FOURTH SECTION
CASE OF URBONAVIČIUS v. LITHUANIA
(Application no. 549/17)
JUDGMENT
STRASBOURG
21 May 2019
This judgment is final but it may be subject to editorial revision.
In the case of Urbonavičius v. Lithuania,
The European Court of Human Rights (Fourth Section), sitting as a Committee composed of:
Paulo Pinto de Albuquerque, President,
Egidijus Kūris,
Iulia Antoanella Motoc, judges,
and Andrea Tamietti, Deputy Section Registrar,
Having deliberated in private on 30 April 2019,
Delivers the following judgment, which was adopted on that date:
PROCEDURE
1. The case originated in an application (no. 549/17) against the Republic of Lithuania lodged with the Court under Article 34 of the Convention for the Protection of Human Rights and Fundamental Freedoms (“the Convention”) by a Lithuanian national, Mr Deivis Urbonavičius (“the applicant”), on 20 December 2016.
2. The applicant, who had been granted legal aid, was represented by Ms I. Abramavičiūtė, a lawyer practising in Vilnius. The Lithuanian Government (“the Government”) were represented by their Agent, most recently Ms L. Urbaitė.
3. On 1 June 2018 the complaint under Article 3 about the refusal of the prison authorities to purchase and use a medical device recommended by the applicant’s doctor was communicated to the Government and the remainder of the application was declared inadmissible pursuant to Rule 54 § 3 of the Rules of Court.
THE FACTS
I. THE CIRCUMSTANCES OF THE CASE
4. The applicant was born in 1970 and is currently detained in Alytus Correctional Facility.
5. The applicant was arrested on 3 June 2012 and transferred to Kaunas Remand Prison on 4 June 2012. On 5 June 2012 he was examined by a doctor (see paragraph 15 below). During that examination, the applicant did not indicate that he needed any special devices.
6. On 26 November 2012 the applicant consulted a doctor and indicated that he had sleep apnoea and he wished to acquire a continuous positive airway pressure (hereinafter “CPAP”) device for its treatment.
7. On 15 March 2013 a report was issued by a medical expert, indicating that the use of a CPAP device was the most effective way to treat sleep apnoea and that the applicant’s condition was deteriorating because he had not been using a CPAP device. It also indicated that there was a risk of complications if the sleep apnoea was not treated properly.
8. Between 12 and 17 September 2013 the applicant was hospitalised in the Prison Hospital. A doctor recommended that he continue using a CPAP device following his discharge from the hospital.
9. On 19 September the applicant asked the prison administration to allow him to use a CPAP device. On 3 October 2013 the administration of Kaunas Remand Prison responded that under domestic law such a device was not among the items that could be given to detainees by their spouses or close relatives (see paragraph 14 below), but indicated that such an item could be purchased from the prison shop. The applicant then asked the Kaunas Remand Prison Administration to allow his relatives to give him the device. On 29 October 2013, this request was also refused, on the grounds that there were no indications in the applicant’s medical history or in the document issued by the Prison Hospital that the applicant needed the device (see paragraph 16 below).
10. On 20 October 2014 the applicant lodged a complaint before the domestic courts, which he specified on 19 February 2015. He asked the court to award him 86,800 euros (EUR) in compensation for non-pecuniary damage suffered in the period between 4 June 2012 and 20 October 2014. The applicant stated that while he had been detained in Kaunas Remand Prison, he had asked the prison administration to allow him to have a CPAP device to treat his sleep apnoea, as recommended to him by a doctor in the Prison Hospital (see paragraph 8 above). The applicant stated that the prison administration had refused to allow him to have such a device, and he had been experiencing serious health issues.
11. On 12 October 2015 the Kaunas Regional Administrative Court allowed the applicant’s complaint in part and awarded him EUR 1,100 in respect of non-pecuniary damage. The court stated that the prison administration had failed to provide the applicant with the same level of healthcare available to persons who were not detained. It was clear from the case file that the applicant had twice asked the prison administration to allow him to purchase and use a CPAP device. The refusal of permission by the Kaunas Remand Prison Administration had been unfounded because there had been a recommendation issued by a doctor. The court held that the applicant had a right to compensation in respect of non‑pecuniary damage suffered from 3 October 2013 (when his request was refused by the prison administration – see paragraph 9 below) until 20 October 2014 and thus decided to award the applicant EUR 1,100 in this regard. The court also noted that there was no information in the case file to indicate that the applicant had not received appropriate healthcare in Kaunas Remand Prison. It stated that although the recommendation issued by the specialist contained a reference to possible complications, there was no information in the applicant’s case file to show that the inability to use a CPAP device had had any negative consequences for his health.
