On February 19, 2023, a group of specialists/experts set up by the Public Defender of Georgia made another visit to the VivaMedi clinic in order to assess the condition of Mikheil Saakashvili.

In accordance with the Public Defender’s mandate, the purpose of the visits paid by the group, from the day of its creation, has been to monitor the medical services provided to the patient. The group has not been involved in the process of treatment.

Members of the group aimed to examine the patient and his medical documentation on February 19. Mikheil Saakashvili's physical examination was conducted, but unfortunately, the clinic could not provide medical materials to the members of the group due to non-working days. However, the Public Defender’s Office has requested full medical materials covering the period from December 4, 2022 (the last visit paid by the experts to Mikheil Saakashvili) until now and the group of experts will additionally study the materials.

The Public Defender’s Office and the group of experts will continue intensive documentary monitoring of Mikheil Saakashvili's health management in the near future.

The following experts took part in the February 19 visit: Tengiz Tsuladze (neurologist), Grigoli Khurtsidze (therapist, internal diseases/hospital medicine), Giorgi Katcharava (cardiologist) and Nino Zavrashvili (endocrinologist). Giorgi Papiashvili (cardiologist/arrhythmologist) and Giorgi Grigolia (anesthesiologist-reanimatologist) also took part in the online discussions held after the visit.

Conclusion:

Condition of the patient:

Considerable aggravation after December 4 (last visit).

On the basis of objective examination:

Severe sarcopenia is evident.

The patient lost another 5.7 kilograms due to significant muscular dystrophy. Movement is significantly limited due to weakness.

When standing up, there is a sharp drop in blood pressure from 125/75 to 60/40, which is accompanied by loss of balance and significant loss of coordination. Further decline in mental functions is worth noting.

Impression:

1. Sarcopenia, muscular dystrophy, severe 4^th stage of cachexia.
2. Critical drop in orthostatic pressure along with loss of coordination.

Prognosis and risks:

1. The patient has entered the phase of active catabolism.

After losing another 5-7 kilograms, he will become bedridden, because his lower limbs will be completely wasted and he will not be able to move due to weakness.
If losing weight at this pace, it is expected to reach the above point in 1-2 months.
The critical weight for him is 52-53 kilograms, after which irreversible changes will begin in the body.

2. Peripheral and autonomic neuropathy has deepened, which causes a critical pressure drop when standing up.

Currently, unsupervised movement by the patient is dangerous, as the risks of falling down, sustaining body injuries/fractures is very high. In case of the latter, the resource of the cachexic body to heal the wound or fracture is very low, which will lead to the cascading development of other critical complications (hemorrhage, infection, deep vein thrombosis, etc.) with a high probability of lethal outcome.

Members of the group of specialists/experts:

/Giorgi Grigolia/

/Grigoli Khurtsidze/

/Giorgi Kacharava/

/Giorgi Papiashvili/

/Tengiz Tsuladze/

/Nino Zavrashvili/