FIRST SECTION
DECISION
Application no. 29687/09
Azamat Rakhmetovich ISMATULLAYEV
against Russia
The European Court of Human Rights (First Section), sitting on 6 March 2012 as a Chamber composed of:
	Nina Vajić, President,
	Anatoly Kovler,
	Peer Lorenzen,
	Elisabeth Steiner,
	Khanlar Hajiyev,
	Mirjana Lazarova Trajkovska,
	Julia Laffranque, judges,
and Søren Nielsen, Section Registrar,
Having regard to the above application lodged on 27 April 2009,
Having regard to the decision to grant priority to the above application under Rule 41 of the Rules of Court,
Having regard to the observations submitted by the respondent Government and the observations in reply submitted by the applicant,
Having deliberated, decides as follows:
THE FACTS
1.  The applicant, Mr Azamat Rakhmetovich Ismatullayev, is a Turkmen national who was born in 1976 and is serving a sentence in a correctional colony in the Saratov Region. The respondent Government are represented by Mr G. Matyushkin, Representative of the Russian Federation at the European Court of Human Rights.
A.  The circumstances of the case
2.  The facts of the case, as submitted by the parties, may be summarised as follows.
1.  Criminal proceedings against the applicant and subsequent attempts to reopen the criminal case
3.  On 25 May 2001 the Supreme Court of the Russian Federation, as court of final instance, found the applicant guilty of manslaughter and attempted aggravated murder and sentenced him to fifteen years’ imprisonment.
4.  On 18 January 2007 a deputy prosecutor for St. Petersburg, acting on the applicant’s representative’s request and having considered that a psychiatric forensic examination of the applicant, performed during the criminal proceedings and finding that he did not suffer from any mental illness, could have been erroneous, initiated an inquiry to determine whether there were grounds to reopen the criminal case against the applicant in view of newly discovered evidence. The deputy prosecutor noted that it was necessary to conduct an additional expert examination of the applicant’s psychological state at the time when he committed the crime.
5.  After the additional expert examination had confirmed the findings of the initial examination, on 4 May 2008 the Vyborg District Prosecutor in St. Petersburg closed the proceedings, having found no newly discovered evidence warranting the reopening of the criminal case.
6.  In 2010 the applicant’s representative lodged a complaint with the Vyborgskiy District Court in St. Petersburg, alleging that the investigators had committed a number of procedural violations when they had authorised the psychiatric expert examinations of the applicant during the criminal proceedings against him and in the course of the inquiry in 2007-2008.
7.  On 30 March 2010 the District Court accepted the complaint in part, having confirmed that the investigators had failed to notify the applicant of their decisions authorising the expert examinations. On 24 June 2010 the St. Petersburg City Court quashed that decision and closed the proceedings. Having noted that the applicant’s criminal case had been determined by a final judgment in 2001 and that the inquiry into a possible reopening of the case had been closed in 2008, the City Court held that the complaint was no more than an appeal in disguise by which the applicant had attempted to have matters reviewed which had already been settled by final decisions. On 28 June 2010 the Supreme Court of the Russian Federation examined the applicant’s complaint about the prosecutor’s decision of 4 May 2008 and his request for the reopening of his criminal case. Both the complaint and the request were dismissed on the grounds that there were no procedural defects in the actions of the prosecutors or courts.
2.  The applicant’s state of health
8.  According to the applicant, following a complex medical examination including blood tests and an examination by a physician, in December 2007 he was diagnosed with hepatitis C, which was not considered to be acute. The applicant submitted that he had contracted the disease at a dentist’s surgery in the prison hospital. He alleged that he had not suffered from the illness prior to his detention. Relying on copies of letters from the head of the St. Petersburg City Hospital and the acting prosecutor for the Vyborgskiy District, the applicant further argued that his medical file drawn up prior to 2004 had been lost or misplaced.