12. The applicant appealed against the decision of the Kaunas Regional Administrative Court. On 4 October 2016 the Supreme Administrative Court upheld the first-instance decision in its entirety.
13. On 12 July 2017 the applicant asked the Prison Department for a transfer to Alytus Correctional Facility from Vilnius Correctional Facility, where he had been transferred on 20 March 2015. The applicant submitted that he had been serving his sentence in premises for disabled persons but that he could be transferred to the standard dormitory-type premises. On 2 August 2017 the applicant’s request was allowed and he was transferred to Alytus Correctional Facility on 21 August 2017 where he was able to continue using his CPAP device.
II. RELEVANT DOMESTIC LAW
14. In accordance with Article 24 § 1 of the Law on Pre-trial Detention, detainees have a right to receive one postal or hand-delivered package of clothing, bedding (except for blankets, mattresses and pillows) or footwear every three months, as well as an unlimited amount of small packages containing newspapers, envelopes, postage stamps and writing paper. Under Article 24 § 2, one postal package cannot exceed ten kilograms, and packages handed to the detainee cannot exceed fifteen kilograms each.
15. Under Article 45 § 1 of the Law on Pre-trial Detention, medical treatment provided to persons in pre-trial detention has to be equivalent to that provided to persons who are not detained. In accordance with Article 45 § 3, it is obligatory to perform a health check on all persons newly transferred to a remand prison. Under Article 45 § 4, if a detainee is in need of emergency medical aid and it is not possible to provide it in the Prison Hospital, such aid can be provided in other State or municipal healthcare institutions. The supervision of a detainee has to be ensured.
16. In accordance with the Rules on Purchase, Possession and Recording of Medical Products in Detention Facilities, approved on 24 April 2012 by Order No. V-156 of the head of the Prison Department, detainees and convicted inmates wishing to purchase, or to accept from other persons who are not detained, medicine or medical products, that have been prescribed or recommended by a doctor, have to submit a written request to the relevant facility (rule 42). The head of the facility may allow the purchase of the medical products if the detainee or convicted inmate has enough funds and if he or she has a prescription or recommendation from a doctor (rule 43). The purchase of medical products is organised by a pharmacist or other responsible person (rule 45). Medical products received from persons who are not detained are transferred to the healthcare service of the detention facility or to a hospital unit where the patient is treated (rule 46).
THE LAW
I. ALLEGED VIOLATION OF ARTICLE 3 OF THE CONVENTION
17. The applicant complained that his detention had amounted to inhuman and degrading treatment contrary to Article 3 of the Convention because of the refusal of Kaunas Remand Prison to allow him to use a CPAP device.
Article 3 reads as follows:
“No one shall be subjected to torture or to inhuman or degrading treatment or punishment.”
A. Admissibility
1. The parties’ submissions
18. The Government submitted that the applicant could no longer be considered a “victim” of a violation of Article 3 of the Convention. His case had been reviewed by the administrative courts and decisions in his favour, proving him with adequate and sufficient compensation, had been delivered.
19. The applicant argued that the amount awarded to him at the domestic level had been inadequate.
2. The Court’s assessment
20. The principles governing the assessment of an applicant’s victim status have been summarised in paragraphs 178-92 of the Court’s judgment in the case of Scordino v. Italy (no. 1) ([GC], no. 36813/97, ECHR 2006-V). In that connection, the Court notes that a decision or measure favourable to the applicant is not, in principle, sufficient to deprive him or her of his or her status as a “victim” for the purposes of Article 34 of the Convention unless the national authorities have acknowledged, either expressly or in substance, and then afforded sufficient redress for, the breach of the Convention. One of the characteristics of sufficient redress which may remove a litigant’s victim status relates to the amount awarded as a result of using the domestic remedy. Thus, an applicant’s victim status may depend on the level of compensation awarded at domestic level on the basis of the facts about which he or she complains before the Court (ibid., §§ 180 and 202).
21. The Court notes that in the present case the applicant sued the State, submitting that the defendant had failed to ensure that he had the opportunity to use a CPAP device as recommended by a doctor to help his condition (see paragraph 10 below). Taking into account the domestic courts’ findings in respect of the length of the applicant’s detention without a CPAP device, the Court finds that the compensation awarded to the applicant by the domestic court is insufficient to deprive him of his victim status. It therefore dismisses the Government’s objection in that regard.
