CEDH · CASELAW;JUDGMENTS;CHAMBER;ENG — 5 février 2015

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RUSSIA   (Application no. 46404/13)               JUDGMENT     STRASBOURG   5 February 2015       FINAL   05/05/2015   This judgment has become final under Article 44 § 2 of the Convention. It may be subject to editorial revision.   In the case of Khloyev v. Russia, The European Court of Human Rights (First Section), sitting as a Chamber composed of:   Isabelle Berro, President,   Elisabeth Steiner,   Khanlar Hajiyev,   Mirjana Lazarova Trajkovska,   Julia Laffranque,   Ksenija Turković,   Dmitry Dedov, judges, and Søren Nielsen, Section Registrar, Having deliberated in private on 13 January 2015, Delivers the following judgment, which was adopted on that date: PROCEDURE 1.     The case originated in an application (no. 46404/13) against the Russian Federation lodged with the Court under Article 34 of the Convention for the Protection of Human Rights and Fundamental Freedoms (“the Convention”) by a Russian national, Mr Andrey Ruslanovich Khloyev (“the applicant”), on 22 July 2013. 2.     The applicant was represented by Mr S. Golubok and Mr   D.   Laktionov, lawyers practising in St Petersburg. The Russian Government (“the Government”) were represented by Mr G. Matyushkin, the Representative of the Russian Federation at the European Court of Human Rights. 3.     The applicant alleged, in particular, that he had not received adequate medical assistance while in detention and that he had been remanded in custody without valid reasons. 4.     On 3 October 2013 the President of the First Section, acting upon the applicant’ s request, decided to apply Rules 39 and 41 of the Rules of Court, indicating to the Government that the applicant should be immediately examined by medical experts independent from the penitentiary system with a view to determining (1) whether the treatment he was receiving in the temporary detention facility was adequate for his condition; (2) whether his state of health was compatible with the conditions of his detention; and (3) whether his condition required his placement in a hospital. 5.     On 18 November 2013 the application was communicated to the Government. Among other matters the Court asked the Government whether their response to the Court’s decision to impose, on 3   October 2013, an interim measure under Rule 39 of the Rules of Court could entail a breach of Article 34 of the Convention. THE FACTS I.     THE CIRCUMSTANCES OF THE CASE 6.     The applicant was born in 1974 and lives in St. Petersburg. A.     The applicant’s detention 7.     On 28 February 2012 the applicant was arrested on suspicion of having organised a stable criminal group to commit several counts of aggravated kidnapping, extortion, robbery and possession and trafficking of firearms. 8.     On the following day the Oktyabrskiy District Court of St. Petersburg accepted the investigator’s motion for the applicant’s remand in custody, having linked the necessity to detain him to the gravity of the charges against him and the risk of his absconding, reoffending and obstructing justice. In particular, the District Court noted the applicant’s potential to influence his accomplice, Mr G. (the prosecution’s main witness in the case against the applicant), and stressed that firearms had been found in the applicant’s car during his arrest and that he was skilled in combat and fighting military techniques, as well as that he had a serious military experience. The District Court took into account the investigator’s argument that there was a serious risk of the applicant tampering with witnesses, including with other members of his criminal group by mounting threats against them and their family members. In addition, the investigators argued, and the District Court found it convincing, that the applicant was attempting to contact other members of the criminal group to plot their defence, in particular taking into account his authority within the criminal group and his connections to the criminal underworld. The District Court linked the applicant’s potential to reoffend to, among other things, the fact that, in addition to the firearms discovered in the applicant’s car, a large arsenal of firearms had been found in the accomplices’ houses. It finally noted the applicant’s potential to abscond given his frequent travelling to various regions of the Russian Federation prompted by the nature of his activities. The District Court concluded that no alternative measure of restraint could mitigate the cited risks. That decision became final on 21   March 2012 when the St. Petersburg City Court upheld it on appeal having fully accepted the District Court’s reasoning. 9.     On 25 April 2012 the Oktyabrskiy District Court authorised the applicant’s detention until 21 June 2012, having mainly cited the similar reasons as in its previous detention order. Having mentioned the risk of collusion and, in particular, possible threats to witnesses from the applicant, the District Court relied on handwritten statements by Mr G. and a Mr K. expressing fear for their lives and lives of their relatives. In addition, the District Court noted that a number of members of the criminal group were on the run, which provided ground to conclude, that if released, the applicant could use his influence to interfere with the investigation. A month later the St. Petersburg City Court fully endorsed the District Court’s reasoning and upheld the extension order on appeal. 10.     By another detention order issued on 19 June 2012 the District Court extended the applicant’s detention until 21 August 2012, having essentially relied on the same reasons as on the previous occasions. That detention order was also challenged on appeal and, with the appeal having been unsuccessful, became final on 10 July 2012. 