Conclusion No. 6 of Group of Specialists/Experts Set up by Public Defender for Monitoring Mikheil Saakashvili’s Medical Condition
The public is aware that on November 16, 2021, the Public Defender of Georgia, by Order No. 157, established a group of specialists/experts 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 purpose of the group of experts, from the day of its establishment, has been to monitor the medical services provided to the patient. The group has not been involved in the treatment of the patient.
The group of experts visited Mikheil Saakashvili 6 times in total. In particular, visits were made to Medical Establishment No. 18 of the Special Penitentiary Service on November 16 and 18, 2021, to the Giorgi Abramishvili Military Hospital of the Ministry of Defence on November 23 and December 12 and to Penitentiary Establishment No. 12 on January 11 and April 22.
During the visits, members of the group examined patient Mikheil Saakashvili, reviewed his medical records and spoke with local medical/treatment personnel.
As a result, the group of specialists/experts of the Public Defender made six conclusions, namely: 17.11.2021, 18.11.2021, 25.11.2021, 14.12.2021, 19.01.2022 and the present one - 27.04.2021.
Following the visit paid on 17 November 2021, the Public Defender’s group of experts, given the patient's critical condition, made a recommendation to ensure immediate treatment of the patient in a well-functioning and well-experienced poly-profile hospital, in particular in an intensive care unit, the conditions of which could not be met by the clinic of Establishment No. 18 of the Special Penitentiary Service. The same recommendation was repeated after the visit of November 18, 2021, during the aggravation of Mikheil Saakashvili's health condition (convulsions caused by Wernicke encephalopathy were observed).
On November 19, 2021, the patient was transferred to the Giorgi Abramishvili Military Hospital of the Ministry of Defence LEPL.
After being placed at the Gori Military Hospital and then transferred to Penitentiary Establishment No. 12, the Public Defender’s team visited Mikheil Saakashvili four additional times (23.11.2021, 12.12.2021, 11.01.2022 and 22.04.2022).
Results of the April 22 visit
The following experts took part in the visit: neurologist Tengiz Tsuladze and therapist (internal medicine/hospital medicine) Grigoli Khurtsidze.
After the visit, the group of experts held an online discussion, in which other experts also took part, namely: Giorgi Grigolia (anesthesiologist-resuscitator), Giorgi Kacharava (cardiologist), Giorgi Papiashvili (cardiologist/arrhythmologist), Aida Gozalova (hematologist, clinical oncologist, internist, palliative medicine specialist), Nino Zavrashvili (endocrinologist).
I.General assessment of the patient's condition
Compared to the last visit (11.01.2022), the patient's condition has further deteriorated. The patient is currently in a negative catabolic state (the body consumes proteins released by the breakdown of its own organs). In particular, although Mikheil Saakashvili has not formally declared a hunger strike at the moment, unlike his previous hunger strike, he is losing weight at the expense of losing muscle mass (protein). Currently the patient's condition can be described as protein starvation (cause - anorexia)
II. Key issues and recommendations
After the January visit, unfortunately, we have been dealing with the formation of a vicious circle:
- Resistant post-traumatic stress disorder, depression and anorexia; Reduced food intake (he takes much less than the required calories per day, up to 1/4-1/3 of the daily dose, 8 kg weight lose in a month) and selective refusal of protein products - due to intolerance;
- Clear and significant muscle fatigue and weakness developed as a result of protein starvation;
- Significant reduction in quality of life and efficiency of functioning.
Timely, complex neuro-psychological and physical rehabilitation is recommended at this stage to get out of the vicious circle of this syndrome. Otherwise, in general - such a significant restriction of food intake, and in particular - protein starvation - will inevitably lead to significant loss of muscle and organic weight, a high risk of infections and disruption of the functioning of internal organ systems.
It should be noted that the recommendations made by the Public Defender's group of experts in December-January regarding psychotherapy and physical rehabilitation have not been/could not be implemented. The medications given to the patient after this period did not work and his condition worsened. Consequently, continuation of medications alone, under similar conditions, without following the above-mentioned recommendations, will be ineffective, will still not yield positive results in the future, and will lead to the aggravation of the patient's condition in the above-mentioned form, which may lead to irreversible consequences.
Members of the group of specialists/experts:
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 His daily energy norm is 2100-2200 calories (according to the Harris Benedict principle), he gets up to 600-800 calories.