5.  The applicant was born in 1948 and lives in Yerevan.
6.  The applicant had a daughter, K.M., who was born on 19 November 1985.
7.  On 7 September 2007 at 10 p.m. K.M., who was in the early weeks of pregnancy at the time, was at home with her parents and husband when she fainted and began to have convulsions. An ambulance was called, which arrived 40-45 minutes later.
8.  Upon arrival, the ambulance doctor, A.G., found K.M. nearly unconscious, with impaired breathing and low blood pressure. According to the applicant, the doctor was told at that point that K.M. was pregnant. A.G. diagnosed a convulsion syndrome, gave K.M. two injections – one of relanium and one of magnesium – and took her to hospital. It appears that neither the doctor nor the nurse nor the driver of the ambulance helped her family carry K.M. downstairs from the eighth floor of the building and put her into the ambulance. Moreover, although K.M. had not regained consciousness after the injections, A.G. chose not to sit beside her during the journey to hospital, but instead sat beside the driver in the driver’s cab.
9.  On the same day A.G. and the nurse drew up an ambulance visit record stating that they had arrived seven minutes after receiving the ambulance call and that they had administered only one medical injection, of relanium.
10.  On 14 September 2007 K.M. died in hospital without ever regaining consciousness.
11.  On the same day the Avan and Nor-Nork District Prosecutor’s Office of Yerevan launched an inquiry into her death and ordered an autopsy, which was also carried out that day. According to its report (forensic medical opinion no. 728), K.M. died from general intoxication of the organism, caused by an impairment of vital brain function, which in turn had been caused by extensive and diffuse thrombosis of neuro-vessels.
12.  During the inquiry, the investigator took statements from the medical personnel who had provided assistance to K.M., including A.G., the nurse, and the driver. In particular, in her statement of 14 November 2007 the nurse stated that the doctor had ordered her to administer an injection of magnesium sulphate but that K.M.’s convulsions had continued, after which the doctor had handed her a phial of relanium, which she had injected. In her statement made on the same day A.G. explained that upon arrival they had found K.M. having seizures and that, from talking to her family, she had learnt that K.M. was pregnant. She had then ordered the nurse to inject relanium and, knowing that K.M. was pregnant, she did not inject any other medication and did not take any further measures since she did not consider it necessary in the circumstances.
13.  On 26 November 2007 the ambulance nurse and A.G. were questioned again. The nurse stated, in particular, that the fact that only the injection of relanium and not the one of magnesium had been mentioned in the ambulance visit record could possibly be explained by her having forgotten to remind the doctor about the injection of magnesium. A.G. stated, inter alia, that she had ordered the nurse to give two injections.
14.  In the course of the inquiry the investigator ordered a forensic medical investigation to be carried out by a panel of experts. According to the results of the opinion (forensic medical opinion no. 89) produced on 14 January 2008, the injection of relanium 2 mg and magnesium 3 g by the ambulance crew had been correct at the given moment, taking into account the patient’s condition − that is to say convulsion syndrome − and the injection of the given quantity of those substances was not contra-indicated. The opinion also stated that K.M.’s medical treatment had been correct and had corresponded to the diagnosis.
15.  On 27 February 2008 the investigator decided to reject the institution of criminal proceedings for lack of corpus delicti.
16.  On 29 February 2008 the applicant lodged an application with the Avan and Nor-Nork District Prosecutor’s Office of Yerevan, seeking a new forensic medical investigation in which he would be allowed to participate. In particular, he claimed that his daughter had died as a result of negligence by A.G., who had given her two injections of chemical substances, the use of which was contra‑indicated given K.M.’s pregnancy, impaired breathing and low blood pressure. In this respect, the applicant referred to medical instructions on the use of relanium and magnesium and extracts from a medical book, copies of which he attached to his application. The applicant also alleged that the ambulance had arrived belatedly, had lacked essential medical equipment such as an oxygen cylinder, and that the ambulance crew in general had not acted with due diligence.
17.  On 3 March 2008 the District Prosecutor’s Office decided to quash the decision of 27 February 2008 and remit the case to the investigator for further inquiry. The decision stated, in particular, that the applicant’s request for an additional forensic medical investigation involving his participation was well-founded.
18.  On 5 March 2008 the investigator ordered an additional forensic medical investigation by a panel of experts which was asked to determine the following:
“1.  The cause of K.M.’s death, whether she suffered from any illnesses from birth ... whether an illness she had suffered from birth could have caused her death or somehow have a causal link to her death. 2.  Whether the injection of relanium 2 mg and magnesium 3 g by the ambulance crew was correct, whether the quantity was within that allowed and whether injecting magnesium might have entailed negative consequences. 3.  Whether there was any medication (in medical theory, in science) or medical approach the administration of which could have improved K.M.’s condition and whether it should have been administered by the ambulance crew or in hospital. Whether the medical treatment had been appropriate and sufficient or whether omissions had occurred and, if so, who had been responsible for them. 4.  K.M.’s transfer to the hospital took about 40 minutes; whether speedier transfer to the hospital would have made it possible to save K.M. 5.  Whether K.M.’s five-week pregnancy contributed to the emergence and development of her illness, whether the pregnancy and the illness she was diagnosed with had a direct causal link with each other. 6.  K.M.’s hospital record ... contained notes concerning the medical assistance, injections and medication and the doctors who had administered them over seven days. Whether the medical treatment provided had been correct, the injected medication correctly chosen with regard to type and quantity and whether these were permissible or not. If not, which doctor was responsible for errors and finally whether the medical treatment administered had brought about death. 7.  The scientific methods on which forensic medical opinion no. 728 and the forensic medical opinion no. 89 of the panel of experts were based, whether these were supported by medical literature and which methods had been applied during previous examinations...