22. The Court notes that the application is not manifestly ill-founded within the meaning of Article 35 § 3 (a) of the Convention. It further notes that it is not inadmissible on any other grounds. It must therefore be declared admissible.
B. Merits
1. The parties’ submissions
23. The applicant argued that he had been left completely in the hands of Kaunas Remand Prison which had intentionally denied him the opportunity to use a CPAP device. He had suffered humiliation and fear because of the possibility that his breathing might stop during the night, which could have led to a heart attack and, consequently, to his death. He also stated that no other treatment had been offered to him to treat his sleep apnoea and that he had only been allowed to use his CPAP device once he had been transferred to Vilnius Correctional Facility on 20 March 2015 (see paragraph 13 above).
24. The Government argued that the applicant’s condition could be treated in various ways and that using a CPAP device was only one of them. They also submitted that a CPAP device required a power socket and that it emitted a certain sound when in use which could have made it difficult for other people in the same area to sleep. Moreover, obstructive sleep apnoea could not be cured and a CPAP device could only reduce or eliminate the symptoms of the illness and reduce the risk of complications.
25. The Government noted that the Kaunas Regional Administrative Court had stated that the refusal of the authorities to purchase and use a CPAP device had had a negative impact on the applicant’s physical and mental condition; however, they reiterated the court’s indication that there had been no information to show that the applicant’s health had deteriorated because of the unavailability of a CPAP device (see paragraph 11 above). The Government stated that the courts had not found that the healthcare services provided to the applicant had otherwise been inappropriate.
2. The Court’s assessment
(a) General principles
26. The Court reiterates that Article 3 of the Convention enshrines one of the most fundamental values of a democratic society. It prohibits in absolute terms torture or inhuman or degrading treatment or punishment, irrespective of the circumstances and the victim’s conduct (see, for example, Labita v. Italy [GC], no. 26772/95, § 119, ECHR 2000‑IV). Ill‑treatment must, however, attain a minimum level of severity if it is to fall within the scope of Article 3. The assessment of this minimum is relative: it depends on all the circumstances of the case, such as the duration of the treatment, its physical and mental effects and, in some cases, the sex, age and state of health of the victim (see Sergey Antonov v. Ukraine, no. 40512/13, § 70, 22 October 2015).
27. Ill-treatment that attains such a minimum level of severity usually involves actual bodily injury or intense physical or mental suffering. However, even in the absence of these, where treatment humiliates or debases an individual, showing a lack of respect for or diminishing his or her human dignity, or arouses feelings of fear, anguish or inferiority capable of breaking an individual’s moral and physical resistance, it may be characterised as degrading and also fall within the prohibition of Article 3 (ibid., § 71).
28. The Court has emphasised on a number of occasions that the State must ensure that a person is detained in conditions which are compatible with respect for human dignity, that the manner and method of the execution of the measure of deprivation of liberty do not subject him to distress or hardship of an intensity exceeding the unavoidable level of suffering inherent in detention, and that, given the practical demands of imprisonment, his health and well-being are adequately secured. A lack of appropriate medical care may thus amount to treatment contrary to Article 3 of the Convention (ibid., § 72 and the references therein).
29. The Court considers that the “adequacy” of medical assistance remains the most difficult element to determine. When assessing it, the Court considered that the mere fact that a detainee was seen by a doctor and prescribed a certain form of treatment could not automatically lead to the conclusion that the medical assistance was adequate (see Hummatov v. Azerbaijan, nos. 9852/03 and 13413/04, § 116, 29 November 2007). The authorities must ensure that a comprehensive record is kept concerning the detainee’s state of health and the treatment he underwent while in detention (see Sergey Antonov, cited above, § 73 and the references therein), and that, where necessitated by the nature of a medical condition, supervision is regular, systematic and involves a comprehensive treatment strategy aimed at helping the detainee to recover or preventing the aggravation of his condition, rather than addressing it on a symptomatic basis (see Hummatov, cited above, §§ 109 and 114). The authorities must also show that the necessary conditions were created for the prescribed treatment to be actually followed through (ibid., § 116).
30. On the whole, the Court reserves sufficient flexibility in defining the required standard of healthcare, deciding it on a case-by-case basis (see Aleksanyan v. Russia, no. 46468/06, § 140, 22 December 2008).
