4.  The applicant was born in 1961 and lives in Biržai. 5.  On 11 April 2008 the applicant’s son, M.P., was arrested on suspicion that he had committed a burglary and stolen a laptop computer. He was taken to a police station in Biržai, where he was held until his death (see below). On 12 April 2008 the police searched M.P.’s home and found an amount of drugs (cannabis). On 13 April 2008 the authorities informed M.P. that he was suspected having committed crimes of theft and possession of drugs. 6.  By a ruling of 13 April 2008, a court sanctioned M.P.’s pre-trial detention for a period of eighteen days, on the grounds that he could flee from justice, for previously he had worked in Norway and had connections in that country. M.P. confessed to possession of drugs, but denied the theft. M.P. was present at the court hearing; he also had a lawyer, J.P., representing his interests in the courtroom. The court indicated that M.P. had no criminal record. 7.  While detained at Biržai police station, M.P. was kept in cell no. 1 alone for the entire time, given that the other detainees at that station had prior convictions, and, pursuant to the relevant domestic law, persons with no criminal record had to be held separately from those with prior convictions (see paragraph 53 in fine below). 8.  As later established by the prosecutor, whilst detained at Biržai police station between 12 and 14 April 2008 M.P. was taken out of his cell four times so that he could meet his lawyer and the investigator. During the pre-trial investigation M.P.’s lawyer, J.P., would later also testify that he had met M.P. at around 2-3 p.m. on 14 April at Biržai police station to discuss whether to appeal against the court ruling imposing detention, but M.P. had stated that there had been no need because he had been ready to confess of the theft. Later that day the lawyer had taken part in M.P.’s questioning by the pre-trial investigator, when M.P. had made a statement about the theft. According to the lawyer, M.P. had communicated in a calm manner, he had not been agitated and had had no complaints. 9.  On the morning of 15 April 2008 M.P. was found dead in his cell at Biržai police station. As was later established during the pre-trial investigation, at around 8 a.m. that morning the guards’ shift was changing, and, in accordance with the applicable rules, the doors of all the cells were being opened. M.P. was found standing with his feet on the ground leaning forward; a blanket was looped tightly around his neck while the other end of the blanket was attached to the metal bar at the side of the top bunk of his bunk bed. The body bore the marks of strangulation, without marks of any other injuries. Police Officer D.M. immediately took M.P. out of the noose and laid him on the floor of the cell. 10.  As transpires from the medical records and the prosecutor’s decision of 19 December 2014 (also see paragraph 44 below), at 8.08 a.m. on 15 April 2008 officers at Biržai police station called an ambulance, which arrived at the scene within a couple of minutes, at 8.12 a.m. The paramedics indicated in the medical report and also later testified during the pre-trial investigation that they had examined M.P.’s body at 8.12 a.m.: the body had been found lying on the floor, had shown no signs of breathing or a pulse, the pupils had been dilated and had not reacted to light, the neck had shown signs of strangulation, post-mortem discoloration had set in, as had rigor mortis. The paramedics also stated that they had not attempted to resuscitate M.P. because according to what they had seen he had died one or two hours before. The paramedics further asserted that apart from strangulation marks on M.P.’s neck there had been no injuries on M.P.’s face or hands. They also attested that there had been no signs on M.P.’s hands which would have indicated that he had been handcuffed or tied with a rope. The paramedics also noted that, if any other injuries had have been visible on M.P.’s body, they would have been noted in the medical report. 11. There was a suicide note found in the cell. It was addressed “To Mother”. An empty box of matches was found in M.P.’s cell, and the authorities later established that the suicide note had been written with charcoal from used matches (also see paragraphs 21 and 44 below). 12. On 15 April 2008, the incident scene was inspected, photographs were taken, one of them showing a white sheet on the bunk bed, and police officers who worked at Biržai police station had been questioned. The same day the prosecutor also questioned the applicant, who stated that “recently her son [had] not complain[ed] about any problems or troubles, everything [had been] good”. She also stated that previously “M.P. ha[d] never attempted to hang himself or to commit suicide, there [had been] no similar accidents in the past, and he [had] not mention[ed] such things either”. The prosecutor continued questioning the police officers on 17 April 2008. 13.  