6.  The applicant was born in 1979. He is currently serving a sentence in correctional colony no. IK-1 in Penza. 7.  In the early morning of 7 August 2007 the applicant stabbed a man in the leg during a drunken fight. Several hours later the victim died in hospital from massive blood loss. 8.  On the same day the applicant was arrested. According to the police, he had started the fight and knifed the victim. 9.  Two days later the applicant was remanded in custody by the Salsk Town Court of the Rostov Region (“the Town Court”). It was further extended at the investigative authorities’ requests on a number of occasions given the seriousness of the charges, negative references about the applicant’s character and the fact that the applicant did not have permanent residence or a job. 10.  On the day of the incident a medical expert, B., performed an autopsy of the victim at the request of the investigator. He concluded that the victim, M., had died from blood loss between midnight and 4 a.m. on 6 August 2007. 11.  The next day the investigator asked B. to carry out a repeat examination of the body, without informing the applicant or his lawyer. The expert stated that the victim had died between midnight and 4 a.m. on 7 August 2007. A considerable amount of alcohol was found in the victim’s system. 12.  On 12 September 2007 a doctor discovered several bruises on the applicant’s body. The date the injuries were sustained could not be determined. 13.  In October 2007 the defence were presented with the autopsy report. Having been informed of their procedural rights, including the right to challenge an expert, seek the appointment of a particular person as an expert, adduce further questions, be present during an expert examination in person and make comments or requests, including in writing, the applicant and his lawyer studied the expert report and signed it without making any remarks or objections. 14.  The applicant’s main line of defence at trial was that he had acted in self-defence against the unlawful actions of the victim, who had allegedly attacked him with a knife. The prosecution disputed that version of events with the in-court testimony of six people who had witnessed the incident. In particular, five of the witnesses stressed that the applicant had attacked the victim with a knife. The other witness stated that he had not seen the fight itself but had seen the victim lying wounded and had been told by others present that the applicant had knifed him and had then fled. 15.  The autopsy expert testified that on the night of the murder the victim had been heavily drunk to such a point that he had been unable to think clearly. He had died because of a knife wound to his femoral artery. Neither the applicant nor his lawyer asked the expert to explain any possible contradictions between the two autopsy reports. They did, however, challenge the admissibility of the second report in view of the fact that they had only been notified of it afterwards. The trial court rejected the objection, noting that the defence had had an opportunity to put questions to the expert in open court or to seek an additional expert examination. 16.  The defence repeatedly asked the trial court to hear the three witnesses who had allegedly seen the fight. The applicant said that he had seen one of the witnesses working at the Central Market but he did not know her name. The trial court, convinced by the prosecution witnesses that the three individuals had not been present during the attack, dismissed the applicant’s request. It also noted that it had no legal power to find witnesses. 17.  The day before the verdict, the applicant unsuccessfully asked the trial court to order an additional autopsy of the victim. 18.  On 8 August 2008 he was convicted of unintentional killing and sentenced to eight and a half years’ imprisonment. His conviction was mainly based on the expert and witness testimony and the second autopsy report. 19.  On 12 November 2008 the Rostov Regional Court quashed the conviction because of certain contradictions in the legal analysis of the applicant’s criminal intent. The case was remitted for fresh examination. The Regional Court also ordered that the applicant should remain in custody pending a retrial. 20.  On 19 December 2008 the trial court rejected an application by the applicant for release, in which he complained that his detention had been excessively lengthy, that there was no reason to suspect that he had been involved in the crime, that he had a permanent place of residence and that he suffered from a serious medical condition. The court extended the applicant’s detention until 20 March 2009, referring to the seriousness of the charges, negative references about the applicant’s character and the “need to proceed with the trial.” 21.  On 29 December 2008 the defence appealed against the detention order. A week later the applicant gave the prison authorities an amended statement of appeal, which reached the trial court on 19 January 2009. It was returned as belated. 22.  On 19 January 2009 the Regional Court examined the appeal in the absence of the applicant and his lawyer. It neither verified whether the defence had been duly summoned nor looked at the reasons for their absence or reflected upon the need to obtain their attendance. Having heard the prosecutor, who insisted on the importance of the applicant’s continued detention, the Regional Court upheld the detention order, agreeing that the seriousness of the charges and stage of the proceedings warranted the extension. 23.  On 18 March 2009 the Town Court again extended the detention until 20 June 2009. In addition to the grounds previously indicated, it held that there was a lack of evidence to support the applicant’s argument of poor health. 24.  Nine days later the applicant lodged an appeal and application for leave to appear. 25.  