“They denied Caesar’s and began to put pressure on his stomach”: what is the former head of the former 27th maternity hospital accused of

On Wednesday, February 5, the Presnensky District Court of Moscow extended the house arrest of Marina Sarmosyan, the former head of the maternity hospital at the S.K. Spasokukotsky (formerly maternity hospital No. 27). Since the end of 2019, the Investigative Committee has been conducting a case of negligence (Article 293 of the Criminal Code of the Russian Federation) in relation to Sarmosyan. She and the heads of all departments of the maternity hospital lost their posts after the appearance of a Muscovite Tatyana Bengraf on Facebook. The woman claimed that her daughter and three other newborns were injured due to the lack of professionalism of doctors. RT tried to understand all the details of this high-profile case.

On February 5, the Presnensky court of Moscow extended house arrest by the former head of the branch maternity hospital at the State Clinical Hospital named after S.I. Spasokukotsky (former maternity hospital No. 27) to Marina Sarmosyan until March 17. A decision was made to dismiss Sarmosyan and the heads of all departments based on the results of an internal audit, the capital Department of Health said on December 6 last year. The department indicated the revealed “improper performance of official duties” as a reason. The IC charged Sarmosyan with negligence (Article 293 of the Criminal Code of the Russian Federation) and the provision of services that did not meet security requirements (Article 238 of the Criminal Code of the Russian Federation), and on December 8, the court sent a doctor with more than 20 years of experience to two months in jail. Later, the measure of restraint was changed to house arrest.

“He became an incurable disabled person”

“I had good tests, the child was healthy and full-term, but the baby became an incurable disabled person. Doctors used too aggressive methods. An overdose of epidural anesthesia was allowed (when the pain medication is administered through a catheter into the epidural space of the spine. - RT ). At some point, when the birth was delayed, several doctors at the time of the contractions pressed their hands on my stomach, from the ribs down. As I later found out, this is a forbidden technique. My Olivia now has various diagnoses - a whole page, ”Tatyana Bengraf told RT. Muscovite gave birth at the end of 2018.

In addition to Bengraf, three more families turned to the UK - they all consider themselves affected by the actions of the employees of the hospital.

“During childbirth, my wife got an infection. Because of this, the child began meningitis - although the tests already at discharge were bad, and the doctors had no right to just let my son go. They were required to conduct additional examinations and start injecting antibiotics. Now my child is in a coma, doctors say that he will not be able to survive, ”Muscovite Kirill Yudin told RT.

The rest of the stories of parents are similar. Pregnancy passed without problems, the tests were good, we went confidently to the former maternity hospital No. 27. Moreover, the place’s reputation is excellent - there are a lot of positive reviews on the Internet.

Something went wrong during the birth itself. The child did not come into the world for a long time, the doctors, as women in labor say, either chose too aggressive tactics for assisting with childbirth, or committed violations (they could have caused an infection, as Yudin said). And in all cases, parents talk about postpartum diseases in infants.

Each story is literally drowning in a host of medical nuances and terms. In order not to get confused in all these specific things and better understand the possible guilt of the doctors, we tried to analyze the details that are important for understanding separately.

Cesarean section

“I had a rather large fruit. When concluding a contract with a doctor, we agreed that we would not risk it and for any deviations we would go for surgery. However, during childbirth, all my requests were ignored. As a result, I had to give birth in a natural way, even when it became clear that the baby turned incorrectly, which is dangerous and threatens with birth injuries. I am sure that the doctors refused a cesarean section so as not to spoil the statistics. Maternity hospital No. 27 has a high percentage of natural births. This is considered a good indicator. And for superfluous cesarean, the manager understands with obstetricians, ”Tatyana Bengraf told RT about her version of the incident.

Other women in labor who wrote the statement agree with the opinion of the Muscovite. Women are sure that if they had a cesarean section, then complications could have been avoided.

However, RT doctors interviewed by doctors do not share the position of women in labor.

“Doctors don't make decisions just like that. For different cases, there are clinical recommendations. Same thing with cesarean section. Women do not have surgery just at will. There are indicators at which a cesarean section is performed. If a woman does not gain the necessary indicators, then she gives birth herself, ”explained Lyubov Erofeeva, obstetrician-gynecologist, expert of the World Health Organization, RT.

“If labor has begun, then a cesarean section can only be done at the very beginning. If the head has already lowered down, then the operation cannot be performed, the woman will have to give birth to the end, ”added the obstetrician-gynecologist of the Scientific Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakova Julia Kubitskaya.

Apparently, Bengraf did just that. At first, there was not enough evidence for Caesarean, and when the child, as Tatyana says, “turned a little wrong,” it was too late to operate.

But could doctors initially make a decision not to spoil the statistics (according to the UK, in the 27th maternity hospital, 13% of deliveries occur in a caesarean hospital, and 30% on average in Moscow)? Experts do not believe this. Indeed, a large proportion of natural births in the 27th maternity hospital is the result of how the system of maternity hospitals in Moscow is organized. They are divided into three categories in the capital.

