Conclusion No. 5 of Group of Specialists/Experts Set up by Public Defender for Monitoring Mikheil Saakashvili’s Medical Condition

19 January, 2022

The public is aware that on November 16, 2021, the Public Defender of Georgia, on the basis of Order No. 157[1], established a group of specialists/experts to assess the adequacy and timeliness of the medical services provided to accused/convicted Mikheil Saakashvili.

The group was composed of the following members:

Giorgi Grigolia - Anesthesiologist-resuscitator
Grigoli Khurtsidze - Internal diseases/hospital medicine
Giorgi Kacharava - Cardiologist
Giorgi Papiashvili - Cardiologist/arrhythmologist
Aida Gozalova - Hematologist, clinical oncologist, internist, palliative medicine specialist
Mamuka Machaidze - Infectionist, therapist
Tengiz Tsuladze - Neurologist
Nino Zavrashvili - Endocrinologist
Marine Kuratashvili - Psychiatrist.[2]

In accordance with the mandate of the Public Defender of Georgia, the purpose of the group of experts, from the day of its establishment, has been to monitor the medical services provided to the imprisoned patient; the group has not been involved in the treatment of the patient.[3]

The group of experts paid a total of 5 visits to Mikheil Saakashvili. In particular, the visits took place on November 16 and 18, 2021 – to Medical Establishment No. 18 of the Special Penitentiary Service, on November 23 and December 12 - to Giorgi Abramishvili Military Hospital of the Ministry of Defence and on January 11 - to Medical Establishment No. 12.

During the visits, patient Mikheil Saakashvili was examined, his medical records were reviewed and local medical staff were interviewed.

Accordingly, the group of specialists/experts issued five conclusions, namely on: 17.11.2021[4], 18.11.2021[5], 25.11.2021[6], 14.12.2021[7] and 19.01.2022[8].

Following the visit paid on 17 November 2021, the experts, given the critical condition of the patient, recommended that the patient be treated immediately at a well-functioning and well-experienced polyprophylactic hospital, in particular in an intensive care unit, conditions of which could not be met by Establishment No. 18 of the Special Penitentiary Service. The same recommendation was repeated after the visit of November 18, 2021, during the aggravation of Mikheil Saakashvili's health condition (convulsions caused by Wernicke’s encephalopathy).

On November 19, 2021, the patient was transferred to the Giorgi Abramishvili Military Hospital of the Ministry of Defence.

After being transferred to Gori Military Hospital and then to Penitentiary Establishment No. 12, the Public Defender’s team additionally visited Mikheil Saakashvili three times (on 23.11.2021, 12.12.2021 and 11.01.2022). After the achievement of positive results (elimination of vital risks) in the process of refeeding, no significant improvement (in terms of neurological status), nor deterioration has been observed in the patient's health condition during the last three visits. The issue of patient’s psychotherapeutic and physical rehabilitation remains a substantial problem.

Results of the January 11 visit:

The following experts participated in the visit: Aida Gozalova, Tengiz Tsuladze, Nino Zavrashvili, Grigoli Khurtsidze and Giorgi Grigolia. After the visit, the group of experts held an online discussion, in which experts Marine Kuratashvili, Giorgi Kacharava and Giorgi Papiashvili also took part.

I. General assessment of the patient's condition

The patient's condition still requires attention.

II. Key issues

The following are the main problems at this stage:

Consequences of Wernicke's encephalopathy - neurological symptoms, in particular eye paresis, imbalance, general weakness, worsening of limb sensitivity;
Anemia;
Post-traumatic stress disorder and moderate/severe depression (assessed during the December 12 visit, after which the patient has received only pharmacological treatment but no psychotherapy).[9]

From the somatic point of view, the patient’s ongoing pharmacological treatment is more or less satisfactory.

The first-line treatment of depression and post-traumatic stress disorder is psychotherapy, which has not been provided to the patient, although this recommendation was made by the Public Defender’s team of experts as early as November 25, 2021. The group believes that in the current conditions (considering both the specifics of the prison and the context of the imprisonment of this particular patient), full psychological rehabilitation is less realistic at this stage.

Despite repeated recommendations regarding the patient’s post-traumatic stress disorder and depression requiring psychological and physical rehabilitation, unfortunately, this treatment has not been provided. Currently the patient's condition is not improving. The group is unable to identify any other remedies at this time other than those listed in the present and previous reports. Failure to take the above measures is expected to aggravate the condition, in particular the stress disorder and depression.

Prolonged neurological symptoms are the result of Wernicke’s encephalopathy and neuropathy developed on the basis of thiamine (vitamin B1) deficiency.

III. Recommendations:

For the treatment and full rehabilitation of the patient, the group of experts considers it necessary to provide:

Psychotherapy - which is a first-line treatment of depression and post-traumatic stress disorder, and is likely to help restore an adequate diet;
Physical rehabilitation;
MRT examination, recommended as additional examination;
Neurological monitoring and electroneuromyographic examination in case of progression.

Members of the group of specialists/experts:

/ Giorgi Grigolia /

/ Grigoli Khurtsidze /

/ Giorgi Kacharava /

/ Giorgi Papiashvili /

/ Aida Gozalova /

/ Tengiz Tsuladze /

/ Nino Zavrashvili /

/ Marine Kuratashvili /

[1] See < shorturl.at/duwLV>

[2] Psychiatrist Marine Kuratashvili was added to the group on the basis of Public Defender’s Order No. 175 on December 10, 2021.

[3] See < shorturl.at/duwLV>