Medical Statements
MEDICAL REPORT OF DOCTOR ALBERT BENCHABBAT ON EXAMINATION OF EMANUEL ZELTSER IN THE KGB PRISON IN MINSK, BELARUS
(JUNE 26, 2008)
1. The Doctor’s Credentials
I am Albert Benchabbat, MD, and I am licensed to practice medicine in the States of New York and Florida. I practice medicine for about 20 years and am certified by the American Board of Internal Medicine.
2. The Patient’s data.
Patient’s name: Emanuel Zeltser, DOB: 11/9/53
Place of examination: The premises of the KGB prison in Minsk, Belarus
Date of examination: June 26, 2008
Time of examination: approximately from 10:00 AM to 1:20 PM
3. The Patient’s medical history and physical examination
On June 26, 2008, from approximately 10:00 AM to 1:20 PM I performed a medical examination of Emanuel Zeltser who is currently in custody of the Belarus authorities in the KGB prison in Minsk, Belarus. Present were a KGB investigator, Belarus Doctor Yuri Michael Prozenko and interpreter Vladimir. Representatives of the US Consulate and the patient’s lawyer were not present.
Two hours were dedicated to a complete review of the prison medical records with the help of Doctor Yuri Prozenko and the local interpreter.
The prison medical report is quite incomplete and is missing important medical information such as the patient pain and suffering from debilitating gout and spondylosis. The weight is not recorded, the glycosilated hemoglobin for diabetes follow up was never performed and the patient RIGHT ankle swelling and inflammation of the joints was not included in the report. Therefore, the prison medical record is incomplete and does not reflect the patient’s state of health that I had the opportunity to examine on this day.
Blood pressure in the left arm 165/90 and in the right arm 160/90, heart rate 72, and respiration 16.
I was presented with a 54 year old white male looking 10 years older than his real age unable to walk without help, the patient has severe kyphosis of the spine and is unable to stand without help. During the examination the patient complained of pain in the spine, lumbar-sacral spine, shoulder and feet, abdominal pain, the right kidney pain. The patient also complained that he could not sleep because of such excruciating pain.
The patient’s complaints have also been reflected in the prison medical chart shown to me that was dated from March 16, 2008 to June 3, 2008. As seen from the chart, on June 3, 2008, there was an evaluation of the patient; the patient complained of the chest pain and was diagnosed with “Angina pectoris”.
The patient’s head, eyes, ears and neck reflect very poor oral hygiene, there are infected dental cavities and beginning of the cataract development in both eyes.
Chest: bilateral cracles and ronchi that decreased after cough.
Heart: normal heart sound, mild diastolic murmur and point of maximum impulse deviated to the left due to left ventricular hypertrophy as documented by the chest X-ray.
Abdomen: Bowel sounds are normal and non tender.
Extremities: severe swelling of the right foot and tophus of the third toe, the left foot has decreased pulse and severe deformity related to the diabetic neuropathy.
Neurological exam: cranial nerves peripheral neuropathy from diabetes and as documented in the medical record there is a positive Romberg sign. The muscle tone is reduced and there is evidence of muscle mass loss over a short term period.
Laboratories showed hypercholesterolemia, microproteinuria, hypocalcaemia and negative rheumatoid factor, the sedimentation rate was reported 20, no mention of Hba1c.
The patient appears to be very weak, has difficulty walking, his gait is abnormal, his right foot and ankle are severely swollen that causes him constant pain. Patient has discolored teeth due to the excessive use of tobacco – as he informed me, he smokes a lot in order to alleviate the pain.
4. Current Medical Treatment and Recommended Medical Treatment
According to the prison medical chart shown to me, the patient is treated with only ibuprofen and some ointment. The patient has developed a major complication from this medication such as gastric ulcer as documented by the prison doctor in the middle of April. This rudimentary treatment and obviously insufficient for the above described illnesses from which the patient is suffering. According to the medical history, the patient has been treated for about 15 years with lipitor, metformin, hydrocodone, flomax, bitalbutal, phentermine, requip and some others medications.
Therefore, it is imperative to resume the patient medications that were taken away before his incarceration and, more precisely, the patient’s pain will be best relieved with the same pain killers that were prescribed by his primary care physician as he did for the past fifteen years (eg. Hydrocodone, bitalbutal, phentermine and requip) these same medications are generally used in the USA for pain control by medical doctor prescriptions.
Having reviewed the medical literature, Journal of American Medical Association (JAMA) article of April 2nd 2008 and also article in the JAMA by Dr Steven E. Nissen and colleagues at the Cleveland clinic in OHIO, and consulted with other medical specialists, “the progression of coronary atherosclerosis in a severe complication of diabetes mellitus represent the ultimate cause of death in aproximatively 75% of the cases” that was also reported in the JAMA in 1999 by Doctor K. GU.
These same conclusions are reported by Doctor Philippe Gabriel Steg and Doctor Michel Marre: “cardiovascular events particularly acute myocardial infarction and stroke are the main causes of death in patients with diabetes”.
5. Conclusion
Upon review and comparison of the patient’s medical history, his chart from March 17, 2008 to June 3, 2008 and results of examination of the current condition of the patient, I can definitely conclude that the patient’s health is in a very poor state, his medical condition is rapidly deteriorating and having taken into consideration the current medical treatment which is clearly rudimentary and insufficient for these serious illnesses, Emanuel Zeltser may not survive his detention if his treatment is not resumed and all his pain killers that he was taking prior to his arrest as prescribed by his physician, are reinstated and available to the patient.
