Boy weighing 714 grams

In Kaliningrad, the trial of doctors accused of killing the baby for the sake of statistics began. Their persecution is compared with the "Doctors' Affairs"

On August 6, in Kaliningrad, consideration began on the merits of the case of the former chief physician of the local maternity hospital Elena Bely and anesthetist-resuscitator Elina Sushkevich. They are accused of intentionally murder of a baby born premature. According to the investigation, the boy decided to kill, so as not to spoil the statistics of the hospital. Doctors do not admit their guilt, most of the professional community is expressed in their protection. And the head of the National Medical Chamber Leonid Roshal has already compared the process with the “doctors' affair”. At the request of the Medusa about the case and the beginning of the court, the journalist Ekaterina Medvedeva from the local publication Novy Kaliningrad tells.

Late in the evening of November 5, 2018, the 27-year-old Zamyakhon Akhmedov was urgently brought to the Kaliningrad hospital No. 4. The woman who had a miscarriage in the spring of that year was waiting for the child again - the gestational age was a little more than 23 weeks. She did not register with the consultation - she said, planned to leave to give birth to Uzbekistan in the fall. Akhmedova was observed with a familiar gynecologist in another hospital. During the next appointment, the doctor saw the threat of premature birth and offered Ahmedova to go to the hospital, but she refused. Then the medic set her a pessary . But the painful pain in the lower back and lower abdomen did not pass, and after a few days only intensified. I had to call an ambulance. It turned out that the woman had a birth.

Early in the morning of November 6, Ahmedova was born a boy weighing only 714.5 grams and a height of 32 centimeters. The child was immediately transferred to the intensive care unit. At about 8:20, an resuscitation brigade from the regional perinatal center (Russian Orthodox Church)-a nurse and an anesthetist-resuscitator (neonatologist) Elina Sushkevich arrived at the maternity hospital. According to the medic, the baby had very low blood pressure, shock, low temperature and severe anemia - it was impossible to take it to the perinatal center. “The condition of the child throughout the entire period remained extreme severity, it was unstable,” Sushkevich later said .

Zamirakhon Akhmedova said (her testimony is at the disposal of Medusa) that at about 9:20 she went to her ward and. O. The head physician of the maternity hospital Elena Belaya and took her to the intensive care unit to the child. According to her, the doctor said that the boy was unlikely to survive - and in any case he would remain disabled. In response, Akhmedova began to assure the doctor that she would never give up the child, and ask him to save his life.

A few hours later, Akhmedova, accidentally hearing the nurse’s conversation in the corridor, found out that her son had died. The woman had a hysteria, the doctors had to inject her sedative.

Detention in the hospital

On November 7, 2018, the head of the investigation department in the Central District of Kaliningrad received an anonymous call with the report that in the hospital No. 4 “doctors killed a premature newborn” - the case file states. On the same evening, investigators seized medical documents in the maternity hospital, interviewed the personnel and Akhmedov herself. She, according to Belaya, initially had no complaints against the maternity hospital, but after a conversation with the investigator she wrote a statement to the Investigative Committee.

A week later - November 15 - the White was detained in her office, and the next day the court sent her to a pre -trial detention center. Initially, a criminal case was instituted against the head physician about abuse of authority - the investigation believed that Belaya ordered the baby to injure the expensive drug Kurosurf . This version appeared due to the evidence of several employees of the hospital that Belaya allegedly gave instructions “to take all possible measures so that the child does not survive” and the discrepancies about the amount of the ampoules of the drug in the hospital. However, later it turned out that the drug was given to the child.

But besides this, in the history of Ahmedova’s clans, investigators found signs of falsification of documents: someone introduced information to them that the baby was born “without signs of life”, and information about resuscitation assistance disappeared.

The Governor of the region Anton Alikhanov and the head of the National Medical Chamber Leonid Roshal stood up for the White. A week after the detention, the court changed the preventive measure and sent the medic under house arrest. A few days later, the case was transferred to the central apparatus of the Investigative Committee of the Russian Federation.

