FIFTH SECTION       CASE OF TEMCHENKO v. UKRAINE (Application no. 30579/10)        JUDGMENT   STRASBOURG 16 July 2015  FINAL 16/10/2015 This judgment has become final under Article 44 § 2 of the Convention. It may be subject to editorial revision. In the case of Temchenko v. Ukraine,The European Court of Human Rights (Fifth Section), sitting as a Chamber composed of: Angelika Nußberger, President, Boštjan M. Zupančič, Ganna Yudkivska, Vincent A. De Gaetano, André Potocki, Helena Jäderblom, Aleš Pejchal, judges,and Claudia Westerdiek, Section Registrar,Having deliberated in private on 23 June 2015,Delivers the following judgment, which was adopted on that date:PROCEDURE1. The case originated in an application (no. 30579/10) against Ukraine lodged with the Court under Article 34 of the Convention for the Protection of Human Rights and Fundamental Freedoms (“the Convention”) by a Ukrainian national, Mr Anatoliy Georgiyevich Temchenko (“the applicant”), on 21 May 2010.2. The applicant was represented by Ms A. Mukanova and Mr M. Tarahkalo, lawyers practising in Kharkiv. The Ukrainian Government (“the Government”) were represented by their Agent, Mr N. Kulchytskyy, of the Ministry of Justice.3. On 8 December 2011 the application was communicated to the Government.THE FACTSI. THE CIRCUMSTANCES OF THE CASE4. The applicant was born in 1942 and lives in Kryvyy Rig. Before his arrest he was rector of a State-owned university.5. On 23 September 2009 the applicant was medically examined. An endocrinologist noted that he had type-2 diabetes and prescribed insulin injections. The endocrinologist advised that commencement and adjustment of the insulin treatment should take place on an in-patient basis in a local hospital.A. The applicant’s detention and the criminal proceedings against him1. The applicant’s arrest and the criminal proceedings6. On 29 September 2009 an investigator from the Dnipropetrovsk Regional Prosecutor’s Office arrested the applicant on suspicion of having received bribes in his capacity as university rector. He was detained in the temporary detention facility of Kryvyy Rig (“the ITT”).7. On 2 October 2009 the Dzerzhynskyy District Court of Kryvyy Rig (“the District Court”) ordered the applicant’s detention for three months, stating, without referring to any concrete facts, that he might abscond, hinder the investigation or continue his criminal activities. The court also noted that there was evidence in support of the prosecutors’ suspicion that the applicant had received bribes.8. On 5 October 2009 the applicant was transported to the Kryvyy Rig remand centre (“the SIZO”).9. On 7 October 2009 the Dnipropetrovsk Regional Court of Appeal (“the Court of Appeal”) upheld the above decision. The court noted, without providing further details, that the case file contained evidence that the applicant had attempted to hinder the investigation, and medical documents indicating that he was physically fit for detention. No further information about the said evidence and documents was made available to the Court.10. On 18 November 2009 the District Court extended the applicant’s detention to 29 January 2010, relying on the same grounds as in its previous decision.11. On 25 November 2009 the Court of Appeal upheld that decision. Referring to unspecified medical documents, it again noted that the applicant was physically fit for detention.12. On 29 January 2010 the investigation in the applicant’s case was completed and the case was referred to the District Court for trial.13. In a preliminary hearing on 9 March 2010, the District Court ruled that the preventive measure in respect of the applicant had to be maintained as there were no reasons to change it. The court did not fix the length of the applicant’s detention.14. In a judgment of 23 May 2011, the District Court sentenced the applicant to five years and two months’ imprisonment for bribery. On 5 October 2011 the Dnipropetrovsk Regional Court of Appeal modified that judgment and sentenced the applicant to five years’ suspended imprisonment with a probationary period of three years. On the same date the applicant was released from the SIZO. The judgment became final.15. In the course of the criminal proceedings the applicant took part in fifty court hearings and in a number of investigative actions.2. The applicant’s requests for release16. In a written request for release, the applicant stated that his state of health was incompatible with detention and that, as he no longer held the post of rector, he could not hinder the investigation. On 31 May 2010 he submitted his request to the SIZO administration asking them to send it to the District Court for examination. On 2 June 2010 the SIZO administration duly forwarded