I correctly predicted that there was a violation of human rights in SERGEYEVA AND PROLETARSKAYA v. RUSSIA.

Information

  • Judgment date: 2017-06-13
  • Communication date: 2013-09-03
  • Application number(s): 59705/12
  • Country:   RUS
  • Relevant ECHR article(s): 2, 2-1, 3
  • Conclusion:
    Violation of Article 2 - Right to life (Article 2-1 - Life) (Substantive aspect)
  • Result: Violation
  • SEE FINAL JUDGMENT

JURI Prediction

  • Probability: 0.824885
  • Prediction: Violation
  • Consistent


Legend

 In line with the court's judgment
 In opposition to the court's judgment
Darker color: higher probability
: In line with the court's judgment  
: In opposition to the court's judgment

Communication text used for prediction

The applicants, Ms Valentina Olegovna Sergeyeva and Ms Irina Yuryevna Proletarskaya, are Russian nationals, who live in Moscow.
They are represented before the Court by Mr I. Sharapov, a lawyer practising in Moscow.
The facts of the case, as submitted by the applicants, may be summarised as follows.
The first applicant is a sister of Mr B. who died of AIDS on 6 May 2008 in the Botkin Infectious Diseases Clinical Hospital in St. Petersburg (hereinafter – the Botkin hospital).
The second applicant is the mother of Mr P. who died of AIDS on 19 June 2009 in the same hospital.
A.
Circumstances of Mr B.’s death Mr B. was diagnosed with HIV infection in October 2004 during a medical check-up performed in a temporary detention facility where he was kept on remand.
On 1 December 2005 the Frunzenskiy District Court of St. Petersburg sentenced Mr B. to seven years of imprisonment, having convicted him of aggravated robbery.
Mr B. was sent to serve his sentence in penitentiary facility no.
US-20/5 in the Leningrad Region.
Following a serious deterioration of his condition, in March 2007 Mr B. was transferred to the Gaaza prison hospital in St. Petersburg (hereinafter – the Gaaza hospital).
During his stay in the Gaaza hospital from March to June 2007 the applicant underwent a number of tests to monitor his immune status.
In particular, a CD4 test showed the presence of less than 163 cells per cubic millimetre of blood.
Mr B. was also diagnosed with chronic hepatitis B, tuberculosis of the peripheral lymph nodes and bowel dyskinesia.
In June 2007 Mr B. was transferred to medical colony no.
4 in the Karelia Republic to undergo tuberculosis treatment.
According to the applicants, the medical colony specialised in treating inmates who suffered from tuberculosis.
A further transfer of Mr B. was effected on 4 July 2007 to medical penitentiary facility no.
RB-2 in Karelia following his complaints of an acute stomach pain.
In the latter facility Mr B. was subjected to clinical blood and urine tests and to an ultrasound examination of the abdominal cavity.
Given that the initially posed diagnosis of appendicitis had not been confirmed, Mr B. was sent back to medical colony no.
4 where he received intensive anti-tuberculosis treatment until 3 September 2007.
In March 2008 Mr B.’s health seriously deteriorated with his having been diagnosed with right-sided poly-segmented pneumonia.
As his condition remained moderately grave, specialists interpreted it as a sign of a further progress of his HIV infection.
Mr B. was sent to medical penitentiary facility no.
RB-2 for testing and assessment whether the anti-retroviral therapy should be initiated.
On admission to medical facility no.
RB-2 Mr B.’s condition was considered by doctors as moderately grave.
The assessment was done on the basis of the visual examination and results of clinical blood and urine tests.
On 10 April 2008 Mr B. was admitted to the infectious diseases department of the facility where mostly inmates suffering from the HIV infection were detained.
Six days later he was examined by a neurologist who diagnosed Mr B. as follows: “discirculatory encephalopathy of toxic genesis accompanied by movement and trophic impairments; polyneuropathy”.
Mr B. was prescribed treatment with anti-bacterial drugs (antibiotics) vitamins, injections of glucose, iron and potassium chloride.
On 22 April 2008, given a drastic deterioration of Mr B.’s health, detention authorities decided to send him to a medical expert commission to prepare a report to seek his release on parole.
An extract from the expert report prepared by the commission read as follows: “From the anamnesis: the HIV infection was diagnosed for the first time in a detention facility in St. Petersburg on 25 October 2004... At the present moment the patient’s condition is grave.
Clinical diagnosis is: progressing HIV infection in stage 4B, candidiasis of the oral cavity, cachexia, a fever syndrome of unknown genesis, discirculatory encephalopathy of the second degree in the third stage of toxic genesis accompanied by movement and trophic impairments, chronic viral hepatitis B and C, extra-pulmonary tuberculosis”.
Three days later the Medvezhyegorsk District Court of the Karelia Republic authorised Mr B.’s early release in view his extremely fragile health.
In particular, the District Court noted that Mr B.’s “health was extremely poor, [that] his life prognosis was unfavourable [and that] he could not move without assistance”.
Mr B. was not brought to the hearing as his health did not warrant his transport.
When the first applicant came to facility no.
RB-2 to pick up her brother, the latter was carried out on a stretcher by warders.
Mr B. was unconscious.
He was extremely skinny, “resembling a skeleton covered with the bluish skin”.
