CEDH · CASELAW;JUDGMENTS;CHAMBER;ENG — 26 mars 2024

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text-align:justify; page-break-inside:avoid; page-break-after:avoid } .s69DCC830 { margin-top:36pt; margin-bottom:0pt } .sC986E16F { font-family:Arial; color:#ffffff } .sB6A7F5BF { width:17.54pt; display:inline-block } .s7E447BAE { width:130.42pt; display:inline-block } .s5D826FD4 { width:25.88pt; display:inline-block } .s1B61D60 { width:156.43pt; display:inline-block } SECOND SECTION CASE OF V.I. v. THE REPUBLIC OF MOLDOVA (Application no. 38963/18)   JUDGMENT   Art 3 (substantive and procedural) • Inhuman and degrading treatment • Involuntary placement in a psychiatric hospital and psychiatric treatment (including with neuroleptics and tranquilisers), without proven medical necessity and any safeguards, of an orphaned 15 year old child with a mild intellectual disability in the State’s care • Material conditions of applicant’s subsequent placement in the adults’ section and his being subjected to chemical restraint, in the absence of a therapeutic necessity • Requisite threshold of severity attained • Failure to carry out an effective investigation into arguable allegations • No consideration to applicant’s vulnerability, age or disability aspects of his complaint concerning institutionalised neglect and medical violence committed against him • Failure to protect applicant’s physical integrity and dignity • Existing legal framework falling short of the requirement inherent in the State’s positive obligation to establish and apply effectively a system providing protection to intellectually disabled persons in general and to children without parental care against serious breaches of their integrity • Lack of independent review of involuntary placement in a psychiatric hospital, involuntary psychiatric treatment, the use of chemical restraint, and other mechanisms to prevent abuse of children without parental care and, in general, intellectually disabled persons Art 3 (substantive and procedural) • Inhuman or degrading treatment • Ineffective investigation into allegations of violence and abuse at the hands of other patients during the applicant’s stay in the adult section • Resulting difficulty in determining whether there was any substance to his allegations • Absence of prima facie evidence capable of shifting the burden of proof on to respondent Government Art 14 (+ Art 3) • Art 13 • Discrimination • Effective remedy • Authorities’ actions amounting to a perpetuated a discriminatory practice in respect of the applicant as a person and, particularly, as a child with an actual or perceived intellectual disability • Absence of convincing reasons to rebut the presumption of discrimination against the applicant on intellectual disability grounds • Failure to provide for an appropriate mechanism capable of affording redress to people with intellectual disabilities, particularly children Art 46 • Execution of judgment • Systemic problem • Respondent State to take general measures aimed at reforming the system of involuntary placement in a psychiatric hospital and of involuntary psychiatric treatment of persons with intellectual disabilities, particularly children • Measures to address discrimination and to include legal safeguards and mechanisms   Prepared by the Registry. Does not bind the Court.   STRASBOURG 26 March 2024   FINAL   26/06/2024   This judgment has become final under Article 44 § 2 of the Convention. It may be subject to editorial revision. In the case of V.I. v. the Republic of Moldova, The European Court of Human Rights (Second Section), sitting as a Chamber composed of:   Arnfinn Bårdsen,   Jovan Ilievski,   Pauliine Koskelo,   Saadet Yüksel,   Lorraine Schembri Orland,   Frédéric Krenc,   Diana Sârcu , judges , and Dorothee von Arnim, Deputy Section Registrar, Having regard to: the application (no.   38963/18) against the Republic of Moldova lodged with the Court under Article 34 of the Convention for the Protection of Human Rights and Fundamental Freedoms (“the Convention”) by a Moldovan national, Mr V.I. (“the applicant”), on 8 August 2018; the decision to give notice to the Moldovan Government (“the Government”) of the complaints under Articles 3, 8, 13 and 14 of the Convention and to declare the remainder of the application inadmissible; the decision not to disclose the applicant’s name; the parties’ observations; Having deliberated in private on 20 February 2024, Delivers the following judgment, which was adopted on that date: INTRODUCTION 1.     The application concerns the involuntary placement of the applicant in a psychiatric hospital and his psychiatric treatment, which, along with the material conditions and the conduct of the medical staff and other patients, allegedly amounted to ill ‑ treatment. He also complained that the investigation into those allegations had been ineffective. The applicant relied on Articles   3, 8 and 13 of the Convention and Article 14 read in conjunction with his other complaints. THE FACTS 2.     