On 15 April 2008 an autopsy was ordered. The prosecutor provided the expert with a plastic bag containing M.P.’s clothes and a blanket which had been found in M.P.’s cell. The expert examination was performed the following day, 16 April 2008. The expert, who was from the Panevėžys branch of the Mykolas Romeris University Forensic-Medicine Institute (Mykolo Romerio Universiteto Teismo medicinos instituto Panevėžio skyrius), concluded that the cause of M.P.’s death had been mechanical asphyxiation as a result of his neck being squeezed by a noose. Whilst noting that there were light scratches on M.P.’s forehead and nose, the expert observed that this could have resulted from scratching of acne and concluded that it was not related to M.P.’s death (report no. M 224/008(05)). 14.  The applicant requested that an additional autopsy be performed and the prosecutor granted her request. The additional autopsy was performed on 18 April 2008 (report no. M 759/08(01)). The forensic expert at the Vilnius branch of the Mykolas Romeris University Forensic-Medicine Institute concluded that there were strangulation marks on the neck and bruising on the back. The neck injuries could have been inflicted several minutes prior to death as a result of the neck being squeezed by the bed sheet. As to the bruising on the back, this could have been caused when the body hanging in the noose went into convulsion hitting off hard blunt surfaces. The expert concluded that there were no objective indications which could have denied M.P.’s cause of death as having been asphyxiation when the neck had been squeezed in a noose. The expert noted that there were no signs of strangulation by hands; he also indicated that it had been a one-time constriction on the neck.
The findings of this additional autopsy were later confirmed when, following the last reopening of the criminal proceedings, the pre-trial investigation judge ordered another forensic examination (report no. EKM 52/14(01)) to be performed to answer certain questions, including those submitted by the applicant. 15.  According to the Government – who have not been contested on this point by the applicant – upon the applicant’s request, after the second autopsy the bailiff examined the corpse and took photographs in order to establish factual circumstances. The bailiff noted injuries on the back and the neck of the corpse. 16.  On 7 May 2008 the applicant was granted victim status. She was represented by a lawyer. 17.  On 25 November 2008 the prosecutor summarised the findings made as a result of the criminal investigation and decided to discontinue it, citing the lack of any indication of a crime. The prosecutor considered that M.P. had died through suicide, which was corroborated by his suicide note. 18.  However, by a ruling of 5 February 2009 the Panevėžys Regional Court, on appeal by the applicant, found that the pre-trial investigation had not been thorough and annulled the prosecutor’s decision to discontinue it. For the court, it had been necessary to investigate whether M.P. had been harmed by other persons, taking into account the injuries on M.P.’s wrists, as alleged by the applicant, as well as to examine the suicide note and to establish whether it had been written by M.P. and with what writing instruments. The video recordings from Biržai police station had not been properly inspected, and the statements of some of the police officers had been contradictory, even false. Moreover, an internal investigation had established gross breaches of duty by the police officers at the police station (see paragraphs 47-50 below), which in turn could attract criminal liability under Article 229 of the Criminal Code (see paragraph 52 below). Nevertheless, the prosecutor had failed to assess that internal-investigation report. 19.  In March and April 2009 another prosecutor continued the investigation and questioned witnesses. 20.  In May 2009, and in order to establish whether the suicide note had been written by M.P., the prosecutor ordered a handwriting expert examination of the note, which then was compared to several other documents handwritten by M.P. One of those other documents was a note which M.P. had handwritten to the applicant on 14 April 2008, whilst detained at Biržai police station. It transpires from the material before the Court that that document had been in the possession of the applicant who had refused to give it to the authorities. A copy of that note had eventually been obtained by the authorities under a court order. 21.  In June 2009 the handwriting experts produced a report concluding that the suicide note had been undoubtedly been written by M.P. In December 2009 the forensic experts concluded that there was high probability that the suicide note had been written with burned matches, which could have come from one of the two match boxes that had been found in M.P.’s cell or from another box of matches (expert report no. 11–1457(09)). 22.  