9.  In addition, he argued that his numerous complaints of the deterioration of his health accompanied by acute pain in the right side of the body, absence of appetite, depression and insomnia and requests for the provision of adequate medical assistance had been left without any response, save for the authorities’ assertions that the treatment for his illness was extremely expensive and the detention facility did not have the funds to purchase the necessary medicines. There is, however, no evidence that the applicant has ever raised those complaints before a prosecutor or a court.
10.  Having relied on voluminous evidence, including the applicant’s medical history, medical certificates, expert reports and registration logs, the Government submitted that on 27 June 2000 the applicant had been admitted to temporary detention facility no. 4 in St. Petersburg. According to the Government, while performing regular blood tests to identify HIV infection and syphilis, as well as X-ray exams to identify cases of tuberculosis, the authorities had not employed routine screening for the presence of hepatitis C virus (“HCV”) upon the placement of detainees in detention facilities. On admission to the facility the applicant had been tested for HIV and syphilis with both tests producing negative results, but no samples had been taken from him for assays meant to detect the specific antibody to hepatitis C virus. The Government insisted that it had not been necessary to establish the applicant’s HCV infection status as there had been no evidence that he had had a history of risk of exposure to the virus and he had had no symptoms of acute or chronic illness. They further pointed out that during the entire period of his detention the applicant had benefited from close medical attention, having received, on a number of occasions, courses of antibacterial treatment in respect of his chronic maxillary sinusitis in a specialised hospital in St. Petersburg and having undergone an operation which had radically improved his condition pertaining to that illness. The applicant had been under regular medical supervision by prison physicians and otolaryngologists. He had been repeatedly screened by tuberculosis specialists, with the tests showing no presence of tuberculosis bacteria. He had also received routine dental treatment. Every health complaint the applicant had raised had been promptly and duly addressed by the medical personnel of the detention facilities. However, the doctors could not, even remotely, have connected any of those complaints to his suffering from hepatitis C until the applicant asked a prison doctor to test his blood for viral hepatitis on 28 October 2010. Although having noted his surprise at the request in the applicant’s medical history, the doctor had granted it. The results of the test performed on 10 November 2010 had showed the presence of antibodies against HCV.
11.  The Government insisted that it was not until 10 November 2010 that the prison doctors had learned of the applicant’s diagnosis. They, however, acknowledged that on 7 November 2007 the applicant had been transferred to the St. Petersburg City Psychiatric Hospital for a psychiatric examination. On admission to the hospital, he had been subjected to a thorough clinical assessment, including blood tests. As a result, he had been diagnosed with chronic hepatitis C in the “dormant stage”. The applicant, however, had withheld that information from the prison authorities and the hospital had not transferred the applicant’s medical records with the results of the blood tests to the applicant’s detention facility.
12.  Following the applicant’s diagnosis in 2010, he had been assigned inpatient clinical monitoring. A number of additional specialised tests performed in November and December 2010 had confirmed the diagnosis of chronic hepatitis C in remission. Examinations by hepatologists and tests performed to evaluate the applicant for liver disease had showed that he did not yet require HCV treatment. At the same time, the prison doctors had attempted to provide the applicant with psychological support, having tried to identify the possible cause of the illness, having explained his future treatment and having counselled him regarding prevention of the spread of the virus to others. The applicant’s complaints in late November 2010 and April 2011 of pain in the right subcostal area and a bitter taste in his mouth had led to his being diagnosed with biliary dyskinesia. The applicant had received the necessary treatment, including with hepatoprotective medicines.
13.  Further relying on various medical documents, copies of licences and so forth, the Government argued that the prison hospital in the correctional colony where the applicant is detained has all necessary medical specialists and equipment for successful medical management of the applicant’s condition. They stressed that the applicant remains under dynamic clinical assessment, including laboratory testing and regular medical examinations, which will allow a decision for the introduction of antiviral therapy, if appropriate, to be promptly taken. However, the most recent medical assessment of the applicant in June 2011 showed no signs of deterioration in the state of his health. The results of the clinical testing had confirmed that the HCV infection is still in remission. The applicant had not made any complaints as to the state of his health.