the request. On 7 June 2010 the District Court rejected the request, holding that if he were freed, the applicant could influence witnesses. It continued:“... In so far as the applicant’s health is concerned, it appears from the medical certificates provided by the SIZO and municipal hospital no. 8 that the applicant is being provided with medical treatment. Therefore, the court finds no reason to change the applicant’s preventive measure.”17. The court did not refer to any concrete facts supporting its finding that the applicant could influence witnesses. Nor did it examine the adequacy of the medical treatment provided to him. No details of the “medical certificates” to which the District Court referred were made available to the Court.18. On an unspecified date, the applicant wrote another request for release against an undertaking not to abscond. He argued that during his detention his state of health had deteriorated as a result of the inadequate medical treatment provided to him in the SIZO. He also argued that the conditions of his transportation to court hearings had been inappropriate given his state of health. In particular, due to the insufficient ventilation in the van transporting him, his blood pressure had risen and he had had difficulty breathing. It remains unknown when this request was submitted to the District Court.19. On 17 June 2010 the District Court examined and rejected the applicant’s request, stating:“... the applicant could influence witnesses and thus hinder the investigation ... Where necessary the applicant has received medical aid in the SIZO.”20. On 6 August 2010, 21 and 22 February 2011, the applicant submitted further requests for release, either against an undertaking not to abscond or on bail. Relying on the findings of forensic medical examinations carried out on 12 November 2010 and 28 January 2011 (see paragraphs 62-66 below), he argued that the treatment provided to him during his detention had not been adequate and that he needed in-patient treatment in a specialist medical institution. That kind of treatment could not be provided to him in the SIZO.21. On 28 March 2011 the District Court rejected those requests. The court based its decision on the findings of the forensic examination of 28 January 2011, noting that the applicant’s diseases were of a chronic nature and could last for a long time. The court also stated: “If necessary the applicant can be transported to court hearings in an ambulance accompanied by a doctor”.... “From the medical certificates issued by the SIZO and the certificate issued by hospital no. 9 on 25 March 2011, it follows that when necessary the applicant receives medical aid in the SIZO and in municipal hospitals. The applicant may influence witnesses”.No details of the “medical certificates” to which the District Court referred were made available to the Court.22. On 7 April 2011 the applicant submitted another request for release, advancing the same arguments as in his requests of 6 August 2010, 21 and 22 February 2011.23. On 28 April 2011 the District Court rejected the applicant’s request, essentially relying on the same grounds as in its decision of 28 March 2011.3. The applicant’s detention from 29 January to 9 March 201024. On 9 March and 7 June 2010 the District Court examined the applicant’s complaint that his detention from 29 January to 9 March 2010 had been unlawful and rejected it as unsubstantiated. The court found that, although that period of detention had not been covered by any court decision, the detention had been justified because the applicant had been awaiting committal for trial.B. Medical assistance provided to the applicant in detention25. On 5 October 2009 the doctor who had examined the applicant upon his arrival at the SIZO decided, in view of the applicant’s abnormally high blood pressure, to place him in the cardiology department of a municipal hospital. On the same date the applicant was taken to municipal hospital no. 3, which had cardiology and endocrinology departments.26. The applicant was diagnosed with ischemic heart disease, stenocardia, hypertensive diseases (stage II), chronic cholecystitis (remission stage) and pancreatitis (remission stage), type-2 subcompensated diabetes of medium severity, kidney cyst, prostate adenoma, and chronic pielonefritis (remission stage).27. The applicant was discharged from the hospital on 27 October 2009. He was recommended constant monitoring by a doctor and prescribed various medications, including an oral medication to lower his sugar level (Gliclazide).28. On the same date the applicant was returned to the SIZO medical unit, which was tasked with providing primary medical aid to SIZO detainees and did not have the equipment