Communicated on 16 January 2017

FIRST SECTION

Application no. 6920/14 Hovhannes TIRATURYAN against Armenia lodged on 13 December 2013

STATEMENT OF FACTS

The applicant, Mr Hovhannes Tiraturyan , is an Armenian national who was born in 1968. He was serving a sentence of imprisonment when he lodged his application with the Court. He is represented before the Court by Mr T. Safaryan , a lawyer practising in Yerevan.

A. The circumstances of the case

The facts of the case, as submitted by the applicant, may be summarised as follows.

By a judgment of 9 July 2011 the applicant, who had been in pre-trial detention since 17 February 2011, was convicted of various drug offences and sentenced to four years ’ imprisonment.

While detained in the remand facility, the applicant had been transferred to the Central Prison Hospital on 5 April 2011, where he had been diagnosed with generalised chronic destructive osteomyelitis of the upper and lower jaw.

According to the applicant, he suffered from constant pain in the jaw area, as a result of which it became impossible for him to eat the food offered to him in the detention facility. He could only eat a small amount of bread after having soaked it in tea. When he experienced acute pain, he was given painkillers, and from time to time his abscesses were removed.

According to medical records of 8 and 14 April 2011, made by a maxillofacial surgeon at the Central Prison Hospital, the applicant had deformed bones in the upper and lower jaw areas; his face was asymmetrical due to a swollen lower jaw and chin, and there were numerous abscesses in those areas. It was advised that the applicant be treated in a specialist maxillofacial department and undergo surgery: a resection of the right half of the upper jaw and a resection of the left half of the lower jaw.

On 1 May 2011 the head of the dental department at the Central Prison Hospital recorded in the applicant ’ s medical file that it was necessary for him to have surgery.

The entries in the applicant ’ s medical records from October 2011 to November 2013 indicate that his condition was serious but stable; he received treatment for his symptoms and was kept under observation, awaiting treatment in a specialist maxillofacial clinic.

It appears that on 31 October 2013 the Public Observers Group to Monitor Penal Institutions and Entities under the Ministry of Justice (“the Monitoring Group”) sent an enquiry to the Minister of Justice in relation to the applicant ’ s medical treatment in detention.

On 1 November 2013 the applicant was examined by the head of the dental department at the Central Prison Hospital, who recorded, in particular, that the applicant was complaining of pain in the lower jaw, which was projecting towards his temple and ear. The bones in the upper and lower jaw areas were dark, covered with dead tissue, and there was crepitation of bone segments and a fracture in the left part of the lower jaw. The applicant was diagnosed with generalised chronic destructive osteomyelitis of the upper and lower jaw, a pathological fracture of the left part of the lower jaw, and hepatitis C. It was indicated that the applicant was receiving treatment for his symptoms at that time, and that it was necessary for him to have surgery in a specialist maxillofacial clinic.

On 11 November 2013 the applicant ’ s lawyer sent a set of written questions about the applicant ’ s state of health and medical treatment to the head physician at the Central Prison Hospital. He referred, in particular, to the record of the applicant ’ s examination of 1 November 2013, which indicated that the applicant had been receiving treatment for his symptoms, and asked the head physician to specify what was meant by such treatment and whether it was adequate, given the applicant ’ s diagnosis. The lawyer also asked to be provided with details concerning the applicant ’ s pathological fracture of his lower jaw, and particularly for confirmation as to whether it had been as a consequence of inadequate treatment of his disease. Furthermore, he enquired as to the reasons why the surgery which had been recommended in 2011 had not yet been performed. The lawyer also asked questions concerning the compatibility of the applicant ’ s diet with his state of health: in particular, whether he was being given special food considering that he had difficulty eating. Lastly, the lawyer enquired as to whether the applicant was receiving any treatment for chronic hepatitis C, and, if so, what type of treatment.

By a letter of 26 November 2013 the head physician of the Central Prison Hospital provided the following answers to the questions put by the applicant ’ s lawyer:

“...

5. [The applicant] currently receives treatment for his symptoms: analgesics, anti-inflammatory medication, antibiotics, oral cavity sanitation. The treatment described is not adequate for the treatment of his disease.

6. On 6 September 2013 [the applicant] was diagnosed with a pathological fracture of his lower jaw.

7. The pathological fracture of the lower jaw is the result of chronic destructive osteomyelitis, which in turn has resulted from long-term ... drug consumption.

8. ... [ the applicant] needs two-stage surgery: fundamental resection of the dead tissue, and thereafter plastic surgery using titanium or other implants which can only be obtained abroad. In view of the foregoing, State-financed treatment of people suffering from such diseases is not possible in the Republic of Armenia.

9. The level of food consumption in the Central Prison Hospital is sufficient for [the applicant], since in the course of his hospitalisation no weight loss has been recorded.

10. [As regards] the chronic hepatitis C ..., in accordance with the results of biochemical blood tests, [the applicant] does not need medical treatment.”

On the same date the Minister of Justice informed the Monitoring Group that the only radical treatment for the applicant ’ s disease was a surgical intervention involving different stages, including bone reconstruction with metal implants. This type of intervention was included in the list of advanced medical services available to all population groups, including detainees, on a paid basis, according to the Order of the Minister of Health of 21 February 2012. The letter further stated that the applicant was under the close observation of the medical staff at the Central Prison Hospital, and was receiving treatment for his symptoms.

B. Relevant domestic law

The Law on Detention Conditions for Arrested and Detained Persons ( « Ձերբակալված և կալանավորված անձանց պահելու մասին » ՀՀ օրենք )

In accordance with section 13, a detainee has the right to health care, including sufficient food and urgent medical assistance.

Section 21 provides that a detention facility administration shall ensure the sanitary, hygienic and anti-epidemic conditions necessary for the preservation of health of detained persons. At least one general practitioner shall work at a detention facility. A detainee in need of specialist medical assistance must be transferred to a specialist or civilian medical institution.

COMPLAINTS

The applicant complains under Article 3 of the Convention that the medical treatment provided to him while in detention was not adequate, given his health condition. In particular, the lack of specialist medical treatment resulted in the further deterioration of his state of health, since he suffered a pathological fracture of the lower jaw. Furthermore, although he was in constant pain and eating became extremely difficult for him, no special arrangements were made in this respect, and he continued to be provided with the same food as the rest of the detainees, although he was not able to eat it. Lastly, the applicant complains that he did not receive any treatment for his chronic hepatitis C.

The applicant complains under Article 13 of the Convention that he did not have at his disposal an effective domestic remedy for his complaints under Article 3.

QUESTIONS TO THE PARTIES

1. Has the applicant been subjected to treatment, contrary to Article 3 of the Convention? In particular:

- During the entire period of his detention, starting from February 2011, was he provided with prompt and adequate medical assistance?

- Was the applicant ’ s diet compatible with his individual needs, taking into account his state of health?

2. Did the applicant have at his disposal an effective domestic remedy for his Convention complaints under Article 3, as required by Article 13 of the Convention?

The Government are invited to submit a typed copy of the applicant ’ s medical file and other relevant reports which describe the state of his health and the medical treatment provided during his detention.