‘State prosecutors don't like losing’

The Kaliningrad murder case driving Russia’s neonatologists out of the field

Story by Katerina Orlova. Abridged translation by Sam Breazeale.

On September 6, the Moscow Regional Court sentenced two Kaliningrad doctors — Yelena Belaya and Elina Sushkevich — to 9.5 and 9 years in prison, respectively. The women were charged with deliberately killing a premature baby to keep their hospital’s official infant mortality rate low. They were originally acquitted by a jury in their home region back in 2020, but when the Russian Attorney General's Office took issue with the verdict, the case was transferred to Moscow, where the doctors were found guilty. Meduza tells the story of a ruling medical professionals say will be disastrous for the quality of Russian healthcare.

On November 6, 2018, in Kaliningrad’s Maternity Hospital No. 4, an infant died just hours after being born. The 714-gram (1.6-pound) baby was the son of 27-year-old Zamirakhon Akhmedova, a citizen of Uzbekistan who was 24 weeks into her pregnancy when she gave birth. The baby was transferred to the NICU immediately after birth, and a team of medical workers was soon (though not immediately) called in from the regional perinatal center. One of those workers was anesthesiologist-resuscitation specialist Elina Sushkevich.

According to Sushkevich, the baby showed symptoms of shock and had low blood pressure, a low body temperature, and severe anemia. She prescribed him the appropriate medications “according to protocol” and oversaw his treatment, she said, but the infant’s condition only worsened. Six and a half hours after being born, he died.

Later that month, the Russian Investigative Committee opened a criminal case against Yelena Belaya, the maternity hospital’s acting head physician, for allegedly abusing her power. One year later, they escalated the charges, accusing Belaya of organizing the baby’s murder and Elina Sushkevich of carrying out her instructions.

Investigators alleged that Belaya, seeing that the baby would likely die soon and not wanting to bring down the hospital’s official infant mortality rate, decided to kill the baby herself and change the birth record to make it appear as though he had died in the womb. As an additional motive, they cited her alleged desire to preserve hospital resources and medications. They claimed Belaya instructed Sushkevich to give the baby a fatal dose of magnesium sulfate and that Sushkevich complied, ultimately stopping the baby’s heart.

The prosecution’s key witness was Tatyana Kosareva, the head of the hospital’s neonatal ward, who claimed to have heard Belaya admonishing doctors for trying to resuscitate the baby when he no longer had any chance of survival. According to Kosareva, Belaya demanded that the birth record be edited and that the baby’s mother, Zamirakhon Akhmedova, be told the baby was stillborn. The birth record, which was seized by investigators, does indeed have “intranatal fetal death” written in the entry for Akhmedova’s baby, and obstetrician-gynecologist Irina Shirokaya claimed to have amended the document under pressure from Belaya, who she said threatened to fire her.

But even for jurors willing to believe investigators’ claims about Belaya’s alleged motives (though the head physician has denied benefitting from the boy’s death in any way), Elina Sushkevich’s alleged participation immediately raised questions in Kaliningrad, where she had long enjoyed a shining reputation. First of all, Sushkevich wasn’t Belaya’s subordinate, so Belaya didn’t have the power to give her orders. Secondly, the magnesium sulfate detail didn't appear until a second expert examination found elevated magnesium levels in the baby’s body, months after his death. Not only did the first examination not find heightened magnesium levels, it also found that the baby was “non-viable” due to the immaturity of his organs and tissue. Sushkevich believes the chemist who performed the second analysis made a mistake by using adult indicators to assess a newborn baby.

After the case was opened, the doctors were put under house arrest. Meanwhile, their colleagues and former patients launched a campaign in their support. Russian National Medical Chamber president Leonid Roshal spoke out in favor of the doctors, saying he was “ready to be put in a detention center” for Elina Sushkevich. The women gained support from other doctors, too, including toxicologist Galina Sukhodolova, neonatologist Dmitry Degtyarev, and Distinguished Physician of Russia Nikolai Volodin.

In 2019, the Right to a Miracle Foundation, which provides support to premature babies, launched an online solidarity campaign with the hashtag #IAmElinaSushkevich. Supporters of the initiative posted on social media, and some even gathered outside of the hospital, chanting “I am Elina Sushkevich!”

Former patients whose babies were saved by Elina Sushkevich launched their own support campaign. Many shared their stories with the hashtag #ElianSushkevichIsMyDoctor. “She surrounded our little girl with such tenderness, rejoicing at every gram of weight she gained. She wouldn’t let us, the parents, lose faith, but at the same time she didn’t get our hopes up with empty promises. If you ask me, those are exactly the kinds of doctors we need in our medical centers: competent, professional ones who haven’t lost their humanity and their sensitivity to patients,” wrote one former patient.