The first applicant was forced to immediately take Mr B. by car to St. Petersburg where he was admitted to the Botkin hospital.
As follows from an extract of medical record no.
10631 issued by the Botkin hospital, Mr B. stayed in the hospital from 26 April to 6 May 2008, having been diagnosed with the HIV infection in the stage 5 (the terminal stage), disseminated candidiasis of mucous membranes, overwhelming tuberculosis primarily affecting the thoracic and abdominal lymph nodes in the infiltration stage, the HIV-encephalitis, toxoplasmosis of the brain, brain oedema, right-sided pneumothorax, acute erosive ulcerous gastritis, gastrorrhagia, progressing multiple organ failure, anaemia of the mixed genesis, chronic hepatitis B and C, heroine dependency.
On 6 May 2008, at 9.55 p.m., Mr B died without regaining consciousness.
B.
Circumstances of Mr P.’s death On 12 December 2006 the Lomonosovskiy District Court in St. Petersburg found Mr P. guilty of robbery and sentenced him to three years of imprisonment.
By that time Mr P. was already serving a sentence of imprisonment following conviction of theft.
In August 2006 Mr P. was diagnosed with tuberculosis and was sent to the Gaaza hospital for treatment.
Following a further progress of the illness in February 2007 he was transferred to medical correctional colony no.
4 in Karelia.
Until 16 October 2008 Mr P. remained in the latter facility for treatment.
On admission to medical colony no.
4 Mr P. was diagnosed with the HIV infection in the stage 4B accompanied by infiltrative pulmonary tuberculosis, cachexia, candidiasis, generalized lymphadenopathy, genital pointed condyloma, nutritional dystrophy of the first degree, chronic hepatitis B, C and D. Doctors also noted that Mr P. had been under medical supervision in respect of his HIV infection since 1999.
During Mr P.’s stay in the medical colony, he was subjected to clinical blood and urine testing.
He also underwent a chest X-ray examination and received sputum smear tests.
According to the second applicant, Mr P. received anti-tuberculosis treatment, as well as a symptomatic treatment of the viral hepatitis and candylomathosis.
On 17 April 2008 a medical social forensic expert commission diagnosed Mr P. as suffering from maltidrug-resistant infiltrative pulmonary tuberculosis in the infiltration and disintegration stage, HIV infection in the 4B stage, multiple genital condylomas, chronic hepatitis B, C and D, nutritional dystrophy of the first degree.
Six months later the Segezhsk Town Court, having assessed the expert opinion and recommendations by the colony administration, released Mr P. on parole.
Having been released on 31 October 2008, Mr P. was immediately taken by his relatives to the Botkin hospital.
Relying on the text of Mr P.’s interview which he had given to the head of the Fund for Health Protection and Social Justice, the second applicant argued that he had not received the antiretroviral therapy and had never been immunologically tested during the entire period of his detention, despite his numerous complaints about the rapidly deteriorating health.
The medical colony where he had been detained was only equipped to treat inmates suffering from tuberculosis.
It did not employ an infectious diseases specialist or a dermatologist.
A month prior to Mr P.’s release, he started complaining of a high fever, nausea and extremely poor condition.
Citing his coming release, colony staff members refused to examine him or provide with any assistance.
After he had been admitted to the Botkin hospital, Mr P. was informed of a difficult medical choice that his doctors faced.
His tuberculosis was in an extremely active and advanced stage blocking the commencement of the antiretroviral therapy.
At the same time, he desperately needed that therapy as a life-supporting procedure.
The doctors did not make any prognosis.
Mr P. died in the Botkin hospital on 19 June 2009.
The death certificate indicated that he died from “an illness caused by the HIV infection”.
C. Complaints to prosecution authorities The applicants, supported by an NGO, sent a letter to the Prosecutor General of the Russian Federation complaining about the lack of medical assistance leading to their relatives’ deaths.
Their complaint was readdressed to the prosecutor’s office of the Karelia Republic.
As follows from a letter sent by a deputy prosecutor of the Karelia Republic, the medical colony where both Mr B. and Mr P. had been kept was not licenced to provide treatment to HIV-infected inmates, despite the fact that more than 320 persons suffering from that disease were detained there.
The deputy prosecutor admitted that in 2007 and 2008 detention facilities of the Karelia Republic “had [had] problems with providing medical assistance to HIV-infected convicts in view of the fact that a large number of those inmates had been sent to the Karelia [detention facilities] from other regions”.
In particular, the deputy prosecutor indicated that almost a hundred HIV-infected inmates had been transferred to the Karelia detention facilities in 2006 and another 176 convicts were sent to Karelia in 2007.
Forty inmates suffering from the HIV infection died in 2006 and 2007.
In 2008 the Karelia detention facilities received 270 inmates suffering from the HIV-infection and 272 inmates with tuberculosis.
Twenty-eight inmates died of the HIV infection or tuberculosis or combination of the two diseases in the Karelia detention facilities in 2008.
