Communicated on 26 November 2014
FIRST SECTION
Application no. 14185/14
V.P. against Estonia
lodged on 11 February 2014
STATEMENT OF FACTS
The applicant, Ms V.P., is an Estonian national, who was born in 1928 and lives in Paldiski.
The circumstances of the case
The facts of the case, as submitted by the applicant and as they appear from the documents on file, may be summarised as follows.
The case concerns suicide of the applicant’s son L. who was born in 1955. He had a history of mental disorder (paranoid schizophrenia) and had been hospitalised in a psychiatric hospital on fourteen occasions since 1980. Since 1989 he was a disability pensioner.
On 30 April 2012 L. took a large number of pills prescribed to himself and to the applicant in order to commit suicide. The applicant called ambulance; L. was diagnosed with intoxication and hospitalised in North Estonian Regional Hospital. On 1 May 2012 he was transferred from the nephrology department to an intensive care unit of the department of internal medicine located on the 12th floor of the hospital. On the same day L. committed suicide by jumping out of the window.
The applicant requested explanations from the hospital, in particular, why the safety of L. who was a suicidal patient had not been ensured and why he had not been sent to a psychiatric clinic. According to a reply from the hospital, L. had been under regular supervision and had received the necessary care but the hospital staff had not been with the patient at all times.
The applicant also turned to the Expert Panel of Quality of Medical Aid (Tervishoiuteenuse kvaliteedi ekspertkomisjon). The Expert Panel heard the applicant and examined the medical documentation concerning L. It also had an expert opinion of one of its members at its disposal. The Expert Panel gave its opinion on 13 December 2012. It considered that the psychiatric treatment L. had received had been in compliance with the usual medical practice; there had been no link between his psychiatric treatment and the attempted suicide on 30 April 2012. L.’s hospitalisation in the departments of nephrology and internal medicine had been justified as he had been in need of medical supervision. His suicidality had been properly assessed at his admission to the hospital on 30 April 2012. However, his supervision had been insufficient and the technical features of the building – the fact that the windows could not be closed in a manner excluding jumping out – had also served as factors contributing to the suicide. The Expert Panel advised the North Estonian Regional Hospital to implement a protocol concerning the supervision of suicidal patients and to train its staff accordingly. Technical solutions such as monitoring facilities in the rooms and windows with shatterproof glasses that could not be opened should be used in order to minimise the risk of suicide. It was noted in the Expert Panel’s assessment that the Panel’s assessment created no legal rights or obligations but it could be used as evidence in civil proceedings.
On 14 May 2013 the applicant filed an offence report with the prosecutor’s office who refused to initiate criminal proceedings as no offence had been committed. On 18 June 2013 the applicant’s appeal was dismissed by the State Prosecutor’s Office. The applicant filed an appeal with the Tallinn Court of Appeal. She admitted that such an appeal had to be filed by an advocate but noted that she had been assisted by a lawyer of the Estonian Patients’ Advocacy Association (a non-governmental organisation promoting patients’ rights) and asked the Court of Appeal to make an exception from the requirement of legal representation by an advocate. In case such an exception could not be made, the applicant requested that she be granted free legal aid and given an additional time-limit for drawing up a request to that effect.
By a decision of 21 August 2013 the Court of Appeal declined to entertain the appeal since it had not been filed by an advocate and there were no grounds for making an exception to that requirement. The Court of Appeal also rejected the request for an additional time-limit for filing a request for legal aid noting that no reasons had been advanced for the applicant’s failure to submit the supporting documents in time to prove her indigence. In addition, the Court of Appeal noted that the applicant’s prospects of success were negligible. The refusal to initiate criminal proceedings and the decision of the State Prosecutor’s Office contained detailed reasons as to why there were no grounds for initiating criminal proceedings. The conclusion that the hospital staff had not committed any criminal offence was well-founded.
The applicant then asked the Supreme Court to grant her legal aid for filing an appeal against the Court of Appeal’s decision. An appeal to the Supreme Court also had to be filed by an advocate. By a decision of 30 September 2013 the Supreme Court refused to grant the requested legal aid. It considered that the decisions of the prosecutor’s office and the Court of Appeal were thoroughly reasoned as to why no criminal proceedings had been commenced and that an appeal against the Court of Appeal’s decision had no prospects of success.
COMPLAINTS
The applicant complains under Article 2 of the Convention that the authorities failed to carry out an effective investigation into the circumstances of her son’s death. No investigation had been commenced by the authorities who only relied on documents submitted to them by the applicant who as a private person was unable to gather sufficient evidence. The applicant considers that the authorities had an obligation to foresee the suicidal tendencies of the psychiatric patient and take measures for his protection even if he was in an ordinary medical establishment. However, no required treatment, care and supervision was ensured for the applicant’s son. The medical staff had not been trained to adequately assess his condition and he had not been timely sent to a psychiatric hospital. The fact that there was no service in Estonia that would cover the needs of both involuntary psychiatric treatment and somatic treatment did not relieve the authorities of their liability. The fact that no regulations and practice relating to the assessment of a person’s capacity to exercise his will were in place was also unlawful.
The applicant also notes that there is no clarity as to the question whether there had been accomplices involved in causing L.’s death and there was no information on whether and how thoroughly the medical staff concerned had been interviewed. The authorities have not dealt with the case sufficiently thoroughly and the possible commission of an offence had not been excluded. Nor did the authorities examine the possible responsibility of the hospital in connection with its failure to ensure sufficient training of the staff, the technical features of the building, insufficient surveillance, failure to assess L.’s capacity to exercise his will.
QUESTIONS TO THE PARTIES
1. Has the applicant exhausted effective domestic remedies, as required by Article 35 § 1 of the Convention, for complaining about the allegedly insufficient measures taken by the authorities to ensure the protection of the life of his son and about the death of her son in the hospital (see Vučković and Others v. Serbia [GC], no. 17153/11, §§ 69-77, 25 March 2014)?
2. Having regard to the positive obligation of the authorities to take measures to protect an individual, in particular circumstances, from himself (see, for example, Mikayil Mammadov v. Azerbaijan, no. 4762/05, 17 December 2009; Reynolds v. the United Kingdom, no. 2694/08, 13 March 2012; Osman v. the United Kingdom, 28 October 1998, Reports of Judgments and Decisions 1998‑VIII; Keenan v. the United Kingdom, no. 27229/95, ECHR 2001-III; Renolde v. France, no. 5608/05, ECHR 2008 (extracts); Haas v. Switzerland, no. 31322/07, ECHR 2011; Arskaya v. Ukraine, no. 45076/05, 5 December 2013), was there a breach of Article 2 of the Convention in the present case?
3. Having regard to the procedural obligation under Article 2, was there an effective independent judicial system set up in Estonia so that the cause of death of the applicant’s son could be determined and those responsible made accountable (see, for example, Calvelli and Ciglio v. Italy [GC], no. 32967/96, ECHR 2002‑I; Šilih v. Slovenia [GC], no. 71463/01, 9 April 2009; Eugenia Lazăr v. Romania, no. 32146/05, 16 February 2010; Reynolds v. the United Kingdom, no. 2694/08, 13 March 2012; and Tikhonova v. Russia, no. 13596/05, 30 April 2014)? Was the investigation in the present case by the domestic authorities in breach of Article 2?
4. Were any civil-law or other non-criminal remedies available and relevant in the circumstances of the present case (see, for example, Calvelli and Ciglio; Reynolds; and Arskaya, all cited above)?
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