In 2016, three women die, suffering from cancer, in the Haas Prison Hospital in St. Petersburg. For Russia’s correctional system, it is a usual occurrence. The court refused to release for health reasons any woman in prison with the grim diagnosis. They fought for life, freedom, and the right to be with their children. Three women died within three months of their diagnosis, just a few tragedies preceded by court denial of release. This multimedia project is dedicated to the memory of these victims of injustice and the answer to the question: why did this happen? What has changed since that time? This is the story about how the toll of several human lives managed to break through the St. Petersburg blockade of human rights.
“The Merciless Moloch of Justice”
“Woman. Prison. Society” presents the project
As part of this investigation, we talk about four prisoners who found themselves threatened by signs of cancer. Their stories formed the basis of a large investigation that the head of our group, Leonid Agafonov — who for many years was the head of the Public Monitoring Commission of the Central Internal Affairs Directorate of St. Petersburg and the leading expert of the joint project “New Generation” of the ombudsman of Russia and the Council of Europe’s Directorate for the Protection of Human Rights — prepares for print.
As a rule, oncological diseases, which, according to statistics, place second in the negative “rating” of deaths in Russia, do not leave prisoners with any chance to live. Those arrested and convicted cannot fight the disease, as they lack the basics: timely diagnosis, necessary medication, and competent medical care. The project team tried to figure out why inhuman treatment of seriously ill patients became the norm in Russian detention centers and colonies.
In 1999, the Constitutional Court of the Russian Federation imposed a moratorium on the death penalty, and since 2009 the sentencing of defendants to capital punishment has been prohibited. For crimes, including serious crimes, prison terms are given in our humane country. In this investigation, the human rights group “Woman. Prison. Society” will tell about people for whom their conclusion was the equivalent to an executed death sentence.
In 2016, three female cancer patients died at the Haas Prison Hospital in St. Petersburg. Endless pain and unfulfilled hope for prisoners and their families are common cases for the Russian penitentiary system. All three women were imprisoned with the grim diagnosis, but the court refused to release them for health reasons. They fought for life, freedom, and the right to be with their children. And they lost. Look. Read. Do not pass by.
RUSSIAN FEDERATION MINISTRY OF JUSTICE
AUGUST 16, 2006 No. 263
On the approval of the lists of medical-preventive and medical correctional institutions of the federal penitentiary system for the providing of medical assistance to convicts.
The document states: “Cancer treatment is provided to convicts (by the number of women and minors) at the place where they are serving their sentences. This order is used as the basis for sending patients with stage 4 cancer to correctional facilities.”
DECREE OF THE RUSSIAN FEDERATION GOVERNMENT ON FEBRUARY 6, 2004, No. 54
“On the medical examination of convicts submitted to release them from serving their sentence in connection with a disease,” decree of the Russian government dated February 6 2004 No. 54.
The document states: “If they have an illness included on the list of diseases that prevent people from serving sentences confirmed by clinical survey data at an inpatient medical facility, convicts are sent for medical examination by medical institutions and the medical unit of the penitentiary system, as well as the medical institutions of the state and municipal healthcare systems.”
Lawyers, human rights defenders, and medical experts analyzed the three stories.
All three women that died from cancer only managed to see a doctor when it was too late, and they waited a long time to receive diagnosis and treatment. In the meantime, the tumors developed further and metastasized in the body — note, they appear everywhere in the fourth stage. Neither the presence of underage children nor the terrible diagnosis softened the judges, who did want to consider the position of the terminally ill prisoners and present them with the lawfully guaranteed right to receive quality medical care, including palliative care. The terrible result of this reluctance to see living people in these prisoners is death in a prison hospital or just a few weeks after release.
Sergei Shabanov, Commissioner for Human Rights in the Leningrad region, personally went to court for the release of Ekaterina, one of the protagonists of this project. He learned of this story after the appeal from Leonid Agafonov, a member of the Public Monitoring Mission. Sergei Sergeevich: “The prevailing disregard for cancer-stricken prisoners is inhuman.”
“The first complaint is on the injustice of the verdict and the investigation. And medicine is the second. There are many questions surrounding medical care, including providing medicine and medical examinations without a specialist. In other words, they write to a specialist, but he doesn’t come and you have to wait for the next visit.
The Criminal Code states that there are three goals in punishment, and prevention and correction are two of them. I’m saying that it’s impossible to reach the goals of punishment when it’s stage 4 cancer and the prognosis is unfortunate. If the aims are impossible to reach, then why insist that the punishment continue? But the prosecutor says she didn’t receive any incentives because she did not work. She is in the colony for only three months, with stage 4 cancer – what kind of behavior does the prosecutor expect?”
The Commissioner: “In the report we make a proposal. First — provide licensed FSIN (translator’s note: Federal Penitentiary Service of Russia) institutions in all regions. Second – revise the list of diseases for liberation. And a clarification — it must be serious, but not at the dying stage of the patient. Third — we must consolidate authoritative standards. Fourth — oblige judges to consider such petitions as a matter of priority. Fifth — as soon as the court reaches a decision, they immediately throw the person on the street. Even if relatives are not able to come for him or her. It is necessary to immediately transfer the patient to a civil hospital, or to extend the opportunity to apply for a few days in the prison hospital.