On 29 January 2010 the prosecutor again discontinued the pre-trial investigation, holding that M.P.’s death had been suicide. In reaching that decision he relied on an abundant body of evidence, including analyses of the video recordings from the police station cameras, which showed that no–one had entered M.P.’s cell at the relevant time. Between 5 p.m. on 14 April 2008, when M.P. had already been in the cell, until 8.04 a.m. on 15 April 2008, when M.P.’s body had been found, the doors of his cell had been opened only once, at 8.00 p.m. on 14 April 2008, when the guards D.M. and D.A. had changed shift. Furthermore, the recordings showed that the guards D.A. and D.M. had checked on M.P. several times though the peep hole, and during the night the guard D.M. had patrolled his area several times. 23.  As to the possible criminal liability under Article 229 of the Criminal Code (see paragraph 52 below) on the part of the police, the prosecutor took into account the conclusions of the internal investigation to the effect that the Officers D.M. and R.S. had not followed the internal instructions regarding the obligation to constantly observe detainees. That being so, the prosecutor also noted that the two officers could not have foreseen the consequences of such behaviour – M.P.’s suicide – and prevent it, because M.P. had been a quiet and introverted person, he had been calm, had caused no problems in the police station and had not complained. There had been no indication that M.P. had had suicidal tendencies or a tendency to self-harm, and therefore no signs that special supervision had been needed. Accordingly, since there had been no causal link between the actions of the officers and the consequences, there were no grounds to start a pre-trial investigation for failure to perform official duties. 24.  On the basis of an appeal by the applicant, who had argued that during such a flawed pre-trial investigation her suspicions that her son had been murdered had only become stronger, by a ruling of 13 May 2010 the Panevėžys Regional Court in a public hearing again annulled the prosecutor’s decision to discontinue the criminal proceedings. This time the court considered that there were certain contradictions with regard to the bed sheet as the object used for strangulation. 25.  Having performed an additional examination of the bed sheet in the light of all available evidence, such as the witnesses’ statements, the photographs from the scene and expert reports, by a decision of 6 September 2010 the prosecutor again discontinued the pre-trial investigation into the circumstances of M.P.’s death. 26.  The applicant appealed, and on 25 October 2010 the Rokiškis County District Court quashed the prosecutor’s decision. The court considered that, in order to eliminate all doubts as to how M.P. could have killed himself, it was possible to conduct a reconstruction which would also verify the applicant’s version that her son could not have killed himself in the way suggested (see paragraph 9 above). The court also stated that it was necessary to establish why burned matches with which M.P. had written the suicide note had not been found in the cell. Lastly, the specific instrument which had been used as a noose around M.P.’s neck had to be established. That decision was upheld by a higher court. 27.  On 14 December 2010 two reconstructions were performed at Biržai police station, with the participation of the applicant, the prosecutor, Police Officer D.M., who had found M.P.’s body, and others. It was examined whether M.P. could have hanged himself in the manner stated by the police officers on 15 April 2008 (see paragraph 9 above). After the first reconstruction the applicant maintained that her son could not have hanged himself in the manner described. She had no remarks as to the results of the second reconstruction. The results of those reconstructions were written down in two reports. 28.  In order to find the instrument which had caused M.P.’s strangulation, the prosecutor sent requests to the Biržai county prosecutor’s office and to the forensic experts in Panevėžys, and questioned certain witnesses. Even so, the blanket could not be found. 29.  In the meantime, the applicant lodged an application to have a pre-trial investigation on the charges of failure to perform official duties (Article 229 of the Criminal Code, see paragraph 52 below) opened in respect of the prosecutors who had earlier discontinued the pre-trial investigation. By a final ruling of 10 January 2011 the Panevėžys Regional Court refused her application, noting that it was within the prosecutors’ competence which actions to take when handling a criminal case. More importantly, in this case, once the courts had annulled the prosecutors’ decisions to discontinue criminal investigation, the prosecutors had continued the pre-trial investigation and the actions which the court had ordered had been carried out. 30.  