The applicant was born in 1998 and lives in Vincenza, Italy. He was represented by the Validity Foundation, a non-governmental organisation (NGO), with its seat in Budapest, and Mr I. Schidu and Mr V. Mămăligă, lawyers practising in Chișinău and associated with the NGO Moldovan Institute for Human Rights. 3.     The Government were represented by their Agent, Mr D. Obadă. 4.     The facts of the case may be summarised as follows. 5 .     The applicant is affected by a mild intellectual disability. After his mother’s death in 2005 and his father’s imprisonment and subsequent death in 2009 he was in the exclusive care of his aunt from 2005 to 2012. From 24   December 2012 to 7 November 2014 the mayor of Ciutești acted as the applicant’s guardian and legal representative. 6.     In 2013 the applicant was placed temporarily in the children’s resocialisation centre Casa Așchiuța and subsequently in the placement centre Regina Pacis. On account of a lack of available places, the applicant was discharged and, after further attempts to identify foster care arrangements had failed, he was enrolled for the 2013-14 academic year in the Rezina boarding school. 7 .     The applicant was repeatedly placed for treatment in the Codru Psychiatric Hospital: once in 2012 from 27 November to 24 December and twice in 2013 from 18 March to 9 April and from 18 June to 11 July. 8.     On 29 May 2014 the Rezina boarding school administration called the mayor of Ciutești and asked him to identify a summer placement for the applicant, as his staying at the boarding school would not be possible over the summer because all the children would be leaving. The applicant’s placement and stay in the Codru Psychiatric Hospital 9 .     According to the applicant, on 3 June 2014 a doctor from the Nisporeni hospital, V.G., referred him for placement in a psychiatric hospital and for psychiatric treatment, citing a diagnosis of “mild mental disability and decompensated psychopathiform syndrome ( sindrom psihopatiform ) with irritability and nervousness”. The applicant submitted that the doctor had issued this referral without ever seeing him. 10 .     On 9 June 2014 the Rezina boarding school administration issued the following assessment of the applicant: “[V.I.] was enrolled in the school on 13 July 2013 as an orphaned child ... Diagnosed with personality disorder F 07.0, he has adapted with difficulty. He has average intellectual development but is not interested in school, he refuses to attend and to be involved in classes and when he attends, he creates various conflicts, uses swear words and insults the teachers and students. He finds the school curriculum very easy and has never manifested any interest in grades and learning; he graduated with six and seven [out of ten]. During classes he is an impulsive, disobedient and insolent student. He reacts aggressively, swears in response to any remarks and defies all disciplinary rules in school. He searches for means to get money in order to buy cigarettes and alcohol. He seeks contact with people outside the school to elicit their mercy because he is orphaned. If [that is to no avail], he collects scrap metal and steals whatever he can from people, [including from] colleagues and the school staff. Being an impulsive child, he vehemently slams doors, pounds on the walls with his legs and upsets the girls and weaker colleagues. He manages to withhold violence only in respect of colleagues who are able to reciprocate with violence. He does not exhibit tenderness or any gratitude or kindness towards people around him. Certain positive qualities surface only when he seeks something. He behaved nicely only for the New Year’s school play. He memorised and recited his part well. A lot of resocialisation work was carried out with this child but the results have been minimal. He needs ongoing psychiatric treatment.” 11.     On 13 June 2014 the Nisporeni Committee for the Protection of Children at Risk examined the applicant’s case and recommended his “treatment in a specialised clinic in accordance with his diagnosis” and afterwards his “placement in a local care service”. The Committee cited the following reasons: “[The applicant] requires treatment in a specialised clinic two times per year. He has no family in the area ( raion ).” 12.     On the same day, with reference to the above-mentioned Committee’s advisory decision, the mayor of Ciutești ordered the applicant’s transfer from the Rezina boarding school to the Codru Psychiatric Hospital for treatment “for a duration prescribed by a doctor”. The decision designated the Ciutești social assistant T.P. as responsible for its implementation. 13 .     On 16 June 2014 the applicant was brought by T.P. and E.T., an employee of the Nisporeni child protection authority, to the Codru Psychiatric Hospital. According to the applicant, T.P. had told him that they were going to a summer camp. The Government provided the Court with a copy of the consent form for the applicant’s admission, signed by T.P. 14.     