and staff to provide specialist medical treatment and assistance. The unit’s medical staff included two nurses, two feldshers (paramedics), a doctor, a psychologist and a gynaecologist.29. On 11 February and 9 March 2010 the SIZO medical unit informed the applicant’s lawyer that, according to the results of medical tests, the applicant’s diabetes and kidney pathology warranted in-patient examination in a specialist medical institution. However, no further steps were undertaken in this respect.30. On 24 March 2010 an endocrinologist from hospital no. 3 studied the results of the applicant’s sugar-level tests and recommended that he start insulin injections on 9 April 2010.31. On 1 and 6 April 2010 the applicant was transported to municipal hospitals nos. 3 and 8 respectively, where he was examined by surgeons. On the latter date the applicant was diagnosed with chronic pancreatitis. After the examinations, which lasted for several hours, the applicant returned to the SIZO.32. On 9 April 2010 an endocrinologist from hospital no. 3 confirmed the insulin prescription and recommended regular sugar-level tests. From that date onwards the applicant received insulin injections and did not raise any objection in that respect. He bought the insulin in the SIZO pharmacy, while the insulin syringes were sent to him by his relatives.33. In a letter of 15 April 2010 addressed to the applicant’s lawyer, the SIZO medical unit stated that the applicant’s condition during his detention was of medium severity and unstable.34. On 13 May 2010 the applicant complained to the SIZO medical staff of a sudden deterioration in his health. The medical staff noted that his pancreatitis had worsened and that there had been a significant rise in his sugar level. They called an ambulance to take him to hospital no. 8, which, however, did not have specialist endocrinology or cardiology departments. The applicant was placed in the intensive-care department, underwent a number of medical tests and was examined by an urologist, a neuropathologist, a cardiologist and an endocrinologist. He received treatment in connection with his diabetes and pancreatitis. The doctors established that his state of health had deteriorated since October 2009 and his general condition was serious.35. On 21 May 2010 the applicant was discharged from the hospital and transported back to the SIZO medical unit.36. In the applicant’s discharge note the hospital doctors recommended that he be monitored by an endocrinologist and that his sugar level be regularly measured. His diabetes treatment was modified and he was prescribed a special diet – so-called “fractional nutrition”.37. On three occasions between 27 May and 8 June 2010 a SIZO doctor raised the dose of insulin administered to the applicant. According to the Government, the dosage was raised on the advice of an endocrinologist. The applicant disagreed.38. On 2 June 2010 the SIZO medical unit informed the applicant’s lawyer that it did not have sufficient equipment and staff to provide the applicant with adequate insulin treatment, which could only be administered on an in-patient basis in a specialist medical institution.39. On the same date the head of the SIZO medical unit informed the judge dealing with the applicant’s criminal case that it was impossible to provide the applicant with adequate medical treatment in the SIZO. He noted that the applicant’s condition warranted comprehensive in-patient treatment in an outside medical institution and asked the judge to consider changing the applicant’s preventive measure. He also noted that further modification of the insulin dosage in the SIZO “without the endocrinologist’s supervision might lead to undesired results”. The judge did not react to that information.40. On 16 June and 2 July 2010 the applicant requested that the Court, under the Rule 39 of the Rules of Court, oblige Ukraine to transfer him to a specialist hospital, where he could receive adequate medical care. He alleged that as a consequence of that request, the SIZO medical staff stopped registering his complaints and providing him with any medical assistance. The Government contested the applicant’s allegation. On 30 July 2010 the Court refused the applicant’s request.41. On 13 July 2010 an endocrinologist examined the applicant in the SIZO, confirmed his previous diagnosis and adjusted his treatment.42. On 20 July 2010 the applicant was examined by an urologist and an oculist in hospital no. 8. He underwent a kidney ultrasonic examination and was diagnosed with retinal angiopathy. On the same date he returned to the SIZO.43. On 28 January 2011 the applicant was examined in the SIZO medical unit by an endocrinologist, a cardiologist and a urologist