On 10 February 2011 the Rokiškis County District Court allowed an application by the applicant’s lawyer to have a medical expert evaluate the results of the second reconstruction (see paragraph 27 above) in order to answer the question as to whether in hanging himself in the manner shown during the second reconstruction M.P.’s neck bones should have broken. According to the applicant, one needed “acrobatic” skills to commit suicide in such a manner. Having performed the examination of the second reconstruction report and the additional autopsy report (see, respectively, paragraphs 14 and 27 above), on 27 November 2011 the expert concluded that he could not answer the question posed by the applicant’s lawyer, because the question was speculative. 31.  On 13 January 2012 the prosecutor again discontinued the pre-trial investigation into the circumstances of M.P.’s death and also, for the reasons set out earlier (see paragraph 22 above) refused to open one in respect of Officers D.M. and R.S. for failure to perform official duties.
His decision was upheld by the first-instance court, which dismissed the applicant’s appeal. 32.  By a final ruling of 6 April 2012 the Panevėžys Regional Court rejected an appeal by the applicant and upheld the part of the prosecutor’s decision regarding the refusal to open a criminal investigation in respect of the actions of Officers D.M. and R.S., on the grounds that they had failed to perform their duties. The court reached this decision in a public hearing in which the applicant and her lawyer took part and could present their arguments. The court concurred with the prosecutor’s view that the authorities had not been aware that M.P. had been a suicide risk, so as to confer liability on the officer. Pursuant to domestic law as applied in this case, persons detained in several cells at Biržai police station had to be constantly monitored through spy holes. Even so, on the basis of the medical report the court nevertheless underlined that M.P. had died within a couple of minutes of the moment when the noose had closed around his neck, that is to say within a very short time. It would have been physically impossible for D.M. and R.S. to constantly monitor, through the holes in the cell doors, all the persons detained at the police station, including M.P. This was one more reason why the court could not hold that D.M.’s and R.S.’s failure to perform their duties had caused M.P.’s death. 33.  On 27 April 2012 the Rokiškis County District Court granted the applicant’s appeal and quashed the prosecutor’s decision of 13 January 2012 in the part discontinuing the pre-trial investigation into the circumstances of M.P.’s death (see paragraph 31 above). The court held that in order to eliminate any contradictions about alleged violence against M.P., a confrontation had to be performed between the applicant and one of the police interrogators who had questioned her son on 14 April 2008 (see paragraph 8 above). In addition, the applicant requested that other persons who were detained at Biržai police station between 14 and 15 April 2008 be questioned, and the court granted that request. 34.  As requested by the court, the prosecutor then performed a confrontation between the applicant and the police interrogator and questioned eight individuals who had been detained at Biržai police station at the time of M.P.’s death. They all stated that they had heard no suspicious sounds during that night. In particular, D.Ž., M.P.’s co-accused in the case of theft, who had also been detained in the same Biržai police station but in another cell, averred that the two of them had talked through the slots intended for passing food at about 9 p.m. on 14 April 2008. M.P. did not state that any violence had been used against him or that he had been threatened. Neither had D.Ž. heard any suspicious sounds from M.P.’s cell. 35.  On 22 October 2012 the prosecutor again discontinued the pre-trial investigation into the circumstances of M.P.’s death, holding that it had been the result of suicide. 36.  As she was dissatisfied with the way in which the pre-trial investigation had been conducted, on 14 November 2012 the applicant applied to have the entire office of the Panevėžys regional prosecutor’s office removed from the investigation. By a final ruling of 7 March 2013 the Panevėžys Regional Court held that her complaints were without substance, and that there was no reason to believe that any prosecutors from that office would not be able to effectively carry out the pre-trial investigation. 37.  By a ruling of 31 January 2013 the Panevėžys Regional Court however allowed an appeal by the applicant against the prosecutor’s decision to discontinue the criminal proceedings (see paragraph 35 above). The applicant was present at the court hearing. She asked that an expert report be prepared in order to establish whether the video recordings from Biržai police station had not been tampered with. The court granted her request. 38.  The prosecutor then proceeded with the pre-trial investigation. On 20 June 2013 the forensic experts produced report no. 11–745(13), wherein they concluded that even if there were small gaps between the clips, each of the clips in those video recordings was complete, and that none of the clips had any signs of having been altered by deletion or addition. 