Seven months later - in June 2019 - they detained the second person involved in the case - Elin Sushkevich. She was also sent under house arrest. Sushkevich was immediately accused of killing a child. The article of Belaya was also re -qualified - now she was accused of organizing the murder. According to investigators, Belaya persuaded Sushkevich to introduce the baby a deadly dose of magnesium sulfate . The investigation is sure: the head physician did this so as not to spoil the statistics of the hospital and create a “picture of successful work”. Both physicians categorically deny their guilt. Sushkevich claims that Magnesium did not introduce the child.

"Shortcomings in work"

The main witness of the prosecution is Tatyana Kosareva, head of the department of newborn maternity hospitals No. 4. She claims that on November 6, 2018, the head physician called her, obstetrician-gynecologist Irina Shirokoy, a resuscitator, Yekaterina Kiseel and the head of the maternity ward Tatyana Sokolova.

In the office, Belaya allegedly accounted for doctors for providing resuscitation assistance to the baby, who, in her opinion, had no chance to survive. The case file has a video of an excerpt of this dialogue made by Sokolova on a mobile. The decryption, which Medusa got acquainted with, says that in the video Belaya dismissively calls the “rescuers” of doctors who tried to help the child.

According to Kosareva, the head physician demanded to remake the magazine of childbirth and convince Akhmedov that her child was born dead. In Ahmedova’s history, the “ intranatal death of the fetus ”, which was seized by investigators, is written on another sheet, and a deeply premature boy was born on another sheet without signs of livestock. ” Irina Shirokaya admitted that she made edits in the documents under the threat of dismissal.

In addition, witnesses of the accusations described the boy’s death itself. According to Kosareva and Sokolova, in the morning of November 6, Belaya persistently asked Sushkevich that they were “doing with such children” in the perinatal center. She replied that they introduced Magnesia. Belaya allegedly demanded: “So you go and do! Have you heard me? ”

Then Sushkevich returned to the ward and once again checked all the indicators of the newborn. White entered there. According to the prosecution, after which Sushkevich took out the magnesium sulfate ampoule, gained the contents into the syringe and introduced the drug into the catheter on the baby's navel. The monitor began to show the reducing heart rate of the child, says the witness. After the drug, according to the investigation, the pressure dropped sharply, the heartbeat stopped, and the child died. Sushkevich denies that she introduced magnesium to the child.

“In your opinion, can a person who is nobody and nothing threaten to be a witness to the murder? Stand? Look? Silence? Do not call for help? Do not beat your hands? Do not scream: “What are you doing, will you kill him?” Can not provide assistance? Just watch how the child dies? If “maybe” - is it not an accomplice? Then why isn't he sitting next to me? ”Kosareva later commented on Sushkevich. The neonatologist uttered these words at a special briefing for journalists after approving the indictment in the case. After him, the court forbade her to communicate with the media and use the Internet.

Sushkevich herself tells another version of what was happening in the ward: 6.5 hours after birth, the child had a cardiac arrest, so Kosarev tried to reanimate it, but her heart massage did not help and the doctors stated death. Sushkevich filled out the necessary papers, where she noted the results of the inspection and all her appointments, but most of these documents were not attached to the case. Belaya and her lawyers emphasize that Sushkevich was not a subordinate head physician of the maternity hospital-and she could not give her orders or somehow crush her.

Belaya believes that Kosareva is trying to hide the possible “shortcomings in his own work” with his testimony when assisting the boy and shift responsibility to others.

Lawyer Timur Marshani, representing Belaya's interests, drew attention to the fact that at the end of 2018 Kosareva gave completely different evidence, but they did not enter into an indictment. For example, then Kosareva did not say that Magnesia was introduced to the child, as well as the fact that the doctors allegedly tried to organize the murder of the baby. “The man turned 180 degrees and accepted the position of the investigator, who initially declared us his belief that in the hospital and the perinatal center of children they were“ drowned in buckets ”and this practice is everywhere widespread throughout Russia,” the defender says. Marshani is sure that the investigation pressed Kosarev to get such evidence.