The medical record of his admission on the same day cited the diagnosis of “mild intellectual disability, psychopathiform syndrome” with the diagnosis code F 70 and gave the following reasons for admission: “[V.I.] complains of headaches, vertigo and memory difficulties; he lags behind in mental development and experiences nervousness and aggressiveness; he runs away from school and smokes. He graduated from the ninth grade of the auxiliary school and has difficulty assimilating the school curriculum. His last hospital admission was in July 2013. He is being urgently admitted to the children’s section”. 15.     The first page of the applicant’s medical file, submitted to the Court by the Government, reads, under the diagnosis for psychiatric referral and the diagnosis at admission, “Mild intellectual disability. Psychopathiform syndrome,” and the diagnostic code F 70.1. 16.     According to the applicant, he had protested against his admission, even though he had been told that he would only be there for three weeks. 17 .     On 7 July 2014 the applicant’s treatment was completed but no one came to arrange for his discharge and further placement. On 22 July 2014 the hospital administration demanded that the mayor of Ciutești urgently arrange for someone to pick up the applicant from the hospital because his treatment had been completed. 18 .     The medical record from 25 July to 22 September 2014 reads as follows: “5 July 2014 – The patient is impulsive, aggressive towards other children, does not follow the instructions of the medical staff, is negativist ... 28 July 2014 – [He is in] satisfactory somatic condition, [he had a] good night’s sleep; during the day [he exhibits] free behaviour, is active [and] periodically beats disobedient children. ... 1 August 2014 – [He had a] good night’s sleep; during the morning visit he was with the other children; he replies to questions without any interest and reacts to grievances with indifference. A call was made in respect of discharging him but no reply followed from the social assistance authorities. 25 August 2014 – According to the information provided by the night team, the doctor on duty was called yesterday evening on account of [V.I.’s exhibiting] uncontrolled and aggressive behaviour and a sedative treatment was administered. Now he is among the other children, is insolent and provocative, beats the other children openly [and] is hard on the weakest. ... Somatic state: no irregularities, no complaints. 28 August 2014 – Behavioural disorders persist and he is difficult to communicate with for correction; he does not draw conclusions from any grievances expressed. Has told the staff that he plans to escape from the hospital if no one comes for him by 1   September. The hospital legal team informed the staff that the legal guardian had been informed repeatedly by phone and by mail and that he had promised to come to discharge him after 1 September. 2 September 2014 – [He exhibits] undisciplined and aggressive behaviour, does not respect the internal rules, smokes and swears at the medical staff. He threatens to escape. No one has come to arrange for his discharge and no one replies to phone calls. Treatment: levomepromazine three times per day. 5 September 2014 – The patient is negativist, refuses to attend classes and spends most of his time on the steps of the building next to the entry door asking about his discharge, waiting for his legal guardian and planning his escape. Among his peers, he acts aggressively and beats and pushes other children. A call was made to the legal team of the hospital, to the deputy director of the hospital and to the representatives of the Nisporeni child protection service. The Ciutesti administration is not answering the phone. Treatment: risperidone two times per day. 16 September 2014 – His behaviour remains aggressive, negativist and oppositional; he does not react to grievances, becomes agitated after several reprimands, manifests impulsive reactions and smokes. He has refused to speak to the social worker who came to see him in view of finding a solution for his discharge. A phone call to the Nisporeni child protection service was made. 19 September 2014 – According to the information provided by the night shift team, [V.I.] went into the girls’ room, was accused of stealing and pushed patient [U.M.] forcibly, which resulted in her falling and hitting the floor with the back of her head. The patient is rude to the staff, becomes suddenly agitated and is impulsive. Treatment: diazepam and diphenhydramine. 22 September 2014 – According to the information provided by the night shift team, the patient became upset with the mothers of the other children in the unit and the other children; he was upset about not getting cigarettes; he broke the glass on a window in the room and categorically refuses to admit his guilt. Medical summary upon [the patient’s] transfer [V.I.] was in the [children’s] section from 16 June 2014, after being diagnosed with “mild intellectual disability and psychopathiform syndrome”; he was examined and administered a calming treatment. During the treatment he manifested a negativist, asocial and aggressive behaviour, did not respect the rules of the unit, did not comply with the requirements of the staff and had difficulty communicating during productive psychological correction. In view of his asocial behaviour, increased aggressivity and reduced impulse control, with the consent of the deputy director, the boy is being transferred [to the adults’ section].” 