11.     Another extension followed on 17 August 2012 when the District Court accepted a request of an investigator to keep the applicant detained until 21 November 2012. The reasoning for the extension was slightly amended with the District Court citing the complexity of the case, the risk of the applicant’s tampering with witnesses, in particular Mr G. and Mr K. who had expressed their fear of the applicant in view of murder threats they had received, the risk of his absconding in view of his having worked in another region of the Russian Federation with his work requiring a large number of trips, and a possibility for the applicant, if released, to contact other accomplices who had not yet been apprehended. That extension order was also supported by the St. Petersburg City Court, on 19   September 2012. 12.     Subsequent extension orders were issued by the District Court on 12   November 2012 and 24 January 2013, respectively, with the reasons for the applicant’s detention remaining the same as on the previous occasions. The detention order of 12 November 2012 was quashed on appeal by the City Court which on 10 January 2013, having remitted the matter back to the District Court, decided that it was necessary, in the meantime, to authorise the applicant’s detention until 24 January 2013. The detention order of 24   January 2013 was upheld by the City Court on appeal. Each time the court concluded that no alternative measure could mitigate the risks of the applicant’s absconding, reoffending or obstructing judgment. The District Court also was not convinced that the applicant’s health warranted his release. 13.     The following request for extension lodged by an investigator was examined by the St. Petersburg City Court on 28 February 2013. Referring to Article 5 of the European Convention on Human Rights, the City Court found it necessary to keep the applicant in detention given, in particular, the gravity of the charges against him and the particular complexity of the case. The applicant’s arguments of a difficult family situation and precarious health condition which, in his eyes, called for his release, did not convince the City Court. That decision was upheld by the appellate division of the City Court a month later. 14.     A detention hearing on 20 May 2013 before the City Court was adjourned following the applicant’s complaints of poor state of health and his having been attended to by an emergency medical team. Given that the applicant was unfit to continue participating in the hearing, he was taken back to the temporary detention facility. 15.     On the following day the City Court authorised the applicant’s detention until 28 August 2013, having cited the usual grounds, such as complexity of the case, the gravity of the charges, the applicant’s combat skills, and fears of Mr G. and Mr K. for their life and limb should the applicant be released. Having addressed the defence argument pertaining to the applicant’s extremely grave health condition, the City Court concluded that he could receive necessary medical attention in detention. 16.     At a hearing held on 25 June 2013 in response to the defence appeal against the detention order of 21 May 2013, the appellate division of the City Court heard an expert who had supported the view that the applicant’s health was rapidly deteriorating in detention and that urgent medical care was required to preclude any further grave consequences to his health. Having concluded that the necessary medical services could be provided to the applicant in detention and that the extension of his detention until 28   August 2013 was warranted by all the pertinent reasons cited in the detention order, the appellate division dismissed the appeal. A cassation appeal against the detention order of 21 May 2013, as upheld on 25   June 2013, was rejected by a City Court’s judge without hearing on the merits on 26 August 2013. 17.     Having noted that the applicant and his defence team were studying the case file, on 26 August 2013 the City Court authorised the applicant’s custody until 28 October 2013. The remaining factors cited by the City Court as those warranting the continuation of the detention were the same: the gravity of the charges and the usual fears of the applicant colluding or reoffending. The defence arguments pertaining to the applicant’s state of health were dismissed as unreliable given that the expert opinions confirming the dangers to the applicant’s health in the absence of the proper medical assistance in detention were summoned in violation of “procedural requirements”. The appellate division of the City Court dismissed the appeal against that detention order on 13 September 2013. B.     The applicant’s medical condition 18.     On 10 April 2012 the applicant was subjected to a medical examination in detention facility no. 1 where he stayed at the time. The examination also included a chest X-ray exam which did not reveal any pathology. During the following examination by a prison physician on 10   May 2012 the applicant acknowledged his suffering from chronic viral hepatitis C. On 14 September 2012 following complaints of stomach pain, nausea and vomiting, he was diagnosed with an acute attack of the chronic gastritis and received treatment. A week later his diagnosis was amended to include diabetes. He was transferred to the Gaaza prison hospital for inpatient treatment. 19 .     