AMSTERDAM, Netherlands – Slobodan Milosevic defied doctors' orders to quit smoking and took unauthorized medication smuggled to him in prison, a U.N. war crimes tribunal report into his death said Wednesday.
In the most complete survey of events leading to the former Yugoslav president's death in March, the report cleared U.N. authorities of giving inadequate medical care, and said the fatal heart attack probably could not have been prevented.
Milosevic's brother disputed the report, saying the tribunal "bears responsibility for my brother's death" because it "denied him the opportunity for treatment." The tribunal rejected Slobodan Milosevic's request to see a heart specialist in Moscow.
The report by the tribunal's vice president said special privileges accorded to Milosevic compromised security at the U.N. Detention Unit, enabling him to receive nonprescribed medications.
It called for a review of prison procedures and access to medical records, now protected by Dutch confidentiality laws.
The Serb leader was found dead March 11 in his cell near The Hague. He was defending himself against 66 counts of genocide, crimes against humanity and war crimes during the Balkan wars.
The report by Judge Kevin Parker provided a detailed survey of Milosevic's medical record since he was extradited to the U.N. Detention Unit in June 2001, already suffering from high blood pressure and a list of other coronary ailments.
Even then, his Belgrade physician warned U.N. doctors that Milosevic was at high risk of a stroke or a sudden heart attack.
The account lent some support to accusations by the prosecution during Milosevic's trial that he was manipulating his medical regime to gain time in preparing his case.
It cited Milosevic's cardiologist and two independent doctors as advising that heart surgery was unnecessary, but it quoted a Moscow doctor as disagreeing with that opinion.
"In these circumstances it cannot be concluded that there was a failure to provide proper care," the report said.
It said the tribunal had consulted outside physicians on Milosevic's treatment. The court also had twice reduced the trial schedule and had repeatedly called lengthy adjournments to allow him time to rest from the stress of conducting his own defense.
"Having regard to these matters, proper care was taken by the tribunal in the provision of medical care to Mr. Milosevic during his detention at UNDU," it said.
"On a number of occasions, Mr. Milosevic refused to accept the advice of his treating doctors," it said. "He refused to take some prescribed medications and varied prescribed dosages of others. He also self-medicated," the report said, citing evidence of other drugs found in his cell and in his blood.
"On occasions, he refused to be tested or refused to be hospitalized," it said.
In 2004, an inspection of the office Milosevic used to prepare for trial uncovered unauthorized drugs and a bottle of whisky, its normal metal cap replaced by a plastic cap to evade the metal detector, it said. The drugs were found in an envelope brought by one of Milosevic's legal aides, Dragoslav Ognjanovic, it said.
But Borislav Milosevic dismissed the claim that his brother was self-medicating. He also said an independent panel of doctors in November diagnosed his brother as having a cardiovascular condition that needed urgent treatment.
"He wasn't receiving a due medical treatment," Milosevic told The Associated Press. "They only gave him pills from hypertension and ignored the fact that his illness was rooted in a cardiovascular condition."
The 42-page report was the latest of several official investigations into Milosevic's death that began with the autopsy by independent Dutch pathologists. They concluded that Milosevic died of natural causes, dismissing allegations by his family and some supporters that he had been poisoned.
Earlier in May, a Swedish panel that audited conditions at the detention unit in Scheveningen, a suburb of The Hague, recommended a review of some administrative and security issues but found no fault with the medical facilities or treatment of detainees.
The tribunal's internal inquiry, ordered immediately after Milosevic's death, faulted the guards who discovered Milosevic for first calling the jail's commander rather than the medical officer.
It also found that some information on Milosevic's health was blocked by Dutch confidentiality laws. It disclosed that one specialist who examined Milosevic was hauled before a Dutch medical review board in 2004 after he provided his report to the judges without the patient's consent. The proceedings were later dropped.
Parker's report said more than 60 people were interviewed for the investigation, including all the detainees in Milosevic's cell block, and doctors in Serbia, Russia, Belgium, France and the Netherlands.