 95, 27 November 2012, and Sakhvadze v. Russia, no. 15492/09, § 83, 10 January 2012).

48.  On the whole, while taking into consideration “the practical demands of imprisonment”, the Court reserves a fair degree of flexibility in deciding, on a case-by-case basis, whether any deficiencies in medical care were “compatible with the human dignity” of a detainee (see Aleksanyan v. Russia, no. 46468/06, § 140, 22 December 2008).

49.  The Court reiterates that an unsubstantiated allegation of no, delayed, or otherwise unsatisfactory medical care is normally not sufficient to disclose an issue under Article 3 of the Convention. A credible complaint should normally include, among other things, sufficient reference to the medical condition in question, medical prescriptions that were sought, made or refused, and some evidence – for instance, expert reports – capable of disclosing serious failings in the applicant’s medical care (see Valeriy Samoylov v. Russia, no. 57541/09, § 80, 24 January 2012).

50.  The Court also reiterates that its task is to determine whether the circumstances of a given case disclose a violation of the Convention in respect of an applicant, rather than to assess in abstracto the national legislation of the respondent State, its regulatory schemes or the complaints procedure used by an applicant. Thus, mere reference to the domestic compliance with such legislation or schemes, for instance as regards licensing of medical institutions or qualifications of medical professionals, does not suffice to oppose an alleged violation of Article 3 of the Convention. It is fundamental that the national authorities dealing with such an allegation apply standards which are in conformity with the principles embodied in Article 3 (ibid., § 81).

51.  Concerning its own scrutiny, the Court reiterates that, in view of the subsidiary nature of its role, it must be cautious in taking on the role of a first-instance tribunal of fact where this is not rendered unavoidable by the circumstances of a case. The Court has held in various contexts that where domestic proceedings have taken place, it is not the Court’s task to substitute its own assessment of the facts for that of the domestic courts and, as a general rule, it is for those courts to assess the evidence before them (see, among others, Giuliani and Gaggio v. Italy [GC], no. 23458/02, §§ 179 and 180, 24 March 2011). Although the Court is not bound by the findings of domestic courts, in normal circumstances it requires cogent elements to lead it to depart from the findings of fact reached by those courts (ibid.).

52.  In its assessment of issues under Article 3 of the Convention, the Court gives thorough scrutiny to the question of the authorities’ compliance with the prescriptions issued by medical professionals, in the light of the specific allegations made by an applicant (see Vladimir Vasilyev v. Russia, no. 28370/05, § 59, 10 January 2012).

65.  The Court has been unable to assess on the basis of the available information whether the applicant’s HIV status in 2003 to 2006 required (HA)ART or whether some other form of medical care was appropriate and afforded to him. The fact remains, however, that for several years there was no proper immunological assessment to determine the appropriate time to initiate antiretroviral therapy. It was not until 2007, that is, nearly four years after the authorities had learned of the applicant’s illness, that he was enabled to commence the therapy.

66.  These considerations are sufficient for the Court to conclude that in the circumstances of the present case the authorities failed to comply with their responsibility to ensure the provision of adequate medical care to the applicant (see A.B. v. Russia, §§ 132-135, and Koryak, § 102, both cited above).

67.  In view of the gravity of the applicant’s medical condition and the respondent Government’s omission to substantiate their position regarding the absence of any need for medical care in relation to the applicant’s HIV between 2003 and 2006, the case discloses a failure on the part of the respondent State leading to a situation in which the applicant can be said to have been subject to distress or hardship of an intensity exceeding the unavoidable level of suffering inherent in detention. The Court thus considers that the authorities’ failure amounted to inhuman and degrading treatment within the meaning of Article 3 of the Convention.

68.  There has therefore been a violation of this provision.

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