In addition to the circumstances of the boy’s death in their testimony, Kosarev and other employees of the maternity hospital give characteristics of white as a leader. They describe it as an imperious, ambitious and emotionally unbalanced person - most colleagues had a stretched relationship with her. “As a leader, she is very demanding,” explained Nikolai Ivanaev Executive Director of the Medical Chamber of the Kaliningrad Region. “Maybe this exactingness served as the reason why the employees opposed the Investigative Committee against her.”

Strange examination

The first forensic examination of the boy’s body was held at the Bureau of the SME of the Kaliningrad Region. On December 6, 2018, the expert concluded that the child was born alive, and death occurred as a result of respiratory disorders - diseases of the hyalin membranes . The document noted that “the baby is non -viable,” as evidenced by the immaturity of organs and tissues.

In June 2019, experts who conducted a second examination said that the findings of the Kaliningrad expert on the “non -viable” of the child were made on the basis of outdated ideas about the criteria for the survival of newborns. The commission of doctors with the participation of the chief freelance neonatologist of the Ministry of Health of the Russian Federation Dmitry Ivanov conducted a comprehensive forensic medical examination. It is on its results that the current accusation of Belaya and Sushkevich is built in many respects.

In conclusion, it is emphasized that for the baby "the probability of a favorable outcome was quite high." However, according to the All-Russian Society of Neonatologists, the probability of survival of newborns with the same indicators and without severe complications around the world does not exceed 5-10%. In the UK and the USA, for example, medical organizations usually do not recommend starting the active resuscitation of children born before 22 weeks, considering it more humane. However, in 2011, Russia adopted the recommendations of the World Health Organization, according to which infants need to be nursed from 22 weeks with a weight of 500 grams - but not every Russian maternity hospital has the opportunity to cope with this task .

“An extremely premature child weighing 700 grams is difficult to consider completely viable, since mortality in such children is high in the world, and survivors often have severe, including neurological disorders. Moreover, very few years ago in the USSR, and then in Russia, they did not at all attribute the death of a child weighing up to one kilogram to the causes of infant mortality. He died and died for natural reasons, ”said Leonid Roshal and added that in the Kaliningrad maternity hospital a baby“ essentially in an agonal state ”was born.

But the main thing is that experts found a large amount of magnesium in the newborn bodies. Moreover, the “deadly” (according to the conclusion of the examination) the concentration of magnesium was found not only in the liver, but even in the stomach and kidneys. This indicates, according to the members of the commission, about the “pathological (toxic) accumulation” of the element in the body and its ingress there shortly before death.

For example, a concentration of magnesium ions “at least 20 times higher than the permissible content of the newborn in the blood serum” was found in the child’s kidney. Experts cannot be such indicators, if a woman during pregnancy simply took drugs with magnesium and did not introduce magnesia during childbirth. “Consequently, Magnesium entered the body of Akhmedov after his birth by intravenous administration ... The cause of death is acute parental poisoning by magnesium sulfate,” the commission members came to the conclusion.

However, Sushkevich disputes such conclusions. She claims that the chemical expert mistakenly concluded about the excess of doses-since he compared the indicators of the newborn with the indicators of an adult. In the literature used by the commission, according to a neonatologist, there is no data on the toxic or lethal dose of magnesium either for children or adults. A neonatologist, citing scientific studies, emphasizes that the magnesium content in the tissues of a deceased child (about 400 μg/g) was 1.5 times lower than those values ​​that were recorded in the body of other babies who died for various reasons.

Anna Karpova, who was involved in the case as an independent researcher, agree with the colleague with a colleague as an independent researcher. She believes that the level of magnesium indicated in the examination is characteristic of such a gestational age. “It turns out that the physiological features in some strange way experts interpreted as toxic doses. Although toxicity is discussed when the level in the blood is determined - and this child has no one in the blood of magnesium. The recalculation of its level from the organs does not have any scientific basis, ”said Karpova Medusa.

