Judgment Lavorgna v. Italy - Restraint of psychiatric patient for eight days violated Convention

issued by the Registrar of the Court   ECHR 261 (2024)   7.11.2024   Restraint of psychiatric patient for eight days violated Convention   The case of Lavorgna v. Italy (application no. 8436/21) concerned the treatment given to   Mr Lavorgna while in confinement in a psychiatric ward. He had been strapped down and given   sedatives owing to reported aggressive actions.   In today’s Chamber judgment1 the European Court of Human Rights held, unanimous, that there had   been:   a violation of Article 3 (prohibition of inhuman or degrading treatment) of the European   Convention on Human Rights as regards both the treatment of the applicant and the ensuing   investigation.   The Court found in particular that the Government had failed to demonstrate why such a long period   of restraining Mr Lavorgna had been necessary and had not addressed his arguments that the   restraint had been “precautionary” rather than a “last resort”.   Principal facts   The applicant, Matteo Lavorgna, is an Italian national who was born in 1995 and lives in Segrate   (Milan, Italy). He was diagnosed as suffering from a psychotic disorder not otherwise specified   (psicosi non altrimenti specificata).   On 7 October 2014 a compulsory-treatment order was issued in respect of Mr Lavorgna, who had   been receiving psychiatric treatment. He was treated in Santa Maria delle Stelle Hospital in Melzo   The reasons given were his state of psychomotor agitation, aggressiveness towards others, and his   overall diagnosis. That order was renewed.   On 14 October 2014 two psychiatrists lodged an urgent notification of social danger (segnalazione   urgente di pericolosità sociale) in respect of Mr Lavorgna. They stated that he had attacked his   parents and a doctor, but had a lack of awareness of his actions, and highlighted that he had had to   be constantly restrained. They called for urgent measures from the authorities.   Mr Lavorgna was kept under pharmacological sedation until his transfer to another hospital on   27 October 2014.   In November 2015 the applicant lodged a criminal complaint against two doctors of the Melzo   hospital, alleging ill-treatment, false imprisonment and criminal coercion on account of, among   other things, the alleged lack of justification for and long period – almost eight days – of his being   strapped down, and that the treatment had been administered in an inhuman and degrading   manner, causing him intense physical and psychological suffering. The treatment, he argued, had   been disproportionate to his situation. He emphasised the fact that two doctors had admitted not   being competent or structurally equipped to look after him during his compulsory hospitalisation. He   argued that his being strapped down in the expectation of “repentance” for his actions amounted to   “pedagogical” use of restraint, a use condemned by the Committee for the Prevention of Torture.   1. Under Articles 43 and 44 of the Convention, this Chamber judgment is not final. During the three-month period following its delivery,   any party may request that the case be referred to the Grand Chamber of the Court. If such a request is made, a panel of five judges   considers whether the case deserves further examination. In that event, the Grand Chamber will hear the case and deliver a final   judgment. If the referral request is refused, the Chamber judgment will become final on that day.   Once a judgment becomes final, it is transmitted to the Committee of Ministers of the Council of Europe for supervision of its execution.   Further information about the execution process can be found here: www.coe.int/t/dghl/monitoring/execution.   In February 2016 an investigation was opened. The public prosecutor at the Milan District Court   appointed a medical expert to assess the situation. The ensuing report noted that the restraint   measures had been carried out following a specific act of violence, but noted that the use of   restraints had been unusually prolonged. In February 2019 the prosecutor applied to have the   proceedings discontinued.   In July 2020, the Milan District Court preliminary investigations judge (giudice per le indagini   preliminari) discontinued the proceedings. The judge cited “the doctors not [having] commit[ed] any   errors of therapeutic practice, [and] having complied with the guidelines and protocols applicable to   the specific case” and that Mr Lavorgna had been “carefully assessed daily by the medical staff, so   there had been no negligence or superficiality”.   Complaints, procedure and composition of the Court   Relying on Article 3 (prohibition of inhuman and degrading treatment), Mr Lavorgna complained of   his psychiatric treatment. He also complained of an inadequate investigation in that connection.   The application was lodged with the European Court of Human Rights on 29 January 2021.   Garante nazionale dei diritti delle persone detenute o private della libertà personale, L’altro Diritto   ODV, La Società della ragione ONLUS, and the Fondazione Franca e Franco Basaglia were given leave   to intervene as third parties.   Judgment was given by a Chamber of seven judges, composed as follows:   Ivana Jelić (Montenegro), President,   Krzysztof Wojtyczek (Poland),   Lətif Hüseynov (Azerbaijan),   Gilberto Felici (San Marino),   Erik Wennerström (Sweden),   Raffaele Sabato (Italy),   Alain Chablais (Liechtenstein),   and also Ilse Freiwirth, Section Registrar.   Decision of the Court   Article 3   There was no dispute between the parties that Mr Lavorgna had been deprived of his liberty and   had therefore been under the control and responsibility of the State during his committal to a   psychiatric hospital. He had been strapped down in his bed with wrist and ankle straps for a total of   almost eight days.   The Court was satisfied that the initial ordering of the restraint measure had been necessary to   prevent Mr Lavorgna from harming himself or others. However, it reiterated that was for the State   to show that the restraint was strictly necessary and to demonstrate convincingly that such a   condition had been met. A “potential” danger would not suffice. It noted that the Italian Court of   Cassation had banned the practice of “precautionary” restraint measures.   It also cited the Committee for the Prevention of Torture’s conclusion that any restraint of more   than a few hours should be reviewed by a doctor at regular intervals. In this case, there had been   significant periods with no reassessment according to Mr Lavorgna’s patient records.   As regards the investigation into Mr Lavorgna’s allegations, it had failed to address the issues around   the prolongation for such a long period of the initial restraint measure, or to address his arguments   2 that his being strapped down had not been a “last resort”, especially given that the hospital   protocols set out that other measures should be used first.   On the final day of Mr Lavorgna’s being strapped down, two doctors of the psychiatric service had   requested the continuation of his care “in a more appropriate context” owing to what they had seen   as a “social danger” that they had not been equipped to deal with. They stated that Mr Lavorgna’s   continued restraint had been both problematic to manage and “ethically questionable”. The Court   highlighted this as very concerning.   The long period of the restraint measure had not been shown to have been strictly necessary. It had   exposed Mr Lavorgna to pain and suffering in violation of Article 3. The Court found, therefore, a   violation of Article 3 as regards his treatment in hospital.   The Court decided that there was no need to examine Mr Lavorgna’s complaint concerning his   pharmacological treatment, as it had already dealt with the main legal question raised by the case.   Regarding the investigation, the Court reiterated that the obligation to carry out an effective   investigation into allegations of treatment infringing Article 3 suffered at the hands of State agents   was well established in the Court’s case-law.   In this case, the Court noted that three years and four months had elapsed from the criminal   complaint to the discontinuance application; that there was no evidence that either witness   statements had been taken or other investigative steps carried out; there had been significant   periods between the medical assessment and the discontinuance request; and the general   timeframe had been overly long, which for the Court did not appear to be justified.   Furthermore, there had been an obligation on the investigating authorities to engage with   Mr Lavorgna’s submissions, which they had failed to do.   The Court therefore found a violation of Article 3 as regards the effectiveness of investigation into   the applicant’s allegations of ill-treatment.   Just satisfaction (Article 41)   The Court held that Italy was to pay Mr Lavorgna 41,600 euros (EUR) in respect of non-pecuniary   damage and EUR 8,000 in respect of costs and expenses.   The judgment is available only in English.   This press release is a document produced by the Registry. 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