The Forensic Experts Commission of the Empathy Center with the participation of 10 Georgian and 6 international experts performed a forensic medical examination, in accordance with the principles of the Istanbul Protocol, and international and national healthcare legislation. The examination lasted from June 1, 2022, through November 28, 2022. On November 29, 2022, the lawyers were provided with the Report and the accompanying annexes. The Report contains 194 pages and 22 Annexes, a total of 2980 pages. The examinee has more than 20 diagnoses or sets of symptoms, of which about 10 diagnoses are leading and are incompatible with imprisonment. At this stage, the mentioned leading diagnoses are not made public.
Based on the analysis of the clinical and para-clinical studies and the submitted medical documentation, the Experts Commission of the Empathy Center, with the participation of international experts, came to the following conclusions:
1) Until the moment of detention (01/10/2021) the examinee was practically healthy. He had arterial hypertension, which was periodically treated with symptomatic medications; Due to an anxiety-depressive state, which developed in the post-covid period (2020-2021), he took certain drugs in small doses, periodically discontinued; with this treatment, the examinee felt well, and no disturbance of social functioning was observed, neither any neurological disorders of any kind.
2) Currently, the examinee has symptoms and diagnoses (psycho-neurological, gastrointestinal, musculoskeletal, vision), fever of unknown etiology, anorexia, rapid weight loss, pain in muscles, joints, and bones, excoriations – traces of scratching, muscle atrophy, which may be the result of an undiagnosed infectious process and/or possible intoxication, since the toxicological examination of the hair sample revealed Ba, Bi, Mercury (Hg) in the amount exceeding the reporting limit. These toxic substances are dangerous because they can cause not only physical but also sometimes mental disorders.
3) Thus, we believe that Mikheil Saakashvili must not remain in the current institution, or under imprisonment since we consider it impossible to conduct a complete toxicological study in these facilities; it is necessary to timely diagnose toxic agents, including chemical compounds and radioactive substances, otherwise, given the probability of intoxication, the condition may lead to coma and death.
4) In the penitentiary system of Georgia, the patient was subjected to alleged torture and ill-treatment, as well as inadequate medical care. The above experts’ conclusions contain the facts of physical and psychological inhumane treatment and the narratives of the examinee, including the deceit, forced hospitalization, humiliation, and death threats by the prisoners representing the criminal subculture. On November 8, 2021, upon his transfer from the penitentiary facility N12 to the facility N18, he was forcibly pulled out of the ambulance and dragged into the building. He was met with continuous shouting, insults, and threats from the prisoners. For 11 days in the facility N18, he was unable to sleep, because when the lights went out and the TV was turned off, the prisoners immediately started cursing and swearing – the patient was deprived of sleep; in the condition of hunger and Wernicke’s encephalopathy, which developed as a result of starvation, in a vulnerable state, he was left alone in the intensive ward set up in haste. Nobody responded to his calls. The prisoners screamed and threatened to kill him. In these conditions, the examinee was at risk of being killed (19/11/2022).
5) As a result of torture and inhumane treatment (with the infliction of physical injuries), he most likely received a traumatic injury of the spine. He developed a severe form of traumatic stress disorder aggravated by starvation and organic damage and dysfunction of the brain. According to the rules of the forensic medical examination establishing the degree of severity of the bodily injury, unfortunately valid in Georgia since the Soviet era, this injury is assessed as an injury of moderate severity, however, taking into account the combined physical and mental injuries and their consequences, it is assessed as severe injury.
6) Thus, the whole traumatic stressful experience in the prison system, with physical and psychological components, and inadequate medical care, taking into account the severe consequences, is assessed as causing severe physical and mental suffering and therefore as torture. Z 65.4. – Victim of torture and ill-treatment.
7) According to the presented (psychiatric and neurological) diagnoses, Mikheil Saakashvili’s current health condition is assessed as severe and incompatible with imprisonment; The diagnoses, both separately and in combination, will lead to irreversible deterioration of his health condition, shortening of life expectancy and even death, if the patient is not given the opportunity to undergo adequate diagnostics and treatment. According to the Order of the Minister of Labor, Health and Social Protection of Georgia N01-6/N (February 15, 2013), and Order N01 – 55/N on amendments (August 30, 2017), this condition is the basis of release from imprisonment. Gastroenterological diagnoses and nutrition status are assessed as containing the risk of severe cachexia. The patient needs invasive/aggressive diagnostics and treatment/rehabilitation procedures.
8) According to professor Cobey, the condition of his musculoskeletal system is severe: „He needs an accurate diagnosis, as well as possibly a complete replacement of the left shoulder joint and the hip joint. After these procedures, he will need to fuse the C5-C6-vertebrae, and subsequently, decompression of L4-5 stenosis. Severe weakness in the left arm and leg may be associated with atrophy due to the spine condition and immobility due to the pain.
9) According to doctor S.I Finkel, he will need aggressive diagnostic procedures, i.e., regular surveillance EGDs and multiple gastric biopsies. These procedures are widely available in Western Europe and the United States, where they are performed by competent GI endoscopists.
10) Based on the consultations with psychiatrists, neurologists, and forensic experts:
Psychiatric and neurological diagnoses require additional aggressive/invasive studies of neurocognitive disorders (for example, assessment of cerebrospinal fluid, repeated CT, MRI, 24-hour EEG) and proper treatment and rehabilitation, otherwise rapid progression will lead to insanity, cachexia, and death.
11) The examinee/patient needs high-tech research to confirm or exclude infectious-intoxicating genesis and/or neuro-degenerative process/disease, or dysmetabolism. Z13.8: Special screening examination for other specified diseases and disorders
12) Therefore, Mikheil Saakashvili needs to be immediately released from prison and urgently transferred to a US and/or European Union multi-profile third-level university clinic for diagnostics and treatment.
13) At the same time, it should be noted that the diagnosed post-traumatic stress disorder – PTSD – F 43.1., which is related to the ill-treatment in the Georgian penitentiary system and to the fear of being killed, significantly aggravates the neuropsychological and general health state and makes it impossible to even stabilize the condition.
14) Any additional stress factor, including imprisonment itself, causes aggravation of the health condition.
15) The imprisonment of Mikheil Saakashvili, considering his neuropsychological condition is unacceptable and contradicts international standards on detention. His psychological and neurological condition on its own, as well as in combination with musculoskeletal and digestive disorders, is incompatible with imprisonment.