The doctor also noted that she raises questions that experts ignored the presence of a high concentration of other elements in the child’s organs: “Zinc, copper and iron are increased, but they say nothing about them. And this is also a physiological feature of the human body in this intrauterine age. ”

At the same time, the autopsy of the child was carried out only on the fourth day after his death, and a spectrographic study - after five months. “Experts say that we can get true data only if this study is carried out within an hour or two after death, but not in five months,” says Leonid Roshal.

The petitions of the lawyers Sushkevich and Belaya to conduct another expertise, as well as on the introduction of the opinions of independent specialists to the case materials, were rejected.

"Frontied prepositions to give a motive"

The defenders of the doctors also doubt the motive indicated in the indictment. Allegedly, the doctors wanted to record the baby “stillborn” so as not to spoil the statistics of infant mortality.

In a conversation with Medusa, Timur Marshani emphasizes that in neither the regional nor the Federal Ministry of Health has adopted a single document that would establish the dependence of statistics on children's mortality in maternity hospitals with an assessment of the effectiveness of their work. “These are far -fetched prepositions that were needed to give a motive,” says Marshani.

In turn, the Deputy Minister of Health of the region Natalya Berezdovets in its testimony in the case admitted that the deterioration of mortality indicators affects the assessment of the work of maternity hospitals and the perinatal center. And employees of the institutions can be brought to disciplinary liability if those "could not go out of the child."

“This is generally a negative assessment of the work of the institution and the leader, that is, the more deaths, the, of course, worse,” the birch bark testified. “Of course, cases of early neonatal mortality are the most serious.”

In this case, we could talk about the statistics of the most maternity hospital, Roshalnoted , but not the perinatal center. “And if the acting chief doctor of the maternity hospital asked to really define him as a stillborn and fake the history of the disease, then she should answer this by law, but this has nothing to do with the“ murder of a child ”,” he emphasized.

Negative statistics of infant mortality can be reflected on the performance of the regional Ministry of Health, but not a separate medical institution, neonatologist Anna Karpova believes. She emphasized that the Minister of Health is responsible for statistics and his subordinates - the heads of medical institutions - also strive to improve it. “That is, statistics are primarily important,” the medic said. - But infant mortality does not depend only on the maternity hospitals and chief doctors of the maternity hospitals. The same mortality in the first year - it depends on the pediatric service, on the clinic, on children's hospitals, on a heap of any organizations, it depends on obstetric care, on everything. ”

Карпова полагает, что улучшать показатели любой ценой никто из медиков не стал бы — тем более, что один случай смерти новорожденного статистику на уровне целой области не испортит: «У административного должностного лица такой интерес присутствует, но он крайне мал — не до такой степени, чтобы за это в тюрьму идти».

#яЭлинаСушкевич

В защиту калининградских врачей развернулась масштабная общественная кампания. Большинство акций проходят в поддержку именно Элины Сушкевич. Например, Леонид Рошаль считает, что подделка медицинских документов по требованию Белой доказана.

Как только стало известно о задержании и аресте Сушкевич, в ее поддержку выступило Российское общество неонатологов. Обвинение медиков в убийстве главный детский реаниматолог Минздрава Сергей Степаненко назвал абсурдным: «Это идиотизм полный. We can talk about medical errors; а то, что обвиняют в убийстве, преступном сговоре — это полный бред». Губернатор Калининградской области Антон Алиханов выразил надежду на справедливые следствие и судебное разбирательство.

Представители фонда помощи недоношенным детям «Право на чудо» запустили в соцсетях акцию солидарности с хэштегом #яЭлинаСушкевич, а сотрудники калининградского перинатального центра выстроились у стен медучреждения и под вой сирен карет скорой помощи и хором прокричали «Я — Элина Сушкевич».

«У людей, которые работают в медицинской отрасли, не укладывается в голове это дело. Мы не знаем, что там на самом деле происходило, но мы склонны верить нашей коллеге, которая говорит, что она этого не делала. Мы все хорошо знаем Сушкевич — она характеризовалась, как очень грамотный специалист. Она всегда старалась максимально помочь», — поясняет Карпова.

