Conclusion of the Ombudsman's expert group on Mikheil Saakashvili full version

"The condition has sharply deteriorated and is assessed as serious" - the conclusion of the group of experts created by the Public Defender, regarding the health condition of the third president of Georgia.

See the full conclusion:

"The conclusion of the group of specialists/experts created by the Public Defender on the results of the monitoring of the medical condition of Mikheil Saakashvili.

It is known to the public that on November 16, 2021, the Public Defender of Georgia, by order N157, created a group of specialists/experts in order to assess the adequacy and timeliness of the medical services provided to the accused/convicted Mikheil Saakashvili.

  In accordance with the mandate of the Public Defender of Georgia, the goal of the expert group, since its creation, is to monitor the medical services provided to the patient. The group was not involved in the direct treatment process of the patient.

The group of experts has so far developed six conclusions, namely: 17.11.2021, 18.11.2021, 25.11.2021, 14.12.2021, 19.01.2022 and 27.04.2021 conclusion.

In the current period, as a result of the active dissemination of information about the significant worsening of Mikheil Saakashvili's health condition, the Public Defender made a decision to carry out another monitoring of the expert group.

  Accordingly, on December 4, 2022, four experts were at the "Vivamed" clinic in order to directly examine Mikheil Saakashvili and get familiar with the relevant medical materials, and on December 5 of the same year, in order to obtain additional detailed information on specific issues, one of the representatives of the expert group was at "Vivamed" to discuss with the attending physician of Mikheil Saakashvil.

The purpose of the visits on December 4-5 was to describe and evaluate the patient's current condition, complaints and symptoms. Also, the evaluation of the dynamics in relation to the previous visits, within the competence and ability of the Public Defender's expert group.

Experts participated in the December 4 visit: Tengiz Tsuladze (neurologist), Grigoli Khurtsidze (therapist, internal diseases/hospital medicine), Giorgi Papiashvili (cardiologist/arrhythmologist), Aida Gozalova (hematologist, clinical oncologist, internist, palliative medicine specialist). Giorgi Grigolia (anesthesiologist-reanimatologist) visited on December 5. Giorgi Katcharava (cardiologist) and Nino Zavrashvili (endocrinologist) also took part in the online discussions held after the visits.

I. General assessment of the patient's condition

According to the position of the expert group, the patient's condition, after the last assessment (27.04.2022), has deteriorated sharply and is assessed as severe.

II. Patient assessment data and reasoning

We have the following main symptoms:

• Weight loss is 42 kg, in October last year he was 115 kg, in May 2022 he was 104 kg. Currently he is 73.6 kg. Currently, the body mass index is 20 kg/m2
• Decreased muscle strength
• Reduced muscle mass
• restriction of movement
• energy depletion
• Disturbance of sensitivity in the limbs
• Fever
• Cognitive impairment (impaired memory, behavioral changes)
• diagnoses

1. Cachexia - a hypercatabolic state, which is associated with various chronic diseases and is characterized by a decrease in muscle mass with or without a decrease in fat mass.

At least three of the given criteria are necessary for diagnosis:

I. Decreased muscle strength

II. Decreased muscle mass

III. Low energy/fatigue

IV. Anorexia

V. Biochemical changes (anemia, inflammation, hypoalbuminemia).

The patient currently has:

I. Decreased muscle strength

II. Reduced muscle mass

III. energy depletion

IV. Anorexia

V. Anemia

VI. Fever

VII. Weight loss 42 kg (36% of initial weight)

Thus, the patient's condition meets cachexia level 4 (derived from the cachexia grading system: body mass index BMI ≤20 kg/m2 and weight loss of 6 to -11% indicates). If from October 2021 to May 2022, i.e. in 7 months, he lost 115-105=10 kg, in 7 months from May 2022 to the beginning of December it was already 105-73.6=31.4 kg (29.5% of weight), i.e. the rate of weight loss tripled.

1. Daily episodes of fever (of unknown origin)
2. Anorexia, asthenia
3. stretching the muscles
4. advanced anemia
5. Polyneuropathy
6. Orthostatic hypotension
7. cognitive impairment
8. Post-traumatic stress syndrome (diagnosed by the findings of December 14, 2021 and January 19, 2022

Reasoning:

1. The patient's condition has continuously worsened during the last year and especially the last two months;
2. Encephalopathy, sensorimotor neuropathy, anemia worsened, and newly discovered autonomic neuropathy was added with a significant drop in blood pressure upon standing up;
3. Unfortunately, the transition from anorexia to life-threatening cachexia, predicted more than once by the expert group, has developed, and currently, the patient is in the phase of active catabolism (self-digestion and tissue breakdown), which is confirmed by a very rapid weight loss - since September, the weight has dropped from 98 kg to the current 73.6 kg;
4. Patient management cannot be done in a proactive manner (which is usually the standard of patient management in modern medicine) and treatment approaches are limited to responding to various complications. The patient is undergoing many studies, but there does not seem to be any logical strategy for managing the disease, and treatment is mainly carried out in response to various new complications;
5. According to the Consilium, the patient's condition after the last assessment (27.04.2022) has sharply deteriorated and is assessed as serious. Such development of the process was also predicted in our earlier conclusions.

conclusion

1. After the last assessment (27.04.2022), the patient's condition has deteriorated sharply and is assessed as severe;
2. Deterioration of neurological status, worsening of anemia, anorexia and gastrointestinal events are observed. Sharp and rapid weight loss, loss of muscle mass, fever. There is cachexia, which in itself is a condition with a severe prognosis;
3. The patient's condition is progressively deteriorating. The rate of weight loss has tripled in recent months. While decreasing at such a speed, the critical BMI <14 (which corresponds to <52 kg) will be reached in 2-3 months, after which irreversible damage to organ systems will begin;
4. Current treatment does not work. Patient management cannot be proactive and treatment approaches are limited to responding to various complications;
5. According to the expert's opinion, the patient underwent all laboratory and instrumental research and treatment available in Georgia, in several multi-specialty clinics, despite this, the patient's condition is rapidly deteriorating. We believe that in order to prevent the expected irreversible deterioration of health, it is necessary to take timely and basic measures.