The applicant stayed in the hospital until 11 October 2012 having received treatment in respect of the following diagnoses: sub-compensated first-type diabetes, diabetic polyneuralgia, chronic hepatitis C in the moderately active state. Having diagnosed the applicant with the left-sided pneumonia of the upper lobe of the lung, doctors suspected tuberculosis. The infiltrative pulmonary tuberculosis was confirmed by an X-ray examination on 26 September 2012. However, no bacteriological testing was performed to see whether the applicant was smear-positive. Another X ‑ ray exam performed two weeks later did not show any dynamic in the illness process. The applicant received treatment with hepatoprotectors and antibiotics. 20 .     On his release from the Gaaza hospital the applicant was transferred to prison hospital no. 2 where he stayed until 18 October 2012 having continued treatment with antibiotics. A culture test performed in the hospital showed that the applicant was smear-positive. The applicant’s transfer to tuberculosis hospital no. 3 followed. On his admission to that hospital the applicant was diagnosed with acute right-sided lower-lobe pneumonia, first ‑ type diabetes and polyneuropathy of the lower extremities. The applicant’s condition was considered satisfactory. An X-ray test performed on 19   October 2012 resulted in the applicant having been diagnosed with pleuropneumonia in the lower lobe of the right lung. He received antibacterial treatment with enlarged drug doses. The smear and culture testing produced negative results. The applicant also underwent clinical blood and urine testing. A tomography of the left lung performed on 25   October 2012 did not demonstrate any signs of the disintegration process. The applicant was transferred from the tuberculosis hospital to prison hospital no. 1 with his diagnosis having not been entirely confirmed. In particular, doctors placed a “question mark” in his medical record having cited such conditions as an abscess of the lung or empyema. At the same time, a medical certificate prepared in the tuberculosis hospital showed that between 23 and 28 October 2012 the applicant was subjected to another series of culture and sputum smear testing. However, the results of those tests which showed that the applicant was MBT positive were only received by the facility in December 2012 which led to his return to the tuberculosis hospital (see paragraph 22 below). 21.     Another month and a half, until 26 December 2012, the applicant spent in prison hospital no. 1. His diabetes took a “moderately grave” course. He was still continued being diagnosed with pneumonia having tested sputum smear and culture negative. At the same time the doctors’ reading of an X-ray exam performed on 7 November 2012 raised a suspicion of the applicant suffering both from the infiltrative tuberculosis of the upper lobe of the left lung and the right-sided pneumonia. The applicant was seen by a tuberculosis specialist who prescribed treatment with four anti-tuberculosis drugs, including isoniazid, rifampicin, ethambutol and pyrazinamide. Twenty days later he was examined by an endocrinologist who amended his insulin therapy and introduced new hepatoprotectors in his regimen. Another exam performed in the first days of December 2012 showed a positive dynamic in the arrest of the pneumonia process and no dynamic in the infiltrative tuberculosis process in the left lung. 22 .     However, following a smear-positive test of the applicant, he was transferred back to tuberculosis hospital no. 3 on 26 December 2012 with the following diagnosis: smear-positive infiltrative tuberculosis, moderately grave course of the sub-compressive first-degree diabetes, diabetic polyneurologia and chronic hepatitis C. The applicant’s condition on his admission to the hospital was considered “sufficiently satisfactory”. As appears from the medical record, he continued receiving antibacterial chemotherapy with four first-line anti-tuberculosis drugs. His regimen also included hepatoprotectors, vitamins and insulin. An X-ray exam performed on 28 December 2012 disclosed the resolution of the infiltration process in the lower lobe of the lung. At the same time a test performed in October 2012 the results of which were received in January 2013 showed that the applicant developed multi-drug resistance, in particular to the majority of the first-line drugs, including streptomicin, ethambutol, isoniazid, rifampicin, cycloserine and rifabutin. That test led to the amendment of the applicant’s chemotherapy regimen with the mentioned drugs having been excluded from his therapy and second-line anti-tuberculosis drugs having been introduced. 23 .     Tests performed in the tuberculosis hospital demonstrated that the applicant’s tuberculosis was in the disintegration stage. Further X-ray tests performed each two months showed minimal dynamic of the tuberculosis process. The applicant continued being seen at least once a month by an endocrinologist who recorded the negative development of the applicant’s diabetes which he linked to the tuberculosis process. 24.     On 5 April 2013 the applicant’s anti-tuberculosis treatment was interrupted given particularly negative results of the liver functions clinical tests. Three months later the applicant resumed antibacterial treatment with second-line anti-tuberculosis drugs. The applicant stayed in pre-trial detention facility no. 6 to which tuberculosis hospital no. 3 was attached. It appears that he was subsequently transferred between medical unit no. 78 of the detention facility and tuberculosis hospital no. 3. C.     The Court’s request for information and Rule 39 request 1.     Request for information 25.     On 19 July 2013 the applicant asked the Court to apply Rule 39 of the Rules of Court and to authorise his transfer to a specialised civil medical facility as an interim measure. 