Tribunal Dismisses Milosevic Negligence Claims

The Hague tribunal judge responsible for an internal inquiry into the death of Slobodan Milosevic from a heart attack in custody earlier this year has dismissed claims that the former Yugoslav president was denied proper medical care.



In his final report, published on May 31, Judge Kevin Parker said doctors consulted after Milosevic’s death disagreed over whether the former Yugoslav president would still be alive if he had undergone surgery to correct heart problems.



The document has met with consternation from the court’s critics, including Milosevic’s brother, Borislav, who told the Russian Interfax news agency that its findings were “absolutely wrong” and called for an independent investigation.



Before he died in March, Milosevic had been lobbying for permission to receive treatment at the Bakoulev Centre for Cardiovascular Surgery in Moscow. The former Yugoslav president’s supporters say resistance to this move was ultimately responsible for his death, and there have even been allegations of poisoning.



But Judge Parker’s report instead suggests that Milosevic was as least partly to blame for his own demise. It cites his failure to follow medical advice and a habit of self-medicating using drugs smuggled into the Hague prison, as well as indications that he was intentionally impairing his treatment.



At the same time, the document acknowledges that Milosevic had greater freedom to take such measures because of security failures at the detention unit. These failures resulted from privileges granted to him to help him mount his own defence case.



Judge Parker’s report lifts the lid on key issues relating to Milosevic’s health which were always close to the surface during his trial but remained subject to speculation, partly because of confidentiality issues.



“What did come through in the report was how severe his heart condition was,” noted Judith Armatta, who reported on Milosevic’s trial for the Coalition for International Justice.



Judge Parker also documents repeated evidence that Milosevic was having drugs smuggled to him in the Hague detention unit.



As early as February 2002, medication for high blood pressure was apparently found in Milosevic’s jacket pocket after he received a visit. In another example, in July 2004, unprescribed drugs and a bottle of whisky were discovered in an office made available to him in the Hague prison for preparing his defence. The metal cap on the whisky bottle had apparently been replaced with a plastic one which would not trigger prison metal detectors.



Around the same time, tests on samples of Milosevic’s blood revealed the presence of medication used to treat anxiety, which had not been prescribed to him.



Later in 2004, the commanding officer of the detention unit expressed concerns that because of Milosevic’s privileges – including the office, which only he had access to – it was not possible to properly control his access to unprescribed drugs.



Measures were subsequently taken to tighten security around Milosevic, including installing a one-way viewing window into his office. But these efforts apparently failed to solve the problem and in December 2005 the prison chief reiterated that he could not take responsibility for Milosevic’s health.



“It must be accepted,” Judge Parker concludes in his report, “that the arrangements in this case for the provision of privileged facilities within [the] UNDU [United Nations Detention Unit]… compromised the security of [the] UNDU and provides an explanation for Mr Milosevic’s ability to gain access to a variety of medication which had not been prescribed by his treating doctors.”



The eventual transfer of the detention unit to a new block of cells within the Dutch prison which houses it allowed staff to make further improvements to Milosevic’s security. But this happened only in February this year, just weeks before he died.



Judge Parker says efforts to clarify the situation with regard to the accused’s access to drugs were ongoing at the time of his death. They were not helped, he says, by “strenuous opposition” from Milosevic himself, including a refusal to allow disclosure of his medical data.



It was at the start of this year that the question of Milosevic’s alleged use of the drug rifampicin - now at the heart of controversy surrounding his death - first arose.



Seeking to counter suggestions that low levels of medication in his blood showed that he was not following his treatment regime, on January 12 Milosevic took his medicines in front of a nurse and was watched for two hours to make sure that he didn’t spit them out. But tests still revealed low levels of the drugs in his system.



It was at that point that doctors first suspected that he might have secretly been taking rifampicin, which is used to treat leprosy and tuberculosis and has the side-effect of countering medicines used against high blood pressure. A new set of tests on the January 12 blood samples confirmed the presence of this drug.



Shortly before he died in March, Milosevic, who had only recently been told of the rifampicin discovery, wrote to the Russian authorities claiming that he was being poisoned. He cited the two-month delay in confronting him about the presence of the drug in his system as evidence of foul play.



Judge Parker’s report offers another explanation for this time lapse, saying that it took several weeks for the tests to be carried out which confirmed the presence of rifampicin, and for these results to be communicated to the medical officer at the tribunal’s detention centre. The prison doctor then consulted with colleagues and a lawyer about whether under Dutch law he could rightfully inform the court of these findings without Milosevic’s consent. He then finally confronted the accused in early March.



On the advice of the doctor who carried out the tests for rifampicin, Judge Parker also expresses doubts that Milosevic could have been ingesting the drug unawares. Had that been the case, he says, it is “highly likely” that the accused would have reported side effects to his doctors such as a “marked” reddish discolouration of the urine.



Despite denials by Milosevic, Judge Parker says the conclusion can be drawn that he was administering the rifampicin to himself. “If this were the case,” he goes on, “the circumstances would also support a conclusion that he was manipulating the effectiveness of his prescribed treatment for other purposes, at obvious risk to himself.”



Besides using unprescribed drugs and not following the medication regime recommended by doctors in The Hague, Judge Parker also notes Milosevic’s poor lifestyle as a potential factor in his death, including his refusal to exercise, his continued smoking and his failure to follow a proper diet.



With regard to the other key question of whether Milosevic received satisfactory medical care, the report notes the opinion of Professor Leo Bockeria of the Bakoulev Center in Moscow, where Milosevic wanted treatment. Following his death, Backeria wrote a letter to the inquiry team apparently suggesting that if Milosevic had been hospitalised in Moscow, it could have become clear that he needed surgery and such intervention could then have prevented his death.



At the same time, however, other doctors consulted during the inquiry – including a French cardiologist who was one of three experts engaged by Milosevic to assess his condition in December last year – did not agree that surgery was necessary or that it would have saved his life.



In light of the opinions offered by this latter group, Judge Parker says, “This inquiry cannot reach the conclusion that there was a failure to provide proper medical care to Mr Milosevic by those treating him at [the] UNDU.”



It was always unlikely, however, that an investigation carried out by tribunal staff would satisfy the court’s critics.



Jonathan Widell, a doctoral student of law who has written about tribunal affairs for the Serbianna website, insists that this latest set of findings should not be the end of the matter.



“All in all, the report is pleading for the innocence of the tribunal,” he told IWPR, arguing that the investigative team appeared to have made little effort to consider the possibility of foul play by anyone other than Milosevic.



He also pointed to what he believed to be contradictions within its conclusions, including the implication that at the start of this year, Milosevic was taking rifampicin in order to worsen his health while also having drugs smuggled to him in prison which were designed to treat his health problems.



But Armatta said the latest report serves to confirm rumours which had already existed about Milosevic’s manipulation of his own health problems.



“As for the ICTY, it can be faulted for being too trusting of Milosevic in providing him the means to secure contraband from outside,” she said. “But it was Milosevic who was responsible for jeopardising his health.



“That he would manipulate [his] medication, given the severity of his condition, is astounding. But Milosevic was a gambler. He gambled with the lives of his countrymen and women – and with his own.”



Michael Farquhar is an IWPR reporter.