On 8 April 2009 the Regional Court held a hearing. The defence were absent but the prosecutor attended and argued in favour of the applicant’s continued detention. There is nothing to suggest that the reasons for the defence’s absence were checked by the court. It held that the applicant’s presence was not necessary since his arguments were set out in his statement of appeal. Referring to the length of the criminal proceedings, the court decided to reduce the period of the applicant’s detention by one month until 20 May 2009. 26.  In the meantime, the trial court proceeded with the examination of the case. The applicant’s only request was to have defence witnesses heard who were allegedly meant to testify that the applicant had not had any injuries prior to the fight and that all the prosecution witnesses had agreed to make untrue statements about him. It was dismissed by the trial court as irrelevant and ill-founded. The trial court again noted the difficulties in finding one of the witnesses in the absence of any relevant information about her identity. 27.  The applicant also challenged the autopsy reports and, in particular, the cause of death. 28.  On 21 January 2009 the trial court heard the autopsy expert. The applicant was removed from court because of insulting conduct towards the expert. The applicant’s counsel stayed, but did not call into question the two reports or other expert evidence. The applicant’s subsequent requests for an additional cross-examination of the expert were dismissed as unfounded. 29.  On 13 May 2009 the trial court convicted the applicant of unintentional killing and sentenced him to eight and a half years’ imprisonment. The judgment was based on the in-court testimony of six prosecution witnesses, including eyewitnesses to the incident, the second autopsy report and the expert’s testimony. The court found that the weight of the evidence proved that the applicant had not acted in self-defence. 30.  On 7 October 2009 the Regional Court upheld the sentence. It confirmed the findings of fact and law and concluded that there had been no procedural violations in the applicant’s case. 31.  The parties submitted the applicant’s medical documents for the period September 2008 to January 2013. 32.  It appears that in late September 2008 the applicant complained to a prison doctor of palpitations, fatigue, shortness of breath and chest pain. The prison doctor examined him on 29 September 2008, diagnosed him with mitral valve prolapse and ordered that he be transferred to a prison hospital “in due course”. 33.  On 23 December 2008 the applicant underwent an echocardiogram, which revealed symptoms of supraventricular tachycardia. He was also seen by a cardiologist, who confirmed the diagnosis of mitral valve prolapse and diagnosed him with neurocirculatory dystonia (нейроциркуляторная дистония). A course of drugs was prescribed. 34.  On 28 January 2008 the applicant was admitted to the interregional prison hospital in the Rostov Region. Having undergone various medical tests and consultations he was diagnosed with grade II mitral valve prolapse, neurocirculatory dystonia and various comorbidities, such as encephalasthenia and behavioural disorder. The applicant was prescribed vitamin B, cardiovascular and hypotensive drugs and painkillers. He received the prescribed medication until he was discharged from the hospital on 24 February 2009. Doctors recommended further treatment with beta blockers, potassium and magnesium based drugs, nootropics and vasoprotective medication. 35.  It seems that no significant changes occurred in the applicant’s medical condition over the months that followed. His medical file does not contain any information on whether the detention authorities complied with the prescription. The applicant stated that he had not received the prescribed drugs for an entire year. 36.  On 20 November 2009 a panel of psychiatrists examined the applicant and found that he suffered from organic personality disorder and vegetative nervous system disorder in the form of somatophrenia. 37.  In 2010 a prison doctor saw the applicant on several occasions in relation to the latter’s chronic gastritis, acute respiratory disease, urinary infection and heart condition. After each visit a course of drugs was prescribed. On several occasions he was seen by a psychiatrist about his physical symptoms. 38.  Over the year that followed the applicant mostly complained to the prison doctor of heartburn and palpitations. Unsatisfied with the quality of care and drugs he was receiving, he insisted on an in-depth medical examination of his condition. 39.  In July 2011 a psychiatrist noted that the applicant had minor depressive disorder and a tendency to bring vexatious claims. 40.  The following month the applicant was sent to a civilian hospital in Penza for an in-depth medical examination. A gastroduodenoscopy showed that he had superficial gastroduodenitis, duodenogastric reflux and partial erosion of the esophagus. An abdominal ultrasound did not reveal any pathological conditions. Shortly after his return to the correctional colony he was prescribed various medicines to treat his conditions. He was regularly seen by a prison doctor and psychiatrist. His general medical condition remained satisfactory. 41.  In January 2012 the applicant developed acute rhinitis, which was cured by prison doctors within several weeks. In March 2012 he received medical treatment for anxiety disorder and was given medication for a mild case of gingivitis. 42.  On 6 September 2012 the deputy head of the prison hospital examined the applicant and noted that the applicant was absolutely convinced that he was in a serious state of ill health. The applicant submitted a number of general complaints and alleged that he become infertile in detention. However, there were no signs of any acute physical or psychiatric conditions, save for a runny nose. The applicant’s heart problems had not worsened. He refused to undergo a medical examination in a prison hospital, giving the excuse that he was “too busy” until January 2013. 43.  In late 2012 and the beginning of 2013 the applicant was diagnosed with chronic noninflammatory prostatitis and prescribed a complex course of treatment based on antibiotics.