Having been alarmed by that situation, in June 2007 the prosecutor’s office of the Karelia Republic and the Prosecutor General’s office sent letters to the Ministry for the Execution of Sentences drawing its attention to the fact that the Karelia detention facilities, and in particular medical colony no.
4 which specialised on treatment of tuberculosis patients, could not perform examination of inmates suffering from the HIV-infection in combination with tuberculosis.
The facility neither had a licenced special immunological laboratory to carry out examinations of HIV-infected inmates and to assess their immunological status, nor it had staff members qualified and educated to perform examinations and treatment of such inmates.
Moreover, the facility did not have funds or resources to pay to specialists and to provide treatment to HIV-infected inmates.
At the same time, the deputy prosecutor noted that after 2007 significant positive changes had been introduced in the Karelia detention facilities to satisfy the medical needs of inmates: staff had been re-qualified and certified to provide necessary treatment, the detention facilities had started receiving drugs included in the antiretroviral therapy, and civil specialists were invited on regular basis to provide assistance to prison medical personnel.
As follows from the same letter by the deputy prosecutor, Mr B. and Mr P. had never received the antiretroviral therapy during detention.
The deputy prosecutor concluded that given that the medical assistance provided to the applicants’ relatives had not been of requisite quality, the authorities were to determine whether it was necessary to open a criminal case into the events.
The applicants were to be informed of a decision taken.
In a letter sent by the Health Department of the Karelia Republic to the republican prosecutor’s office as a result of the examination of Mr P.’s case in 2010, the health official noted that there was no evidence in his medical record that Mr P. had ever been seen by an infectious diseases specialist in detention.
Furthermore, the official noted that he had not been subjected to any of the mandatory medical procedures provided to a patient suffering from the HIV infection in stage 4B, such as HIV viral load testing, CD4/CD8 count tests, examinations by a neurologist, otolaryngologist, surgeon and oculist to determine any AIDS accompanying illnesses, examinations by an infectious diseases specialist at least once in four months, ultrasound and ECG examinations, biochemical testing, clinical blood testing to determine the presence of antibodies related to hepatitis B and C, and antiretroviral therapy.
The officials concluded that the lack of those procedures could have determined the active course of the chronic illnesses and precluded administering of the proper treatment.
On 5 August 2010 a senior investigator of the Karelia Republic prosecutor’s office refused to open a criminal case into the deaths of Mr B. and Mr P. Having cited difficulties encountered by the penitentiary system of the Karelia Republic in 2006-2008, including an extremely large number of HIV-positive inmates, lack of specialists capable of dealing with inmates suffering from that infection (the entire Karelia Republic only had one specialist), absence of an immunological laboratory and no reserve of drugs included in the antiretroviral therapy, the senior investigator, nevertheless, stated that the penitentiary authorities in Karelia had “taken all currently possible measures to provide medical assistance to HIV-infected inmates”.
The senior investigator described steps which had been taken in 2008-2010 to ameliorate the situation, including the opening of a new infectious diseases facility, disciplinary measures against penitentiary officials, and cooperation with civil medical personnel.
He also noted that both Mr B. and Mr P. had died from the infection which they had contracted prior to their arrival to detention facilities in Karelia.
The senior investigator concluded that there was no causal link between the quality of medical services provided to them in detention, including the lack of the antiretroviral therapy, and their deaths.
He also stressed that Mr B. had managed to live for almost three years in the Karelia detention facilities without the antiretroviral therapy and that Mr P. had died more than seven months after his release from detention.
D. Tort proceedings In 2011 the applicants lodged an action against the Russian Ministry of Finance and penitentiary authorities seeking compensation for damage caused by their relatives’ deaths.
They argued that Mr B. and Mr P. had died as they had not received adequate medical assistance in detention.
On 28 October 2011 the Tverskoy District Court of Moscow dismissed the action, having found no evidence that any of the implicated State officials had acted unlawfully or had failed to act or that they had violated any rights of the plaintiffs or their relatives.
In particular, the District Court noted that there were no court decisions showing that Mr B. and Mr P. had not received proper medical care in detention.
To the contrary, having cited the senior investigator’s decision of 5 August 2010, the District Court held that both inmates had “received medical assistance”.
On 22 February 2012 the Moscow City Court upheld the judgment on appeal, having fully endorsed the District Court’s reasoning.
COMPLAINTS The applicants complain under Articles 2 and 3 of the Convention that the lack of proper medical assistance in detention had subjected their relatives to inhuman and degrading sufferings and had caused their death.