from municipal hospitals.44. On 30 January 2011 the SIZO administration requested hospital no. 8 to assess whether the applicant needed in-patient treatment. The hospital did not reply, and the SIZO administration did not follow up on the request.45. From 1 March 2011 onwards the SIZO medical unit had no doctors among its staff.46. On 16 March 2011, following a new request submitted by the applicant under Rule 39, the Court decided that the Government should “ensure that the applicant received treatment in the specialised institutions referred to in the report of 28 January 2011” (see paragraphs 63-66 below). On 17 March 2011 the Court informed the Government of its decision.47. On 18 March 2011 the applicant was taken by ambulance to hospital no. 8, where he remained until 19 March 2011. The Government submitted that the applicant’s hospitalisation had been based on the Court’s decision of 16 March 2011. The applicant challenged that statement and submitted that he had been hospitalised solely because of a sudden deterioration in his health, which the SIZO staff had been unable to deal with.48. On 19 March 2011 the applicant was transferred to the cardiology department of hospital no. 9, which had an endocrinologist on its staff.49. During his stay at the hospitals, the applicant was advised to undergo a coronography (heart examination) as soon as possible.50. On 26 March 2011 the applicant was discharged, the hospital doctors having noted an improvement in his state of health. He returned to the SIZO medical unit.51. The SIZO administration proposed that the applicant undergo the coronography at any of the hospitals in Kryvyy Rig and receive treatment for diabetes in the endocrinology department of hospital no. 3 in Kryvyy Rig. The applicant refused, maintaining that he did not trust the Kryvyy Rig doctors. He would only agree to be taken to the Strazhesko Cardiology Institute in Kyiv.52. On 8 April 2011 the applicant was examined in the SIZO by an endocrinologist from hospital no. 3 and his treatment for diabetes was modified.53. On 15 April 2011 the governor of the SIZO informed the judge dealing with the criminal case against the applicant that the latter’s condition was of medium severity and unstable. He asked the judge to consider changing the applicant’s preventive measure, in particular, in view of his age and state of health. The judge did not react to that request.54. On 19 April 2011 the SIZO administration asked the judge to allow the applicant to be moved to the Strazhesko Cardiology Institute in Kyiv. On 6 June 2011 the judge granted the request.55. In the meantime, on 21 April 2011, the applicant was urgently taken to the endocrinology department of hospital no. 8 because of a sudden deterioration in his health. He remained in the hospital until 27 April 2011 and received treatment for diabetes.56. On 10 July 2011 the applicant was transported to Kyiv by train.57. Between 11 and 22 July 2011 the doctors of the Strazhesko Cardiology Institute in Kyiv examined the applicant and prescribed non-urgent heart surgery. In addition to the diseases previously noted by other doctors, the applicant was diagnosed with poliposis of the stomach and sigmoid colon, stomach polipantruma, repeated Q-wave infarction of the posterior wall of the left ventricular valve of the heart, atherosclerosis of the coronary arteries, mitral valve regurgitation, tricuspid valve regurgitation, atrioventricular valve regurgitation and atherosclerotic cerebrovascular insufficiency.58. On 30 July 2011 the applicant returned to the Kryvyy Rig SIZO medical unit.59. While the applicant remained in detention, his wife and lawyer submitted several requests to the authorities seeking his move to a specialist hospital instead of the SIZO. The SIZO administration replied that the applicant was receiving adequate treatment in the SIZO and occasionally in municipal hospitals, and that his health condition did not require specialist in-patient treatment in an outside medical institution.60. The applicant lodged a number of complaints with the prosecutors stating that he had not been provided with adequate medical assistance in detention. The prosecutors rejected his complaints as unsubstantiated. The applicant did not challenge the prosecutors’ decisions before the courts.61. According to the applicant, he was handcuffed to his bed at all times during his stays in municipal hospitals. He did not raise any complaint in this connection before the national authorities and did not provide any evidence in that regard. The Government denied that the applicant had been handcuffed.C. Forensic medical examinations of the applicant62. On 12 November 2010, following a request from the applicant’s lawyer and