Communicated on 9 December 2015

FIFTH SECTION

Application no. 71506/13 Evija DUMPE against Latvia lodged on 10 November 2013

STATEMENT OF FACTS

1. The applicant, Ms Evija Dumpe, is a Latvian national, who was born in 1970 and lives in Valmiera. She is represented before the Court by the Zelda Resource Centre for People with Mental Disabilities, an association based in Riga.

A. The circumstances of the case

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

1. A.P. ’ s placement in a social care home and his death

3. The applicant ’ s son, A.P., was born on 18 January 1991. Shortly after his birth he was diagnosed with Down ’ s syndrome and epilepsy. No indications of congenital heart disease were found during an early consultation with a cardiologist. A.P. had two epileptic seizures after 2001.

4. Due to delays in psychomotor and language development A.P. attended a specialised kindergarten and, subsequently, a specialised boarding school. In an experimental psychological examination, carried out on 24 April 2006, it was established that A.P. could only orient himself in very familiar surroundings, that he could not communicate his needs in an understandable manner, and that his development was comparable to that of a three-year-old child. Between 12 September and 8 October 2006 A.P. was treated in a psychiatric hospital where it was concluded that he had a serious mental abnormality with considerable language impairment, history of cramp syndrome; and an atypical parenting situation. Subsequently, on three different occasions in 2006 and 2007 A.P. was treated in psychiatric hospitals as a result of increased psychiatric changes leading to significant behavioural disorders.

5. In 2007 the applicant placed A.P. in Ezerkrasti, a long-term State social care home, which was intended for children with mental disabilities. At the time of admission A.P. ’ s weight was 59.6 kg and his height was 165 cm. During A.P. ’ s stay in this institution he had several outbursts of violence towards other residents and staff. On those occasions he was temporarily placed in a psychiatric hospital.

6. On 18 December 2009, because of institutional reorganisation, A.P. was transferred to the Rūja branch of the Vidzeme State Social Care Home ( Valsts sociālā aprūpes centra “Vidzeme” filiāle “Rūja;” hereinafter – “the Rūja social care home”). At the time of admission A.P. ’ s weight was 68 kg and his height was 168 cm. According to the applicant ’ s account, during A.P. ’ s stay in the Rūja social care home he became apathetic, slow and passive. Her complaints in that regard were not acted on. The applicant further contends that A.P. had been given drugs with the purpose of controlling his behaviour and that he had been made to walk barefoot so that he would not attempt to escape. When the applicant visited A.P. on 15 December 2011 she noticed that he had become weaker and slower. During her visit of 26 January 2012 A.P. was even weaker, more apathetic and drowsy; his appetite was good but owing to psoriasis on his palms and nails he had difficulties holding a spoon.

7. On 14 April 2012 A.P. was admitted to Vidzeme Hospital. The admission documents stated that he was malnourished, his skin was covered with psoriasis rashes and he had decubitus injuries with a diameter of 4 cm on both hips. During the examination A.P. ’ s verbal reactions were inadequate. A.P. ’ s general condition was described as poor. His respiratory rate was sixteen breaths per minute; his pulse rate was ninety-four beats per minute; his blood pressure was 76/40 mm Hg. The diagnosis was: potential viral hepatitis, hepatorenal syndrome, hypoglycaemia, psoriasis decubitus of the gluteal muscles, Down ’ s syndrome. Following a further examination the same day it was added that A.P. had massive and complete psoriasis, his skeleton was deformed and he was cachectic – his weight was approximately 36 kg. A.P. was placed in an infectious diseases ward.

8. The entry from the third day, 16 April 2012, noted that the patient did not react to the examination. The medical record specified that the bedsores of II-III stage were approximately 6x6 cm on the left hip and 3x3 cm on the right hip. Bedsores were also identified on A.P. ’ s earlobes. His nails were damaged, his palms were covered in eczema. The skin diseases were estimated to have lasted for approximately half a year. The patient was described as hypotrophic, neglected, and as having extreme asthenia. The infectologist ’ s conclusion was: coma, cardiac insufficiency of unclear etiology, cachexia, hepatorenal syndrome, progressive psoriasis, Down ’ s syndrome, bedsores and epilepsy. The examining neurologist added to this list an impaired glucose tolerance (hypoglycaemia) and hyperglycosuria.