B.  Relevant domestic and international law and reports
14.  The relevant provisions of domestic and international law on health care of detainees and the authorities’ procedural obligation to investigate alleged instances of ill-treatment (criminal offences) in detention facilities are set out in the following judgments: Pakhomov v. Russia, no. 44917/08, 30 September 2011; and Yevgeniy Alekseyenko v. Russia, no. 41833/04, 27 January 2011.
15.  The Russian Criminal Code establishes criminal responsibility for the intentional or negligent infliction of serious health damage with negligent conduct being punishable by up to three years of limitation of liberty and intentional actions by up to eight years of imprisonment (Articles 111 and 118). However, the infliction of serious health damage by an official as a result of his or her failure to fulfil professional responsibilities constitutes a separate, aggravated criminal offence attracting an increased penalty, with the possibility of sentencing the defendant to imprisonment coupled with a prohibition on holding an official position or engaging in the practice of certain activities (Article 118 § 2).
COMPLAINTS
16.  The applicant complained under Article 3 of the Convention that he had contracted hepatitis C in detention and had not received the necessary medical assistance although his health had continued deteriorating rapidly.
17.  The applicant complained under Article 6 of the Convention of various procedural violations committed by the prosecution authorities and courts during the criminal proceedings leading to the final judgment of 25 May 2001 and when they had dealt with his case in 2007-2010 during his attempts to reopen the criminal case. He further complained that all of the proceedings had been extremely lengthy.
THE LAW
I.  ALLEGED VIOLATION OF ARTICLE 3 ON ACOUNT OF BEING INFECTED WITH HEPATITIS C
18.  The applicant complained that he had contracted the hepatitis C virus (“HCV”) when he had received dental treatment in the prison hospital. Article 3 of the Convention reads as follows:
“No one shall be subjected to torture or to inhuman or degrading treatment or punishment.”
A.  Submissions by the parties
19.  The Government argued that the applicant had failed to exhaust domestic remedies, as he had neither complained to the colony administration nor lodged a criminal law complaint or a tort action, alleging his having been infected with the virus during his detention. They further submitted that there was no evidence of his contracting the infection in detention. While not disputing that the applicant had received dental care in the colony, the Government argued that it could not be established “beyond reasonable doubt” that the HCV infection had been transmitted during a medical procedure. They stressed that an assessment of the epidemiological situation in the detention facilities in St. Petersburg had not revealed any cases of HCV transmission to or among inmates. The Government also stressed that the medical procedures performed in Russian penitentiary facilities complied with the highest standards of medical care. It included the use of sterilised or disposable medical equipment to avoid exposure of inmates to infections. The Government concluded by noting that when questioned by the prison doctors on the potential source of the virus, the applicant had not disputed the possibility of HCV transmission through sexual contact with an HCV-infected partner.
20.  The applicant submitted that he had not been infected with HCV prior to his arrest. He argued that immediately after his arrest he had been sent to hospital no. 3 in St. Petersburg, where his blood had been tested for viral hepatitis. The tests had showed that he had been healthy. However, the test records had been lost or misplaced. He further stressed that his having been HIV-negative supported his allegation that he had been infected during a medical procedure in detention and not by way of sexual transmission. In addressing the Government’s objection of non-exhaustion, the applicant noted that his complaint of HCV infection was subordinate to his Article 6 complaints. He had raised the present complaint before the Court in order to obtain priority treatment of his application, the foremost complaint therein being the unfairness of the criminal case against him.