26.     The applicant claimed that the medical assistance he was receiving in detention was insufficient in view of his very grave diseases which required constant medical supervision by specialised medical staff. The prison doctors were incompetent to deal with a patient in his condition. According to the applicant, such inadequate medical assistance resulted in a brutal deterioration of his health. 27.     On 22 July 2013 the Court decided to request the Government under Rule 54 § 2 (a) of the Rules of Court to submit information on the applicant’s health, the amount of medical aid he received and the authorities’ compliance with recommendations made by forensic medical experts in their report on 13 March 2013 (see paragraph 32 below). 28.     Both parties responded to the Court’s request for information, having provided a number of documents describing the applicant’s condition and the quality of the medical care. 29 .     In particular, the Government produced a certificate prepared on 13   August 2013 by the director of the tuberculosis hospital where the applicant had remained until his release in November 2013. The certificate showed that the applicant was treated with the second-line antibacterial drugs. His diagnosis indicated in the certificate read as follows: “infiltrative pulmonary tuberculosis, [MBT smear-positive], multi-drug resistance, first-degree sub-compressive diabetes in the moderately grave course, polineuropathy of the lower extremities, chronic viral hepatitis C in the replication phase and moderately acute condition”. The applicant’s condition was considered “satisfactory”. In another certificate issued in August 2013 the hospital director stressed that the applicant was subjected to necessary diagnostic and clinical testing, that he was placed on chemotherapy regimen having received full courses of drugs, including insulin, vitamins and antibacterial medicaments, and that he was seen by specialists, including a prison physician and tuberculosis specialist. 30.     After 12 August 2013 the applicant was examined by a physician, a tuberculosis specialist, an endocrinologist, an ophthalmologist and a psychiatrist. He continued being subjected to clinical and biochemical blood and urine tests, smear sputum tests, X-ray exams, ultrasound-scanning, and electrocardiograms. The level of his glucose was measured daily. The applicant started gaining weight, having gone from 72 kilograms to slightly over 76.     On 18 September 2013 an expert medical commission assigned the second-degree disability to the applicant. 31.     According to the Government, given the quality of the applicant’s treatment in detention the applicant’s life and limb were not at risk. 32 .     At the same time, the applicant relied on a forensic medical report issued on 13 March 2013 by a commission of several experts, including, inter alia , a tuberculosis specialist, and endocrinologist, an infectious diseases specialist and a surgeon. As follows from that report, the applicant suffered from “insulin-dependent diabetes in a grave stage accompanied by the de-compensation of the carbohydrate metabolism ... with symptoms of polyuria and polydipsia in the presence of chronic complications: diabetic angiopathy and polyneuropathy of the upper and lower extremities, diabetic nephropathy and encephalopathy of the mixed genesis; ... infiltrative multi-resistant tuberculosis of the upper lobe of the left lung in the dissolution stage, in open form; chronic hepatitis C in the moderately active stage, toxic hepatitis as a result of [the applicant] taking large quantities of anti-tuberculosis drugs; kidney failure of the second degree”. 33.     The commission also concluded that given a high risk of the development of further grave complications, the applicant was in need of “constant dynamic medical supervision and treatment to restore and support his general state of health, which could only be done in the conditions of a specialised medical facility employing an endocrinologist, a hepatologist, an infectious diseases specialist, and a tuberculosis specialist”. The commission also noted that the applicant could only stay in an ordinary detention facility if he remained under constant and dynamic supervisions of the mentioned specialists and received necessary treatment. Having been asked whether the applicant suffered from a condition precluding his detention in an ordinary detention facility, the experts repeated their finding that the applicant could not participate in investigative actions or be detained in a detention facility “without proper medical assistance”. 34 .     The applicant also submitted two reports prepared by infectious diseases specialists from two very prominent Russian civil hospitals attached to medical universities. On the basis of the applicant’s medical record, the specialists concluded that he required a far-more reaching assessment and treatment in a specialised civil hospital. 2.     Application of Rule 39 of the Rules of Court 35.     Following the receipt of the Government’s submissions and the applicant’s comments to them, on 3 October 2013 the Court decided to indicate to the Russian Government, under Rule 39 of the Rules of Court, that it was desirable in the interests of the proper conduct of the proceedings that the applicant be immediately examined by medical experts independent from the prison system with a view to determining: (1) whether the treatment he was receiving in the penitentiary facilities was adequate to his condition; (2) whether his current state of health was compatible with detention in the conditions of a detention facility; and (3) whether his current condition required his placement in a hospital. 