Albert Benchabbat, MD
Lev J. Paukman, M.D.
400 Avenue X
Brooklyn, NY 11223
(718) 376-6500
EXTREMELY URGENT!
May 13, 2008
TO: Mr. A. Lukashenka,
President, Belarus
RE: EMANUEL ZELTSER
Dear Mr. President:
Emanuel Zeltser has been under my medical care for over 20 years.
In my letters to Prosecutor General, Mr. G. Vasilevich of March 15 and April 10, 2008, I have advised him of my patient, Emanuel Zeltser’s serious health conditions, specified the necessary medications vitally important for his health, and clearly warned about complications that may result due to the lack of a quality medical care. As I understand, Emanuel Zeltser, for over 2 months has been deprived from the critically needed medications properly described by me in my previous letters to Prosecutor General, and has been denied the appropriate medical supervision.
I further understand that Mr. Zeltser’s investigation and detention have recently been extended with no court date in sight. Due to the above, I make another attempt to alert you, Mr. President, about Mr. Zeltser’s seriously deteriorated health conditions that, as reported by the US Embassy in Belarus, the US State Department, Amnesty International statements and the international press, has drastically deteriorated to the point of becoming a direct threat to his life.
The US State Department states: “During the visit on April 25, the consular officer from the U.S. Embassy noticed a significant physical deterioration of Mr. Zeltser’s health since the previous visit on March 27. Mr. Zeltser lost a considerable amount of weight and was very weak. Despite all efforts by the U.S. Embassy and his U.S. doctor to comply with prison procedures, Mr. Zeltser has not been permitted to take his required daily medications, which may be causing irreversible internal damage.”
Amnesty International Emergency Appeal Letter to President Lukashenka (copies to the Prosecutor General and Minister of Internal Affairs Naumov) dated May 8, 2008 states: “the US Consul, Caroline Savage, reported that Emanuel Zeltser’s health was failing, noting that he had lost weight, was very weak and had difficulty walking and talking, and that he had been beaten two or three times while in custody. Emanuel Zeltser suffers from Type 2 diabetes and a severe form of arthritis, for which he has been on prescription medication for over 15 years. A letter from his doctor to the Mr. President in Belarus states that without access to the appropriate medication Emanuel Zeltser may suffer "excruciating debilitating pain" and risk irreversible multiple internal organ damage.”
In addition, the US State Department advised me that the US request on April 25 to release Mr. Zeltser on humanitarian grounds has been completely ignored by the Belarus authorities.
I respectfully remind you, Mr. President that I warned the Belarusian authorities about such critical and irreversible conditions in my letters to Prosecutor General dated March 15 and April 10. There has been no reply to my communications and no apparent improvement in Emanuel Zeltser’ medical care other than his placement in the psychiatric facility that reminds me the shameful period of the Soviet era.
Mr. President, Emanuel Zeltser’s life is in imminent danger. I appeal to you again to do everything in your power to save the life of Emanuel Zeltser.
Sincerely yours,
Lev J. Paukman, MD 917 859 3153 Cell
Copy: Mr. G. Vasilevich, Prosecutor General
Copy: Mr. V. Naumov, Minister, Ministry of Foreign Affairs
Lev J. Paukman, M.D.
400 Avenue X
Brooklyn, NY 11223
(718) 376-6500
March 15, 2008
EXTREMELY URGENT!
TO: The US Embassy in Belarus
The Belarus Embassy in the USA
RE: EMANUEL ZELTSER
Gentlemen:
Please be advised of the following:
Emanuel Zeltser has been my patient for many years, and I am very concerned about his health. Mr. Zeltser suffers from diabetes, diabetic polyneuropathy, lumbosacral radiculopathy, gouty arthritis and other medical problems.
His medications are:
1. Metformin 1000mg once/day
2. Hydrocodone 10/325mg 4 to 6 times/day
3. Butalbital 30mg 3 times/day
4. Phentermine 37,5mg 3 times/day
Medication # 1 is for diabetes, and ## 2, 3 and 4 are for pain.
IMPORTANT: Mr. Zeltser will suffer debilitating pain if he doesn't take
the above medications regularly. It is vitally important to provide Mr.
Zeltser with the above medications.
Please do everything possible to release this very sick man; I don't believe he can survive detention.
Thank you very much.
Sincerely,
Lev J. Paukman, MD 917 859 3153 Cell
Lev J. Paukman, M.D.
400 Avenue X
Brooklyn, NY 11223
(718) 376-6500
EXTREMELY URGENT!
April 10, 2008
TO: Mr. Grigory Vasilevich, Prosecutor General, Belarus
RE: EMANUEL ZELTSER
Dear Sir:
Emanuel Zeltser has been my patient for many years, and I am very concerned about his health. Mr. Zeltser suffers from diabetes, diabetic polyneuropathy, lumbosacral radiculopathy, gouty arthritis and other serious medical problems.
I have advised the Belarus authorities, the US Embassy in Minsk, the
Belarus Embassy in Washington and the US State Department of the
necessary medical care and medications that are of vital importance to
Mr. Zeltser. The reports from the State Department and the US Embassy
in Minsk are frightening: Mr. Zeltser has been denied the medications
since his detention on
March 12. Due to the lack of medications Mr. Zeltser must suffer
excruciating debilitating pain. In addition, there is a real danger of
the irreversible multiple internal organ damage, the process that may
already be happening.
I, again, appeal to you to do everything possible to save this very
sick man. I don't believe he can survive Belarus detention.
Thank you very much.
Sincerely yours,
Lev J. Paukman, MD 917 859 3153 Cell