B.  The Court’s assessment
21.  While assessing the Government’s argument that the applicant failed to exhaust domestic remedies, the Court reiterates that the rule of exhaustion of domestic remedies referred to in Article 35 of the Convention obliges those seeking to bring their case against the State before the Court to first use the remedies provided by the national legal system. Consequently, States are dispensed from answering before an international body for their acts before they have had an opportunity to put matters right through their own legal system. The rule is based on the assumption, reflected in Article 13 of the Convention – with which it has close affinity – that there is an effective remedy available to deal with the substance of an “arguable complaint” under the Convention and to grant appropriate relief. In this way, it is an important aspect of the principle that the machinery of protection established by the Convention is subsidiary to the national systems safeguarding human rights (see Kudła v. Poland [GC], no. 30210/96, § 152, ECHR 2000‑XI, and Handyside v. the United Kingdom, 7 December 1976, § 48, Series A no. 24).
22.  An applicant is normally required to have recourse only to those remedies that are available and sufficient to afford redress in respect of the breaches alleged. The existence of the remedies in question must be sufficiently certain not only in theory but also in practice, failing which they will lack the requisite accessibility and effectiveness (see, inter alia, Vernillo v. France, 20 February 1991, § 27, Series A no. 198, and Johnston and Others v. Ireland, 18 December 1986, § 22, Series A no. 112). It is incumbent on the Government claiming non-exhaustion to satisfy the Court that the remedy was an effective one available in theory and in practice at the relevant time, that is to say, that it was accessible, was one which was capable of providing redress in respect of the applicant’s complaints and offered reasonable prospects of success. However, once this burden of proof has been satisfied it falls to the applicant to establish that the remedy advanced by the Government had in fact been used or was for some reason inadequate and ineffective in the particular circumstances of the case or that there existed special circumstances absolving him or her from the requirement.
23.  The Court would emphasise that the application of the rule must make due allowance for the fact that it is being applied in the context of machinery for the protection of human rights that the Contracting Parties have agreed to set up. Accordingly, it has recognised that the rule of domestic remedies must be applied with some degree of flexibility and without excessive formalism (see Cardot v. France, 19 March 1991, § 34, Series A no. 200). It has further recognised that the rule of exhaustion is neither absolute nor capable of being applied automatically: in reviewing whether it has been observed it is essential to have regard to the particular circumstances of each individual case (see Van Oosterwijck v. Belgium, 6 November 1980, § 35, Series A no. 40). This means amongst other things that it must take realistic account not only of the existence of formal remedies in the legal system of the Contracting Party concerned but also of the general legal and political context in which they operate, as well as the personal circumstances of the applicants (see Akdivar and Others v. Turkey, 16 September 1996, §§ 65-68, Reports of Judgments and Decisions 1996‑IV).
24.  Where the fundamental right to protection against torture, inhuman and degrading treatment is concerned, the preventive and compensatory remedies have to be complementary in order to be considered effective. The existence of a preventive remedy is indispensable for the effective protection of individuals against the kind of treatment prohibited by Article 3 of the Convention. Indeed, the special importance attached by the Convention to that provision requires, in the Court’s view, that the States parties establish, over and above a compensatory remedy, an effective mechanism in order to put an end to any such treatment rapidly. Had it been otherwise, the prospect of future compensation would have legitimised particularly severe suffering in breach of this core provision of the Convention (see Vladimir Romanov v. Russia, no. 41461/02, § 78, 24 July 2008.
25.  Having regard to the principles cited above, the Court is not convinced that either a complaint to the prison authorities or a tort action in the circumstances of the present case could have been considered to provide effective relief for the applicant’s claim of having been infected with the hepatitis C virus in detention.
26.  In particular, the Court notes that the primary responsibility of the prison officials in charge of the detention facility is that of ensuring the appropriate conditions of detention, including the adequate health care of prisoners. It follows that a complaint of negligent actions by prison medical personnel resulting in transmission of a life-threatening infection would necessarily call into question the way in which the prison management had discharged its duties and complied with the domestic legal requirements. Accordingly, the Court does not consider that the prison authorities would have a sufficiently independent standpoint to satisfy the requirements of Article 35 of the Convention (see Silver and Others v. the United Kingdom, 25 March 1983, § 113, Series A no. 61): in deciding on a complaint concerning an inmate’s medical care for which they are responsible, they would in reality be judges in their own cause (see Goginashvili v. Georgia, no. 47729/08, § 55, 4 October 2011).