Judgment

THIRD SECTION

CASE OF SERGEYEVA AND PROLETARSKAYA v. RUSSIA

(Application no.
59705/12)

JUDGMENT

STRASBOURG

13 June 2017

This judgment is final but it may be subject to editorial revision.
In the case of Sergeyeva and Proletarskaya v. Russia,
The European Court of Human Rights (Third Section), sitting as a Committee composed of:
Branko Lubarda, President,Pere Pastor Vilanova,Georgios A. Serghides, judges,and Fatoş Aracı, Deputy Section Registrar,
Having deliberated in private on 23 May 2017,
Delivers the following judgment, which was adopted on that date:
PROCEDURE
1.
The case originated in an application (no. 59705/12) against the Russian Federation lodged with the Court under Article 34 of the Convention for the Protection of Human Rights and Fundamental Freedoms (“the Convention”) by Russian nationals, Ms Valentina Olegovna Sergeyeva (“the first applicant”) and Ms Irina Yuryevna Proletarskaya (“the second applicant”), on 20 August 2012. 2. The applicants were represented by Mr I. Sharapov, a lawyer practising in Moscow. The Russian Government ("the Government") were represented initially by Mr G. Matyushkin, the Representative of the Russian Federation to the European Court of Human Rights, and then by his successor in that office, Mr M. Galperin. 3. The applicants alleged that the Russian authorities had failed to provide their two relatives with the appropriate medical care in detention, and had thus failed to protect their lives. 4. On 3 September 2013 the application was communicated to the Government. 5. The Government objected to the examination of the application by a Committee. Having considered the Government’s objection, the Court rejects it. THE FACTS
I.
THE CIRCUMSTANCES OF THE CASE
6.
The first applicant is a sister of Mr B., who died of AIDS in the Botkin Hospital in St Petersburg on 6 May 2008. 7. The second applicant is the mother of Mr P., who died of the same disease in the same hospital on 19 June 2009. 8. The applicants live in Moscow. A. Mr B’s detention and medical treatment
9.
On 13 October 2004 Mr B. was arrested on suspicion of robbery. The next day the Frunzenskiy District Court of St Petersburg authorised his detention pending investigation. He was then taken to remand prison no. IZ‐47/6 in the Leningrad Region. Twelve days later he was diagnosed with HIV. 10. In November 2004 Mr B. was transferred to remand prison no. IZ‐47/1 in St Petersburg. On admission he informed the prison doctor about his HIV status. A relevant entry was made in his medical file, but no treatment was prescribed. 11. On 1 December 2005 the Frunzenskiy District Court of St Petersburg convicted Mr B. and sentenced him to seven years’ imprisonment. In August 2006 he was sent to serve the sentence in correctional colony no. IK-5 in the Leningrad Region. 12. Having complained of abdominal pain, on 4 March 2007 Mr B. was admitted to the prison hospital, where he was later diagnosed with tuberculosis of the peripheral lymph nodes. It was decided that he should stay in the hospital for tuberculosis treatment. 13. On 16 March 2007 Mr B. was seen by an infectious diseases doctor, who ordered a CD4 count to be conducted. The test, performed five days later, showed that the level of CD4 cells was 163 cells/mm3, which corresponded to an advanced stage of the disease. 14. On 31 May and 16 June 2007 the infectious diseases doctor visited Mr B. According to the medical records, the latter asked for antiretroviral therapy. In response, the doctor “gave him a talk”. No HIV treatment was prescribed. 15. On 20 June 2007 Mr B. was discharged from the prison hospital. Until April 2008 he was transferred from one prison medical facility to another for anti-tuberculosis treatment. Although the treatment was successful, the patient’s overall medical condition continued to deteriorate. Medical specialists interpreted that as a sign of progressing HIV. 16. On 2 April 2008 Mr B. was admitted to prison hospital no. RB-2 in the Republic of Karelia. At that time he was unable to walk, was feverish and extremely emaciated. Eight days later he was transferred to an infectious diseases unit. His doctor alleged that his grave medical condition resulted from a lack of highly active antiretroviral therapy (HAART). Mr B. was prescribed antibacterial and disintoxication therapy. 17. On 22 April 2008 the medical authorities applied for Mr B.’s early release on medical grounds. Three days later the Medvezhyegorsk Town Court of the Republic of Karelia granted the request. On the same day Mr B. was released from detention. 18. On 26 April 2008 Mr B. was admitted to Botkin Hospital in St Petersburg. He did not regain consciousness and died there on 6 May 2008. B. Mr P.’s detention and medical treatment
