The inadequate investigation of a patient’s death in a hospital consists of a violation of the right to life

JUDGMENT 

Prizreni v. Albania  11.06.2019 (no. 29309/16)

see here  

SUMMARY

Death of a hospitalized patient under non specified conditions. Authorities’  failure to carry out an adequate and effective investigation into the circumstances of the death and his treatment. Protection of life.

The applicant’s brother passed away while being hospitalised for serious illness. The forensic investigation that was carried out, was not properly establish, regarding to the quality of treatment received by the deceased, the alleged medical treatment and the presence of bruises on his body.

The ΕCHR held unanimously that there was a violation of Article 2 (right to life)  because the authorities had failed to carry out an adequate and effective investigation into the circumstances of the death of the  applicant’s brother  and there had been a breach of the State’s procedural obligation to protect the right to life, violation of the procedural part of Article 3 (prohibition of torture) as the authorities had  failed to carry out an effective investigation into whether the deceased  had been subjected to ill treatment, and held that there was no violation of Article 3 in the substantive limb because it was not found  from the medical report that the deceased had been ill-treated.

PROVISIONS 

Article 2

Article 3

PRINCIPAL FACTS 

The applicant, Fatos Prizreni, is an Albanian national who was born in 1963 and lives in Elbasan
(Albania).

In February 2011, the applicant’s brother, Sh.P., was transferred from Lezhë detention facility to a
hospital. The applicant went to visit his brother on 22 February 2011, but found that he had died
that day. It appears from the hospital file that Sh.P. had been diagnosed with elephantiasis, morbid
obesity and multi-organ insufficiency, and had been prescribed medication.

The authorities began to investigate the death on the day he passed away, carrying out an on-site
examination and later questioning hospital doctors. The doctors stated that he had been treated like
any other patient and given treatment in accordance with the rules. The applicant told investigators
that during an earlier visit he had found his brother unconscious and tied to the bed with sheets.

A post-mortem forensic report found no trace of medication in Sh.P.’s blood, noted bruising on both
forearms and gave the cause of death as acute cardio-respiratory insufficiency. It left the question of
any negligent medical treatment to another forensic medical commission.

The Tirana prosecutor’s office decided in April 2011 against bringing criminal proceedings, citing the
forensic report and the fact that it had found no evidence of an offence. The applicant complained
about that decision but his case was rejected at all levels, including the Constitutional Court in 2015.

The courts found in particular that he did not have legal standing and that under domestic law only
people who had reported an offence could complain about a decision not to institute criminal
proceedings.

THE DECISION OF THE COURT

Article 2

The applicant submitted that the investigation had failed to provide a satisfactory explanation about
the circumstances surrounding his brother’s death. In particular it had not excluded beyond any
reasonable doubt that the health issues described in the medical report, which had included
observations of bruises on the body and forearms, had not been caused by ill-treatment or a lack of
appropriate medical care. The Government rejected those arguments.

The Court first dealt with an objection by the Government that Mr Prizreni had been too passive,
failing to report the case to the prosecutor’s office. However, it noted that under its case-law
authorities must act of their own motion once a matter has come to their attention. It was therefore
immaterial whether Mr Prizreni had himself been active in involving the investigating authorities.
The Court noted that the investigation had started promptly, on the day Mr Prizreni’s brother had
died. However, an inconsistency had emerged as the forensic report had found no traces of drugs in
Sh.P.’s blood, while the hospital file stated that he had been treated with medication.

The question of whether he had been receiving drugs for his condition or not was never clarified and
the Court was not satisfied that it had been established beyond a reasonable doubt that Sh.P.’s
death had been caused by his illnesses or inadequate treatment and care.

The investigation had not addressed the applicant’s allegations about his brother being handcuffed
while in hospital and whether that had contributed to his death. Furthermore, the prosecution
decision not to pursue the case had been based on the inconclusive forensic examination.

The Court stressed the importance of involving relatives in investigations into the death of a member
of their family, in particular to ensure that their interests were properly protected, which could be in
conflict with those of the police or the security forces. Mr Prizreni, however, had been barred by
statute from making an effective challenge to the prosecutor’s decision against opening criminal
proceedings. That was inconsistent with the State’s obligation to conduct an effective investigation.
The Court held that the authorities had failed to carry out an adequate and effective investigation
into the circumstances of the applicant’s brother’s death and there had been a breach of the State’s
procedural obligation under Article 2 to protect the right to life.

Article 3

Mr Prizreni’s complaint of ill-treatment was based on his finding his unconscious brother tied to his
hospital bed with sheets, the possibility that he had been handcuffed while in hospital and the
question mark over his medical treatment raised by the forensic examination. The Government
disputed the applicant’s submissions.

The Court found that Mr Prizreni had raised an arguable claim that his brother had been ill-treated in
hospital in a way that was contrary to Article 3, triggering an obligation on the authorities to
investigate. The authorities had never provided any explanation for the bruises found on his
brother’s body and had never questioned any prison police officer or hospital personnel specifically
on this issue.

Handcuffing, in particular if carried out in connection with lawful detention, did not normally give
rise to an issue under this Article. The forensic medical report had mentioned the existence of marks
on the body that could have been caused by the impact of a blunt object, but no further
investigation had been carried out. The Court concluded that it could not establish whether there
had been a violation of the substantive limb of Article 3.

On the other hand, the Court found that it was clear that the authorities had failed to carry out an
effective investigation to establish whether Mr Prizreni’s brother had been subjected to ill-treatment
while in custody and there had thus been a violation of Article 3 under its procedural limb.

Other Articles

Given its findings under Article 2 and Article 3 the Court decided that it did not need to examine the
complaints separately under Article 13 of the Convention.

Just satisfaction (Article 41)

The Court held that Albania was to pay the applicant 12,000 euros (EUR) in respect of non-pecuniary
damage and EUR 1,450 in respect of costs and expenses (echrcaselaw.com).