749 (21%) of applicants die before the start of court hearings
Another 119 (3%) die before the court decision goes into effect.
From January to June 2016, lawyer Vitaly Cherkasov led the cases of five female cancer patients and personally took on their tragic stories in court:
“These people experience very strong, physical pain, and they’re morally suppressed. At the court proceeding where their fate is being decided, everyone works on the principle ‘all right let’s just take a quick look and go about our business.’ They do not care the person’s fate.”
Treating cancer with vitamins
Judges and prosecutors assert that women receive treatment, however experts and St. Petersburg Health Services Committee members come to a different opinion. (Scans of the Health Committee’s answers, materials of the appeal to the prosecutor’s office, as well as a response to a request from FSIN Medical Unit-78 on the availability of licenses rendering specialized medical services to prisoners with oncological diseases).
Valuable time for the treatment of cancer patients in Russian prisons is spent in the state procurement system. The full text of medical expert Ksenia Barkhatova’s conclusion can be found below.
“In the absence of specialized doctors in the institution where patients are serving their term, they have to be escorted to FSIN medical and sanitary unit and receive all the necessary approvals for the given consultation, and are then convoyed from there.”
The multimedia film presents the stories of four women with malignant tumors. Their lives were cut short in the institutions of the federal penitentiary system. Why did it happen this way and why is medical assistance not being implemented to the full extent?
We will analyze all aspects of the problem that the imprisoned women encountered with medical services in institutions of the federal penitentiary system:
Delayed diagnosis of malignant tumors, which is associated with the lengthy process of receiving consultations from specialized medical experts, such as gynecologists, mammologists, and oncologists.
According to current legislation, Article 101 of Russia’s Criminal Code states that medical and preventive care for prisoners sentenced to deprivation of liberty is organized and presented in accordance with the internal regulations of correctional institutions and legislation of the Russian Federation. Also, the rights of persons detained, imprisoned, serving out sentences of restriction of freedom, arrested, deprived of freedom, or administratively arrested, are to receive medical care as regulated by Article 26 of Federal Law No. 323 “on the fundamentals of healthcare of citizens of the Russian Federation.”
Often consultation in penal institutions involves full-time specialists, who are not always available at health centers or parts of Russia’s Federal Penitentiary Service, or, if medical assistance is not possible, doctors in the institutions of the penitentiary system on the basis of contracts executed with state and municipal health systems.
And here is where precious time is wasted. After all, in the absence of specialized doctors in the institutions where patients are serving their sentence, they must be escorted to the medical and sanitary unit of FSIN, get all the necessary approvals for the consultation, and are then convoyed from there. But we also need more laboratory tests (biochemical, immunological, hormonal), and studies such as ultrasounds, Pap smears (cervical cancer), mammography (breast cancer), FGDS – fibrogastroduodenoscopy with biopsy (stomach cancer, duodenal ulcers), computed tomography (CT), multi-slice spiral computed tomography (MSCT), and magnetic resonance imaging (MRI).
And if there is no specialist in the FSIN, according to the decree of the Russian Federation Government dated December 28, 2012 No. 1466, primary and specialized healthcare, including high-tech care, is provided in healthcare organizations. And again, most of the time is spent in concluding contracts for medical services (inpatient and outpatient medical care). All necessary competitive procedures must be carried out or an agreement concluded with a single contractor with the provisions of Article 44 of the Federal Law “On the contractual system…” dated April 5, 2013, and all of this is subject to the availability of funding. Compliance with all of these bureaucratic procedures leads to a loss of time, which for cancer treatment cannot be lost.
So, for example, such contracts were executed by the FSIN Medical Unit-78, but as always, the amount of financial resources are not enough. In 2016, contracts were concluded with St. Petersburg City Clinical Hospital “City Clinical Oncology Center,” St. Petersburg State Medical Academy “City Mariinsky Hospital,” and FGBOU VO (translator’s note: Federal State Budgetary Institution of Higher Education) Northwestern State Medical University I.I. Mechnikov, and the Russian Ministry of Health.
But even if the consultation is received, the studies are conducted, and the diagnosis is posed, again there is a problem with the provision of medical care. After all, a license is required to provide high-tech medical care in inpatient oncology.
According to paragraph 16 of the Russian Ministry of Health Order dated November 15, 2012 No. 915 “on the approval of the procedure for providing medical assistance to the population on the ‘oncology’ profile” with the amended Order No. 379 dated July 4, 2017, specialized — including high-tech — medical assistance is provided by oncology doctors, radiotherapists in the oncology dispensary, or in medical organizations that provide medical care to cancer patients that have a license, the necessary material, technical base, and certified specialists within inpatient facilities and hospital conditions that include prevention, diagnosis, and treatment of oncological diseases requiring the use of special methods and complex, unique medical technology, as well as medical rehabilitation.
It is very difficult to implement licensing of such medical care in Russia’s FSIN institutions because special methods of treatment, such as radiotherapy or drug therapy and surgical interventions, require significant financial resources, facilities, standards, equipment, and certified specialists.
