CEDH · CASELAW;CLIN;ENG — 9 décembre 2008

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Poland - 77766/01 Judgment 9.12.2008 [Section IV] Article 2 Positive obligations Article 2-1 Life Inadequate medical treatment during pre-trial detention and failure to investigate: violation   Facts : The applicant was arrested in September 1997 and placed in pre-trial detention on suspicion of organised international drug-trafficking. At the time he was already suffering from a heart disease and had had two heart attacks. Despite his numerous requests for release on grounds of ill-health, the domestic courts repeatedly extended his detention, relying on the reasonable suspicion against him and the complexity of the investigation. In September 1998 and February 1999 a medical panel which had examined the applicant concluded that he was well enough to remain in detention, provided that there was a hospital wing in the detention centre where he was being held. The applicant's wife, who visited him twice a month, submitted that his health constantly deteriorated during his detention. She alleged that his serious health problems started in November 1999 when he was transferred to Łódź Detention Centre, which had no hospital facility, and declined to the extent that in March 2000 he lost consciousness and had to be transferred to Łódź Prison Hospital, where he spent 10 months. Subsequently, in January 2001 the applicant was transferred to another detention centre, where his health deteriorated even further. He collapsed six months later and was taken to Warsaw Prison Hospital where he was treated for pneumonia. During the period spent in that hospital, he was examined by doctors from a cardiology institute who decided that he should have a heart-bypass operation. Three appointments were scheduled for surgery. The applicant submitted that he was not informed of the first appointment on 27 July 2001; the Government maintained that that date had been cancelled due to renovation work to the institute. As to the second appointment, the applicant's wife testified that her husband received notification, but only after the proposed date, 21 September 2001. She also submitted that the envelope in which the notification was sent was marked by the authorities as “censored 24.09.01”. Finally, she said that she had had to attend the institute in person to obtain a third appointment, scheduled for 26 October 2001; she gave the notification to the applicant's lawyer in person so that he could inform the detention centre. On 1 October 2001 a medical panel examined the applicant again and concluded that detention posed a threat to his health. In view of his scheduled surgery, it was recommended that the preventive measure against him be changed. On 5 October 2001, without examining the applicant's state of health, the court extended his pre-trial detention for another four months. The applicant's trial started on 16 October 2001 and he also attended hearings on 18 and 19 October. During that time he was prevented from having any medical consultations as he was transferred to the trial court before the doctors' arrival at the detention centre and was returned to his cell when they had already gone off duty. According to the applicant's wife and other evidence examined by the Court, on 22   October 2001 the applicant was brought to the court room where he fainted before the hearing began. At 9.30 a.m. he was taken back to the detention centre's hospital wing, where he was examined by a doctor and transferred back to his cell. The same day the trial court was forwarded the medical panel's report of 1 October 2001 and decided to release the applicant on 26 October 2001 so that he could have his heart surgery. Meanwhile, at 3.45 p.m. the applicant was taken unconscious from his cell back to the hospital wing before being hospitalised in Warsaw where he died on 25 October 2001. The post mortem examination concluded that he had died of acute coronary insufficiency. Following an investigation into the applicant's death that was launched in December 2001 and ultimately discontinued in January 2004, medical experts concluded that he had died as a result of unsuccessful medical treatment for which no-one could be held responsible and that it was impossible to assess whether surgery would have improved his health, given the advanced stage of his illness. Law : Article 2 – Following the applicant's death, his wife maintained that the Polish authorities had contributed to his death through inadequate and belated medical care and that the investigation into his death had been ineffective. (a)     Alleged failure to protect the applicant's life : It was not in dispute that the applicant had suffered from a serious heart disease, had had heart attacks prior to his detention, and that his health had deteriorated during his years in custody. Nor had the Government denied that the authorities had been aware of his disease, which had required periodic hospitalisation and medical interventions and had, eventually, qualified him for heart surgery. However, contrary to the recommendations of medical panel reports the applicant had been kept in a detention centre without a hospital wing. There was no evidence in the case file to show that he had received any medical treatment during the four months he spent in that facility or even that he had seen a doctor. It had taken the deterioration in the applicant's health to the point of collapse for him to be transferred to hospital. The very fact that he had then had to stay in that hospital for 10 months indicated the gravity of his illness. On a subsequent occasion it had taken a diagnosis of pneumonia for him to be hospitalised. As regards the surgery, the Court considered that neither the domestic authorities nor the Government had given a satisfactory explanation as to why the applicant was not transferred to the institute on the first two of the dates scheduled. It was particularly troubling that the envelope containing the notification of the appointment scheduled for 21 September 2001 had apparently been delayed by a prosecutor for the purpose of censorship until 24 September 2001. Indeed, the Court was struck by the fact that even though the medical panel had recommended the applicant's release on 1 October 2001 as it considered further detention a threat to his health, its decision was only forwarded to the trial court 22 days later. Moreover, the Government's failure to give a detailed account of the circumstances of 22 October 2001 directly preceding the applicant's death made it difficult for the Court to assess the appropriateness of his medical care on that day. However, as concerned the days immediately before 22 October 2001, the Government had not contested that the applicant had attended the hearings in his case and so been denied access to a doctor, as he had remained outside the detention centre during the doctors' hours of duty. Finally, the grounds given by the domestic authorities for extending the applicant's detention were particularly unsatisfactory given the serious state of his health, which had provided increasing cause for concern, and could not justify the overall period of his detention. The above elements were sufficient for the Court to conclude that the quality and promptness of the medical care provided to the applicant during the four years of his pre-trial detention had put his health and life in danger, in breach of Poland's obligation to protect the lives of those it held in custody. Conclusion : violation (unanimously). (b)     Alleged inadequacy of the investigation : The Court considered that the facts of the case required a prompt and diligent reaction from the investigating authorities. The investigation had, however, lasted more than two years and had been discontinued by the prosecutor without consideration of the doubts expressed by the experts about the postponing of the applicant's surgery on three occasions. More importantly, the incomplete and inadequate character of the investigation was highlighted by the fact that the exact course of events directly preceding the applicant's death was never established. The prosecutor failed to establish whether the applicant had been taken to the court room that morning, what exactly happened in the court building, why the ambulance brought him back to the detention centre and what happened before the applicant was taken unconscious from his cell at 3.45 p.m. Nor had the prosecutor assessed the accuracy of the witness statements, or heard other witnesses such as prison guards, the applicant's cell mates or the ambulance team. The authorities had thereby failed to carry out a thorough and effective investigation into the allegation that the applicant's death had been caused by ineffective medical care during his four years of pre-trial detention. Conclusion : violation (five votes to two). Article 41 – EUR 20,000 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