Group of Specialists/Experts Set up by Public Defender Issue Report No. 7 on Monitoring of Mikheil Saakashvili’s Medical Condition

6 December, 2022

As public is aware, on November 16, 2021, the Public Defender of Georgia, by order No. 157,[1] set up a group of specialists/experts in order to assess the adequacy and timeliness of the medical services provided to accused/convicted Mikheil Saakashvili.

In accordance with the mandate of the Public Defender of Georgia, the goal of the group of experts, since its creation, has been to monitor the medical services provided to the patient. The group has not been involved in the treatment of the patient.[2]

The group of experts has issued six reports, namely: 17.11.2021,[3] 18.11.2021,[4] 25.11.2021,[5] 14.12.2021,[6] 19.01.2022[7] and 27.04.2021.

Since information about the significant worsening of Mikheil Saakashvili's health condition has been actively disseminated in the recent period, the Public Defender decided to carry out another monitoring.

Accordingly, on December 4, 2022, four experts arrived at the VivaMedi clinic in order to personally examine Mikheil Saakashvili and check the relevant medical materials, and on December 5, in order to obtain additional detailed information on specific issues, one of the representatives of the expert group met with Mikheil Saakashvili’s doctor at VivaMedi.

The purpose of the visits on December 4-5 was to evaluate and describe the patient's condition, complaints and symptoms, as well as to assess the dynamics in relation to the previous visits, within the competence and capabilities of the Public Defender's group of experts.

The following experts participated in the December 4 visit: Tengiz Tsuladze (neurologist), Grigoli Khurtsidze (therapist, internal diseases/hospital medicine), Giorgi Papiashvili (cardiologist/arrhythmologist), Aida Gozalova (hematologist, clinical oncologist, internist, palliative medicine specialist). The December 5 visit was made by Giorgi Grigolia (anesthesiologist-reanimatologist). Giorgi Katcharava (cardiologist) and Nino Zavrashvili (endocrinologist) also took part in the online discussions held after the visits.

I. General assessment of the patient's condition

According to the group of experts, the patient's condition has deteriorated sharply after the last assessment (27.04.2022) and can now be assessed as severe.

II. Patient assessment data and reasoning

Key symptoms:

Weight loss - 42 kg, in October last year he was 115 kg, in May 2022 - 104 kg. Currently he weighs6 kg. Currently, the body mass index is 20 kg/m²
Decreased muscle strength
Decliningmuscle mass
Restricted mobility
Low energy
Sensory disfunction in the limbs
Fever
Cognitive impairment (memory deterioration, behavioralchange)

Diagnoses

1. Cachexia - a hypercatabolic state, which is associated with various chronic diseases and is characterized by a decrease in muscle mass with or without a decrease in fat mass.

At least three of the given criteria are necessary for the diagnosis:

Decreased muscle strength
Decliningmuscle mass
Low energy/fatigue
Anorexia
Biochemical changes (anemia, inflammation, hypoalbuminemia).

The patient is currently suffering from:

Decreased muscle strength
Decliningmuscle mass
Low energy
Anorexia
Anemia
Fever
Weight loss - 42 kg (36% of the initial weight)

Thus, the patient's condition meets level 4 of cachexia (according to the cachexia grading system: body mass index BMI ≤20 kg/m² and weight loss indicates 6 to -11%). From October 2021 to May 2022, i.e. in 7 months, he lost 115-105=10 kg, in 7 months from May 2022 to the beginning of December he lost 105-73.6=31.4 kg (29.5% of weight), i.e. the weight loss rate tripled.

2. Daily episodes of fever (genesis unknown)
3. Anorexia, asthenia
4. Muscle atrophy
5. Deepened anemia
6. Polyneuropathy
7. Orthostatic hypotension
8. Cognitive deterioration
9. Post-traumatic stress syndrome(the diagnosis is based on the reports of December 14, 2021 and January 19, 2022)[8]

Reasoning:

The patient's condition has been continuously worsening during the last year and especially the last two months;
Encephalopathy, sensorimotor neuropathy, anemia have deepened and newly discovered autonomic neuropathy has been added with a significant drop in blood pressure when standing up;
Unfortunately, anorexia led to life-threatening cachexia, which had been repeatedly predicted by the group of experts, and currently, the patient is in a phase of active catabolism (self-digestion and tissue breakdown), which is proved by a very rapid weight loss - since September the weight has dropped from 98 kg to the current 73.6 kg ;
The patient management is not proactive (usual standard of patient management in modern medicine) and treatment approaches are limited to responding to various complications. The patient is undergoing many examinations, but there does not seem to be any logical strategy for managing the disease, and treatment is mainly carried out in response to various new complications;
In the opinion of the medical council, the patient's condition after the last assessment (27.04.2022) has sharply deteriorated and should be evaluated as severe. Such development of the process was predicted in our earlier reports.

Conclusion

After the last assessment (27.04.2022), the patient's condition has deteriorated sharply and should be assessed as severe;
Deterioration in neurological status, worsening of anemia, anorexia and gastrointestinal processes are observed. Sharp and rapid weight loss, declining muscle mass, fever. The patient is also suffering from cachexia, which is a condition with a severe prognosis;
The patient's condition is progressively worsening. The weight loss rate has tripled in recent months. At such a speed, the critical BMI <14 (which corresponds to <52 kg)[9] will be reached in 2-3 months, after which irreversible damage to organ systems will begin;
The current treatment is not effective. The patient management is not proactive and treatment approaches are limited to responding to various complications;
According to the expert opinion, the patient has undergone all laboratory and instrumental examinations and treatment available in Georgia, in several multi-profile clinics, but despite this, his condition is rapidly deteriorating. We believe that in order to prevent the expected irreversible deterioration in health, it is necessary to take timely and fundamental

Members of the group of specialists/experts:

/Giorgi Grigolia/

/Grigoli Khurtsidze/

/Giorgi Kacharava/

/Giorgi Papiashvili/

/Aida Gozalova/

/Tengiz Tsuladze/

/Nino Zavrashvili/

^[1] < shorturl.at/enpzX >

^[2]< shorturl.at/duwLV>

^[3]< shorturl.at/fjzIX >

^[4]< https://cutt.ly/hIWRBgU >