27.  As to the claim for compensation, the Court, while noting the Government’s failure to illustrate the practical effectiveness of the remedy with examples from the case-law of the domestic courts, also reiterates that a judicial award of compensation to an applicant in a case raising an arguable claim under Article 3 of the Convention represents only one part of the group of measures necessary to provide redress for the actions of State agents (see, mutatis mutandis, Vladimir Romanov v. Russia, cited above, § 79). The Court is of the opinion that cases of transmission of life‑threatening infections, such as HIV and hepatitis C, resulting from negligent or wilful actions of State agents cannot be remedied exclusively through an award of compensation to the victim, particularly so when domestic law, as in the present case, imposes an obligation on the authorities to open a criminal inquiry and identify those responsible. This is so because, if the authorities could confine their reaction in such cases to the mere payment of compensation, it would be possible in some cases for agents of the State to abuse the rights of those within their control with virtual impunity, and the general legal prohibition of torture and inhuman and degrading treatment, despite its fundamental importance, would be ineffective in practice (see, among many other authorities, mutatis mutandis, Krastanov v. Bulgaria, no. 50222/99, § 60, 30 September 2004, and Yaşa v. Turkey, 2 September 1998, § 74, Reports 1998-VI; Tanrıkulu v. Turkey [GC], no. 23763/94, § 79, ECHR 1999-IV; Velikova v. Bulgaria, no. 41488/98, § 89, ECHR 2000-VI; Salman v. Turkey [GC], no. 21986/93, § 83, ECHR 2000-VII; Gül v. Turkey, no. 22676/93, § 57, 14 December 2000; Kelly and Others v. the United Kingdom, no. 30054/96, § 105, 4 May 2001; and Avşar v. Turkey [GC], no. 25657/94, § 377, ECHR 2001-VII).
28.  Having said that, the Court reiterates its finding made on a number of occasions that a criminal law complaint may be regarded as an adequate remedy within the meaning of Article 35 § 1 of the Convention for an applicant to complain of a violation of his rights guaranteed by Article 3 of the Convention (see, among other authorities, Mikheyev v. Russia, no. 77617/01, § 86, 26 January 2006, with further references, and Hıdır Durmaz v. Turkey, no. 55913/00, § 29, 5 December 2006). Indeed, the applicant should have provided the State with an opportunity to investigate the case and answer his grievances. The criminal law inquiry could have allowed assembling evidence necessary to corroborate the applicant’s allegation of negligent actions by the prison medical personnel leading to his contracting the virus. The investigating authorities would have had broad legal powers to visit the detention facility, interview detainees, study documents including medical records, obtain statements from the prison officials, collect forensic evidence, commission expert reports and take all other crucial steps for the purpose of establishing the veracity of the applicant’s account. The investigating authorities’ role was critical not only to the pursuit of criminal proceedings against the alleged perpetrators of the offence but also to the pursuit by the applicant of other remedies to redress the harm he had suffered (see Dedovskiy and Others v. Russia, no. 7178/03, §§ 98-101, 15 May 2008).
29.  The Court therefore concludes that by failing to submit a criminal law complaint to the investigating authorities the applicant stripped the State of the opportunity to remedy the alleged violation of his rights guaranteed by Article 3 of the Convention. An examination of the case as submitted does not disclose the existence of any special circumstances which might have absolved the applicant according to the generally recognised rules of international law from exhausting that domestic remedy at his disposal. This part of the application must therefore be dismissed under Article 35 §§ 1 and 4 of the Convention for failure to exhaust domestic remedies.
II.  ALLEGED VIOLATION OF ARTICLE 3 OF THE CONVENTION ON ACCOUNT OF THE QUALITY OF MEDICAL ASSISTANCE
30.  The applicant further complained under Article 3 of the Convention that the authorities had not taken steps to safeguard his health and well‑being, having failed to provide him with adequate medical assistance after they had learned of his suffering from hepatitis C. Article 3 of the Convention was cited above.
