Background
Rosalia Federico and Mario Raddi brought this application after their son, A.R., died in Italian prison custody. A.R. entered Turin Prison on 28 April 2019 at age 28, suffering from drug addiction, anxiety, and depression. He received initial psychiatric assessment and treatment for drug withdrawal, with weekly psychological sessions commencing in May 2019.
Beginning in July 2019, A.R. reported reduced appetite and significant weight loss. Over the following five months, he deteriorated dramatically, falling from 76 kg at admission to 51.55 kg by early December—a loss of nearly 25 kg. Prison authorities responded slowly and inadequately to repeated medical concerns raised by both A.R. himself and the National Guarantor of the Rights of People Detained or Deprived of their Liberty. The authorities initially dismissed the weight loss as a “manipulative strategy” and refused external specialist psychiatric support requested by the National Guarantor.
By December 2019, A.R.’s condition had become critical. He fainted on multiple occasions in mid-November, required a wheelchair by late November, and was scheduled for hospitalization on 10 December. He refused admission against medical advice. He was urgently hospitalized on 13 December with pulmonary infection, lapsed into a coma, and died on 30 December 2019 from septic shock. Two of three medical experts appointed during criminal investigations concluded that the weight loss played a causal role in his death and that there were undue delays in acknowledging the seriousness of his condition and providing appropriate treatment.
The Court’s Holding
The Court unanimously found violations of both Article 2 (right to life) and Article 3 (prohibition of torture and inhuman or degrading treatment) of the Convention. The Court held that Italy’s prison authorities failed to provide adequate and timely medical care in violation of the State’s positive obligations to preserve the health and well-being of detainees. The court identified several critical failures: no comprehensive assessment was conducted to investigate the underlying causes of A.R.’s weight loss; no specialist consultations or laboratory investigations were ordered despite good clinical practice requiring them; and no targeted therapeutic interventions were implemented despite weeks of progressive deterioration and repeated warnings.
The Court rejected Italy’s arguments that A.R.’s occasional refusals of treatment and his ultimate refusal to be hospitalized on 10 December absolved the authorities of their obligations. The Court held that a detainee’s lack of cooperation is only one factor in assessing medical care adequacy and does not justify delayed diagnosis or inadequate response. Critically, the authorities had acknowledged the need for hospitalization on 20 November—when A.R.’s condition was already serious or critical—yet scheduled it for three weeks later due to bed availability, rather than insisting on prompt admission.
The Court concluded that the authorities did not do everything reasonably possible, in good faith and in a timely manner, to avert the fatal outcome as required under Articles 2 and 3. The prolonged delays in addressing A.R.’s condition, the lack of earlier efforts to secure appropriate treatment, and the failure to act decisively despite clear warning signs and escalating medical deterioration constituted violations of the applicants’ rights. The Court awarded €27,790 in damages: €6,790 for funeral costs, €20,000 for non-pecuniary damage (moral injury), and €1,000 for legal costs.
Key Takeaways
- Prison authorities bear strict positive obligations under the Convention to provide timely and adequate medical care to detainees, including prompt diagnosis, targeted treatment, and specialist consultation when medically warranted
- A detainee’s refusal of treatment or lack of cooperation does not justify delayed diagnosis or inadequate care; authorities must maintain their duty of care despite prisoner non-compliance, particularly when medical conditions are deteriorating rapidly and critically
- Authorities cannot dismiss progressive, alarming symptoms as manipulative behavior without thorough investigation; they must act decisively when warned by independent monitoring bodies or when clinical evidence shows serious medical deterioration
- Even if enhanced medical intervention could not ultimately have prevented death, failure to act promptly and comprehensively in addressing obvious medical crises may still constitute violations of Articles 2 and 3
Why It Matters
This decision establishes a demanding standard for European prison systems: authorities cannot provide perfunctory medical care or dismiss serious health deterioration without thorough investigation and prompt action. Prison authorities must initiate specialist consultations and diagnostic workups early, maintain close monitoring proportionate to medical need, and escalate care when conditions worsen—not wait for a detainee to cooperate fully or for a condition to become critical before acting decisively. The judgment reinforces that states bear affirmative responsibility for detainee health outcomes and cannot delegate that responsibility by pointing to a prisoner’s refusal of treatment after the authorities themselves have failed to provide timely, proper care.
The case also underscores the important role of independent monitoring bodies like National Guarantors in triggering and verifying state obligations. Prison administrations that ignore or dismiss warnings from such bodies risk violations findings and liability under the Convention. For states operating detention facilities, the decision signals that inadequate healthcare systems and delayed responses to medical crises, even when complicated by prisoner non-compliance, expose them to substantial damages awards and findings of human rights violations.