For example, in the branch of Hospital No.1 FSIN Medical Unit-78, there is a cancer department for women where symptomatic therapy is performed. If appropriate medical specialists conclude that a patient needs specialized medical treatment, medical assistance is provided in a specialized medical institution. In 2016, such assistance was provided on the basis of the contract concluded between FSIN Medical Unit-78 and St. Petersburg City Clinical Oncology Dispensary, but the bureaucratic process of obtaining an opinion and the lack of adequate funding in the FSIN system leads to a small number of people who are sent for treatment in specialized healthcare institutions.
Another important aspect is the provision of drug therapy. Treatment protocols often require the use of trademarked chemotherapy drugs that have been clinically examined outside of the Russian Federation. Procurement of such drugs requires significant financial costs and is managed by specialized oncological institutions. Chemotherapy requires constant monitoring.
“The bureaucratic process of obtaining an opinion and the lack of adequate funding in the FSIN system leads to a small number of people who are sent for treatment in specialized healthcare institutions.” One important aspect is the provision of drug therapy. “Treatment protocols often require the use of trademarked chemotherapy drugs that have been clinically examined outside of the Russian Federation. Procurement of such drugs requires significant financial costs and is managed by specialized oncological institutions. Chemotherapy requires constant monitoring.” — Medical expert Ksenia Barkhatova’s conclusion.
The Main Issues
As a result of the investigation, we are responding to the painful questions of the Russian correctional system.
Does the management at the Federal State Medical Institution “Regional Hospital Dr. F.P. Haas” of the FSIN for St. Petersburg and the Leningrad region have a license to provide specialized medical assistance to convicted prisoners with various kinds of cancer?
There is no license, which confirms the answer of the head of the FSIN Medical Unit-78. It is very difficult to implement licensing of such medical care in Russia’s FSIN institutions because special methods of treatment, such as radiotherapy or drug therapy and surgical interventions require significant financial resources, facilities, standards, equipment, and certified specialists.
For example, in the branch of Hospital No.1 FSIN Medical Unit-78, there is a cancer department for women where symptomatic therapy is performed. If appropriate medical specialists conclude that a patient needs specialized medical treatment, medical assistance is provided in a specialized medical institution.
Are the agreements concluded for the provision of medical assistance to convicts in medical institutions of the state and/or municipal healthcare system by the Federal State Medical Institution “Regional Hospital Dr. F.P. Haas,” subordinate to the Russian Ministry of Health?
Such contracts were executed by the FSIN Medical Unit-78, but as always, the amount of financial resources are not enough. In 2016, contracts were concluded with St. Petersburg City Clinical Hospital “City Clinical Oncology Center,” St. Petersburg State Medical Academy “City Mariinsky Hospital,” and FGBOU VO (translator’s note: Federal State Budgetary Institution of Higher Education) Northwestern State Medical University I.I. Mechnikov, and the Russian Ministry of Health. But even if the consultation is received, the studies are conducted, and the diagnosis is posed, again there is a problem with the provision of medical care. After all, a license is required to provide high-tech medical care in inpatient oncology.
Now the ECtHR (European Court of Human Rights) has three appeals for violating Articles 2 and 3 of the Convention for the Protection of Human Rights and Fundamental Freedoms (the right to life and the prohibition of torture) against our protagonists: Ekaterina and Maria.
The ECtHR ruled on Oksana’s case on October 3, 2017. The court ruled that Oksana was subjected to inhuman treatment in the Russian correctional system. Russia violated Article 3 of the European Convention on Human Rights: “No one shall be subjected to torture or to inhuman or degrading treatment or punishment.”
The ECtHR decided to compensate Oksana’s daughter. Lawyer Sergei Petryakov, who represented the injured party: “The complaints brought to the European Court of Human Rights testify to a systemic Russian problem — the failure to provide medical assistance to convicts. We do not know how the fate of these women would be upon release, we cannot predict whether or not they will defeat the disease. But the very facts of the failure to provide assistance, the lack of necessary diagnostics, the failure to comply with required medical standards, are a violation of the basic human rights to life and health, and therefore arguments to the ECtHR. Prisoners in a colony must receive a set of medical measures for which they can rely on at will. Those suffering from advanced stages of cancer and other incurable diseases need palliative care. This includes not only anesthesia, but also nurses. Our convicts are deprived of this, there are a lot of sick people yet only one paramedic. It turns out that some prisoners are taking care of others. The ECtHR says this is wrong, since a nonprofessional cannot help in an emergency situation. In addition, the person suffers more from having to depend on friends. The Russian Federation has the opportunity to appeal the decision within three months before it goes into effect. Nevertheless, we hope that this does not happen. This problem must be urgently addressed. By the way, according to one of the complaints, we received a letter that referred to the current practice of violating human rights concerning medical care in Russian detention centers. This means the government needs to think about finalizing a unilateral declaration.”
Authors: Leonid Agafonov
The author of the project "Woman, Prison, Society"
Natalia Donskova, Journalist
Natalia Sivokhina, Editor
Yuri Trigubovich, Journalist, expert
Tatiana Komissarova, Photographer
Maxim Polyakov, Journalist, expert of the project