9. On 17 April 2012 A.P. passed away. His final clinical diagnosis read: cardiac insufficiency, acute hepatitis B, hepatocellular dysfunction, Down ’ s syndrome, epilepsy, progressive psoriasis, cachexia and bedsores.

2. Criminal proceedings

10. On 18 April 2012 criminal proceedings no. 11130031812 were instituted concerning A.P. ’ s death. On 20 April 2012 the applicant gave evidence as a witness and on the same day she was given victim status.

11. A forensic medical examination was carried out on 19 April 2012. The report of 22 May 2012 stated that prior to his death A.P. had been in a weakened state. His death had been caused by cardiovascular deficiency triggered by cardiomyopathy. No injuries were found on A.P. ’ s body. The patient had suffered from Down ’ s syndrome, epilepsy, acute hepatitis B and psoriasis. Additionally, during the stay in Vidzeme Hospital an impaired glucose tolerance (hypoglycaemia, hyperglycosuria) had been identified.

12. Following that, an additional forensic examination by a panel of five experts was carried out. On 8 November 2012 the panel concluded that the medical treatment A.P. had received in the Rūja social care home had at times not been appropriate to the client ’ s state of health. For example, it would have been desirable to consider the question of an inpatient examination in a hospital sooner. Nevertheless, A.P. had had Down ’ s syndrome with the associated characteristic mental and somatic health problems, psoriasis and hepatitis B. These diseases (Down ’ s syndrome and psoriasis) had been observed by the medical staff of the Rūja social care home and A.P. had been treated to the extent possible there. The panel found that it was conceivable that if A.P. had been placed in a hospital and comprehensively examined in October to November 2011 (when his health condition had worsened (he had lost weight, walking had become difficult)), the chronic hepatitis B condition could have been diagnosed. Nonetheless, the panel did not consider that this could be viewed as the cause of A.P. ’ s worsening state of health. The panel continued:

“There is a higher probability [than the irregularities in A.P. ’ s medical care] that the negative dynamic of the client ’ s state of health was connected with the metabolic disorders characteristic of Down ’ s syndrome that usually cause dystrophic changes in many vital organs (for example, the heart, muscles, intestinal tract, kidneys, lungs, pancreas, and so forth). A body can compensate for such disorders up to a certain point; however, when the compensatory reserves are exhausted, decompensation occurs which may lead to death, as happened [in this case].

In order to clarify the [reasons for] A.P. ’ s worsening state of health in October to November 2011, a more active reaction on the part of the responsible medical staff would have been desirable; [this could have been done by] carrying out additional examinations, inviting consultants [to examine the patient] or through ordering an inpatient examination in a hospital. It is possible that these steps would have positively affected the lifespan of the client for a certain period of time, though it is difficult to estimate to what extent as, according to the data available in the literature, the life expectancy of Down ’ s syndrome patients is considerably shorter than average.”

13. The panel also noted that the bedsores diagnosis was disputable as the histological changes in the skin were more characteristic of psoriasis. It considered that the acute hepatitis B diagnosis was inaccurate, the correct diagnosis being clinically inactive, “chronic viral hepatitis B”. The panel added that the time and routes of transmission of the hepatitis B could not be determined on the basis of the information available in the file; presumably, it had occurred a long time ago. The panel concluded:

“Thus in this context it is not possible to pronounce on the causal connection between the (possibly improper) carrying out of processional obligations or negligence on the part of the medical staff and the death of A.P. As shown by the pathological and histological examinations of A.P. ’ s body, the direct cause of his death was cardiomyopathy (dystrophy of the heart muscle) with accompanying cardiovascular deficiency. Its development ought to be causally connected to Down ’ s syndrome, which A.P. was genetically proven to have and and which is [usually] accompanied by severe metabolic disorders (for example malnutrition), the cause of which is multifactorial. Psoriasis and chronic viral hepatitis B can be noted as the accompanying diseases, which did not have a significant influence on the patient ’ s lifespan.”

14. On 17 January 2013 an inspector of the State Police terminated the criminal proceedings. She relied on the forensic medical expert report, quoted above, and concluded that the evidence gathered did not establish that the staff of the Rūja social care home were liable for A.P. ’ s death. Even though some violations in A.P. ’ s healthcare had been established, particularly with regard to the fact that the staff of the Rūja social care home had not reacted in a timely and adequate manner to the changes in his state of health in October to November 2011, these actions could not be regarded as an improper or negligent carrying out of professional obligations of the medical staff that would have caused A.P. ’ s infection with hepatitis B or his death – the offence prescribed under section 138 (1) of the Criminal Law.