19.
On 26 July 2006 Mr P. was convicted of theft and sentenced to a term of imprisonment. He was taken into police custody and two days later sent to remand prison no. IZ-47/6 in the Leningrad Region. 20. During the admission procedure he told the resident doctor that in 2000 he had been diagnosed with HIV, which by 2006 had progressed to AIDS. Before his arrest he had been receiving antiretroviral therapy. He was also suffering from hepatitis B, C, and D and a skin disease. 21. Having undergone a routine medical examination, on 31 July 2006 Mr P. was diagnosed with infiltrative tuberculosis of the right lung. A standard drug regimen was prescribed and administered to him in the prison medical unit. A chest X-ray examination carried out on 20 November 2006 showed a decrease in the area of the lung affected by the tuberculosis. 22. Mr P. was convicted of robbery in another set of criminal proceedings and on 12 December 2006 he was sentenced to three years’ imprisonment. He was sent to prison medical facility no. 4 in the Republic of Karelia. 23. Mr P.’s medical condition worsened. The result of a sputum culture test performed on 26 February 2007 was smear-positive. By April 2007 Mr P.’s tuberculosis had developed resistance to six of the drugs he had been taking. Following a decision of the prison medical board on 16 June 2007, his drug regimen was adjusted. 24. On 26 June 2007 Mr P. was admitted to prison hospital no. RB-2 in the Republic of Karelia, where the tuberculosis treatment continued as prescribed. It appears that the change in medication improved the patient’s lung condition. However, doctors noted a further development of opportunistic infections. A viral load test was performed, the results of which, as alleged by the second applicant, were not given to Mr P.
25.
On 13 July 2007 Mr P. returned to the prison medical facility. Chest X-ray examinations carried out on 24 July and 26 September 2007 showed that the condition of Mr P.’s lungs had improved. The results of a smear test proved negative. On 16 October 2008 Mr P. was sent back to a regular prison ward. His treatment continued. 26. On 27 October 2008 at the request of Mr P., the Segezha Town Court of the Republic of Karelia ordered his release on parole. Having been released on 31 October 2008, Mr P. was taken to Botkin Hospital. He died in the hospital on 19 June 2009 from “an illness caused by the HIV infection”. C. Complaints to the authorities
1.
Complaints to the prosecutors
27.
On 26 May and 4 June 2010 a Russian non-governmental organisation, Agora, complained to the Russian Prosecutor General’s Office of the lack of HIV treatment for detainees, including Mr B. and Mr P. The complaint was referred to the prosecutor’s office in the Republic of Karelia. 28. In a letter to the Russian Prosecutor General’s Office dated 6 July 2010 the prosecutor’s office in the Republic of Karelia observed that in 2007 and 2008 prison authorities in Karelia had experienced difficulties with providing medical assistance to HIV-infected convicts in view of the fact that a large number of infected inmates had been sent to the Republic from other regions. The prosecutor’s office said that the supply of drugs had been limited and the number of medical professionals had been insufficient, and acknowledged that the medical care of Mr B. and Mr P. had fallen short of the domestic standards. In particular, they had not received HAART. The prosecutor’s office had sent the evidence it had gathered to the investigative committee in the Republic of Karelia to determine whether a criminal case should be opened. 