Furthermore, the Court considers that “proper medical examinations are an essential safeguard against ill-treatment of persons in custody. Such examinations must be carried out by a properly qualified doctor, without any police officer being present and the report of the examination must include not only the detail of any injuries found, but the explanations given by the patient as to how they occurred and the opinion of the doctor as to whether the injuries are consistent with those explanations.”337 2 The European Regional System Non-compliance with domestic and international procedural guarantees may result in treatment which otherwise would not fall within the scope of Article 3 being considered ill-treatment or torture. For example, the use of handcuffs or other instruments of restraint does not normally give rise to an issue under Article 3 where the measure has been imposed in connection with a lawful detention and does not entail the use of force, or public exposure, exceeding what is reasonably necessary (which can include medical necessity).335 Nonetheless, in such cases, the Court must satisfy itself that the procedural guarantees for the decision to restrain or forcefully treat the applicant are complied with, and that the manner in which the applicant is subjected to the measure does not go beyond the threshold of severity envisaged by the Court’s case law.336 While it has not yet found a violation of Article 3 based solely on a State’s failure to train personnel, the European Court has pointed out that any evaluation of the use of force by law enforcement officials must take into account actions related to the planning and control of the events.338 The level of training of law enforcement officials is likely to be taken into account in this assessment.339 Raninen v Finland, op. cit., §56; Mathew v the Netherlands, op. cit., §180; Kucheruk v Ukraine, no. 2570/04, judgement of 6 September 2007, §139. As regards medical necessity, the Court considers that restraint or forced treatment which is of therapeutic necessity in accordance with established principles of medicine cannot in principle be regarded as inhuman and degrading, although the Court must satisfy itself that the medical necessity has been convincingly shown to exist: Herczegfalvy v Austria, no. 10533/83, judgement of 24 September 1992, §§82–83; Ciorap v Moldova, no. 12066/02, judgement of 19 June 2007, §§82–83, 89. 336 See Nevmerzhitsky v Ukraine, no. 54825/00, ECHR 2005-II, judgement of 5 April 2005, op. cit., §94. The government had not shown any medical justification, the applicant resisted the forced feeding, and handcuffs, a mouth-widener and a special rubber tube were used. In view of the severity of these elements, the treatment was found to constitute torture. See also Kucheruk v Ukraine, op. cit., §139; Ciorap v Moldova, op. cit., §§82–83, 89. 337 Akkoç v Turkey (2000), op. cit., §118. The Court emphasised the findings of the European Committee for the Prevention of Torture in this regard. 338 Andronicou and Constantinou v Cyprus, Rep 1997-VI, judgement of 9 October 1997, §171. 339 Ibid. §185. 335 71