When he arrived in the courtroom, Whelan said he had been injured by the jail guards and was in pain. Judge Yelena Kaneva of the Lefortovsky District Court eventually summoned an ambulance crew, who examined Whelan and said there was no need to treat him. He has a hernia, and his lawyers have argued that it has been exacerbated in jail.

After the medics were through, the hearing resumed.

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Whelan, an ex-Marine who holds passports from four countries, was arrested in his room at the Metropol Hotel in Moscow in late December. He had come to Russia on a tourist visa. His defense lawyers have argued that a flash drive containing “state secrets” was planted in his pocket. So far, no evidence against him has been presented in court.

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At the end of the hearing, Kaneva extended the arrest until the end of October. One of Whelan’s lawyers told the Interfax news agency that he expected an indictment to be filed within a few weeks.

As reporters were being shooed out of the courtroom, Whelan, standing in the usual barred defendant’s cage, quickly read out a statement he had prepared. “I’m innocent of any charges,” he said. “No crime ever occurred. There is no evidence of a crime. This is a setup. Isolation continues in order to force a false confession. Medical care for injuries inflicted by the FSB in prison has been refused.” The FSB is Russia’s security service.

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He also said that “full consular access has been denied.”

His sister, Elizabeth Whelan, later wrote in a tweet: “It was indeed a tough day for Paul Whelan and he looks quite unwell. He needs treatment — and not by the prison doctors — and more importantly he needs the countries of which he is a citizen to work harder for his release and return to Novi, Michigan.”

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Late in the day, the U.S. Embassy here announced on Twitter that it had requested urgent consular access to Whelan “to speak with him about serious statements about his health. The health and well-being of American citizens abroad is our top priority.”