19.  On 23 April 2008 the panel of experts delivered its report (forensic medical opinion no. 6), the conclusions of which read as follows:
“1  and 8: No information indicating that K.M. had congenital disorders was discovered, according to the medical documents. K.M.’s death resulted from general intoxication of the organism, caused by an impairment of vital brain function, which in turn was caused by extensive and diffuse thrombosis of neuro-vessels. As regards prior diseases resulting in functional disorders which could have brought about the convulsion syndrome, it was impossible to draw any conclusions in the absence of relevant medical documents. 2.  Injection of relanium 2 mg and magnesium 3 g by the emergency care specialists was correct in view of the presence of the convulsion syndrome at the given moment. Not injecting magnesium at the given moment could have entailed negative consequences. 3.  In the case in question the medical assistance provided by the ambulance crew and in hospital was appropriate and sufficient, without omissions, which is substantiated by the data contained in the medical documents and by the evidentiary material in the case file. 5.  K.M.’s five-week pregnancy was not linked to the cause of her death since the pregnancy and the illnesses did not have a direct causal link with each other either. 7.  Opinion no. 728 concerning the forensic medical examination of K.M.’s corpse and opinion no. 89 produced by the forensic medical investigation panel are accurate and well‑founded; scientific methodologies were applied: histological examinations of the organs of the corpse were performed, and leading specialists of the Ministry of Health participated in the panel examination.
20.  On 25 April 2008 the investigator decided to reject the institution of criminal proceedings for lack of corpus delicti. The decision stated in particular that the relevant members of the medical personnel, including the emergency care specialists who had provided first aid assistance to K.M., had been questioned. It further reiterated the conclusions of the experts reflected in the forensic medical opinions nos. 89 and 6 and stated that the initial medical assistance administered as first-aid and the subsequent hospital treatment provided to K.M. had been performed properly, appropriately and in a timely manner without any errors or omissions.
21.  On the same day the investigator lodged a request with the director of the “Emergency Medical Service” State Close Joint Stock Company of the Yerevan Municipality (“the Emergency Medical Service”) seeking to impose an appropriate penalty on the ambulance crew. In particular, the investigator stated that there had been a 40-minute delay before the ambulance arrived and that only one of two injections given to K.M. had been mentioned by the ambulance doctor in the visit record. Furthermore, the process of taking the patient to hospital had been slow and disorganised. The ambulance driver had not carried the patient downstairs and had not assisted in putting her in the ambulance. Instead of sitting beside K.M., whose condition was extremely critical, the doctor had chosen to sit in the driver’s cab next to the driver. The investigator’s conclusion was therefore that the ambulance crew had arrived after a serious delay and had not provided proper medical assistance.
22.  On 30 April 2008 the applicant lodged a complaint with the Avan and Nor-Nork District Court of Yerevan concerning the investigator’s decision of 25 April 2008 seeking the institution of criminal proceedings against A.G. and the nurse. The applicant submitted, in particular, that the panel of experts performing the additional forensic medical investigation had not taken due account of his arguments, which had been based on relevant medical literature and Government decrees. He reiterated his arguments with regard to the contra-indication of relanium and magnesium in cases of pregnancy and low blood pressure and the other arguments previously submitted in his complaint lodged with the District Prosecutor’s Office.
23.  On 16 May 2008 the medical council of the Emergency Medical Service held a meeting at which the circumstances described in the investigator’s decision of 25 April 2008 were discussed. It appears that the members of the ambulance crew submitted written “explanations” (բացատրություն) in relation to the events of 7 September 2007. As a result, A.G. received a reprimand for serious breach of work regulations and medical ethics. Also, the head of the relevant emergency department was ordered to improve the supervision of employees as regards respecting work regulations, so as to prevent similar occurrences in future, and to examine every such case.
24.  On 26 May 2008 the Avan and Nor-Nork District Court of Yerevan dismissed the applicant’s complaint, finding that the inquiry into K.M.’s death had been thorough and adequate. In doing so, the District Court referred to the results of the fresh forensic medical opinion. As regards the late arrival of the ambulance, incorrect completion of the visit record and the doctor’s failure to sit beside the patient during the journey to the hospital, the District Court referred to the fact that A.G. had been reprimanded for poor performance of her duties.
25.  On 16 July 2008 the applicant lodged an appeal against this decision with the Criminal Court of Appeal. He argued, in particular, that the District Court had failed to question A.G. and the nurse. Furthermore, the District Court had not adequately addressed their arguments concerning the injection of K.M. with substances that were contra-indicated, given her condition, or the over-dosage thereof which, he alleged, had caused her death.
26.  On 4 September 2008 the Criminal Court of Appeal dismissed the applicant’s appeal and upheld the decision of the District Court. In doing so, it stated that there was no necessity to summon A.G. and the nurse to testify in court since they had already made statements during the inquiry. As regards the applicant’s arguments with regard to the contra‑indication of medical substances administered by injection to K.M., the Court of Appeal relied on the forensic medical opinions according to which their administration had been correct, taking into account the convulsion syndrome at that moment.
27.  On 30 September 2008 the applicant lodged an appeal with the Court of Cassation against the decision of the Court of Appeal.
28.  On 30 October 2008 the Court of Cassation decided to refuse the examination of the appeal on points of law (վճռաբեկ բողոքը թողնել առանց քննության) since it had not been lodged by an advocate (փաստաբան) licensed to act before the Court of Cassation, as required by Article 404 § 1 (1) of the Code of Criminal Procedure. The applicant claims that he could not afford the costly services of such an advocate.