CEDH · CASELAW;CLIN;ENG — 3 mars 2009

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Georgia - 23204/07 Judgment 3.3.2009 [Section II] Article 3 Positive obligations Structural inadequacy of medical care in prisons: violation   Article 46 Article 46-2 Execution of judgment Structural inadequacy of medical care in prisons: violation   Facts : The applicant was arrested and remanded in custody in October 2006, and subsequently sentenced to imprisonment. He alleged that he had been in good health prior to his arrest, even if he had been taking drugs intravenously. He had subsequently been hospitalised three times (from 22 January to 10 February 2007, from 20 February to 31 March 2007 and again from 23 April 2007), when he had successively presented symptoms of acute viral hepatitis C, scabies and tuberculous pleurisy. According to a medical opinion given by a specialist in infectious liver diseases in May 2007, the hepatitis C virus affecting the applicant was developing fast and the progress of the disease in difficult conditions had caused immunodeficiency. The scabies and tuberculosis had allegedly been contracted in prison. The specialist prescribed long-term treatment in a polyclinic where treatment for hepatitis compatible with the treatment for tuberculosis could be administered in such a way as to ensure that the tuberculosis treatment had no irreversible or life-threatening effects on the patient’s liver. A medical opinion given in December 2007 by the president of the association of specialists in infectious and liver diseases concluded that the viral hepatitis C had moved into chronic phase because of the premature interruptions of the patient’s hospitalisation and the administration of the treatment for tuberculosis. Law : The lack of appropriate medical treatment and, more generally, the detention of a sick person in inadequate conditions could, in principle, constitute treatment contrary to Article 3. In this case the Georgian authorities had failed in their positive obligation to protect the applicant’s health but also to administer sufficient appropriate medical treatment for his viral hepatitis C and tuberculous pleurisy. Concerning the hepatitis, while it was not established that the applicant had contracted the disease in detention, the treatment administered by the authorities had clearly been inadequate: firstly, in spite of the appearance of the first signs of the disease upon the applicant’s arrival in prison, they had waited three months, until his health deteriorated badly, before deciding to administer treatment; then, once the final diagnosis had been made, they had not examined the need for other analyses in order to prescribe an appropriate antiviral treatment; and thirdly, in spite of the specialist’s recommendation of May 2007, they had never considered the possibility of coordinating a combined treatment for both illnesses at once, to make sure that the treatment for one illness did not make the other illness worse. As to the scabies, although adequate medical treatment had been administered, it showed the insalubrious conditions in which the applicant must have been detained to contract this contagious disease. The tuberculous pleurisy could easily have been contracted in prison, in particular because of the lack of hygiene and the fact that detainees suffering from the disease were not separated from those in good health. Although the treatment administered after the illness was diagnosed seemed to have been adequate, there was no evidence in the case file that the applicant had received additional treatment to prevent a relapse. Furthermore, in the Court’s opinion there had been no justification for removing the applicant from the prison hospital twice after a short stay there. The interruption of the hospital treatment did not seem to have been authorised by the doctors and the return to prison in insalubrious conditions of a man whose state of health had already been classified as serious had made him even more vulnerable. If, as the Government alleged, an immune system deficiency was at the origin of the applicant’s various ailments, that should have been another reason for the prison authorities to act in concert with the doctors. Lastly, it was not compatible with Article 3 of the Convention for a detainee to be hospitalised only when his symptoms had reached their peak, then sent back to prison, where he would receive no treatment, before he had been cured. Conclusion : violation (unanimously). Article 46 – As it had already done in similar cases (see, in particular, Poghosyan v. Georgia , 24   February 2009, Case-Law Information Note no. 116), the Court pointed out that the number of cases pending against Georgia concerning the lack of medical treatment for detainees suffering from contagious diseases revealed a systemic problem. The necessary legislative and administrative measures should be taken without delay to prevent the spread of contagious diseases in Georgian prisons, introduce a screening system for prisoners upon admission and guarantee the prompt and effective treatment of these diseases. As to the applicant’s case, the respondent State should have him promptly placed in an establishment capable of administering adequate medical treatment, concurrently, for his viral hepatitis C and his pulmonary tuberculosis. Article 41 – EUR 9,000 in respect of non-pecuniary damage.   © Council of Europe/European Court of Human Rights This summary by the Registry does not bind the Court. Click here for the Case-Law Information Notes