39.  By a decision of 8 July 2013 the prosecutor again discontinued the pre-trial investigation. He relied on the entirety of the evidence in the criminal file, including the expert conclusions regarding the video–recordings (see the above paragraph). 40.  The applicant appealed, arguing that the pre-trial investigation had been flawed, and that a number of pieces of evidence, such as, among other things, the marks on her son’s wrists and the video recordings, had been improperly evaluated. 41.  By a decision of 1 October 2013 the Panevėžys Regional Court again quashed the prosecutor’s decision. The court considered that there still remained certain contradictions, in particular, whether the short gaps within the video recording had occurred owing to a technical problem or because of another cause. It was also necessary to ascertain whether the video files had been provided in sequence. Moreover, no clear answer had been obtained from the medical expert as regards the possible reasons for M.P.’s injuries in the light of the results of the second reconstruction (see paragraphs 27 and 30 above). A supplementary medical evaluation had to be performed in which the specialists would be provided with all the existing information about M.P.’s injuries so that the mechanism of his death could be determined and the question of whether there had been signs of violence against M.P. answered. The applicant and her lawyer were given the opportunity to pose questions to the experts. Lastly, the court underlined that a person’s death, and even more so a death in a police station, was “a particular situation (yra ypatingas atvejis)”, which had to be thoroughly examined. 42.  In accordance with the Panevėžys Regional Court’s instructions (see the paragraph above), the prosecutor then asked the forensic experts to examine the video recordings at issue. On 1 April 2014 an expert at the Forensic Science Centre of Lithuania (Lietuvos Teismo ekspertizės centras) then concluded (report no. 11–3422(13)) that it was most likely that the gaps between the clips had appeared when transferring the video files to DVD. The video files were in chronological order. The expert also noted that one of the cameras had recorded two paramedics at the police station at 8.12 a.m. on 15 April 2008. 43.  As instructed by the Rokiškis County District Court on 25 November 2013, the experts at the State Forensic-Medicine Service (Valstybinės teismo medicinos tarnyba) had been given the material of the pre-trial-investigation file, which had amounted to four volumes, to perform an expert examination of the cause of M.P.’s death. They conducted the examination from 26 May to 28 November 2014 and produced report no. EKM 52/14(01). The experts firstly concluded that M.P. could have died as had been demonstrated during the second reconstruction, which had been performed on 14 December 2010 (see paragraph 27 above). They also noted that M.P.’s neck organs could have been placed under pressure because of his own weight, and also underlined the fact that, when a person’s body is in a certain position, his or her weight is sufficient to bring about suffocation. The experts also explained that the death of M.P. should have occurred while he was in a vertical or similar position, as proven by the location of the post-mortem discolouration, and that the bruises on M.P.’s back could have been caused when he was in the noose and his back came into contact with the frame of the bunk bed during his convulsions. As to the injuries to M.P.’s wrists, which the applicant alleged had been inflicted during handcuffing, the experts had explained that those had appeared after the first autopsy when M.P.’s hands had been bound during preparation of his body for burial, which was the usual practice. On the basis of the documentary evidence – photographs of M.P.’s corpse from the scene, the bailiff’s statements of 16 April 2008 (see paragraph 15 above) and the additional autopsy report (see paragraph 14 above) – the experts also categorically and officially stated that there had been no bruising around M.P.’s eyes, unlike what had been claimed by the applicant. 44.  By a decision of 19 December 2014 the prosecutor again discontinued the pre-trial investigation. He relied on the entirety of the evidence which he cross-referenced – including that obtained after the last resumption of the criminal investigation – and held that no crime had been committed, holding that M.P. had died as a result of suicide. For the prosecutor, suicide as the cause of death was also corroborated by the statements of M.P.’s lawyer, who stated that on 14 April 2008 M.P. had been acting calmly, had been responsive, had not complained about anything and had not been agitated (see paragraph 8 in fine above). Among other things, the prosecutor also noted that an empty box of matches had been found in M.P.’s cell, and that the cell had had a toilet and burned matches could have been disposed of there (see paragraphs 11, 21 and 26 above). Although the blanket which had been given to the forensic expert on 15 April 2008 (see paragraph 13 above) had not been found during the later stages of the pre-trial investigation, there was sufficient data to confirm that M.P. had put his neck into a noose made from a blanket, and there was no evidence that someone had forced him to do that or that someone had hanged him. 45.  