36 .     On 1 November 2013 the Government responded to the Court’s letter of 3 October 2013, having submitted: -   a one-page copy of a report drawn up on 21 October 2013. The report indicated that it was issued by three doctors of “medical unit no. 78 hospital no. 3”. A stamp in the corner of the report contained the name and address of St. Petersburg tuberculosis hospital. The main conclusion of the doctors was that the applicant did not suffer from any illness which was included on the list of illnesses precluding detention of suspects, as adopted by Governmental Decree no. 3 on 14 January 2011. In their finding the doctors referred to a medical opinion of 4 February 2013 (the content of which was not disclosed) and the applicant’s medical records, including results of radiology scanning, the most recent of which had been performed in the end of August 2013. In addition to the general conclusion that the applicant did not suffer from an illness included in the Governmental Decree, the back-side of the report contained a short reference to a positive dynamic in the applicant’s condition during the last year and “stable” results of the radiology exams; -     an extract from the copy of the applicant’s medical record issued after August 2013; -     certificates issued by the head of the medical unit no. 78 of the Federal Penitentiary Service to which tuberculosis hospital no. 3 belonged, describing the applicant’s condition and listing certain medical procedures to which he had been subjected. 37.     The Government also provided the Court with copies of lists recording daily measurements of the glucose level, the results of a large number of clinical blood and urine tests, culture and smear sputum tests, as well as of ultrasound scanning to which the applicant was subjected. They further submitted extracts from the daily logs showing the intake of the drugs by the applicant under supervision of the medical personnel 38 .     The Government answered the three questions which, in its letter of 3 October 2013, the Court had asked them to address to independent medical experts. In particular, in their one-page response, the Government stressed that the applicant had been placed under a dynamic medical supervision in relation to his illnesses and was subjected to medical procedures necessary to safeguard his health. The Government submitted that the applicant received necessary medical attention and that no additional medical procedures were required. They further stressed that the applicant’s condition did not call for his placement in a civil hospital. They relied on the report issued on 21 October 2013, having noted that the applicant did not suffer from a condition precluding his detention. They concluded that the applicant was undergoing necessary treatment in medical unit no. 78. 39.     In a letter received by the Court on 6 November 2013 the applicant complained under Article 34 of the Convention that the Government had not organised his examination by civil experts and that the report prepared by the medical staff of medical unit no. 78 and/or tuberculosis hospital no.   3 had not contained answers to the three questions posed by the Court on 3   October 2013. D.     Developments following the application of Rule 39 40 .     On 4 November 2013 the applicant informed the Court that he had been released from detention on the basis of St. Petersburg City Court’s decision of 28 October 2013. On that occasion the City Court dismissed the investigator’s request to continue detaining the applicant. In its decision the City Court relied on the expert opinion of 16 May 2013, having cited at length the applicant’s diagnosis and having repeated the experts’ finding that the state of his health precluded his detention as he suffered from illness included in the List of Illnesses Precluding Detention of Suspects, as adopted by a Governmental Decree on 14 January 2011. The City Court further held as follows: «   In view of the absence of the adequate medical supervision and [the applicant’s complaint about the state of his health, as confirmed in open court by a an emergency doctor who testified to the impossibility for [the applicant] to participate in a court hearing ..., [the applicant] was relieved from an obligation to continue taking part in the hearing on 24 October 2013. Taking into account the abovementioned state of [the applicant’s] health, the fact that the investigation in the case was completed, that the requirements of Article 217 of the Code of Criminal Procedure were complied with, ... the court is of the opinion that the circumstances which served as the ground for [the applicant’s] arrest and the extension of his detention ceased to exist. At the court hearing the investigator did not put forward any evidence in support [of his argument] that [the applicant] may reoffend, abscond the investigation or the court or obstruct the proceedings in the case, given the gravity and the nature of the state of his health. [The applicant’s] continuous detention poses threat to his life and limb, and moreover, will run counter to the requirements of Article 5 § 3 of the European Convention on Human Rights ... and the Russian Constitution. The length of [the applicant’s] detention for more than 20 months ... will become unreasonable, and the examination of the criminal case will become protracted should the court accept the investigator’s request for a further extension of [the applicant’s] detention.” 41 .     