19 .     On 22 September 2014 the applicant was transferred to the adults’ unit (somatic-psychiatric unit). 20.     On 29 September 2014 the hospital administration repeatedly requested the mayor of Ciutești and then the Rezina boarding school to collect the applicant from the hospital because his treatment had been completed. In the absence of any reply, on 10 October 2014 the hospital administration sought the intervention of the Nisporeni local council. In the absence of any reaction from those authorities, the hospital administration contacted the Ombudsperson and the Centre for Human Rights. 21 .     On 6 October 2014 the applicant was visited in the hospital by the Nisporeni Psycho-pedagogical Assistance Service in order to carry out a comprehensive assessment of his development and needs. This was the only visit the applicant received during his stay at the hospital. The relevant parts of the assessment read as follows: “... The language development corresponds to the child’s age. The cognitive development corresponds to the child’s age. The child exhibits communication and learning skills. ... The child has emotional difficulties. As a consequence of the absence of parental warmth (early death of the mother and the father’s death in prison), [V.I.’s] behaviour is rather a reaction to the difficulties in his education and care, with a resulting underdeveloped ability to cope with social and stressful situations. The development of his adaptive behaviour corresponds to his age. ... [V.I.] is a student with personality ( cu caracter ) who is easily aroused emotionally but who easily establishes contact with others. He has friends among his classmates and can take decisions independently in difficult circumstances. He respects the adults, behaves adequately in various circumstances and shows self-control. He is sociable and replies to questions addressed to him. His socio-emotional behavioural development corresponds to his age. ... General conclusion: the child’s condition does not correspond to the category of children with special educational needs.” 22.     On 15 October 2014 the Nisporeni child protection authority assessed the applicant’s case and, noting the absence of any family and his ongoing stay in the psychiatric hospital, concluded that there was a need to find a placement for the applicant in a residential institution. 23 .     On 5 November 2014 the applicant’s cousin, A.B., became his guardian and on 7 November 2014 the applicant was discharged from the psychiatric hospital into A.B.’s care. In subsequent criminal proceedings A.B. submitted that she had found that the applicant was frightened, barely spoke, was very reserved and that he had a puffy face, he had not eaten anything in the first two weeks after his discharge and he spent most of his time sleeping, while his condition gradually improved. Material conditions and medical treatment 24 .     The applicant submitted that three employees had taken him by force to the children’s section. During his stay there, he had received medication, the name and purpose of which had never been made known to him. According to the medical records, upon his admission the applicant was prescribed a tranquiliser (diazepam in tablet form) and from July to September 2014 (see paragraph 18 above), he was administered tranquilisers (diazepam and diphenhydramine) and neuroleptics (risperidone and levopromazine). 25 .     The applicant submitted that in the adults’ section he had initially been placed in room no.   1 of unit no. 24, where the patients were in serious condition and did not leave their beds for most of the day. After one week he had been transferred to another room which held nineteen adult men, some with criminal records. He had been the only child placed in that unit. There had been a strong odour of cigarettes in the unit and some of the patients had been in an acute psychiatric condition. The applicant had only been allowed three walks outdoors during his stay in the adults’ section. He submitted that his medication had been changed and as a result he had spent most of his days sleeping and eating little to no food because he had lost his appetite. He had been afraid for his life and had become very anxious because other patients in the section had previously been convicted, because he had seen a person die there and because he had heard that some patients spent their entire lives in the hospital. 26.     The head of the section told A.B. about an adult patient who had befriended the applicant and who had allegedly given him gifts (a bracelet and a ring). 27 .     According to his medical records from September to November 2014 the applicant was administered, among, other medications, neuroleptics (chlorpromazine (Aminazin), risperidone (Ripsolept) and levopromazine (Tizercine)), tranquilisers (diazepam and diphenhydramine (Dimedrol)), anti ‑ convulsives (valproic acid), nootropics (vinpocetine (Cavinton forte)), drugs to counteract tranquiliser overdoses (diethylamide of nicotinic acid (Cordiamine)) and heart medication (beta-blockers (Metoprolol)). Psychological assessment of the applicant 28 .     