15. In her complaint about this decision the applicant emphasised that several crucial aspects concerning A.P. ’ s basic care and healthcare had been disregarded. In particular, A.P. ’ s dramatic loss of weight – he went from 68 kg to 36 kg – had not been properly addressed. According to the applicant, this weight loss indicated that her son had not received proper nutrition and medical care. The applicant expressed a belief that A.P. ’ s death had been caused by the fact that he had no longer been able to eat independently and nobody had provided him with assistance in that regard. According to the applicant, the bedsores also pointed to the fact that A.P. had spent prolonged periods of time unconscious. Furthermore, no information concerning the use of tranquilisers or similar substances had been provided to the applicant, even though she had explicitly requested it. The inadequacy of the care A.P. had received in the Rūja social care home was further exemplified by the staff ’ s failure to identify that A.P had been infected with hepatitis B. The applicant argued that the criminal investigation should clarify the causes of A.P. ’ s substantial weight loss and that it should establish why it had not been reflected in the medical records, and whether or not it could have been prevented.

16. On 4 March 2013 a prosecutor of the Valmiera district prosecutor ’ s office ( Valmieras rajona prokuratūra ) upheld the police inspector ’ s decision. She reiterated that the evidence had not established a causal connection between the performance of professional duties on the part of the staff of the Rūja social care home and A.P. ’ s death. On the contrary, the forensic medical expert report had concluded that the cause of A.P. ’ s death had been connected with Down ’ s syndrome, which he had suffered from. She also added that any reasonable doubts should be interpreted in favour of the defendant.

17. In her further complaint to the supervising prosecutor the applicant pointed to the findings in the respective investigations of the Health Inspectorate ( Veselības inspekcija ), the Department of Social Services and Social Assistance of the Ministry of Welfare ( Labklājības ministrijas Sociālo pakalpojumu un sociālās palīdzības departaments, hereinafter “the Department”) and the Latvian Movement for Independent Living association ( biedrība “Latvijas Kustība par neatkarīgu dzīvi ”, hereinafter “the Association”). Each of those institutions had pointed out numerous deficiencies in the social and medical care provided at the Rūja social care home (see paras. 20-40 below). In particular, the applicant noted that the medical records provided no information on A.P. ’ s state of health for a period of three months prior to his death, that his medical records could have been altered after his death, and that no action had been taken with regard to A.P. ’ s worsening state of health. The applicant emphasised that the conclusions of the medical forensic expert report were based on incomplete and potentially altered documents. The applicant also pointed to the State ’ s positive obligations emanating from Article 2 of the Convention. According to the applicant, the staff of the Rūja social care home had been aware of the dangers to A.P. ’ s health caused by Down ’ s syndrome but, nonetheless, had failed to pay attention to his state of health for a prolonged period of time, which had eventually led to his death.

18. On 11 April 2013 a supervising prosecutor of the Valmiera district prosecutor ’ s office reiterated in essence that no causal connection between the performance of their professional duties on the part of the staff of the Rūja social care home and A.P. ’ s infection with hepatitis B or death had been established.

19. The applicant lodged a further complaint restating her previous arguments. In a final decision of 10 May 2013 the acting chief prosecutor of the Vidzeme regional prosecutor ’ s office ( Vidzemes tiesas apgabala prokuratūra ) upheld the decision terminating the criminal proceedings. With regards to the applicant ’ s argument about the absence of some medical records, she noted that the applicant had not pointed to any other documents that could have led the experts to a different conclusion. Furthermore, the panel, composed of five experts, had considered the information available to them sufficient to conclude that the direct cause of A.P. ’ s death had been linked to Down ’ s syndrome. The acting chief prosecutor concluded by stating that the applicant ’ s opinion that the investigating authorities should assess whether the staff of the Rūja social care home had been aware of the threat to A.P. ’ s health and whether, in the light of that, they had treated him with the requisite care, indicated that the applicant had insufficient understanding of the elements of the offence prescribed under section 138 of the Criminal Law.