‘They want the trial held here, where they have influence’

The doctors requested a jury trial, and in 2020, a jury convened at the Kaliningrad Regional Court. In December of that year, jurors voted to acquit the women, ruling that there was insufficient evidence to establish a crime. That’s when the Attorney General's Office got involved, successfully filing an appeal and getting the verdict overturned. The appeals court claimed that because the case had provoked such a public uproar, the jurors could have been influenced by media coverage.

In the petition Deputy Attorney General Igor Tkachev sent to the Russian Supreme Court, he claimed that the defense had enlisted “pseudo-experts in infant mortality” to influence public opinion in the region, and that holding the retrial in Kaliningrad could lead to the “destabilization of the sociopolitical environment.”

“I think the prosecution just doesn’t like to lose,” said Andrey Zolotukhin, Elina Sushkevich’s lawyer. “They wanted to transfer [the case] here [to Moscow], where they know they have influence.”

The Supreme Court granted the Attorney General’s request. The Moscow Regional Court was chosen as the new court venue, and the doctors were put in a special detention facility so that they wouldn't be able to “put pressure on the jurors.” “It’s easier for the judge when people are held in detention. It’s like you know they’re right here, in jail. They won’t cause any problems,” said Zolotukhin.

The lawyer also alleged judicial bias:

I can’t exactly say that [the judge] sided with our opponents, because he started out on their side. He constantly reprimanded the defense in front of the jury, claiming we were trying to sugarcoat what the defendants did. He gave his opinion on their decision not to testify, and he told the jury which evidence to pay attention to. We immediately encountered direct resistance here [in Moscow] — not from the prosecutor, but from the judge. Meanwhile, the prosecutor essentially didn’t object to anything for the entire trial, because he knew the judge would do that for him.

In August 2022, jurors in the Moscow Regional Court found Belaya and Sushkevich guilty. The prosecutor requested they each be sentenced to 13 years in prison.

‘This kind of trial happens once a decade’

It’s rare for doctors to be charged with intentionally killing a patient by interfering with treatment in Russia. Outside of the Kaliningrad case, there are only two examples on record: one in Russia’s Kaluga region and one in its Altai Krai. In the Altai Krai, doctor Anatoly Demchuk and NICU head Alexey Katashev were charged with conspiring to kill an infant as well as with abuse of authority. Their case was heard by a jury, which acquitted the doctors. After that, Russia’s Attorney General appealed the sentence and sent the case for a retrial. Once again, the doctors were found innocent.

“The Sushkevich case is a unique one. Usually, when doctors overlook something and it has serious consequences, they’re charged with negligence. But in this case, they’re specifically being [accused] of deliberate murder. It’s something completely new,” said lawyer Andrey Zolotukhin.

Medical lawyer Yulia Kazantseva, who’s been working on these types of cases for 14 years (usually representing the injured party), agreed. “Cases like Sushkevich happen only once a decade,” she said.

Elina Sushkevich’s lawyer, Andrey Zolotukhin, said he had no doubt his client would be given a jail sentence — and he assumed it would be about 15 years. “By law, the judge can reject the jury’s verdict, acquit the defendant, send the case back [to the prosecution], or dissolve the jury and call a new one. But in our case, it was clear the judge would convict,” he said.

Multiple Russian neonatologists have left the field as a result of the Kaliningrad case. Members of the Russia Neonatologists’ Society warn that the case will have serious consequences for Russian medicine as a whole:

Every year, the number of “medical” criminal trials goes up. Working as a doctor is becoming downright scary. It’s become easier to left the medical profession altogether than to try to try to save the lives of people who are in critical condition, because if you fail for reasons that are out of your control, you’ll be interrogated by investigators who are trained to find serial killers but who, for obvious reasons, have no medical knowledge. When that's the approach they take with doctors, the quality of Russian healthcare is unlikely to improve, and the personnel shortage (which many regions, including the Kaliningrad region, are currently suffering from) will get worse.

“I’m not ashamed to look into the eyes of my mother, who brought me up all by herself, raising me to be an honest person, and who managed to give me the best possible education. My mother knows that she raised a doctor — not a murderer,” Elina Sushkevich said in her final statement before her sentence was announced.

Story by Katerina Orlova

Abridged translation by Sam Breazeale