Slawomir Musial v. Poland

The applicant, a Polish national, alleged a violation of Article 3 of the Convention for the Protection of Human Rights and Fundamental Freedoms (the “Convention”) based on inadequate medical care during his detention in various Polish detention centers, as well as the overcrowding and poor conditions in those same facilities.

In April of 2005, the applicant was sentenced to pre-trial detention due to his suspected involvement in robbery and battery. It was uncontested that the applicant suffered from epilepsy, schizophrenia, and other mental disorders. During his detention, the applicant received psychotropic medicines and was examined by multiple psychiatrists. On four occasions, the applicant was temporarily transferred to a psychiatric hospital after reporting hallucinations and suicidal thoughts. Also during his detention, the applicant attempted suicide. While the attempt was thwarted by other detainees and the applicant was immediately seen by the prison’s in-house doctor, he was not taken to a psychiatric hospital until the next day. Although multiple doctors recommended, at various points during the applicant’s detention, that he needed to remain under psychiatric supervision, the applicant received only emergency and short-term psychiatric care. The applicant argued that the treatment provided in detention was insufficient and therefore violated Article 3 of the Convention (prohibiting torture, inhuman or degrading treatment or punishment). He claimed that he should have been detained in a proper psychiatric institution rather than a general detention facility.

With regards to the conditions of the facilities themselves, the applicant claimed that there was overcrowding and sub-par sanitation efforts in each of the three facilities where he was detained. While the Code of Execution of Criminal Sentences states that the area of a cell to be assigned per detainee should not be less than 3 square meters, the facilities, during the applicant’s period of detention, were operating under Ordinances from the Minister of Justice allowing a temporary reduction in the minimum space allocated to each detainee when a facility was exceeding its capacity. The applicant claimed that the low standards were especially problematic when considered in conjunction with his medical condition and that the conditions therefore violated Article 3 of the Convention.

The Court held that the applicant’s treatment during his detention violated Article 3 of the Convention particularly due to inadequate medical care and detention conditions.

States are required to ensure that detention conditions respect human dignity, which requires that the conditions do not impose distress or hardship exceeding the amount already associated with detention. Three factors must be considered to determine the compatibility of a person’s detention with their health: (1) “the medical condition of the prisoner”; (2) the sufficiency of the medical care provided in detention; and (3) “the advisability of maintaining the detention measure in view of the state of health of the applicant.”

The Court raised as a serious issue that the applicant suffers from multiple chronic and severe mental disorders, yet he was kept in detention centers primarily for health people for his nearly 3.5 years of detention. The Court noted that during his detention he had regular access to in-house medical professionals and could make appointments with specialized doctors. However, doctors had recommended that he received regular psychiatric supervision. Even after his attempted suicide, he was not given in-patient care. The applicant’s psychological condition made him “more vulnerable than the average detainee,” and not holding him in a proper medical center resulted in unnecessary risks to his health and anxiety. The Court emphasized that the fact that the applicant received a similar level of care as other inmates demonstrated a failure of the authorities.

With regards to the overcrowding and general condition of the facilities, the Court noted that the conditions would be concerning in any case and were particularly concerning in the present case where the detainee suffered from severe illness.

“88. The Court observes that there are three particular elements to be considered in relation to the compatibility of an applicant’s health with his stay in detention: (a) the medical condition of the prisoner; (b) the adequacy of the medical assistance and care provided in detention, and (c) the advisability of maintaining the detention measure in view of the state of health of the applicant….”

“94. Mindful of the above considerations, the Court finds that while maintaining the detention measure is not, in itself, incompatible with the applicant’s state of health, detaining him in establishments not suitable for incarceration of the mentally-ill, raises a serious issue under the Convention.”

“96. Undeniably, detained persons who suffer from a mental disorder are more susceptible to the feeling of inferiority and powerlessness. Because of that  an  increased  vigilance  is  called  for  in  reviewing  whether  the Convention has been complied with. While it is for the authorities to decide, on the basis of the recognised rules of medical science, on the therapeutic methods to be used to preserve the physical and mental health of patients who  are  incapable  of  deciding  for  themselves,  and  for  whom  they  are therefore responsible, such patients nevertheless remain under the protection of Article 3.”