3. Investigation by the Health Inspectorate and disciplinary proceedings

20. On the basis of the applicant ’ s complaint, the Health Inspectorate – the institution responsible for monitoring the quality of professional medical care in healthcare establishments – carried out an investigation into the medical care provided to A.P. On 22 June 2012 the applicant was informed of the conclusions of this investigation. The Health Inspectorate had, inter alia , observed that on the day of the inspection healthcare had been provided by uncertified nurses who, moreover, had had a very heavy workload. Furthermore, rehabilitation had been provided by a physiotherapist who had mostly handled consultation tasks but had not carried out the actual rehabilitation in practice.

21. With regard to the treatment provided to A.P., the Health Inspectorate found that the medical records contained little information on the patient ’ s mental health. It noted that even though his therapy had been notably altered since June 2010, no indications had been given for the change in the records. On 6 October 2011 a care assistant had entered: “health has worsened, difficulties in walking.” After a few weeks A.P. had been diagnosed with psoriasis and the first entries about the sores on hips and buttocks had been made. A.P. had been prescribed treatment; however, the records concerning the receipt of that treatment were contradictory. In the following month only A.P. ’ s skin ailment had been assessed, disregarding his general psychosomatic condition. On 7 December 2011 a referral for a consultation with a surgeon had been made; this consultation had never taken place. On 16 December 2011 and 27 January 2012 a course of antibiotics had been prescribed; however the drugs had never been provided. For the period from 28 January 2012 through 10 April 2012 the medical records contained no entries at all. Thus, the Health Inspectorate concluded that it was impossible to examine the dynamics of the changes in, and the overall state of, A.P. ’ s health over that period of time.

22. Further, on 11 April 2012 A.P. had been examined by a general practitioner who, again, had only noted the symptoms of psoriasis. The general state of A.P. ’ s health had not been comprehensively assessed. In particular, the Health Inspectorate emphasised that cachexia, a disease that could not have appeared in a few days, had been disregarded. Thus, the Health Inspectorate concluded that section 37(1 )( 1) of the Medical Treatment Law had been violated. On 13 April 2012 a nurse had made an entry that A.P. had “become unwell in the bath” ( vannā kļuva slikti ) (the term used was highly inclusive and could cover getting sick, collapsing due to weakness, fainting, and so on); however, an ambulance had not been called. The Health Inspectorate considered that this oversight amounted to a violation of section 45(1 )( 1) of the Medical Treatment Law. An ambulance had only been called the following day, after which A.P. had been taken to Vidzeme Hospital.

23. The conclusions of the Health Inspectorate were: the applicant had not been informed of the worsening of the state of A.P. ’ s health; the fatal outcome had also been determined by the undiagnosed and untreated hepatitis B; the staff of the Rūja social care home (care assistants, nurses, the head of the healthcare section, a psychiatrist) and the general practitioner had not assessed the changes in the state of A.P. ’ s health, despite the fact that he himself had been incapable of understanding and communicating concerns about his wellbeing; the analysis of the documents did not exclude the possibility that the medical records had been tampered with; the effectiveness of the therapy could not have been assessed owing to the shortcomings in the medical records and the fact that A.P. ’ s skin condition had been examined by different doctors; the worsening of A.P. ’ s health in October 2011 could be considered the beginning of the acute hepatitis B manifesting itself clinically; the routes of transmission could not be determined.

24. Owing to the seriousness of the violations found, the Health Inspectorate sent the full report and the case materials to the Office of the Prosecutor General. Following the termination of the criminal proceedings on 17 January 2013 the issue was referred back to the Health Inspectorate for assessment of any potential disciplinary liability. The Ministry of Welfare and the Vidzeme State Social Care Home informed the applicant ’ s representative that disciplinary proceedings had been initiated against some of the employees of the Rūja social care home. However, the applicant has no information as to the outcome of those disciplinary proceedings.

4. Inspection by the Ministry of Welfare

25. On 18 April 2012 the Department carried out an inspection of the Rūja social care home. In their report of 25 April 2012 the Department noted that at the time of the inspection the number of staff on duty had been lower than required and below what had been put down in their records. Further, protection of the clients ’ right to privacy had not been ensured, as the sanitary facilities had not been adequately partitioned.

26. With regard to A.P. ’ s medical records the Department found that the information provided in his social care file was either incomplete or contradictory. For example, an entry from 5 April 2012, made by a social worker and care assistant stating “requires full care”, was inconsistent with a physiotherapist ’ s entry of the same day stating “moves independently, does not use technical aids.” Furthermore, the dates on which A.P. had allegedly received visitors differed between several documents. Additionally, A.P. ’ s client file included an activity schedule; however, there was no information as to which of them A.P. had been attending, and if so, how frequently. Thus, the Department noted that the evaluation of the social care process had been cursory and that the documents did not provide comprehensive information about the attained results. Further, A.P. ’ s patient notes contained entries, made on 7 and 16 October 2011, concerning bedsores but, even though treatment had been prescribed, no further information on this issue could be found. Owing to the above, the Department concluded that the continuity of care and handover of medical information between different persons providing care and medical assistance to A.P. had not been ensured.