Летом 2019 года по всей России в поддержку Сушкевич прошли уличные акции. Петиция с требованием объективного расследования дела на Change.org на данный момент собрала более 247 тысяч подписей.

В поддержку калининградского медика высказались и зарубежные неонатологи. Например, профессор кафедры педиатрии в Колумбийском университете и Колледже врачей и хирургов в Нью-Йорке Ричард Полин, считает, что у ребенка изначально не было никаких шансов выжить. «Этот младенец умер бы в любом учреждении в любой стране мира», — заявил Полин.

Леонид Рошаль дажепопросил президента Владимира Путина «внимательно посмотреть» на дело врачей. Ранее к главе государства обратилась и Региональная врачебная палата. Отвечать на упреки медицинского сообщества в том, что Следственный комитет сфабриковал дело пришлось лично главе ведомства Александру Бастрыкину, который заявил, что доказательств вины врачей достаточно. В ответ на это Рошаль сказал, что председателя СК «просто подставили» следователи, занимавшиеся делом .

О том, что в стране надо менять подход к вопросу выхаживания недоношенных младенцев российские врачи говорят уже давно. «Есть так называемая „серая зона“ — это дети, рожденные на 22-24 неделе беременности. Во всем мире таким детям рекомендована паллиативная помощь, у нас же — обязательное выхаживание. Хотя мировая статистика показывает, что ни один рожденный на 22-недельном сроке младенец не выживает. На 23 неделях выживаемость составляет всего 6%, и все 100% из них остаются инвалидами», — поясняет главный внештатный неонатолог Минздрава в СКФО Алексей Мостовой.

Как показали результаты опроса Российского общества неонатологов, 87% врачей испытывают тревогу в связи с судебными процессами над медиками, а 94% признались, что не чувствуют защищенности в своей профессии. Например, очень схожее с калининградским уголовное дело врачей рассматривалось в 2015 году в Калужской области — там судили троих медиков, также обвиняемых в смерти младенца из-за нежелания портить статистику. Следствие настаивало, что врачи намеренно не стали реанимировать новорожденного. Одного из медиков суд приговорил к двум годам колонии условно, двое были оправданы.

«Все неонатологи боятся прессинга со стороны Следственного комитета и примерно половина неонатологов готова уйти из профессии, если будет негативный приговор для Сушкевич и Белой, — говорит Мостовой. — Детей со сроком менее 24 недели рождается достаточно много и они не отличаются особой жизнеспособностью. Так, например, любой родитель, которому не понравится, как на него доктор посмотрел или еще что-то, может обвинить того во всем, в чем угодно. Следственному комитету останется выполнить свою работу».

«Восстановить события шаг за шагом»

6 августа дело Элины Сушкевич и Елены Белой начали рассматривать по существу. Вердикт по нему вынесет коллегия присяжных. В основной состав вошли 8 женщин, в числе запасных — двое мужчин.

При этом два свидетеля обвинения — медиков из роддома, где до родов наблюдалась Ахмедова — выступали без слушателей в зале. Заседание прошло в закрытом режиме, так как озвучивались подробности медицинских осмотров и лечения. Защитники медиков не исключают, что процесс могут полностью закрыть. Адвокаты предполагают, что процесс закончится не раньше, чем через два месяца.

«Дело не о врачебной ошибке. Белая и Сушкевич обвиняются в совершении циничного преступления — умышленного убийства малолетнего ребенка», — выступая перед присяжными подчеркнула прокурор Анна Ефремова. Адвокат матери умершего ребенка Лариса Гусева придерживается той же позиции — по ее словам, женщина убеждена в виновности медиков.

Адвокат Камиль Бабасов в свою очередь заявил, что защита категорически не согласна с такой позицией: «Чудовищность обвинения не должна вводить вас в заблуждение. Вы — судьи факта… В предстоящем судебном процессе мы постараемся шаг за шагом восстановить события с 5 по 7 ноября 2018 года. И вы, также как и мы, убедитесь, что не было никакого убийства».

Ekaterina Medvedeva