29. On 5 August 2010 the investigative authorities refused to open a criminal case into the deaths of Mr B. and Mr P. Citing the difficulties encountered by the prison authorities of the Karelia Republic in 2006-08, including the large number of HIV-positive inmates, a lack of specialists trained to treat inmates suffering from that infection, the absence of an immunological laboratory and the lack of medication, the investigators concluded that the prison authorities had taken all possible measures to provide medical assistance to HIV-infected inmates. No causal link between the absence of HIV therapy and the deaths of Mr B. and Mr P. was established. The investigative authorities stressed that Mr B. had managed to live in detention without the antiretroviral therapy for almost three years and that Mr P. had died more than seven months after his release. The conduct of the prison and medical authorities, in the investigators’ opinion, did not reveal any signs of a criminal offence. 30. The above decision was not challenged. 2. Tort proceedings
31.
In 2011 the applicants lodged a claim for non-pecuniary damages against the Russian Ministry of Finance, arguing that their relatives’ death from HIV had been caused by the authorities’ failure to provide appropriate medical care. 32. On 28 October 2011 the Tverskoy District Court of Moscow examined the claim. It found that the burden of proof was on the applicants, who had to prove the unlawfulness of the prison officials’ conduct, the alleged damage, and the causal links between the officials’ conduct and that damage. Having noted the absence of a decision establishing a breach of the law by the prison authorities, and having referred to the decision not to open a criminal case into the deaths of the applicant’s relatives, the court dismissed the claim as unsubstantiated. 33. On 22 February 2012 the Moscow City Court upheld the judgment on appeal, fully endorsing the District Court’s reasoning. II. RELEVANT DOMESTIC AND INTERNATIONAL LAW
34.
The relevant provisions of the domestic and international law on the health care of detainees, including those suffering from HIV, are set out in the following judgments: Pakhomov v. Russia, no. 44917/08, §§ 33-39 and 42-48, 30 September 2011; A.B. v. Russia, no. 1439/06, §§ 77-84, 14 October 2010; and Yevgeniy Alekseyenko v. Russia, no. 41833/04, §§ 60‐66 and 73-80, 27 January 2011. THE LAW
I.
ALLEGED VIOLATION OF ARTICLE 2 OF THE CONVENTION
35.
The applicants complained under Articles 2 and 3 of the Convention that the authorities had failed to provide Mr B. and Mr. P with adequate medical care in detention and that they had thus been responsible for their deaths. 36. The Court considers that the above complaints fall to be examined under Article 2 of the Convention, the relevant part of which reads:
“1.
Everyone’s right to life shall be protected by law.”
A. Submissions by the parties
37.
The Government put forward two lines of argument. 38. Firstly, they argued that the claim should be rejected because the applicants had not exhausted domestic remedies. The applicants had not sought the criminal prosecution of the officials allegedly responsible for their relatives’ deaths, and had not appealed against the decision not to open a criminal case. The Government further stated that a claim for damages was an inappropriate legal avenue. The applicants should have asked the court to declare the prison authorities’ actions/inaction unlawful. 39. In the alternative, the Government argued that the detainees had been under close medical supervision and had received appropriate medical treatment. They questioned the probative value of an expert report submitted to the Court by the applicants (see paragraph 40 below). They observed that it did not constitute forensic evidence and that, accordingly, the expert could not be held criminally liable for untruthful findings. They also argued that more than one medical expert had to assess the quality of the medical care, given that Mr B. and Mr P. had suffered from a large number and variety of illnesses. Lastly, the Government stressed that the expert had not come to any conclusion regarding the consequences of the shortcomings established. 