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(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. Ipractice 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 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 Zeltserwho is currently in custody of the Belarus authorities in the KGB prison in Minsk, Belarus. Present were a KGBinvestigator, Belarus Doctor Yuri Michael Prozenko and interpreter Vladimir. Representatives of the US Consulateand 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 Prozenkoand the local interpreter.
The prison medical report is quite incomplete and is missing important medical information such as the patient painand suffering from debilitating gout and spondylosis. The weight is not recorded, the glycosilated hemoglobin fordiabetes follow up was never performed and the patient RIGHT ankle swelling and inflammation of the joints wasnot included in the report. Therefore, the prison medical record is incomplete and does not reflect the patient’s stateof 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 patientcomplained of pain in the spine, lumbar-sacral spine, shoulder and feet, abdominal pain, the right kidney pain. Thepatient 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 fromMarch 16, 2008 to June 3, 2008. As seen from the chart, on June 3, 2008, there was an evaluation of the patient; thepatient 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 andbeginning 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 leftventricular 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 severedeformity related to the diabetic neuropathy.
Neurological exam: cranial nerves peripheral neuropathy from diabetes and as documented in the medical recordthere is a positive Romberg sign. The muscle tone is reduced and there is evidence of muscle mass loss over a shortterm period.
Laboratories showed hypercholesterolemia, microproteinuria, hypocalcaemia and negative rheumatoid factor, thesedimentation 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 severelyswollen that causes him constant pain. Patient has discolored teeth due to the excessive use of tobacco – as heinformed 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 theprison doctor in the middle of April. This rudimentary treatment and obviously insufficient for the above describedillnesses from which the patient is suffering. According to the medical history, the patient has been treated for about15 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, moreprecisely, the patient’s pain will be best relieved with the same pain killers that were prescribed by his primary carephysician as he did for the past fifteen years (eg. Hydrocodone, bitalbutal, phentermine and requip) these samemedications 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 2008and also article in the JAMA by Dr Steven E. Nissen and colleagues at the Cleveland clinic in OHIO, and consultedwith other medical specialists, “the progression of coronary atherosclerosis in a severe complication of diabetesmellitus represent the ultimate cause of death in aproximatively 75% of the cases” that was also reported in theJAMA in 1999 by Doctor K. GU.
These same conclusions are reported by Doctor Philippe Gabriel Steg and Doctor Michel Marre: “cardiovascularevents 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 andresults of examination of the current condition of the patient, I can definitely conclude that the patient’s health is in avery poor state, his medical condition is rapidly deteriorating and having taken into consideration the current medicaltreatment which is clearly rudimentary and insufficient for these serious illnesses, Emanuel Zeltser may not survivehis detention if his treatment is not resumed and all his pain killers that he was taking prior to his arrest as prescribedby his physician, are reinstated and available to the patient.


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