Report on the State of Human Rights in Institutions for Persons with Disabilities and the regime of insulin therapy was not taken into account during his/her transportation, s/he twice developed diabetic coma accompanied by loss of consciousness for a considerable period, first, during the transportation in a vehicle and, for a second time, several hours after the admission to the boarding house. The aforementioned fact posed quite a serious threat to his/her life and health and was a strong stressogenic factor. For further management of the patient’s condition, the director of the boarding house contacted the Dusheti medical center of Geo-Hospitals LLC, though representatives of the clinic told him/her that the endocrinologist was not available in the hospital. Accordingly, the patient came under the risk of not being able to receive necessary medical consultation for at least three days (the endocrinologist would be available for consultation after three days). In spite of this, based on the director’s personal contacts, after negotiations over the phone, the patient was sent to the Mtskheta Center for Primary Health Care on the same day. S/he was provided with an endocrinologist’s consultation and, as a result, his doze of insulin therapy was changed. The aforementioned case highlights the responsibility of the Social Service Agency for making an adequate assessment when beneficiaries are admitted to care institutions. Since the assessment did not indicate properly to the potentially dangerous condition (diabetes, the risk of development of coma), this factor was not taken into account when the beneficiary’s transportation was organized; the receiving care institution was not informed of the attendant medical risk. The Form #100 that accompanied the patient had not been filled out completely. In the Martkopi institution for disabled people, the preventive group learned that there were serious problems related to the quality of medical service for beneficiaries; according to the administration, the Martkopi Boarding House for Persons with Disabilities is served by the Ambulance Service of the Gardabani District. Due to the small number of crews, the ambulance service only manages to arrive at the boarding house an hour after a call is made. One more formality makes this situation worse: Both in the cases of somatic and psychic diseases, patients are first hospitalized in the Geo-Hospital of the Gardabani District and then transferred to Tbilisi by the Disaster Service. This scheme of hospitalization prolongs the route (from Martkopi to Gardabani – 50 km, from Gardabani to Tbilisi – 25 km), increases fuel expenses, and hinders timely provision of medical service. The Caseof L.M. – Late Hospitalization The situation described above violates right of the patient to accessible and quality medical service envisaged by the Law of Georgia on the Rights of Patients and contradicts the concept of social integration of persons with disabilities in issues related to accessible medical treatment. The Case of Z.D. – Refusal to Provide Medical Service A beneficiary of the Martkopi institution for disabled people, Z.D., who has a diagnosis of post-epilepsy mental retardation and bronchial asthma, has been recognized as legally incapable. The condition of the beneficiary often becomes acute and s/he develops asthma attacks. Z.D. developed another asthma attack on 21/06/2012; Despite the assistance provided onsite (Inhalation with Salbutamol and a Dexametazon injection), his/her condition remained severe. In agreement with the Irao insurance company, the Disaster Service transferred beneficiary Z.D. to the intensive care unit of Samgori Medi. On 22/06/2012, when ANNUAL REPORT OF THE PUBLIC DEFENDER OF GEORGIA NPM Report 2012 A beneficiary of the Martkopi institution for disabled persons, M.G., diagnosed with hypothyreosis and Prader-Willi Syndrome with respiratory insufficiency, who was strongly agitated, was transferred to the Geo-Hospital of the Gardabani District, though, due to his/her severe mental health condition, s/he was brought back from the clinic to the boarding house, as the aforementioned clinic did not have the resources to manage the condition of patients with mental health problems. The patient’s condition became so severe that s/he was transferred in the same evening first to the psychiatric unit and then to the intensive care unit of the Tbilisi Referral Clinic. Other beneficiaries also had to travel a long way: L.M. – diagnosed with epilepsy and mild mental retardation; and S. Sh., with exacerbated psychiatric symptoms, who had to travel for four hours before s/he was provided with adequate medical assistance.