having studied the applicant’s medical records provided by the latter, a committee of medical experts from the Central Bureau for Forensic Examinations based in Kyiv drew up a report on the applicant’s state of health. It found that as a result of the inadequate medical treatment provided to him during his pre-trial detention, his condition had deteriorated. It stated, in particular, that the applicant’s hypertension had been exacerbated and the type-2 diabetes had reached the stage of decompensation. The experts noted that the gravity of the applicant’s condition warranted in-patient treatment in specialist endocrinology and cardiology hospitals, such as the Strazhesko Cardiology Institute in Kyiv. The experts also expressed the opinion that the applicant risked developing a brain haemorrhage and aortic dissection if he was not provided with appropriate treatment. It was recommended that he be transported in an ambulance accompanied by a doctor.63. On 23 November 2010 the District Court, following a prosecutor’s request, ordered a committee of medical experts from the Dnipropetrovsk Bureau for Forensic Examinations to assess whether the applicant was physically fit for transportation and participation in court hearings.64. The medical experts decided that, in view of the instability of the applicant’s condition, it was not necessary to examine him in person. They assessed the applicant’s condition on the basis of his medical file provided by the SIZO. In their report of 28 January 2011 the experts concluded that the applicant’s condition was grave, highly unstable and unpredictable, he was prone to sudden deterioration in his health, which could be fatal if it occurred during transportation in a vehicle without appropriate medical equipment. The applicant’s transportation was thus found to be “undesirable”. However, if it was strictly necessary for the court to contact the applicant, the experts recommended transporting him in a special cardiac ambulance accompanied by a doctor.65. The experts found that the applicant’s condition had deteriorated while in detention as a result of the inadequate and incomprehensive medical treatment provided to him during that period. If not provided with appropriate in-patient treatment at a specialist medical institution – the experts referred to the Strazhesko Cardiology Institute as an example of such an institution – the applicant risked developing potentially fatal complications, such as cardiac arrest, brain haemorrhage or aortic dissection.66. The report of 28 January 2011 contains the statement that “... the applicant’s diseases are of a chronic nature, and may last for a lengthy period of time”.67. On 8 June 2011, following a request from the applicant’s wife, a committee of medical experts from the Central Bureau for Forensic Examinations studied the applicant’s medical records and found that since 12 November 2010 his health had deteriorated and that his condition warranted comprehensive in-patient treatment in a specialist hospital, in particular the Strazhesko Cardiology Institute. Without such treatment the applicant risked developing life-threatening conditions such as a brain haemorrhage and aortic dissection. The experts mentioned that, in view of the instability of the applicant’s condition, his transportation would be potentially fatal. The applicant’s short-term hospitalisations had not constituted appropriate in-patient treatment in the applicant’s case because they had been aimed only at stabilising sudden deteriorations in his condition and had not formed part of a comprehensive treatment.68. The results of the above forensic examinations were submitted to the District Court.D. Provision of the medical records to the applicant, his wife and lawyer69. The applicant claimed that on 29 June 2010 his wife had asked the SIZO administration to send her his medical records. The SIZO administration had not responded to her request. The Government stated that the SIZO administration had not received such a request. A copy of the request which the applicant submitted to the Court bears no evidence that it was received by the SIZO.70. On 4 and 11 August and 22 November 2010, 10 and 31 March 2011 respectively, the applicant’s wife submitted further requests to the SIZO administration asking them to send her the applicant’s medical records. The SIZO sent her the records on 18 August and 29 November 2010, 29 March and 6 April 2011, respectively.71. On 31 March 2011, following a request from the applicant’s lawyer, hospital no. 9 provided the lawyer with a copy of the applicant’s medical records. According to the applicant, all the medical records provided to his wife and lawyer were incomplete and contained false