A criminal case against a hematologist Elena Mishurina became one of the first and most high-profile cases in the “iatrogenic” campaign of the Investigative Committee. The medical community was outraged by the harshness of the sentence – initially, the doctor was sentenced to two years in prison – and its lack of validity. The Moscow city court in April overturned the conviction and sent the case back to the Prosecutor for elimination of violations, but in early August it was started again. In the first extensive interview after the resumption of the case Elena Mishurina examines in detail its medical component, shares with “Provera” reflections on the criminal process and plans for clinical hospital No. 52 of the Department of bone marrow transplantation.
Elena Mishurina. Photo: Pavel Smertin / miloserdie.ru/
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I had to drop all charges
In April all were delighted — it seemed that the story of your business is finished.
— In April, it was not over. On April 16, the Moscow city court ruled to return the case for further investigation, stating that all the evidence was presented by consequence, inaccurate, not scientifically justified, and the motives are not specified. According to the order of Moscow city court I had to drop all charges, to remove a house arrest, to conduct new investigative actions, appointed by the court, the forensic examination, and the results of these data to decide who to blame.
Unfortunately, it turned out otherwise. The case was resumed, made in the UK. No investigation is not conducted, but it was written a decree on the appointment of new expertise, where I again appear as the accused.
Naturally, this has caused me issues — why this is so, where pursuant to the regulations of the Moscow city court? On this background there were letters from public organizations concerned about what is happening, as a result, the case was taken under control. And I hope that now everything will be according to the law.
— Took control refers to the Investigative Committee (SK)?
— In mass media there was news that the case will be under the control of the management of SK and transferred to another Department SK across Moscow. Officially out yet no one contacted me.
In your defense, were many medical experts, their comments and ratings were not taken into account and added to the case?
— Unfortunately, the opinions of experts and officially received by the attorney, was not attached the result, all these petitions were rejected. During the trial the conclusions of the international experts was attached to the case materials, but no one listened, they considered not credible.
— A recognizance not to leave with you still not taken?
— No, not removed. I unless free. When you consider that it is fifth year, of course, it prevents to live and work.
We want to become one of the best haematological centres in Russia
— In parallel with the judicial process after all and went to work on a new branch? You may be in the hospital Department of bone marrow transplantation (BMT)?
— We planned to open it a little earlier, but given all these circumstances, the project has moved about six months. We hope that in September-October this year and will be able to open two new departments: bone marrow transplantation and hematological intensive care.
This project started a few years ago, with the support of the Department of health of Moscow and the hospital administration managed to make a modern renovation and equipping of office equipment, which is required for providing high-quality care to patients in the field “Hematology”. Today was the last touches.
I hope in the near future we will be able to move to these offices and we will have more opportunities to treat patients. Now we perform autologous stem cell transplantation, and the new office will allow for allogeneic BMT. And I hope that the good pace, which we took to transplant now, we’ll proceed.
Hematological intensive care is one of the most important offices for centers or hospitals that deal with high-dosage chemotherapy, is another approach to patients.
From hematological patients receiving high dose chemotherapy in post-course period, joined by a variety of infections and can have serious complications, the risk of critical States. And the task of hematological intensive care is to prevent the development of these critical situations, the right to “hold” the patient, which will allow it to save.
After opening these branches, we can say that the structure of the Department of health of Moscow you can now perform any high-tech medical assistance to oncohematological patients, this will greatly increase the overall and disease-free survival of these patients. And we will try to be one of the best haematological centres in Russia.
I had to prove that the Earth is round, and not stands on three pillars
After the April decision of the Moscow city court was whether it’s easier or more comfortable to come to work?
— I always like to go. As for the internal sensations associated with the criminal case, which lasts for the fifth year, they are classified as pleasant can not be attributed. Of course, thoughts and experiences about this take time, distract from work and normal life. Especially frustrating to prove the obvious things that are clear to any doctor, I would compare this with the proof that the Earth was round, and not stands on three pillars.