On 14 January 2016 the Botanica Mental Health Community Centre carried out a psychological assessment of the applicant at the request of the applicant and his guardian. The relevant parts of this assessment read as follows: “1.     [V.I] perceived his placement in the psychiatric hospital and his transfer to the adults’ section as a punishment for his behaviour at school and in the children’s section. From his description, he experienced anxiety, fear, helplessness, a state of depersonalisation and a loss of reality and of identity. As a result, he suffered from sleep disorders, difficulty concentrating, irritability, agitation, exaggerated vigilance and fear. ... 2.     [V.I.] re-lives his placement in the psychiatric hospital as a traumatic experience ... [and he is] having flashbacks. Any contact with events or discussions which may remind him of his traumatic experience result in a reaction of intense anxiety. ... 3.     Immediately after his discharge, [V.I.] experienced three main types of issues: [1] persistent re-living of the traumatic experience (related nightmares, flashbacks and intense emotional reactions – fear, nervousness, sadness and physiological symptoms of sweating and muscular tension), [2] persistent avoidance of stimuli associated with the traumatic events (avoiding discussion about it, especially as regards the period in which he was in the adults’ section), memory gaps, loss of interest in normal activities, feelings of isolation and detachment from others, emotional numbness and limited future prospects (lack of plans for the future, which he is unable to foresee) and [3] persistent symptoms of neurophysiological hyperactivation (agitated sleep, anger and irritability, difficulty focusing, a continual search for signs of danger and nervous outbreaks). 4.     In the light of his age and vulnerability at the time of his admission to the hospital, one may conclude that [his stay there] had major effects on his psyche and on his emotional state ... According to him, he felt the following while in the hospital: - sadness and a foul mood (feeling worthless in the world and that no one existed who could save him from that nightmare); - a loss of interest in daily activities (all the days were the same, nothing changed and everything was dark); - a loss of energy and strength (powerlessness to change the situation); - a loss of self-esteem and trust in others (feeling that he was nothing and that all the people around him were telling lies just to make him suffer more); -feeling that life was not worth living (thoughts to the effect that if he were to die his suffering would end); - difficulty focusing; - constant fatigue; - trouble sleeping (he could not fall asleep and he had thoughts that the adults in the unit would hurt or even kill him). Conclusion: [V.I.]’s placement in a psychiatric hospital and, in particular, his placement in the adults’ section, was a traumatic event with major effects on his psyche resulting from the inhuman treatment he suffered at the hands of the hospital staff, which caused major emotional suffering and depression and put him at risk of committing suicide.” 29 .     The Government provided the Court with a medical opinion, dated 14   June 2023 and issued by three doctors in the Codru Psychiatric Hospital at the request of the Government Agent, concerning the medical treatment administered to the applicant on the basis of his medical record. The relevant parts read as follows: “The medical file does not include any information concerning the allegedly ‘harmful effects of the medication’. The administered treatment corresponds to the clinical manifestations and to his predominant behaviour, which consisted of behaving aggressively towards others (entry under 19 September 2014 [see paragraph 18 above]), injuring a minor patient U.M., breaking a window (entry under 22 September 2014), kicking a child and pushing a nurse (entry under 24 August 2014). The neuroleptic medications administered in the hospital were not taken all at once and some medication replaced others which were found to be inefficient, all with the purpose of calming and balancing his emotional state. All treatment was administered while his blood circulation, laboratory results and emotional condition were under close surveillance. Furthermore, a neurologist examined [V.I.] and he did not indicate any of the secondary effects of the administered treatment complained of. The speech therapist also did not indicate any pathologies. Patients had daily walks according to their curative programme and depending on their condition; in the present case the medical file shows [that V.I.] took walks and played outdoors (entry under 25 July and 25 August 2014). The record shows an almost continual aggressive, destructive and violent behaviour towards younger patients, [V.I.] representing a direct and imminent danger to the other children’s lives and well-being; for this reason it was eventually decided to transfer him to the somatic-psychiatric unit, conditions with which the teenager complied immediately. ... Upon his discharge, the patient’s condition had improved. Conclusion: the medical file excludes any allegedly negative effects on the patient’s health due to the medical and social assistance provided in the psychiatric hospital; the patient’s health condition at discharge (upon his return home) was not related to the treatment administered in the hospital; it is thus necessary to examine other social factors to which he had been directly exposed.” 