information.E. Conditions of the applicant’s detention in the SIZO and his transportation1. Conditions of detention in the SIZO72. According to the applicant, the window in his cell in the SIZO “had no glass in it”, which resulted in “dampness and air temperature fluctuations”. The food provided by the SIZO was of poor quality. The applicant did not provide further details in that regard.73. The special diet (“fractional nutrition”) prescribed to the applicant was not available in the SIZO and was provided to him by his relatives two or three times a week.74. On 26 August 2011 the Government examined the two cells in which the applicant had been held in the SIZO. They submitted that the windows in the cells were double glazed and measured 110 by 130 cm. The temperature in the cells was 20C and the humidity was 56%. The Government acknowledged that the SIZO had not provided the “fractional nutrition” to the applicant. According to them, he had received it from his relatives and had been able to follow the prescribed diet.2. Conditions of transportation75. From 29 September to 5 October 2009 and from 9 March 2010 to 1 February 2011 – on twenty-six occasions in total – the applicant was transported in a van used for the transportation of healthy detainees. Between 5 October 2009 and 9 March 2010 he was once transported in a police car.76. Between 18 April 2011 and 22 September 2011 the applicant was transported in an ambulance accompanied by a doctor (nineteen times in total). The exact duration of the trips remains unknown; the applicant stated that sometimes his transportation had lasted for up to three hours.77. The above-mentioned van had metal walls and one small window. According to the applicant, it was not sufficiently ventilated and had no heating system, so it was too cold in winter and too hot in summer. It does not appear from the applicant’s submissions that he was transported with other inmates. The Government argued that the van had had sufficient ventilation and the conditions of the applicant’s transportation had been adequate.78. The applicant submitted that the train carriage in which he had been transported to Kyiv had not been fit for transportation of a person in his condition. The Government maintained that the conditions in the train carriage were adequate. The parties did not provide any further details in this regard.79. On 5 July 2011 the prosecutor rejected the applicant’s complaint concerning the inappropriate conditions of his transportation in the train. The applicant did not challenge that decision before the courts.II. RELEVANT DOMESTIC LAW AND PRACTICE80. The relevant provisions of the Civil Code and the Law “on the Procedure for the Compensation of Damage Caused to Citizens by the Unlawful Actions of Bodies of Inquiry, Pre-trial Investigation Authorities, Prosecutors or Courts” (“the Compensation Act”) are summarised in Ratushna v. Ukraine, no. 17318/06, §§ 43-44, 2 December 2010, with further references.THE LAWI. ALLEGED VIOLATION OF ARTICLES 3 AND 13 OF THE CONVENTIONA. Alleged lack of adequate medical assistance in detention and absence of domestic remedies in that respect81. The applicant complained, under Articles 2 and 3 of the Convention, that he had not been provided with adequate medical assistance and treatment during his detention. He also complained, under Article 13 of the Convention, that he had not had an effective remedy for his complaint under Article 3. The Court is master of the characterisation to be given in law to the facts of the case. As such, it considers that the above complaints fall to be examined under Articles 3 and 13 of the Convention, which read as follows:Article 3“No one shall be subjected to torture or to inhuman or degrading treatment or punishment.”Article 13“Everyone whose rights and freedoms as set forth in [the] Convention are violated shall have an effective remedy before a national authority notwithstanding that the violation has been committed by persons acting in an official capacity.”1. Admissibility82. The Government contended that the applicant had not exhausted domestic remedies because he had not raised the above complaints before the domestic courts in the framework of separate judicial proceedings.83. The Court notes that it has rejected the Government’s similar objections in a number of other cases concerning Ukraine (see, for example, Koktysh v. Ukraine, no. 43707/07, § 87, 10 December 2009, Visloguzov v. Ukraine, no. 32362/02, § 64, 20 May 2010). The Government provided no information which would enable the Court in the present case to depart from its findings and therefore it considers that this part of the application cannot be declared inadmissible for non-exhaustion of domestic