27. Further, the Department found that the employees of the Rūja social care home who had signed the forms indicating that they had provided care to A.P. in March and April 2012 had, in fact, been on holiday on those dates. The Department also concluded that there was a possibility of additions after the fact to the client ’ s file, as a big part of the information concerning the care was unsigned and/or contradictory. Thus, the Department considered that there was a possibility that the documents did not reflect the client ’ s real care.

28. In the light of the above, the Department concluded that in the Rūja social care home care services had not been properly provided. Shortcomings were found to exist also with regard to the supervision of the care process. The Department ’ s recommendations pointed to the need to increase the number of staff and to ensure proper documentation, as well as the necessity to provide special education to staff with regards to the care process, ergonomics, psychology and their clients ’ diseases. The recommendations included, inter alia , a suggestion that the clients be weighed at least annually.

5. Assessment by the Latvian Movement for Independent Living

29. On 16 and 17 May 2012 the Association carried out an assessment of the clients ’ living conditions in the Rūja social care home. In its report of 30 May 2012 the Association, inter alia , recounted that most of the clients had spent the better part of the day sitting on the floor in the exercise room or the hallway squatting in the brace position and moving monotonously. According to the Association, this indicated that they had been suffering emotional discomfort and had been trying to isolate themselves – an issue the staff had paid no attention to. The Association noted the lack of attention paid to the clients with regard to several further issues, such as: ignoring the fact that they had had to spend the whole day in cold premises in unsuitable clothing; providing no assistance to clients with physical disabilities; failing to ensure that all clients received sufficient nutrition; leaving clients with severe functional impairment without any supervision; and so forth. The Association concluded that the clients who required full care had not been receiving it to the necessary extent. It also observed that the staff had not encouraged development of independence skills, not even with regard to the clients for whom it had been explicitly included in their social rehabilitation plan. Furthermore, no meaningful activities had been included in the daily schedule. The existing activities had been unstructured, lacked methodology and had only been offered to the more capable clients.

30. The Association also observed that during meals the clients had been cramped in a small room, which allowed the stronger inmates to steal food from the weaker ones. As a result, the clients who had not been able to defend their portions had received less food. Some clients had spoiled a lot of food as they had been incapable of eating properly; they had been issued aprons in order not to soil their clothes. The staff had provided no support through teaching or correcting the eating process. Furthermore, the necessary hygiene had not been observed, as clients had neither washed their hands before meals, nor after using the toilet. The patient notes indicated that the clients regularly had diarrhoea, which the Association considered symptomatic of poor hygiene. It also drew attention to the limited possibilities for ensuring personal hygiene – showers had been made available to clients once a week and for the rest of the time only three sinks had been available to the fifty-seven inmates.

31. The Association also observed that the staff relied on the clients to perform their tasks. Thus, the clients changed others ’ clothes and incontinence pads, provided hygienic care, and brought them to the toilet. The Association considered that this increased the risk of abuse. Moreover, it created a risk that the staff would not notice changes in the clients ’ condition, like the development of bedsores. The Association further noted that many of the inmates had rashes, eczema and untreated injuries. The cause of the poor condition of the clients ’ skin had not been identified. It also observed that the medical staff had merely handed out the prescribed medication without enquiring about the clients ’ health. The Association concluded that any attention to the clients ’ state of health was paid only if the situation became acute.

6. Report of the Ombudsperson

32. On 15 February 2013 the Ombudsperson ( Tiesībsargs ) delivered a report on State social care homes for adults with mental disabilities. The report compiled information acquired during on-site visits carried out from 2010 through 2012. The Ombudsperson concluded that the social services provided in Latvia did not comply with the needs of person s with mental health problems. Amongst other things, the Ombudsperson found that the number of staff in these institutions was insufficient to provide care for such a large number of clients with such serious diseases and disabilities.