Of course, all this takes energy, time, emotions. But this situation exists already in parallel with my main life. And not to lose heart, to reduce the rate and cancel tasks. I have a certain promise for the development of the Hematology service, the leadership of the hospital, in front of colleagues who came with me on this project, and of course, the patients who have entrusted us with their health.
For 2017 medical care in Hematology at the hospital received 3758 patients, and at the opening of new branches, the number would increase.
— How patients react to this story when she got such a response?
All said, we support you, we are with you. Many ask me a question: “Elena, why did you so all stood up?” I don’t know, but I can assume that the absurdity of the charges and, in principle, the impossibility of development of this sequence of events in a patient affected this caused a response of caring people and their reaction after making me an unfair sentence.
The absurdity of the events to understand even the people far from medicine.
The more I am surprised by the forensic scientists who put their signatures under the findings, the meaning of which does not fit with the anatomy and physiology of the human basis of medicine and the nature of the flow of certain diseases. And in support of their position they cite the arguments that can not be attributed to a scientifically sound and reliable.
– Could you give an example of such arguments?
– Here’s an example, understandable to anyone: someone “cut” his wrists — all the people about a situation know. Can a person with that kind of damage to live without medical care for two days? No. And in a situation with me refers to the damage to the artery of the patient when the blood is not oozing, but gushing.
Or another example: on the battlefield wound in the artery, without emergency medical aid person can live two days? If you take physiology, a man with a wound to the upper right of the gluteal artery will not live more than 17 minutes. But from the case I know that after a patient allegedly caused by me wounded artery independently drove a car, worked all day and then came to the hospital where he was operated 18 hours after admission to the hospital. It is almost two days from the date of the alleged injured artery. Very odd arterial bleeding.
But experts in addition to wrongly argue that in addition to the injured artery of the patient and damage to the pelvic venous plexus. However, the pathologist could not specify what it was exactly, because he believes that he is “not supposed to know.” Except for the alleged injuries of arteries and veins, the patient had a serious hematologic disease in the stage of progression of leukemia, which was accompanied by DIC-syndrome. With all of the above data, this patient would not have lived after damage arteries and venous plexus more than seven minutes.
The following data discrepancy, probably more for medical professionals: for the prosecution of massive blood loss is confirmed by the description of CT of pelvis, although pictures nobody saw. According to the description of CT was a big haematoma – it should correspond to the loss of 50% of the whole circulating blood of the patient, the shock index of 1.54. It third degree bleeding is extremely severe, when the patient should be in intensive care and it needs to be treated, and he was in the General surgical ward and no help had been provided to him. That’s what alerted.
And if you calculate the index of the shock at the same time, based on the General analysis of blood (hematocrit — 38, hemoglobin 134 g/l) and ECG data (where a fixed pulse 68 beats per minute), it was 0.72. This indicates the absence of bleeding, all changes fit into the progression of hematological diseases. The question arises: how the patient according to various sources at the same time the index of the shock may be of 1.54 and 0.72? Moreover, the shock index of 0.72 recorded objective data from the medical history of the patient, and a 1.54 on the description of CT scan without pictures. Where is the truth?
Do forensic scientists can not calculate the index of the shock? Why the emergency physician with a doctorate, working dozens of years in the Department, subscribe to the fact that the index of the shock of 0.72 corresponds to massive blood loss in the third degree? Can’t you see from history that the blood loss occurred during surgery (loss of hemoglobin 130 g/l to 53 g/l), but not when the patient performed a lumbar puncture and when he entered the hospital?
Expert resuscitator does not know how to treat hemorrhagic shock, which occurred during surgery? How can a patient in hemorrhagic shock is to withdraw from artificial ventilation of the lungs? How can a patient in shock with blood pressure 80/40 mm Hg. article to be without inotropic support? Is it possible to stop the bleeding in a patient with disseminated intravascular coagulation syndrome without transfusion of fresh frozen plasma? Is it possible to make such blood loss without Central access (a special catheter)?