The applicant was released from detention on the following day. The decision of 28 October 2013 was upheld on appeal on 18 November   2013 by the St. Petersburg City Court, which also attributed particular attention to the expert findings in the report of 16 My 2013 commissioned by the investigation to determine the state of the applicant’s health. The City Court restated the experts’ conclusions that the applicant suffered from a number of particularly serious health conditions accompanied by a heightened risk of the development of acute and grave complications, and a need of permanent and dynamic medical supervision which could only be provided in the conditions of a specialised medical facility employing specialists in several related fields of medicine with a view to subjecting the applicant to a surgical treatment which could not be ensured in the conditions of an ordinary detention facility. The court also noted that the applicant could no longer remain in detention in the absence of the proper medical treatment. 42.     The applicant informed the Court that following his release from detention on 29 October 2013 he had been immediately admitted to St.   Petersburg Research Institute of Phthisiopulmonology for in-patient treatment. It appears that the criminal proceedings against the applicant were stayed in view of his poor state of health. 43 .     The applicant’s lawyers lodged a complaint with the Kuybyshevskiy District Court of St. Petersburg, having disputed the lawfulness of the report prepared by the doctors from medical unit no. 78 in response to the European Court’s decision to apply interim measure under Rule 39 of the Rules of Court. On 20 May 2014, having studied the applicant’s medical records, the District Court noted that his condition was included in the list of serious illnesses precluding detention of accused or charged persons as established by Governmental Decree no. 3 of 14   January 2011. The court therefore concluded that the expert findings in the report of 21 October 2013 were erroneous. Having turned to the essence of the examination of the applicant which had allegedly been perform on 21 October 2013 and which had served as the basis for the report issued on the same day, the District Court noted that the applicant had never been examined by the doctors in person, as he had not been transported to the examination nor he had been visited by the doctors who had issued the report. The court’s final conclusions, in so far as relevant, were: “In these circumstances the court finds that there was a severe violation of the procedure of a medical examination as the latter had been performed in [the applicant’s] absence and in the absence of necessary conditions, which leads to the report [of 21 October 2013] being declared unlawful. ... The court considers that the disputed [report] violated [the applicant’s] right to his health being safeguarded and his being provided with the requisite medical care, as well as his right to seek the revocation of his measure of restraint as established by the criminal procedural law on the ground of [his] suffering from serious illnesses precluding his detention. Submission of the disputed report [of 21 October 2013] to the European Court on Human Rights could have also misled that Court in its assessment of evidence in the case”. That decision became final on 24 June 2014. II.     RELEVANT DOMESTIC LAW A.     Provisions governing the quality of medical care afforded to detainees 44.     Russian law gives detailed guidelines for the provision of medical assistance to detained individuals. These guidelines, found in joint Decree no. 640/190 of the Ministry of Health and Social Development and the Ministry of Justice on the Organisation of Medical Assistance to Individuals Serving Sentences or Remanded in Custody (“the Regulation”), enacted on 17 October 2005, are applicable without exception to all detainees. In particular, section III of the Regulation sets out the initial steps to be taken by medical personnel of a detention facility on the admission of a detainee. On arrival at a temporary detention facility, all detainees should be subjected to a preliminary medical examination before they are placed in a cell shared by other inmates. The aim of the examination is to identify individuals suffering from contagious diseases and those in need of urgent medical assistance. Particular attention should be paid to individuals suffering from contagious conditions. No later than three days after the detainee’s arrival at the detention facility he or she should receive an in ‑ depth medical examination, including an X-ray. During the in-depth examination a prison doctor should register the detainee’s complaints, study his medical and personal history, record any injuries and recent tattoos, and schedule additional medical procedures, if necessary. A prison doctor should also authorise laboratory analyses to identify sexually transmitted diseases, HIV, tuberculosis and other illnesses. 45.     Subsequent medical examinations of detainees are performed at least twice a year or following a detainee’s complaints. If a detainee’s state of health has deteriorated, medical examinations and assistance should be provided by the detention facility medical staff. In such cases a medical examination should include a general check-up and additional tests, if necessary, with the participation of the relevant specialists. The results of the examinations should be recorded in the detainee’s medical file. The detainee should be comprehensively informed about the results of the medical examinations. 46.     Section III of the Regulation also sets out the procedure to follow in the event that the detainee refuses to undergo a medical examination or treatment. For each refusal, an entry should be made in the detainee’s medical record. A prison doctor should comprehensively explain to the detainee the consequences of his refusal to undergo the medical procedure. 