Prizreni v Albania

HEADNOTE

While in the prison, Sh. P. suffered from medical complications which could only be treated at a hospital. While in hospital Sh. P.’s brother, Fatos Prizreni, found Sh.P. unconscious and bound to the hospital bed. Shortly after Sh. P. died. The investigation showed no signs of medication at time of death, despite records of administered medicine, and bruises caused by a blunt object. The European Court of Human Rights held that domestic authorities had violated Articles 2 and 3 of the Convention for the Protection of Human Rights and Fundamental Freedoms due to the lack of an effective investigation in to the circumstances surrounding Sh.P’s death.

FACTUAL AND PROCEDURAL BACKGROUND
The applicant, Fatos Prizreni, was the brother of Sh.P. who was sentenced on March 29, 2010 to four years’ imprisonment for attempted murder. While serving his sentence at the Lezhë detention facility, the prison’s doctor diagnosed Sh.P. with psoriasis, parapanesis inferior (partial paralysis of both legs) and elephantiasis. On February 9, 2011, Sh.P. was transferred to Tirana Prison Hospital as the detention facility could not sufficiently treat his condition. He was transferred again on February 17 to Tirana University Hospital Centre where he was diagnosed with elephantiasis, morbid obesity, and multi-organ insufficiency and was prescribed medication. Sh.P. died on February 22, 2011 at the university hospital.
An inquiry in to Sh.P.’s death was commenced on February 22, 2011 involving an on-site investigation of the hospital, a forensic examination of the body, and the taking of photographs. Upon questioning by the judicial police officer, doctors attending to Sh.P. at the hospital stated he had been treated “like any other patient and the treatment prescribed had been administered in accordance with the rules.” The final forensic medical report concluded that Sh.P. suffered from ecchymosis on both his forearms caused by blunt objects while other illnesses caused other lesions. The report also noted that medications were not detected in Sh.P.’s blood and that his death was a result of acute cardio-respiratory insufficiency. Further investigation was required to determine whether Sh.P. underwent negligent medical treatment. However, when Prizreni was questioned about the events prior to his brother’s death, he stated that when he arrived at the hospital, he had found Sh.P. unconscious and bound to the bed with sheets.
On April 13, 2011, the Tirana prosecutor’s office decided not to commence criminal proceedings for Sh.P.’s death because they found the death was a result of acute respiratory and cardiac insufficiency and other diseases and that there was no evidence of a criminal offence having been committed. On May 17, 2011 the applicant lodged a complaint with the Tirana District Court against the prosecutor’s office’s decision. The District Court rejected the applicant’s complaint on the grounds that Prizreni did not have standing to make the complaint. The Tirana Court of Appeal upheld the District Court’s decision. In January 2014, the Supreme Court rejected the applicant’s appeal. The applicant’s complaints against the domestic courts’ decisions were rejected by the Constitutional Court in late 2015 on the grounds that the denial of standing by statute did not violate Prizreni’s right to access to justice.
Fatos Prizreni filed an application with the European Court of Human Rights against Albania, complaining that authorities had conducted an ineffective investigation into his brother’s death contrary to Article 2 of the Convention for the Protection of Human Rights and Fundamental Freedoms (“the Convention”) since the authorities’ findings did not provide conclusive answers beyond a reasonable doubt that Sh.P.’s injuries and deteriorating health were not caused by ill-treatment or inadequate medical care. He further alleged that Sh.P. experienced inhuman and degrading treatment contrary to Article 3 of the Convention due to evidence and allegations that Sh.P. was handcuffed or otherwise tied to the bed with sheets while in the hospital and that Sh.P. received inappropriate medical care as indicated by the lack of medication found in his blood.
RELEVANT LEGAL PROVISIONS
Article 2 of the Convention for the Protection of Human Rights and Fundamental Freedoms – Right to Life

“Everyone’s right to life shall be protected by law. No one shall be deprived of his life intentionally save in the execution of a sentence of a court following his conviction of a crime for which this penalty is provided by law.”

Article 3 of the Convention for the Protection of Human Rights and Fundamental Freedoms – Prohibition of Torture

“No one shall be subjected to torture or to inhuman or degrading treatment of punishment.
The Court held that there was a violation of Article 2 of the Convention as the national authorities failed to provide an adequate investigation surrounding the death of the applicant’s brother. Article 2 implies the procedural need for an effective and independent investigation when a death results from the use of force, particularly in the penitentiary and health care contexts. Although the Court noted that the public authorities promptly commenced an investigation in to Sh.P.’s death, it also observed that there were shortcomings in the investigation. In particular, the Court noted that while Sh.P. had been prescribed medication as part of his treatment, the investigation did not conclude whether Sh. P was properly medicated at the time of death; therefore, the Court was not able to determine beyond a reasonable doubt that the death had in fact occurred due to the claimed respiratory and cardiac insufficiency as a result of his medical history rather than medical mistreatment. Furthermore, the Court observed that the investigation failed to address the applicant’s allegations his brother was handcuffed while in hospital and whether such restraint of the patient contributed to Sh.P.’s death given his medical conditions. Because the medical examination failed to address such fundamental questions, the Court noted that the prosecutor’s decision to not commence criminal proceedings based on these insufficient findings was also in violation of Article 2.
The Court held that there was a violation of Article 3 of the Convention because of the domestic authorities’ failure to effectively carry out an investigation in to Sh.P.’s cause of death. In particular, the Court noted that authorities failed to give an explanation regarding the bruises on Sh.P.’s wrists, and that the applicant’s allegations that his brother was tied to the bed in combination with the medical report’s findings of the bruises should have given cause for further investigation to determine whether Sh.P. had been subjected to ill-treatment. As such, the Court concluded that the domestic authorities failed to undertake an effective investigation to determine whether Sh.P. had been treated in a way contrary to Article 3 of the Convention.

“Furthermore, in the context of health care, the Court has interpreted the procedural obligation of Article 2 as requiring States to set up an effective and independent judicial system so that the cause of death of patients in the care of the medical profession, whether in the public or the private sector, can be determined and those responsible made accountable…” (Para 41)
“An investigation must be effective in the sense that it is capable of leading to the establishment of the facts and, where appropriate, the identification and punishment of those responsible. Although it is not an obligation of result but of means, any deficiency in the investigation which undermines its ability to establish the circumstances of the case or the person responsible, will risk falling foul of the required standard of effectiveness…The authorities must act of their own motion once the matter has come to their attention. They cannot leave it to the initiative of the next of kin either to lodge a formal complaint or to request particular lines of inquiry or investigative procedures…In all cases, the victim’s next of kin must be involved in the procedure to the extent necessary to safeguard his or her legitimate interests…” (Para 42)
“The Court reiterates that handcuffing does not normally give rise to an issue under Article 3 of the Convention where the measure has been imposed in connection with lawful detention and does not entail use of force, or public exposure, exceeding what is reasonably considered necessary. In this regard, it is important to consider, for instance, whether there is a danger that the person concerned might abscond or cause injury or damage…In the present case, the forensic medical report merely mentioned the existence of signs and the fact that they had been caused by impact of a blunt object…on the applicant’s brother’s body. However, the authorities did not carry out any further examination to establish whether the applicant’s brother had been subjected to any form of ill-treatment…Furthermore, no further investigations were conducted in this respect. Hence, the Court finds that the domestic authorities did not undertake sufficient investigative measures to establish beyond any reasonable doubt if the bruises on the applicant’s brother’s wrists were caused by treatment contrary to Article 3 of the Convention.” (Para 57)