remedies. Nor can it be rejected as inadmissible on any other grounds. It should therefore be declared admissible.2. Merits(a)  Article 384. The Government submitted that the deterioration of the applicant’s health during detention had been natural given his numerous diseases and the mental stress inherent in detention and participation in the criminal proceedings. After having been admitted to the SIZO, the applicant had been under constant medical monitoring and had been provided with adequate treatment, both in the SIZO medical unit and in the local hospitals.85. The applicant submitted that his medical check-ups by specialist doctors had not been carried out at reasonable intervals and his monitoring and treatment had lacked consistency. He stated that the deterioration of his health during detention proved that the treatment provided to him had not been adequate. His state of health had been incompatible with the conditions of detention in the SIZO and adequate treatment should have included in-patient treatment at a specialist hospital. He also complained that in the SIZO he was not provided with insulin and insulin syringes free of charge.86. The Court notes that the general principles applicable in the field of medical assistance to be provided to detainees were summarised in Kharchenko v. Ukraine (no. 40107/02, §§ 58-59, 10 February 2011).87. In the present case the authorities were aware of the applicant’s poor state of health and took certain measures in this respect. In particular, on a number of occasions the applicant was examined by the medical staff of the SIZO and by civilian doctors. He underwent medical treatment inside and outside the SIZO. The Court notes that the Government’s submissions concerning the causes of the applicant’s health deterioration are not devoid of substance.88. In these circumstances, the Court will examine whether the State complied with its obligation to safeguard the applicant’s health in detention.89. Firstly, the Court observes that the domestic medical experts (see paragraphs 62, 64-67 above), in their reports of 12 November 2010, 28 January and 8 June 2011, explicitly stated that the medical treatment provided to the applicant during his detention had been inadequate. The Court sees no reason to put their findings in doubt. Moreover, on 2 June 2010 the SIZO itself acknowledged its inability to provide the applicant with the appropriate treatment in detention (see paragraphs 38-39 above).90. Secondly, on 11 February, 9 March and 2 June 2010 respectively, the SIZO doctors established that the applicant needed to undergo a specialist medical examination and treatment on an in-patient basis at an outside medical institution. However, no measures were taken by the authorities to arrange this in a timely manner (see paragraphs 29 and 38 above). In fact, it was only after application of Rule 39 by the Court that the applicant was placed in an outside medical institution for an in-patient examination.91. Thirdly, the courts’ findings that the applicant’s state of health was compatible with detention lacked sufficient reasoning. In particular, the courts dealing with the applicant’s requests for release did not refute any of the medical findings that the treatment provided to the applicant had been inadequate and that appropriate treatment could not be provided in the SIZO. It appears that the courts were satisfied that in detention the applicant received some medical treatment and did not even attempt to examine whether it had been adequate (see paragraphs 17, 19, 21-23 above).92. Lastly, from the medical expert reports of 12 November 2010 and 28 January 2011, it appears that transporting the applicant in a vehicle without specific medical equipment was dangerous for his health and even potentially fatal (see paragraphs 62-64 above). It has not been suggested that the van and the train carriage in which he was transported had any such equipment. The Court further observes that despite the fact that the authorities were fully aware of the applicant’s poor state of health as from 5 October 2009, the District Court did not order an assessment of the applicant’s fitness for transportation until the end of 2010.93. The Court considers that the above findings are sufficient to conclude that the State failed to comply with its obligations under Article 3 of the Convention. The Court, having regard to its conclusions as to the exhaustion of domestic remedies (see paragraph 83 above) and also to the lack of thorough examination by the domestic courts of the applicant’s complaints, considers that the applicant had no effective remedy in respect of his allegations of inadequate medical assistance in detention.

Outcome for Article 3: violation