30 .     The Government provided the Court with a reply from the Ministry of Health, dated 3 July 2023, concerning the applicant’s case. The reply, in so far as relevant, reads as follows: “According to international studies, typical and atypical antipsychotic drugs (chrolpromazinum and risperidonum respectively) are used worldwide to treat aggressive children and adolescents. Considering the applicant’s medical history, his aggressiveness since 2013 and his first placement in the Codru Psychiatric Hospital, international recommendations were followed. This treatment, however, cannot be considered punishment, torture or ill-treatment; while the side effects described, being frequent and well-known manifestations of antipsychotics, unfortunately often necessitate the interruption of the treatment, their presence does not prove that the treatment was prescribed by the doctor with the intention of punishing the patient by means of those side effects.” Investigation into the applicant’s placement in and delayed discharge from the psychiatric hospital 31 .     On 13 January 2015 a lawyer, instructed by the applicant’s guardian with the support of the Ombudsperson’s Office and of an NGO, lodged a complaint concerning the applicant’s placement and psychiatric treatment at the Codru Psychiatric Hospital from June to November 2014, including acts of violence and potential sexual abuse perpetrated by other patients. The applicant noted that his aunt had never been provided with any support from the authorities and that his opinion had never been sought in respect of his placement in the psychiatric hospital and treatment, although he had clearly opposed being admitted every time he returned there. He challenged his diagnosis and the need for in-patient psychiatric treatment, referring to various assessments which attested to his normal development (for one example of the various documents reflecting the applicant’s academic results with passing grades, see paragraph 10 above; for the development assessment of 6 October 2016, see paragraph 21 above). He noted that in 2014 he had stayed in the hospital for 144 days – whereas the average treatment period lasted twenty-one days – and his stay had come to an end only after the Ombudsperson had intervened. He argued that the authorities had never provided him with any psychosocial support and, against his will, had placed and abandoned him in the psychiatric hospital without any external monitoring or support. He also complained of the conditions of his placement, the lack of information about its duration and his placement in the adults’ section (see paragraphs 24-25 above). He had feared that he would be interned there for life. He also complained about having been administered tranquilisers and neuroleptic drugs (see paragraph 27 above), despite his age and diagnosis and contrary to the medical protocols, which had made him continuously sleepy and passive. Moreover, he noted that inferring from the adjuvant treatment (meant to address his variable blood pressure, high heart rate and rigid muscles) prescribed to him after the administration of neuroleptics, it appears that he had developed neuroleptic malignant syndrome, which was a life-threatening condition. He relied on Articles 3, 5 and 14 of the Convention and requested an investigation into negligence and ill-treatment on discriminatory grounds. 32 .     On 16 January 2015 the Nisporeni prosecutor initiated a criminal investigation into charges of negligence (Article 329 § 1 of the Criminal Code) in respect of the applicant’s placement in and delayed release from the psychiatric hospital after completing twenty-one days of treatment. On 23   October 2015 the Ciutești mayor was charged with negligence which had resulted in serious consequences (Article 329 § 2 (b) of the Criminal Code) and the case was sent for trial. 33.     On 15 June 2016 the Nisporeni District Court acquitted the mayor on all charges, concluding that he had not failed to fulfil any of the tasks entrusted to him. In particular, the court found that the applicant’s admission had been carried out by T.P. and E.T. and that it had been the task of the Nisporeni child protection authority, and not the mayor of Ciutești, to secure the applicant’s placement after his discharge from the hospital. 34.     