40. The applicants argued that they had exhausted domestic remedies through tort proceedings, the most effective remedy available to them. They further argued that Mr B. and Mr P. had not received HIV treatment. They relied on an expert report prepared on 18 March 2014 by a forensic medical expert “of the highest category with twenty-nine years of professional experience”. The expert established that the prison authorities had not observed the “Standard of medical treatment for patients with HIV” approved by the Ministry of Healthcare and Social Development of Russia on 17 August 2006. The “Standard” provided that an HIV-positive patient should be seen by an infectious diseases specialist at least four times, and that he or she should be subjected to in-depth biochemical blood testing at least three times, and to immune testing with a CD4 count at least twice per year. None of the aforementioned requirements had been met in respect of Mr B. and Mr P. The expert also noted the absence of HAART, which Mr B. had needed since 21 March 2007, when a test had revealed a low level of CD4 cells, and which Mr P. had required since his placement in custody in July 2006. B. The Court’s assessment
1.
Admissibility
41.
The Court reiterates at the outset that where a violation of the right to life is alleged, the Convention organs have accepted applications from relatives of the deceased (see Karpylenko v. Ukraine, no. 15509/12, § 73, 11 February 2016, and Şemsi Önen v. Turkey, no. 22876/93, 14 May 2002). The first applicant, a sister of the late Mr B., and the second applicant, the mother of the late Mr P., can therefore claim a violation under Article 2 of the Convention pertaining to the death of their relatives. 42. Turning to the Government’s plea of non-exhaustion, the Court observes that it has already held that a civil claim for damages was capable of providing redress and offered reasonable prospects of success for a claim about inadequate medical assistance in detention, if the applicant himself is not in the situation he or she has complained about (see Morozov v. Russia, no. 38758/05, § 47, 12 November 2015 with further references). In the present case the applicants lodged a claim for damages against the Russian authorities, alleging that the absence of proper medical care in detention had led to the death of their relatives, and subsequently challenged the unfavorable court judgment on appeal (see paragraphs 31-33 above). Accordingly, the domestic remedies have been duly exhausted. 43. The Court further notes that the applicants’ complaints are neither manifestly ill-founded within the meaning of Article 35 § 3 (a) of the Convention, nor inadmissible on any other grounds. They must therefore be declared admissible. 2. Merits
(a) General principles
44.
The applicable general principles were set out in Karsakova v. Russia, no. 1157/10, §§ 46-49, 27 November 2014; Geppa v. Russia, no. 8532/06, §§ 68-72, 3 February 2011; and Slimani v. France, no. 57671/00, §§ 27-32, ECHR 2004‐IX (extracts). (b) Application of the general principles to the present case
45.
Sensitive to the subsidiary nature of its role, the Court reiterates that it is not its task to rule on matters lying exclusively within the field of expertise of medical specialists and to establish whether an applicant in fact required a particular treatment or whether the choice of treatment methods appropriately reflected the applicant’s needs (see Dumikyan v. Russia, no. 2961/09, § 58, 13 December 2016; Ukhan v. Ukraine, no. 30628/02, § 76, 18 December 2008; and Sergey Antonov v. Ukraine, no. 40512/13, § 86, 22 October 2015). However, given the vulnerability of persons in detention, it is for the Government to provide credible and convincing evidence showing that the individual concerned received comprehensive and adequate medical care in detention (see Dumikyan and Sergey Antonov, ibid.). 46. In the present case the Government did not submit any medical opinion on the quality of the medical care afforded to Mr B. and Mr P. The applicants provided the Court with an expert report (see paragraph 40 above), which identified several flaws in the medical treatment of the applicant’s relatives and found that the treatment had failed to respond to the patients’ medical needs. Although the report did not constitute forensic evidence as interpreted by the Government, the Court sees no reason to cast doubt on the veracity of the expert’s conclusions, since the expert – and the Government did not argue otherwise – had appropriate qualifications and credentials, and his opinion was duly reasoned. Therefore the Court is ready to attach particular weight to this evidence. 47. Having closely scrutinised the documents submitted by the parties, the Court observes three major shortcomings in the medical care afforded to Mr B. and Mr P.