(b) Application of general principles to the present case
31. The Court reiterates that it is not its task to rule on matters lying exclusively within the field of expertise of medical specialists or to establish whether an applicant in fact required a particular treatment or whether the choice of treatment methods appropriately reflected the applicant’s needs (see Sergey Antonov, cited above, § 86 and the references therein). Being mindful of the vulnerability of applicants in detention, the Court considers that it is for the Government to provide credible and convincing evidence showing that the applicant concerned had received comprehensive and adequate medical care in detention (ibid.).
32. In the present case, the Court notes that the domestic courts did not assess the quality of the applicant’s medical treatment, as their examinations appear to have been limited in scope. Essentially they were focused on one issue: whether the refusals on the part of the authorities to allow the applicant to purchase and use a CPAP device had been lawful. Moreover, although the domestic courts found that there had been a recommendation issued by a doctor that the applicant should continue using a CPAP device, they merely awarded him compensation in respect of non-pecuniary damage. Although the domestic courts relied on a report from a medical expert, in which it was stated that complications were possible if his sleep apnoea was not treated and that the applicant’s condition was deteriorating (see paragraphs 7, 11 and 12 above), they considered that there were no indications that the applicant’s condition had actually worsened during the period when he had not been able to use a CPAP device. The courts did not take into consideration the possible consequences had the applicant still not received a CPAP device after their decisions had been issued. Indeed, it appears from the case file that the applicant received a CPAP device for personal use for the first time when he was transferred to Vilnius Correctional Facility on 20 March 2015 (see paragraph 13 above).
33. Given these circumstances, the Court gives credence to the doctor’s recommendation and the medical expert report relied on by the courts, in which it was stated that the use of a CPAP device was the most effective method of treatment for sleep apnoea and it was recommended that the applicant continue using such a device (see paragraphs 7, 8 and 11 above). The Court considers that the Government’s arguments that obstructive sleep apnoea could not be cured and that the applicant had not suffered from any negative impact on his health as a result of being prevented from using a CPAP device (see paragraphs 24-25 above) are unconvincing and insufficient to rebut the applicant’s account of the humiliation and fear he experienced because of the unavailability of a CPAP device (see paragraph 23 above). The Court is of the opinion that, taking into account the applicant’s pathology and the risks connected to it, those feelings should have been sufficiently intense as to attain the level of severity required in order to bring Article 3 of the Convention into play (see the case-law quoted in paragraph 26 above).
34. In these circumstances, the Court considers that the applicant’s allegations of inadequate treatment in Kaunas Remand Prison have been established and holds that there has been a violation of Article 3 of the Convention.
II. APPLICATION OF ARTICLE 41 OF THE CONVENTION
35. Article 41 of the Convention provides:
“If the Court finds that there has been a violation of the Convention or the Protocols thereto, and if the internal law of the High Contracting Party concerned allows only partial reparation to be made, the Court shall, if necessary, afford just satisfaction to the injured party.”
A. Damage
36. The applicant claimed 86,800 euros (EUR) in respect of non‑pecuniary damage.
37. The Government contended that the amount was excessive, unreasoned and unsubstantiated.
38. The Court considers that the applicant undoubtedly suffered distress and frustration in view of his inability to purchase and use a CPAP device. However, it considers the amount claimed by him excessive. Making its assessment on an equitable basis, the Court awards the applicant EUR 5,400 in respect of non‑pecuniary damage.
B. Costs and expenses
39. The applicant, who was granted legal aid before the Court (see paragraph 2 above), did not claim the reimbursement of costs and expenses. The Court is therefore not called upon to make an award in this respect.
C. Default interest
40. The Court considers it appropriate that the default interest rate should be based on the marginal lending rate of the European Central Bank, to which should be added three percentage points.
FOR THESE REASONS, THE COURT, UNANIMOUSLY,
1. Declares the application admissible;
2. Holds that there has been a violation of Article 3 of the Convention;
3. Holds
(a) that the respondent State is to pay the applicant, within three months, EUR 5,400 (five thousand four hundred euros), plus any tax that may be chargeable, in respect of non-pecuniary damage;
(b) that from the expiry of the above-mentioned three months until settlement simple interest shall be payable on the above amount at a rate equal to the marginal lending rate of the European Central Bank during the default period plus three percentage points;
4. Dismisses the remainder of the applicant’s claim for just satisfaction.
Done in English, and notified in writing on 21 May 2019, pursuant to Rule 77 §§ 2 and 3 of the Rules of Court.
Andrea Tamietti Paulo Pinto de Albuquerque
Deputy RegistrarPresident
Full & Egal Universal Law Academy