Shchebetov v. Russia

Application No. 21731/02
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The applicant had contracted HIV and Tuberculosis while in prison, and alleged that he was denied adequate medical care in violation of his Article 2 (right to life) and Article 3 (prohibition on torture or inhuman or degrading treatment) rights under the European Convention on Human Rights (“Convention”).

In 1997, the applicant was sentenced to twelve years in prison. A medical examination revealed no presence of HIV infection or tuberculosis (TB). A subsequent examination in 1998 revealed focal tuberculosis, and the applicant underwent treatment. The applicant claimed he had been infected with TB while in detention and that the facility had not addressed his complaints. In 2002, the applicant was diagnosed with HIV. The applicant alleged that he contracted the virus when a medical assistant, who had been drinking, drew his blood with a previously used syringe.

The applicant sued the Ministry of Justice and the detention facility in tort proceedings. The Yakutsk Town Court dismissed the action, holding that it was possible that he contracted TB prior to his incarceration.  The applicant then complained to various domestic officials that he had been infected with HIV. The Town Court dismissed the plaintiff’s action, and the Supreme Court of the Yakutiya Republic upheld the Town Court’s decision.

The Court unanimously held that Russia did not violate Article 2 or Article 3 of the European Convention on Human Rights.

Regarding HIV, the Court noted that while there was no dispute that the applicant was infected with HIV while in prison, there was dispute as to the means by which it was acquired. The Court concluded that there was no evidence that the medical assistant in question even drew the applicant’s blood. While the government was unable to provide adequate evidence indicating how the applicant contracted HIV, the Court was not able to find beyond a reasonable doubt that the Russian authorities were responsible for the applicant’s HIV contraction. Moreover, Russia had complied with its procedural obligation to investigate the circumstances in which the applicant contracted HIV because the authorities opened an investigation less than a month after the applicant was diagnosed with HIV, interviewed relevant witnesses, and closely reviewed the medical evidence.

Regarding TB, the Court reasoned that, because TB can lie dormant in the body without exhibiting signs of illness, the government could not be held accountable for the appellant contracting TB. However, the Court emphasized that regardless of where the applicant contracted the disease, the state had a duty to ensure that individuals are detained in conditions that have respect for human dignity. The adequacy of medical treatment remains one of the most difficult elements to determine. Russian authorities used all existing means for the correct diagnosis of the applicant’s condition, placed the applicant on an intensive chemotherapy regimen to fight tuberculosis, thoroughly considered the question of initiating antiretroviral therapy for the HIV infection, and, once the tuberculosis had been treated, took the necessary steps to prevent a new onset of the disease.

“The ‘adequacy’ of medical assistance remains the most difficult element to determine. The Court insists that, in particular, authorities must ensure that the diagnosis and care are prompt and accurate and that, where necessitated by the nature of a medical condition, supervision is regular and systematic and involves a comprehensive therapeutic strategy aimed at curing the detainee’s health problems or preventing their aggravation.” Para. 67 (citations omitted).

“The Court observes that the applicant did not indicate any specific omissions on the part of the prison medical personnel which had rendered their services ineffective and inadequate. He limited his submissions to the general grievance that an HIV-positive inmate suffering from tuberculosis should not be treated in the way he had been treated. However, having assessed the evidence, the Court finds the quality of the medical care provided to the applicant to have been adequate. In particular, the material available to the Court shows that the Russian authorities used all existing means for the correct diagnosis of the applicant’s condition, placed the applicant on an intensive chemotherapy regimen to fight tuberculosis, thoroughly considered the question of initiating antiretroviral therapy for the HIV infection, and, once the tuberculosis process had been arrested, took the necessary steps to prevent a new onset of tuberculosis by, inter alia, prescribing appropriate prophylactic treatment and admitting the applicant to medical institutions for in-depth examinations. The applicant was subjected to regular and systematic clinical assessment and monitoring, which formed part of the comprehensive therapeutic strategy aimed at preventing a relapse. The Court is unable to find any evidence, and the applicant did not argue otherwise, that the tuberculosis specialists’ recommendations as to the frequency of X-ray testing and prophylactic tuberculosis treatment were disregarded by the medical personnel of the facilities where he was detained at the time.” Paras. 72-73.

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