A.  Submissions by the parties
31.  The Government once again raised the objection of the applicant’s failure to apply to the competent domestic authorities, this time with a complaint of inadequate medical services. In the alternative, they argued that having learned of the applicant’s condition in 2010 the prison medical personnel had taken every possible precaution to maintain his health at a satisfactory level. The applicant had been immediately subjected to dynamic clinical monitoring, regularly being tested to identify the progress of the disease and correctly determine the moment when treatment may be required by the level of the virus. While having pointed to a delay in detecting the HCV infection, the Government stressed that it had been entirely due to irresponsible actions by the applicant, who had not informed prison officials that he had been diagnosed with the virus in a civil hospital in 2007. In any event, the delay in detection had had no negative effect on the applicant’s condition. In conclusion, the Government stressed that at the present time the applicant’s state of health was satisfactory and he continued to receive full medical attention.
32.  The applicant reminded the Court that chronic hepatitis C is a lifelong illness with the infection being present in the human body for years and in most cases leading to a serious condition, such as cirrhosis of the liver or liver cancer. Patients should be placed under regular medical supervision and should be considered as potential candidates for antiviral therapy. Without providing any explanation, the applicant did not dispute that he had not informed the authorities about the infection until the test in 2010 and he directed his complaints towards the alleged absence of medical assistance after that test. He was concerned by the fact that he had not yet started receiving antiviral therapy.
B.  The Court’s assessment
33.  The Court notes the Government’s objection as to the non‑exhaustion by the applicant of the available avenues of domestic protection. However, it does not consider it necessary to deal with the objection, as it, in any event, considers the present complaint inadmissible for the following reasons.
34.  The Court reiterates that the State must ensure that a person is detained in conditions which are compatible with respect for human dignity, that the manner and method of the execution of the measure do not subject him to distress or hardship of an intensity exceeding the unavoidable level of suffering inherent in detention and that, given the practical demands of imprisonment, his health and well-being are adequately secured (see Kudła, cited above, §§ 92-94; and Popov v. Russia, no. 26853/04, § 208, 13 July 2006). In most of the cases concerning the detention of people who are ill, the Court has examined whether or not the applicant received adequate medical assistance in prison. The Court reiterates in this respect that even if Article 3 does not entitle a detainee to be released “on compassionate grounds”, it has always interpreted the requirement to secure the health and well-being of detainees, among other things, as an obligation on the part of the State to provide detainees with the requisite medical assistance (see Kudła, cited above, § 94; Kalashnikov v. Russia, no. 47095/99, §§ 95; and 100, ECHR 2002-VI; and Khudobin v. Russia, no. 59696/00, § 96, ECHR 2006-XII (extracts)).
35.  The “adequacy” of medical assistance remains the most difficult element to determine. The Court insists that, in particular, authorities must ensure that diagnosis and care are prompt and accurate (see Hummatov v. Azerbaijan, nos. 9852/03 and 13413/04, § 115, 29 November 2007; Melnik v. Ukraine, no. 72286/01, §§ 104-106, 28 March 2006; and, mutatis mutandis, Holomiov v. Moldova, no. 30649/05, § 121, 7 November 2006), 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 (see Hummatov, cited above, §§ 109, 114; Sarban v. Moldova, no. 3456/05, § 79, 4 October 2005; and Popov v. Russia, cited above, § 211). On the whole, the Court reserves sufficient flexibility in defining the required standard of health care, deciding it on a case-by-case basis. That standard should be “compatible with the human dignity” of a detainee, but should also take into account “the practical demands of imprisonment” (see Aleksanyan v. Russia, no. 46468/06, § 140, 22 December 2008).
