“All prisoners transferred to the secure wards of VivaMedi Clinic had consented to being treated there12 (indeed, in most of cases, they or their lawyers had actually requested the transfer) and that, in their overwhelming majority, they expressed satisfaction with the treatment received,” notes the report by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT).

The CPT’s assessment, which scrutinized the conditions of the prisoners in the secure wards, includes Georgia’s ex-President Mikheil Saakashvili, identified in the report as Mr. C.

“Material conditions in the secure part of VivaMedi Clinic were on the whole adequate, as could indeed be expected from a healthcare facility. Patients’ rooms were spacious (for example, a single room measuring some 15 m2 , a double room measuring some 40 m2 and a room with six beds accommodating three patients measuring approximately 60 m2 ),9 well-kept and clean. Ventilation and artificial lighting were good as well. Further, patients had unrestricted access to good-quality toilets, washing and shower facilities, and those without their own financial resources were offered basic personal hygiene items. Also, the provision of food and clothing (if needed) posed no problem.

Almost all the rooms had large windows allowing plenty of natural light and offering a pleasant outside view. However, this was not the case with Mr C’s quarters, where windows could hardly be opened and were fitted with frosted glass depriving him (ever since his admission to the Clinic, more than 9 months previously) from an outside view. In this context, the Georgian authorities informed the CPT, in their letter dated 12 April 2023, that the frosted glass had been removed and Mr C was enabled to enjoy outside view and sunlight. The Committee welcomes this positive step.

Mr C’s premises were well furnished (including a sofa, a table, chairs and a fridge) but this was far from being the case on Floors 4 and 6, where patients’ rooms mostly only contained beds (with bedding) and small cupboards. There were no tables and chairs (except in a few rooms accommodating more severely ill patients), which meant that patients could only take their meals sitting on their beds (there were no dedicated canteens or dining rooms) whilst most of the patients the delegation saw clearly were not bedridden. The Committee recommends that steps be taken to improve the furniture in patients’ rooms on Floors 4 and 6 of VivaMedi Clinic, in light of the above remarks.

Only Mr C had access to some means of distraction (such as television, print and online media).

Other patients could borrow books from a very small library (or receive books from home) but had no access to TV, radio and press.

Moreover, none of the patients had access to daily outdoor exercise (there was no yard). Whilst this was not necessarily a problem for the majority of the patients who remained at VivaMedi Clinic for only a few days (the usual stay being between a few days and two weeks), several (at least three) patients had stayed there for much longer periods, including one patient for 5 months and another (Mr C) for over 9 months. For those patients, to be deprived of the possibility to go outdoors to the fresh air, expose themselves to sunlight and (to the extent that their health allowed) exert themselves physically was not only oppressive but also anti-therapeutic.

Furthermore, some of the patients had been accommodated alone in their room, without any real possibility of association, on occasion for prolonged periods. This was inter alia the case with Mr C, whose regime could be considered as resembling solitary confinement,” the report reads.

In addition, the CPT recommends that “urgent steps be taken to remedy the above-mentioned deficiencies, and in particular provide the possibility of daily outdoor exercise, offer access to television, radio and newspapers, and enable patients accommodated alone to have meaningful human contact (at least 2 hours per day) with fellow patients or dedicated and duly trained staff.

In the case of Mr C, although he has access to a range of medical specialists and treatments, the combination of factors such as being held alone for many months, being deprived of outdoor exercise and being subjected to permanent CCTV monitoring results in a situation that is oppressive, degrading and not conducive to improving his health condition.

In the Committee’s view, the only means to remedy this regrettable state of affairs is to introduce the management of the Clinic’s healthcare staff over the three secure wards, so as to enable them to create a therapeutic and trust-based environment.

Whilst it is legitimate for the Special Penitentiary Service to exercise access control with respect to persons external to the Clinic, in order to prevent escapes and smuggling of prohibited objects, any other restrictions in movement within the floors (for the patients and healthcare staff) should be subject to authorisation by the doctors. Further, as already mentioned in paragraph 18 above, non-medical staff should have no access to medical information (except on a need-to-know basis, to be decided by the doctors).

Uniformed and armed custodial officers should not be present on a continuous basis inside the secure wards; their presence should be justified in individual cases by the risk that particular patients represent (for example, the risk of violence vis-à-vis the staff and fellow patients, risk of agitation and self-harm), and that risk should be assessed in consultation with healthcare staff. The decision to call custodial officers into the ward should belong to healthcare staff who should have full authority over any such interventions.

As regards the presence of CCTV cameras, especially the permanent surveillance of Mr C, the current arrangement should be reviewed as a matter of priority. Admittedly, permanent surveillance is only applied to one patient who has had a history of difficult (though not physically violent) relations with the Clinic’s staff and a record of behaviour that might be interpreted as a form of self-harm (for example, refusal to accept the food offered by the Clinic and to follow some of the proposed treatments); however, at least at the time of the delegation’s visit, the measures applied (which represented a flagrant incursion into the patient’s privacy) appeared to be disproportionate to the potential threat. The same objective could have been achieved by ensuring, if and as needed, adequate presence of healthcare staff.

Steps must also be taken (in the form of relevant instructions) to ensure that no confidential medical information regarding the patients (including Mr C) is communicated, without the patient’s consent, to non-medical staff (never mind outside persons, such as media representatives). Exceptions to this principle may only be those set out in the relevant Georgian legislation.

Such confidential medical data could also be transmitted to legally authorised organs of inquiry (such as prosecutors and investigators, in the context of ongoing investigations) and to national (NPM) and international monitoring bodies, within the limits of their legal mandates and while respecting the confidential character of the data.

The Committee remains of the view that a long-contemplated transfer of responsibility for prison healthcare services to the Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs is both indispensable and overdue. The CPT calls upon the Georgian authorities to proceed with such a transfer without further delay”.