Report on the State of Human Rights in Institutions for Persons with Disabilities In accordance with Article 4 of the Law of Georgia on Health Care, the principles of the state policy in the field of health care are as follows: “a) Universal and equal access to medical care for the population in the framework of the obligations taken by the state through state medical programs; b) Protection of human rights and freedoms in the field of healthcare; acknowledgement of the honor, dignity, and autonomy of the patient; c) Responsibility of the state for the amount and quality of the medical service envisaged by the program of mandatory medical insurance; d) Priority of primary healthcare, including urgent medical aid; participation of state and private sectors in it; development of family medicine and the institution of family doctor, and ensuring access to medical care on its basis.” As a result of the monitoring, it has been found out that the medical care in infant houses is mainly limited to provision of primary medical assistance and anti-symptom medicines. The multidisciplinary teams of doctors do not conduct examinations, apart from individual exceptions. Beneficiaries of infant houses belong to the vulnerable category of children who often become ill and, accordingly, require repeated hospitalization. Despite the fact that the insurance package covers hospitalization, it is often difficult to achieve. During the monitoring of the Tbilisi Infant House, the monitoring group learned about a case of restriction of urgent medical care for beneficiary S.B. In connection with this, Public Defender, on his initiative, launched an additional inquiry (Case No. 1271-12) and sent the information for response to both the State Regulation Agency for Medical Activities (No. 2940/08-2/1271-12) and the Social Service Agency (2939/08-2/1271-12) – the body of guardianship and custodial care determined by the national legislation. The case of S.K. – Refusal to provide urgent Medical Service By 10:00 P.M., S.K.’s condition was still severe: the child gave almost no response to irritation; the breathing was superficial; the heart sounds were deafened; hypothermia; despite putting hot water bags, the temperature remained at 350; the look was bleary, with periodic eye deviation (uncoordinated movement of eyes). The duty doctor called the hotline of the Ministry of Labor, Health and Social Affairs and the Alfa insurance company. In several hours, the same ambulance crew was called again, and, already on January 3, at 01:00 A.M., the child was transferred to the intensive care unit of the academic clinic. The medical report drawn up jointly by the Social Service Agency and doctors and administration of the Infant House indicates that it took five hours to transfer the child from the Infant House to the inpatient unit. 152 Adynamia – (Greek: a –negative prefix, dynamis - strength) – loss of strength, intense weakness 153 Apnea (Greek: a - negative prefix; pnoē – to breathe) – a temporary suspension of breathing; develops as a result of blood depletion from carbonic acid (for example, at the time of intensified artificial or natural breathing). ANNUAL REPORT OF THE PUBLIC DEFENDER OF GEORGIA NPM Report 2012 On January 2, 2012, by 8:00 P.M., S.K., who was then a year and two months old, had severe adynamia152, breathing rhythm disorder, and immediate apnea153. The child’s limbs were pale-colored and cold; s/he responded passively to irritation; the heart sounds were deafened, and the pulse on the periphery felt weak; the child was not crying; temperature – 350; pulse – 100; breath frequency – 24. Due to the generally complicated diagnosis (microcephaly, spastic tetraparesis, post-pneumonia period, slight cramps), the duty doctor N.G. considered it necessary to call an ambulance crew after providing first aid. A doctor of the ambulance crew gave the child an injection and oxygen; according to the duty doctor of the infant house, the child required transfer to hospital (“In fact, a dead child was lying in front of me.”), through s/he was not hospitalized. According to an entry made in medical card no. 614 of ambulance crew no. 809, “The patient requires inpatient treatment. I contacted the hospital manager. All pediatric clinics refused to admit the aforementioned patient.”