48.
Firstly, the authorities did not ensure that the detainees were examined regularly by an infectious diseases doctor. Documents show that Mr B. was seen by such a specialist on only three occasions: for the first time in March 2007, more than two years after the authorities had discovered his HIV status (see paragraphs 13 and 14 above). Mr P. was in an even more difficult situation, having never been examined by such a doctor. Such limited access by HIV-positive detainees to the relevant medical specialist has already been the subject of criticism by the Court (see Kozhokar v. Russia, no. 33099/08, § 111, 16 December 2010). 49. Secondly, the authorities did not regularly subject the detainees to immunological testing. Both Mr B. and Mr P. underwent a CD4 count only once (see paragraphs 13 and 24 above). The Court has on many occasions been dissatisfied with such irregular testing, which fell short of the applicable standard of four CD4 cell counts and two viral load tests per year (see Khayletdinov v. Russia, no. 2763/13, § 75, 12 January 2016, and E.A. v. Russia, no. 44187/04, § 65, 23 May 2013). 50. Thirdly, and most importantly, Mr B. and Mr P. were not given HAART, the key treatment for HIV. Both patients’ need for such treatment was obvious given the very advanced stages of their illness, the opportunistic infections that had developed, the low CD4 count revealed by Mr B.’s testing and the fact that Mr P. had been prescribed such treatment even before his imprisonment. The Court considers this to be a particularly serious shortcoming (compare with Khayletdinov, cited above, § 72; M.S. v. Russia, no. 8589/08, § 99, 10 July 2014; and Koryak v. Russia, no. 24677/10, § 102, 13 November 2012, where the authorities were reproached for delayed or interrupted antiretroviral therapy). 51. In the light of the above, the Court supports the expert conclusion and considers that the medical assistance provided to Mr B. and Mr P. was deficient. The seriousness of the shortcomings in their treatment is palpable and enables the Court to conclude that the domestic authorities have failed to comply with the requirements of Article 2 of the Convention by not providing the requisite standard of protection for the lives of the applicants’ relatives. II. APPLICATION OF ARTICLE 41 OF THE CONVENTION
52.
Article 41 of the Convention provides:
“If the Court finds that there has been a violation of the Convention or the Protocols thereto, and if the internal law of the High Contracting Party concerned allows only partial reparation to be made, the Court shall, if necessary, afford just satisfaction to the injured party.”
A.
Damage
53.
The applicants claimed 50,000 euros (EUR) each in respect of non‐pecuniary damage. 54. The Government stated that the claim was excessive. 55. The Court, making its assessment on an equitable basis, considers it reasonable to award each of the applicants EUR 20,000 in respect of non‐pecuniary damage, plus any tax that may be chargeable on that amount. B. Costs and expenses
56.
The applicants did not submit a claim for costs and expenses. Accordingly, there is no call to award them any sum on that account. C. Default interest
57.
The Court considers it appropriate that the default interest rate should be based on the marginal lending rate of the European Central Bank, to which should be added three percentage points. FOR THESE REASONS, THE COURT, UNANIMOUSLY,
1.
Declares the application admissible;

2.
Holds that there has been a violation of Article 2 of the Convention;

3.
Holds
(a) that the respondent State is to pay to each applicant, within three months EUR 20,000 (twenty thousand euros), plus any tax that may be chargeable, in respect of non-pecuniary damage.
That amount, to be converted into the currency of the respondent State at the rate applicable at the date of settlement;
(b) that from the expiry of the above-mentioned three months until settlement simple interest shall be payable on the above amount at a rate equal to the marginal lending rate of the European Central Bank during the default period plus three percentage points;

4.
Dismisses the remainder of the applicants’ claim for just satisfaction. Done in English, and notified in writing on 13 June 2017, pursuant to Rule 77 §§ 2 and 3 of the Rules of Court. Fatoş AracıBranko LubardaDeputy RegistrarPresident