Group of Specialists/Experts Set up by Public Defender Issue Conclusion No. 10 on Monitoring Results of Management of Mikheil Saakashvili’s Medical Condition

The group of specialists/experts set up by the Public Defender of Georgia studied and analyzed the documents provided by the VivaMedi Clinic regarding the management of the health condition of the 3rd President of Georgia, Mikheil Saakashvili, and is providing the following assessment:

The patient's neurological status is practically unchanged and can be compared to the previous records of the group of doctors invited by the Public Defender - cognitive deficit, ataxia, hypoesthesia, diffuse decrease in strength are still evident.

Microcytic anemia is also expressed, which is deepening and is being managed by the clinic with infusion of blood and its products. According to the data of May 22-23, 2023, hematocrit was 22%, reticulocytes - 0.5% (5‰), indicating that a reticulocyte production index of 0.1 and high probability means an inadequate bone marrow response. The group of experts believes that such a data along with the elevated ferritin and normal iron are indicative of a chronic disease (in this case, protein deficiency malnutrition - starvation). This is indicated by hypoproteinemia and hypofibrinogenemia as well.

Electrolyte imbalance is also an expression of nutritional deficiency.

As for the management in the clinic, the group of doctors of the Public Defender has no special remarks in this regard. Symptomatic treatment continues, which is a pragmatic approach from their side.

The doctors assess the patient's condition as stable, noteworthy, of average severity (only one record (31.05.2023) states that the condition remains severe).

It is also noteworthy that after July 14, 2023, there is a decrease in white blood cells (leukopenia), which may be the result of bone marrow suppression, and if this trend continues and there is no technical problem with counting, then it means that bone marrow suppression is currently more evident than before, which is a sign of deterioration in the overall situation. An alternative problem of leukopenia can also be a deficiency of vitamin B12 and folate as a result of malnutrition, which in this sense indicates a worsening of the condition; There may be other alternative reasons, e.g. viral infection.

The expert group believes that, overall, a gradual slow dynamic towards deterioration is maintained, which, unfortunately, is absolutely logical in the context of the present conclusions made by the group.

We would like to remind the public once again that, taking into account the mandate of the Public Defender, the purpose of the expert group's activity, since its creation, has been to monitor the medical services provided to the patient. The group has not been involved in the direct process of the patient's treatment.

The group of doctors will continue to monitor the management of Mikheil Saakashvili's health condition and periodically, with intervals of 2-4 months, will continue to visit the patient, as well as to study the medical documentation. Obviously, in the case of urgent necessity, unscheduled visits will also be carried out.

The next visit of the group of doctors to patient Mikheil Saakashvili is scheduled for September.

Members of the group of specialists/experts:

/Giorgi Grigolia/

/Giorgi Kacharava/

/Tengiz Tsuladze/

/Nino Zavrashvili/

/Aida Gozalova/

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