And imagine, according to experts, such “omissions” doctors of the clinical hospital 3 “meds” did not affect the outcome of the disease! And formulation of diagnosis — iatrogenic damage to the vessel — in medical history appears on the first day of patient admission to the clinic, although iatrogenic nature can only be set when performing the autopsy. And it did not cause any issues? It is unclear why the famous surgeon, doctor of Sciences, Professor, works in the famous city clinic, subscribe to the fact that fine-needle biopsy and sampling of autograft from the iliac bone for reconstructive operations on the spine is the same, and complications are the same.
At trial, the medical examiner said, “I’m not in the circus, nothing will not tell”
– How did you respond to these arguments, the experts at the trial?
– The following question is asked in court: who has seen a damaged artery? Ask the operating surgeon saw? — No answers. Ask the pathologist about the wound: if he had seen the autopsy of the damaged artery? In response to hear: no, I should not have been injury to find. And what happens? With the wound of an artery of the patient to live such a long time could not, injured no one saw evidence of massive blood loss on the description of the CT scan, to put it mildly, fall apart.
A logical question arises: why, with lethal outcome in a private clinic, which lacked a license to pathological activity, and at the diagnosis of “iatrogenic injury of the artery” was not a forensic medical autopsy? All such cases at that time was regulated by the orders of the Department of health of Moscow No. 354, of the Ministry of health No. 82 of Federal law No. 323.
Another question: in the clinic the person died, where the target examination of insurance company? All fatal cases of OMC shall be subject to such examination is the quality of medical care. As an insurance company paid KB # 3 – “meds” the autopsy of the body of the patient, given the lack of a license to autopsy activity? I doubt very much that the insurance company went on this kind of violation. And the insurance company even knew about a fatal case in this patient? For some codes, health and economic standards of Bureau No. 3 of the group filed the case for payment to the insurance company? You know, things didn’t add up, and no one wants to fold it.
On the court, I ask the coroner — what was the course of the wound channel, because it is not specified in the documents? It’s a normal question, which was of interest not only to me but also to the prosecution. The medical examiner says to me: “I’m not in the circus, anything and will not show”. Is this normal? Is this acceptable?
And when we try to paint the likely course of the wound channel — how it follows from the Protocol of autopsy and forensic scientists confirm that the iron needle was to go right inside the bone, inside the bone then turn left about 90 degrees, re-pass, turn 180 degrees, and in the end — of the hoof.
— A gutta-percha, the needle turns.
—This is only the tip of the iceberg of all the issues and inaccurate data in this case is not listed.
I think the truth we already know
— Is it possible now to understand what really happened?
— I think that is impossible, the truth we’ll never know. Can truthfully say only that I came to the patient, it was performed a puncture, it was observed by me about an hour, then went to work. No complaints or ill-being during the follow-up, the patient was not.
And that patient died, I found out six months later, when I received the invitation to visit the UK. Everything that was happening with the patient after, I can only speculate, and only on the medical documentation which was presented to CB # 3 – “meds”. And to the contents of this documentation raises many professional issues.
When you write history, you make all the valid data — what happens to the patient. And when all the rules filled history of the disease gets to the experts, they can restore the entire clinical situation by the minute, to find the error and understand what was happening with the patient. In my opinion, in this situation, too many inconsistencies and direct contradictions in the medical records and the testimony of doctors.
— How your colleagues reacted to this new turn of Affairs?
— Many thought that justice is done, and here — again a new round started. At the moment, the result again is on the beaten path. Colleagues concerned. It is not pleasant. I’m sorry that I and other physicians with that face injustice as much became.
— Your family, your children reacted to the resumption of the case?
— All experience. Nobody wants a repeat of the situation.
— And your husband?
—He is also experiencing. Especially because we so thoroughly for 4.5 years already learned everything, see the whole absurdity of the accusations in my address. But we have to move forward. Endlessly because this can’t last.
— Do I understand correctly that your colleagues and friends and this time would you support?
— I hope so. I want to believe it. Supporting me, my colleagues support, I guess, because my place could be any doctor. Of course, I do not want anyone else to go through what I had and still have to go through. I want to believe in a just future and that there will be a balance between the medical community, patients, the legal framework and power structures.