The applicant appealed against the prosecutor’s decision, asserting that the criminal investigation had not proven that her son had committed suicide. She still insisted that the evidence which had been gathered during the pre-trial investigation had been contradictory and had raised doubts. The applicant still considered that her son could have been a victim of police violence. 46.  The criminal proceedings in respect of M.P.’s death were ultimately terminated by a ruling of the Panevėžys Regional Court on 27 April 2015, dismissing an appeal by the applicant. The court noted that numerous pieces of evidence had been collected and examined. It also emphasised that two of the applicant’s main criticisms had been answered. Firstly, after the last re-opening of the pre-trial investigation an examination of the video recordings was performed by a forensic expert, who had disproved the applicant’s allegation that the video recordings from Biržai police station had been tampered with (see paragraph 42 above). Secondly, report no. EKM 52/14(01) (see paragraph 43 above), as well as earlier medical reports (see paragraphs 13 and 14 above), had reached the same conclusions – that M.P. had died as a result of being strangled in a noose. The court noted that those medical reports had explained that M.P. could have died in the manner which had been demonstrated in the second reconstruction, and also noted that there had been no signs of injuries on M.P.’s body which he could not have inflicted himself. The applicant’s allegation that M.P.’s death could have been caused by someone else had been examined throughout the criminal investigation but no evidence of that had been found. The court also noted that the prosecutor had reached reasoned conclusions after having performed a comprehensive analysis of the gathered evidence. Although the applicant had expressed doubts in respect of the evidence gathered, in her appeal she had not presented any new arguments regarding what particular pre-trial investigation actions had not been performed, what data had not been evaluated, or what investigative actions, had they been performed, would have clarified any important circumstances in this case. Lastly, the court concluded that during the pre-trial investigation all actions provided by law had been used to obtain evidence. Even so, there was “no unquestionable data (neabejotini duomenys)” that a crime had been committed. 47.  After M.P.’s death, the police also conducted an internal investigation. It was led by a senior investigator at the Panevėžys city police. On 30 May 2008 the internal investigator produced report no. 50-1-IS-42, which was approved by the chief of the Panevėžys city police. 48.  Having examined the available material, which included both the criminal case-file regarding the theft and the material of the criminal case-file concerning the circumstances of M.P.’s death, the internal investigator concluded that there was no information which could lead to a conclusion of any kind of abuse of M.P. by the police officers. 49. Within the course of the internal investigation, the safeguarding of M.P. while in police custody was also examined. On the basis of video recordings from the police station the internal investigation established that during his shift the guard D.M. had patrolled his area only a few times and had stopped only briefly at the doors of the cells. He had also only twice slowly walked the corridor along his post and only once, while patrolling his area, had he looked inside cell no. 1, where M.P. had been held. The investigator concluded that D.M. had thus failed to perform his duties in accordance with the internal instruction on ensuring constant supervision of detainees, and had thus committed a disciplinary offence. Lastly, the investigator noted that by making a statement during the internal investigation that he had ensured constant supervision of the detainees, D.M. had given false testimony. Afterwards D.M. was given a reprimand. 50.  As to the other guard – R.S. – the internal investigation established that he had monitored the situation at his post via video cameras, which he considered a possible way of carrying out his duties. The internal investigator admitted that such a method of carrying out his duties could not be seen as unreasonable, even if there had been certain technical errors in how his functions had been assigned. As a result, no disciplinary sanctions were imposed on R.S.