The case in a process

Death in the hospital. The Case of Ekaterina B.

2 April 2020

Names were changed for ethical reasons.

On 31 March 2017, Ekaterina gave birth to her child by caesarean section at the Yoshkar-Ola Perinatal center. The birth was successful, but the next morning the woman died on the operating table. Tragic accident or medical staff negligence? The investigation has lasted for years. In search of justice, Ekaterina's family applied to human rights defenders of the organization "Man and Law".

The inaction of the doctors

On 17 March 2017, Ekaterina went to the Republican Perinatal center to the department of pregnancy pathology. She was 35 weeks pregnant and carrying twins. The doctors diagnosed a "threat of premature birth". On 28 March, Ekaterina was diagnosed with an incorrect location of one of the foetal. It was decided to perform a caesarean section.

On the morning of 31March, Ekaterina was transferred to the maternity ward. The operation by caesarean section was performed by an obstetrician-gynecologist A. E. At the end of the operation, a healthy boy and girl were born. Blood loss in a woman in labor during surgery was assessed by the doctor within the normal range. The happy mother was shown her children. She called her mother, telling her that she had given birth. Lyubov asked her daughter to tell her brother Sergei about the good news. Ekaterina replied: "As soon as I get back on my feet, I'll call".

However, about an hour and a half later, Ekaterina called her mother in a panic, saying that she had strong blood secretions. Lyubov comforted her daughter, saying that doctors were nearby, they would help her. "Go to church, stand and pray for me," Ekaterina begged. This was the last conversation between mother and daughter.

Doctor A. E. examined the patient immediately after the operation at 09: 15 and estimated the amount of blood loss as moderate. Then he did a check-up 45 minutes later at 10:00, and then at 11: 50. According to the protocol of cesarean section treatment, the examination of the woman in labor should be performed every 20-30 minutes for two hours after the operation. Violation of the frequency of examinations led to a late diagnosis of uterine bleeding.

For almost two hours, Ekaterina remained without medical supervision and bled to death. Within a few hours, she lost 20% of her circulating blood.

In the afternoon, doctors began conservative treatment, while with such a significant blood loss, surgery was necessary. The chosen form of treatment was ineffective, so at 16:00, the obstetrician-gynecologist A. E. decided to amputate the uterus without appendages to stop blood loss. All subsequent medical manipulations were an attempt to resuscitate Ekaterina. However, they did not bring a positive result. On the morning of 1 April, Ekaterina died on the operating table.

Violating the Federal law "on the basics of health protection of citizens of the Russian Federation", medical staff performed the operation to remove the uterus without concluding consent to perform the operation with the patient or her relatives. Trying to protect himself, the doctor forged a voluntary agreement to perform the operation on behalf of Ekaterina and attached it to the medical history of the deceased.

Protracted investigation

On 10 May 2017, the Investigative Committee for Mari El Republic opened a criminal case on the death of Ekaterina in the Yoshkar-Ola maternity hospital. The criminal case was conducted under two articles: forgery of an official document (article 327 of the criminal code, part 1) and causing death by negligence due to improper performance of professional duties by a person (article 109 of the criminal code, part 2).

However, the investigation process was suspiciously delayed. The mother and brother of the deceased, realizing that the investigation had reached a dead end, asked for help from human rights defenders of the organization “Man and Law” to bring the perpetrators to justice.

In February 2018, human rights defender Sergei Poduzov prepared a request for additional forensic examination on behalf of the victims. The Investigative Committee granted the request. The examination was carried out in the Bureau of forensic medical examination in Khanty- Mansiysk, as a result of which no violations were found in the actions of the medical staff of the perinatal center. However, the initial examination from August to October 2017 was conducted by employees of the same institution. Moreover, contrary to the investigator’s decision, experts from Mari El Republic were involved in the examination.

On 7 May, Ekaterina’s relatives got acquainted with the results of the next examination, which excluded the guilt of medical staff. And on 10 May, the investigator promptly closed the criminal case, despite the fact that the fact of forgery of an official document by the doctor A. E. had been established.

Sergei Poduzov together with Ekaterina’s relatives again appealed the decision to terminate the criminal case and achieved its cancellation. Since the autumn of last year, the investigation was resumed at the level of the Investigative Committee of the Republic of Mari El and a third forensic examination was appointed. This time the examination was conducted in the Novokuznetsk clinical bureau of forensic medical examination of the Kemerovo region. It lasted almost six months. This time, the experts found violations.

Experts found that the negligence of medical staff had taken place even at the stage of observation of the patient: not the full scope of the examination, the need for prenatal hospitalization. But it was negligence in the examination after the cesarean section operation that led to heavy bleeding. Failure to provide medical aid became one of the causes of Ekaterina’s death.

Despite the fact that the doctor's guilt had been established on both charges against him, on 6 August 2019, the Investigative Committee for Mari El Republic closed the case on the basis of the expiration of the Statute of limitations for criminal prosecution. However, the investigator did not consider the possibility of reclassifying two minor crimes (forgery of consent to perform an operation and causing death by negligence) to a medium one – negligence.

On 25 August, the human rights defender together with Ekaterina's relatives once again appealed the decision to terminate the criminal case. They demand to reopen the criminal case and charge the obstetrician-gynecologist with negligence resulting in the death of a person (293 of the criminal code of the Russian Federation, part 2), as well as to bring to disciplinary responsibility employees of the investigative department for ineffective and untimely investigation of the case.

For more than two years, the employees of the investigative department conducted a preliminary investigation. Without constant complaints from victims, the investigation did not progress. The evidence of guilt was overlooked.

It is hard for the family to go through the sudden death of Ekaterina. Her mother and father have lost their health, and now they live alone in the countryside, because they can't bear to see young girls walking with their children. "No one will ever cure the heartache that is in my heart after the death of my daughter," writes Ekaterina's mother. Nevertheless, she does not give up hope of achieving a fair trial.


New round of the case

In March 2020, the Yoshkar-Ola city court of the Republic of Mari El issued a decision on compensation for non-pecuniary damage to Ekaterina’s mother in the amount of 400 thousand rubles.

The investigative department of the Investigative Committee of Russia for Mari El Republic issued a decree to eliminate actions that led to the crime by the official person that caused the death of a person. The decree contained a list of violations committed by the Republican Perinatal center. It was sent to the Ministry of Health of Mari El Republic for further elimination of violations.

Human rights activists plan to appeal the decision of the Yoshkar-Ola city court regarding the amount of compensation for non-pecuniary damage.

“If you look at the case-law of the European Court of Human Rights for similar violations, at least 20 thousand Euros are collected. For our Republic, 400 thousand rubles is a fairly large amount, – says human rights activist Irina Protasova. "But in general, if we take into account the case-law of compensation for non-pecuniary damage in connection with the death of a person, which occurred due to improper performance by medical workers of their official duties, in this case, such compensation is not enough”.