33. The Ombudsperson pointed to the problems with regard to the allegedly voluntary nature of placement in these social care homes. Upon admission clients signed a complicated legal contract, which was unsuited to their mental capacities. In practice, most of the clients were not allowed to leave the homes, and in cases where they had attempted to escape, they had been brought back by police. Accordingly, the Ombudsperson concluded that in practice many of the clients were deprived of their liberty, yet they did not benefit from the procedural safeguards afforded to those whose deprivation of liberty was formally acknowledged, such as a review before a tribunal.

34. Furthermore, the Ombudsperson observed numerous problems in the area of medical care, emanating from the fact that the domestic law did not formally assign social care homes the function of providing medical assistance to its clients. As a result, social care homes were not registered as medical institutions and were not subject to the checks that were normally applicable to healthcare institutions with regard to the quality of the healthcare provided and documentation. Nonetheless, in practice social care homes did provide certain medical services and a big part of their budgets was spent on medication. However, due to the lack of regulation and supervision, the medical records kept in the social care homes were botched and bulky and did not provide an overview of the clients ’ state of health. General practitioners would prescribe medication for a period of at least three months without even having seen the patient, and psychiatrist consultations would be held too rarely for such prolonged therapy to be prescribed. Besides, the homes held no information on the treatment plans and the clients ’ or the guardians ’ consent to the treatment. The Ombudsperson concluded that many clients received their medical treatment without having been informed about the therapy and its potential side effects – a practice that was contrary to the Medical Treatment Law.

35. Furthermore, a large percentage of clients received heavy doses of medication and in most cases the alternative treatment methods had been replaced with medication. Almost all clients received psychotropic medication, mostly neuroleptics, benzodiazepines and anticonvulsants. Many clients received full doses of several of these medicines, even though they did not have a corresponding diagnosis. Thus the Ombudsperson concluded that this medication was being used for the purpose of controlling clients ’ behaviour and that this practice amounted to chemical restraint. The staff of the social care homes, who had confirmed the existence of this practice, expressed the view that the need for chemical restraint could be notably reduced if the homes could offer their clients the requisite care and suitable activities.

36. The Ombudsperson recommended enhancing the deinstitutionalisation efforts, avoiding placing new clients in social care homes and ensuring immediate additional training for staff.

B. Relevant domestic law

37. Section 138(1) of the Criminal Law at the relevant time provided that a medical practitioner who failed to carry out or negligently carried out his or her professional obligations was liable to a custodial sentence of up to two years if, owing to the negligence of the offender, this offence had caused serious or moderate bodily injury to the victim. Under s ection 138(2), if this offence had resulted in the infection of the victim with human immunodeficiency virus or hepatitis B or C, or had caused the death of the victim, the maximum punishment was deprivation of liberty for up to five years.

38. The relevant parts of the Medical Treatment Law, as in force at the material time, provided:

“Section 37

“ (1) A doctor is a medical practitioner who has acquired training compatible with the requirements of the Law on Regulated Professions and Recognition of Professional Qualifications, and who with scientifically justified medical activities directly or indirectly affects humans, and who within the scope of his or her professional activities:

1) performs illness prophylaxis, diagnosis, medical treatment and medical rehabilitation of the patients

... ”

Section 45

“ (1) In his or her profession a nurse, in conformity with his or her qualifications, shall:

1) provide patient care ...”

COMPLAINT

The applicant complains under Article 2 of the Convention that her son, who was placed in a State social care institution, died owing to the State ’ s failure to provide him adequate basic care and medical assistance and that the investigation into her son ’ s death was not diligent and effective.

QUESTIONS TO THE PARTIES

1. Has the applicant ’ s son ’ s right to life, ensured by Article 2 of the Convention, been violated in the present case?

2. In particular, having regard to the positive obligations under Article 2 of the Convention (see paragraphs 130-131 of Centre for Legal Resources on behalf of Valentin Câmpeanu v. Romania [GC], no. 47848/08, ECHR 2014), did the domestic authorities provide the requisite standard of protection for the applicant ’ s son ’ s life?

3. Further, having regard to the procedural protection of the right to life (see paragraph 104 of Salman v. Turkey [GC], no. 21986/93, ECHR 2000 ‑ VII), was the investigation in the present case by the domestic authorities in compliance with the requirements of diligence and effectiveness under Article 2 of the Convention?

The Government are requested to submit to the Court a copy of the investigation file regarding the death of the applicant ’ s son and to provide information and documents concerning the disciplinary proceedings, if any, connected with the subject matter of the case.