47.     Any medicines prescribed to the detainee must be taken in the presence of a doctor. In a limited number of circumstances, the head of the detention facility medical department may authorise his medical personnel to hand over a daily dose of medicines to the detainee to be taken unobserved. 48.     The Internal Regulations of Correctional Institutions, in force since 3   November 2005, deal with every aspect of inmates’ lives in correctional institutions. In particular, paragraph 125 of the Regulations provides that inmates who are willing and able to pay for it may receive additional medical assistance. In such a situation, medical specialists from a State or municipal civilian hospital are to be called to the medical unit of the correctional institution where the inmate is being detained. 49.     Governmental Decree no. 3 of 14 January 2011 concerning the medical examination of individuals suspected or accused of criminal offences regulates the procedure for authorising and performing a medical examination of a detainee to determine whether he or she is suffering from a serious illness preventing his or her detention. It also contains a list of such serious illnesses. A decision on the medical examination of a detainee is taken by the director of the detention facility following a written request from a detainee or his or her legal representative or a request by the head of the medical unit of that detention facility. The examination is performed by a medical commission of a facility appointed by the health service executive body of the respective region of the Russian Federation. The activities of the medical commission are determined by the Ministry of Health and Social Development of the Russian Federation. 50.     The examination is performed within five days of the medical facility receiving the relevant order. Following the examination, the medical commission issues a report stating whether the detainee is suffering from a serious illness listed in the Decree. If a detainee who was previously examined by the medical commission experiences deterioration in his or her health, a new medical examination can be authorised. 51.     The list of serious illnesses preventing the detention of suspected or accused persons comprises diseases affecting various systems of the human body. The sections devoted to illnesses affecting the endocrinal and pulmonary systems read as follows: “Illnesses affecting the endocrinal system, eating disorders and metabolic disorders Serious forms of insular diabetes accompanied by complications or stable health impairment leading to a significant reduction in vitality and requiring lengthy treatment in a specialised medical facility. Serious disorders of the thyroid gland (if their surgical correction is impossible) and of other endocrine glands accompanied by complications or stable health impairment leading to a significant reduction in vitality and requiring lengthy treatment in a specialised medical facility. ... Diseases of the respiratory apparatus Purulent and necrotic conditions of the lower respiratory tract, as well as chronic illnesses of the lower respiratory tract with the third-degree pulmonary failure or the presence of complications or stable impairments affecting body functions, leading to a significant reduction in vitality and requiring lengthy treatment in a specialised medical facility.” B.     Provisions governing detention 52.     The relevant provisions governing detention are described in the judgment of Pyatkov v. Russia (no. 61767/08, §§ 48-66, 13   November 2012). III.     RELEVANT INTERNATIONAL REPORTS AND DOCUMENTS A.     Recommendation Rec(2006)2 of the Committee of Ministers to   member states on the European Prison Rules, adopted on 11   January 2006 at the 952nd meeting of the Ministers’ Deputies (“the European Prison Rules”) 53.     The European Prison Rules provide a framework of guiding principles for health services. The relevant extracts from the Rules read as follows: “Health care 39.     Prison authorities shall safeguard the health of all prisoners in their care. Organisation of prison health care 40.1     Medical services in prison shall be organised in close relation with the general health administration of the community or nation. 40.2     Health policy in prisons shall be integrated into, and compatible with, national health policy. 40.3     Prisoners shall have access to the health services available in the country without discrimination on the grounds of their legal situation. 40.4     Medical services in prison shall seek to detect and treat physical or mental illnesses or defects from which prisoners may suffer. 40.5     All necessary medical, surgical and psychiatric services including those available in the community shall be provided to the prisoner for that purpose. Medical and health care personnel 41.1     Every prison shall have the services of at least one qualified general medical practitioner. 41.2     Arrangements shall be made to ensure at all times that a qualified medical practitioner is available without delay in cases of urgency. ... 41.4     Every prison shall have personnel suitably trained in health care. Duties of the medical practitioner 42.1     The medical practitioner or a qualified nurse reporting to such a medical practitioner shall see every prisoner as soon as possible after admission, and shall examine them unless this is obviously unnecessary. ... 