The applicant appealed against that judgment, arguing that the main care duties in respect of him had been exercised by the mayor of Ciutești (local public administration) and not by the Nisporeni child protection authority (territorial administration). He argued that instead of providing him with support and care, his legal guardian, the mayor of Ciutești, had placed him in a psychiatric institution and then failed to take action with regard to his discharge. 35 .     The prosecutor also appealed against that judgment, noting that it had been the mayor, and not the Nisporeni child protection authority, who had signed the applicant’s admission to the hospital and who had exercised legal guardianship. The prosecutor referred to evidence in the case file, according to which a “normal child” had been admitted to the psychiatric hospital (with reference to the statements of the specialist who had carried out the assessment on 6 October 2014 cited in paragraph 21 above). The prosecutor cited the statements of V.A., the deputy director of the psychiatric hospital who had contacted the Ombudsperson and the Centre for Human Rights in the Republic of Moldova to intervene in the case after his repeated requests to the mayor of Ciutești and his staff had failed to secure their presence for the applicant’s discharge from the hospital. The prosecutor argued that the mayor had failed to provide care to the applicant and noted that the applicant’s admission to the hospital had been carried out in haste, in the absence of any placement solution, because all the admission documents, such as the referral to the hospital and the placement decision (see paragraphs 9 and 12 above) had been issued without a doctor ever talking to or seeing the applicant. Moreover, the prosecutor argued that had the admission been planned, there should not have been any delays in his discharge and subsequent placement. 36.     On 6 June 2017 the Chișinău Court of Appeal upheld the appeals and convicted the mayor of Ciutești on charges of negligence, sentencing him to two and a half years’ imprisonment, but suspended the enforcement of the sentence for two years. The court awarded the applicant 60,000 Moldovan lei (equivalent to 3,000 euros) in compensation for the non-pecuniary damage sustained. The court concluded that the mayor had failed in his duty of care when he had left the applicant in the psychiatric hospital for 144 days instead of twenty-one days, without any support or external monitoring, thereby inflicting on the applicant serious emotional suffering. 37.     The applicant lodged an appeal on points of law against that judgment. The applicant argued that the court had found the mayor guilty of failing to act in respect of his discharge from the psychiatric hospital but had never ruled on the mayor’s responsibility for his placement in the psychiatric hospital, considering that the applicant had not needed psychiatric treatment as confirmed by evidence in the case file (see paragraph 31 above). The applicant also argued that the sentence was excessively lenient. 38 .     On 12 December 2017 the Supreme Court of Justice reversed the appellate judgment and acquitted the mayor of Ciutești on all charges. The court concluded that the prosecutor had failed to provide evidence of “serious consequences” or “serious bodily injury or serious damage to one’s health”, which was a qualifying element for the offence of negligence. The consequences suffered by the applicant had not been “serious”, as they had been “approximate ( au un caracter estimativ ) and their extent could not be determined with certainty”. Moreover, the court concluded that there had been no issue with the length of the placement because it had constituted “a duration prescribed by a doctor”, as indicated in the mayor’s decision of 13   June 2014. The court found that the social worker T.P., and not the mayor, had been responsible for the follow-up on the placement because she had been delegated to implement the decision. The judgment was final and was served on 12 January 2018. Investigation into ill-treatment in the psychiatric hospital 39.     On 9 February 2015 the applicant sought information about the prosecutor’s decision in respect of the part of his complaints concerning ill ‑ treatment during his stay in the psychiatric hospital (Article 166/1 of the Criminal Code). 40.     On 16 February 2015 the Nisporeni prosecutor replied that the complaint had been premature, since the circumstances of his stay in the hospital had not yet been established beyond doubt. The prosecutor referred to the investigation into charges of negligence and to other preliminary inquiries meant to clarify whether the elements of the offence of ill-treatment had been met. 41.     The applicant appealed against the prosecutor’s refusal, noting that there was sufficient prima facie evidence to launch a formal investigation specifically into the applicant’s placement in the adults’ section, the administration of neuroleptics despite the applicant’s age and diagnosis and the serious consequences for his health, such as the possible development of neuroleptic malignant syndrome. There was also sufficient information to investigate the material conditions in the psychiatric hospital and the violence to which he had been subjected at the hands of other patients. 