radical treatment for the tumour. He argued, in particular, that although it had been acknowledged on numerous occasions and by various authorities that radical treatment was not feasible within the penitentiary system, the prison authorities took no steps to arrange such treatment in a civilian hospital, even at the applicant's expense, which led to his condition becoming irreversible. The Court thus has to establish whether the penitentiary authorities took all necessary measures to ensure the required treatment.
78. The Court notes that on 11 June 2001 microsurgeon M. recommended excision of the haemangioma with prior tomography and angiography. Likewise, during the applicant's placement in the facility US-20/12 in St Petersburg between 15 April and 8 May 2002, radical removal of the tumour was recommended. Following the first recommendation the applicant underwent tomography on 8 October 2001 and, after his placement in the facility US-20/12, a panel of the penitentiary doctors found that the radical treatment was not possible within the penitentiary system. In view of this conclusion the authorities began to examine the possibility of the applicant being operated in a civilian hospital. They first referred the applicant to the SMK for a decision on early release on the basis of his state of health, which would facilitate his surgery outside the penitentiary system. However, on 20 September 2002 the SMK found that the applicant's illness was not life-threatening and did not fall under the list of illnesses that could serve as a basis for early release from serving one's sentence.
79. Subsequently maxillofacial surgeon K., who examined the applicant on 2 February 2003, stated that surgery was not recommended because it would threaten the applicant's life. Later plastic surgeon M., who examined the applicant on 11 August 2004, and professor D., who in November 2004 studied the results of the angiography conducted on 5 August 2004, both stated that the radical treatment was impossible because of the size of the tumour and its structure. At the same time the penitentiary authorities continued investigating the possibility of the radical removal of the tumour having contacted several civilian hospitals, including medical institutions in Voronezh, Moscow and Tyumen, between 2004 and 2007. However, all of them refused to accept the applicant for treatment on the ground of lack of adequate technical facilities and qualified personnel.
80. The Court reiterates that the CPT in its 3rd General Report (see paragraph 68 above) stated that a prison's health care service should be able to provide regular out-patient consultations and emergency treatment. At the same time, prison doctors should be able to call upon the services of specialists and the direct support of a fully-equipped hospital service should be available, in either a civil or prison hospital.
81. The Court observes that it is not in dispute by the parties that radical treatment of the applicant's tumour was not possible within the penitentiary system. However, having regard to the 3rd General Report of the CPT cited in the preceding paragraph and the highly complex nature of the applicant's condition, the Court does not consider that this fact alone gives rise to issues under Article 3 of the Convention. In the circumstances of the present case the question is rather whether the authorities took sufficient steps to ensure adequate treatment for the applicant, having recourse to facilities outside the penitentiary system.
82. The Court notes that, having received the recommendations to conduct radical treatment and having established that it was not possible within the penitentiary system, the authorities referred the applicant to the SMK seeking his early release due to his state of health. It was only after the SMK's refusal that the authorities started contacting civilian hosp
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