36.  Turning to the facts of the present case, the Court observes that while disputing the exact date, the parties agreed that towards the end of 2007 during the applicant’s stay in the St. Petersburg City Psychiatric Hospital he had been diagnosed with hepatitis C. Despite being concerned with the Government’s admission that Russian detention facilities do not employ routine testing of inmates for the presence of HCV infection, even for those detainees who have an identifiable risk factor, the Court cannot overlook the fact that the applicant did not reveal the results of the testing in the psychiatric hospital to the prison officials. In this respect, the Court reiterates its previous finding that patients, such as the applicant, have the responsibility to communicate and cooperate with health authorities and to contribute to the overall health of the community (see Vasyukov v. Russia, no. 2974/05, § 79, 5 April 2011). In the absence of any evidence that the applicant had a history of risk of exposure to the virus and given the lack of complaints by him about the state of his health which could have provided guidance to the prison medical staff that he might be suffering from viral hepatitis, the Court is not prepared to hold the Russian authorities responsible for a delay in detecting the disease. The Court will therefore count the test in November 2010, when the prison authorities learned of the applicant’s infection, as the starting point in the assessment of the quality of the applicant’s medical care.
37.  The Court is unable to identify any defect in the medical services afforded to the applicant in the detention facility. Following the examination in November 2010 when the applicant tested positively for the presence of the HCV antibody, he was promptly placed under dynamic clinical supervision. The prison medical personnel initiated a comprehensive health evaluation to gather all possible information on the level of the virus to determine the proper course of the management of the illness. The evidence put before the Court shows that the Russian authorities used all existing means for the correct diagnosis of the applicant’s condition, thoroughly considered the possibilities for the progression of the illness and the risk of further complications developing, undertook an assessment of the necessity to initiate antiviral therapy and, having considered that such therapy was not yet required, continued close monitoring and in-depth examinations. As to the applicant’s argument that he has not yet started receiving antiviral therapy, the Court does not see any reason to doubt the decision of the medical specialists attending on the applicant. In the absence of any signs of deterioration of his health and in the circumstances of his close clinical monitoring by the medical personnel performing various types of assays to determine the severity of the disease and its prognosis and to predict the likelihood of the applicant’s response to treatment, the authorities’ decision to dispense with therapy, that is, with generally aggressive medical procedures, does not appear to be unreasonable (see Khatayev v. Russia, no. 56994/09, § 88, 11 October 2011).
38.  Furthermore, the Court attributes particular weight to the fact that the facility administration not only ensured that the applicant was attended to by doctors, that his complaints were heard and that he was subjected to regular laboratory testing, but they also created the necessary conditions for him to fully comprehend his diagnosis and accept future treatment. They offered him psychological support and attention, providing clear and complete explanations of medical procedures and possible venues for treatment. The Court also notes that in full compliance with good clinical practice the Russian authorities counselled the applicant on how to avoid the transmission of HCV to others.
39.  The fact that the medical records containing the diagnosis of the applicant with chronic hepatitis C in remission showed no signs of deterioration of his health is yet more confirmation of the effectiveness of the medical care. Finally, the Court is satisfied that the authorities efficiently addressed any other health complaints that the applicant might have had.
40.  To sum up, the Court considers that the Government provided sufficient evidence to enable it to conclude that the domestic authorities, without undue delay, afforded the applicant comprehensive, effective and transparent medical assistance. It follows that this part of the application must be rejected as being manifestly ill-founded, pursuant to Article 35 § 3 (a) and § 4 of the Convention.
III.  OTHER ALLEGED VIOLATIONS OF THE CONVENTION
41.  Lastly, the Court has examined the other complaints submitted by the applicant under Article 6 of the Convention. However, having regard to all the material in its possession, and in so far as these complaints fall within the Court’s competence, it finds that they do not disclose any appearance of a violation of the rights and freedoms set out in the Convention or its Protocols. It follows that this part of the application must be rejected as being manifestly ill-founded, pursuant to Article 35 §§ 3 (a) and 4 of the Convention.
For these reasons, the Court unanimously
Declares the application inadmissible.
	Søren Nielsen	Nina Vajić
	Registrar	President