42.     As a result, on 24 March 2015 the Nisporeni prosecutor initiated a criminal investigation into charges of torture and ill-treatment (Article   166/1   § 2 of the Criminal Code) in respect of allegations concerning the administration of neuroleptics, the applicant’s transfer to the adults’ section and the material conditions in the hospital. 43 .     On 29 September 2015 the Chișinău prosecutor decided to discontinue the investigation. He noted that the applicant’s transfer to the adults’ section had been due to the deterioration of his health condition and his aggressive and dangerous behaviour in respect of other patients and the medical staff in the children’s section. The prosecutor found that the applicant had not been subjected to any intimidation or violence by other patients. The prosecutor cited several witness statements given by the medical staff, which attested to the applicant’s allegedly violent and uncontrollable behaviour while in the children’s section. After he had not been discharged on 7 July 2014 upon the completion of his treatment, he had become increasingly frustrated, insolent and aggressive towards other children. On 22 September 2014 he had broken a window and had subsequently been transferred to the adults’ section. The prosecutor concluded that there was no evidence that the medical staff had deliberately subjected the applicant to any suffering in order to debase or humiliate him. 44.     The applicant appealed against that decision, noting that the investigation was incomplete. 45.     On 22 January 2016 the hierarchically superior prosecutor rejected the applicant’s appeal. 46.     The applicant lodged an appeal with the investigating judge, reiterating his previous arguments. 47.     On 20 April 2016 the Rîșcani investigating judge upheld the applicant’s appeal and ordered the reopening of the investigation, noting that an expert assessment of the applicant was a mandatory piece of evidence missing from the file. 48 .     On 14 November 2016 an expert psychiatric and psychologic assessment of the applicant was carried out, the relevant parts of which read as follows: “[V.I.] is alert and aware ... Emotionally he is slightly depressed, stating that he does ‘not wish to stay in the hospital’. In respect of the criminal case in which he has the procedural standing of a victim, he stated that the boarding school administration had brought him to the hospital while lying to him, telling him that he would be taken to a summer camp ... [he stated] that he had been left at the hospital against his will, that he had been ‘quiet’ in the children’s section where he had stayed before but that when his discharge had not been executed when promised, he had become upset, had broken a window and pushed nurses; [he also stated that] instead of being discharged he had been transferred to the adults’ section, where he had felt bad, had been administered injections which made him feel ill, had been afraid of other patients and had stayed in the hospital for four months instead of three weeks. ... The psychologist’s conclusion: ...His behaviour is adequate if a little tense. He maintains a stable mood corresponding to the situation of being examined. He is unhappy with the way he was placed in the hospital and the late discharge from the hospital. He stated: ‘They lied, saying that they were taking me to a summer camp, and then for two months no one came to take me from the hospital.’ He is focused essentially on the limitation of his freedom and not on how he was treated in the hospital. He is focused on the secondary effects of events, as he is generally egocentric, by protesting against a situation. His emotional reaction to the reproduction of events is dull and unexpressive. ... His IQ is 65. [He exhibits] emotional ‑ volitional instability and shows dissent in stressful circumstances. He shows a tendency towards respectful and affectionate behaviour to compensate for his abandonment complex, manifesting in his being demonstrative and provocative with reactions of protest and opposition. ... His intellectual ability and memory correspond to a mild intellectual disability. His statements are egocentric, subjective and assessed in the light of his personal life experiences and his dissatisfaction with limitations imposed on his personal freedom, to which he reacts with insubordination. In these circumstances, [V.I.] has not suffered a psychological trauma. No symptoms of a psychological trauma have been discerned. The psychological assessment does not show manifestations of the allegedly inhuman treatment. [His psychological condition] stems from the limitation of his freedom and his abandonment issues, developed in the situation described.” 49 .     On 30 May 2017 the Chișinău prosecutor again decided to discontinue the criminal investigation, reiterating most of the reasons given previously (see paragraph 43 above). In addition, the prosecutor concluded that the applicant’s admission to the psychiatric hospital had taken place with the applicant’s informed consent and with the written consent of the guar