42.3     When examining a prisoner the medical practitioner or a qualified nurse reporting to such a medical practitioner shall pay particular attention to: .. ; b.     diagnosing physical or mental illness and taking all measures necessary for its treatment and for the continuation of existing medical treatment; . .. 43.1     The medical practitioner shall have the care of the physical and mental health of the prisoners and shall see, under the conditions and with a frequency consistent with health care standards in the community, all sick prisoners, all who report illness or injury and any prisoner to whom attention is specially directed. ... Health care provision 46.1     Sick prisoners who require specialist treatment shall be transferred to specialised institutions or to civil hospitals when such treatment is not available in prison. 46.2     Where a prison service has its own hospital facilities, they shall be adequately staffed and equipped to provide the prisoners referred to them with appropriate care and treatment.” B.     3 rd General Report of the European Committee for the Prevention of Torture (“the CPT Report”) 54 .     The complexity and importance of health-care services in detention facilities was discussed by the European Committee for the Prevention of Torture in its 3 rd General Report (CPT/Inf (93) 12 - Publication Date: 4   June 1993). The following are extracts from the Report: “33.     When entering prison, all prisoners should without delay be seen by a member of the establishment’s health care service. In its reports to date the CPT has recommended that every newly arrived prisoner be properly interviewed and, if necessary, physically examined by a medical doctor as soon as possible after his admission. It should be added that in some countries, medical screening on arrival is carried out by a fully qualified nurse, who reports to a doctor. This latter approach could be considered as a more efficient use of available resources. It is also desirable that a leaflet or booklet be handed to prisoners on their arrival, informing them of the existence and operation of the health care service and reminding them of basic measures of hygiene. 34.     While in custody, prisoners should be able to have access to a doctor at any time, irrespective of their detention regime ... The health care service should be so organised as to enable requests to consult a doctor to be met without undue delay ... 35.     A prison’s health care service should at least be able to provide regular out-patient consultations and emergency treatment (of course, in addition there may often be a hospital-type unit with beds) ... Further, prison doctors should be able to call upon the services of specialists. As regards emergency treatment, a doctor should always be on call. Further, someone competent to provide first aid should always be present on prison premises, preferably someone with a recognised nursing qualification. Out-patient treatment should be supervised, as appropriate, by health care staff; in many cases it is not sufficient for the provision of follow-up care to depend upon the initiative being taken by the prisoner. 36.     The direct support of a fully-equipped hospital service should be available, in either a civil or prison hospital ... 38.     A prison health care service should be able to provide medical treatment and nursing care, as well as appropriate diets, physiotherapy, rehabilitation or any other necessary special facility, in conditions comparable to those enjoyed by patients in the outside community. Provision in terms of medical, nursing and technical staff, as well as premises, installations and equipment, should be geared accordingly. There should be appropriate supervision of the pharmacy and of the distribution of medicines. Further, the preparation of medicines should always be entrusted to qualified staff (pharmacist/nurse, etc.). ... 39.     A medical file should be compiled for each patient, containing diagnostic information as well as an ongoing record of the patient’s evolution and of any special examinations he has undergone. In the event of a transfer, the file should be forwarded to the doctors in the receiving establishment. Further, daily registers should be kept by health care teams, in which particular incidents relating to the patients should be mentioned. Such registers are useful in that they provide an overall view of the health care situation in the prison, at the same time as highlighting specific problems which may arise. 40.     The smooth operation of a health care service presupposes that doctors and nursing staff are able to meet regularly and to form a working team under the authority of a senior doctor in charge of the service. ... ” THE LAW I.     ALLEGED VIOLATION OF ARTICLE 34 OF THE CONVENTION 55.     The applicant complained that the Government’s failure to have his medical examination performed with a view to answering the three questions asked by the Court had been in breach of the interim measure indicated by the Court under Rule 39 and had thus violated his right to individual application. He relied on Article 34 of the Convention, which reads as follows: “The Court may receive applications from any person, non-governmental organisation or group of individuals claiming to be the victim of a violation by one of the High Contracting Parties of the rights set forth in the Convention or the Protocols thereto. The High Contracting Parties undertake not to hinder in any way the effective exercise of this right.” Rule 39 of the Rules of Court provides: “1.     The Chamber or, where appropriate, its President may, at the request of a party or of any other person concerned, or of its own motion, indicate to the parties any interim measure which it consi