The first category includes large perinatal centers where doctors are ready to take the most complex births and deal with pathologies in infants.

The second category is the maternity hospital with large hospital complexes. Here they are ready to take a difficult birth, but nevertheless the treatment of pathologies in infants is not a clinic profile.

Third category: detached maternity hospital.

Maternity hospital at the State Clinical Hospital named after S.I. Spasokukotsky (which everyone continues to call the 27th maternity hospital from old memory) belongs to the second category.

“If the doctor foresees complications during childbirth, he is very likely to send the expectant mother to the perinatal center. Therefore, it turns out that in places where the best equipment is narrow specialists, most operations are carried out and infants are more likely to find diseases. And in separate maternity hospitals there are good statistics of natural births, because mothers who have no difficulties are expected to go there, ”Yerofeyeva explained.

The expert added that Moscow should not be taken as a statistical example at all. Women in labor from all over the country come with complicated cases.

Abdominal pressure

This is the scariest detail in the scandal with the former 27th hospital. Doctors, according to Tatyana Bengraf, during difficult births with their hands pressed on the stomach, literally pushing the baby out of the mother. She is sure that because of this, her child became disabled.

What could be rational reasons for such rude actions? Perhaps here lies a medical error?

“Attempts have been going on for at least 40 minutes, when it became clear that the child is not moving forward. I was denied a cesarean section and began to put pressure on my stomach to squeeze the child out. They looked at the CTG apparatus (cardiotocography, shows the baby's heartbeat. - RT ) and squeezed out during the fight. This happened 5-6 times in 10-15 minutes. The pressure didn’t help - the child who got stuck in the birth canal had a heartbeat. Then the doctor, using a vacuum extractor, pulled the child by the head. She wheezed and died, there was no heartbeat, ”Tatyana Bengraf told RT.

The girl was resuscitated.

The obstetrician-gynecologist Lyubov Erofeeva, whom we asked to comment on the actions of her colleagues, explained that such actions are called "obstetric aggression."

“Pressure on the abdomen during childbirth was prohibited back in the early 90s because of the high risk of injuring the baby,” Erofeeva says. “But why did the doctors do this now?” This is an extreme measure in difficult births. It happens that doctors used all available methods, medications did not help, labor is weak, the child has been standing in a certain position for a long time, and you can’t do a cesarean section. Then doctors can press on the bottom of the uterus to help the baby move. This is a risk that a doctor can rarely take. ”

The problem is that if the natural birth cannot end in any way, then the doctors do not have many “legal” methods. The child needs to be taken out somehow and now they use vacuum extraction for this (they refused the obstetric forceps with which the fetus is pulled by the head) almost everywhere. A suction cup is inserted into the uterus, which is tightly pressed to the baby's head to create negative pressure between it and the cup of the device, and then the doctor carefully pulls out the baby. In some cases, an episiotomy is also performed (a perineum is cut with a scalpel to a woman). So in the end they did with Tatyana Bengraf. But vacuum extraction is also a risk. The child is not protected from injury.

Medical error or statistics?

Employees of the maternity hospital at the State Clinical Hospital named after S.I. They try not to comment on the reason for dismissing the reasons for dismissing the previous leadership, but they are gently explaining to new women in labor that there is nothing to fear.

“No, nobody presses on our stomach during childbirth. Doctors do everything in accordance with clinical recommendations. Including, this means that cesarean section is performed only with medical indications. At the request of women in labor, we do epidural anesthesia - it removes pain and improves uteroplacental blood flow during childbirth, ”Irina Burenkova, obstetrician-gynecologist of the maternity hospital, told RT.

Asked by RT about whether something had changed in the work of the institution with the appointment of a new leadership, Burenkova said that "everything remained virtually unchanged."

Many doctors actively stood up for colleagues from the former hospital №27.

Leonid Roshal, president of the National Medical Chamber’s Union of Medical Associations, called the situation “a blatant case.”

“The chief doctor under the article“ Negligence ”is fired from the post because in her maternity hospital for six thousand births one newborn died and three received some complications. This is medicine, this is disease. We are not gods. The fact that children die in maternity hospitals and have complications - all over the world this is, this is not an emergency, ”Roshal said in a comment to RIA Novosti.

According to obstetrician-gynecologist Julia Kubitskaya, the success of childbirth is only 50% dependent on the actions of doctors. The nature and health of the mother are no less important than all modern medicine.

Obstetrician-gynecologist Lyubov Erofeeva generally believes that success depends on the doctor during childbirth only by 20-30%.

“It so happens that pregnancy is going well, and deliveries are not easy. Doctors do not have much information about the condition of the child before childbirth: we know his heartbeat, we can evaluate movement, muscles, bones. But that’s all. There is always a risk during childbirth, ”says Erofeeva.

In Russia, 31.5% of newborns fall ill or are born sick (data from the Ministry of Health for 2018, meaning full-term and premature babies weighing more than 1 kg). In the statistics of the ministry, a table listing the diseases of infants occupies sheet A4. But, for example, “cerebral status disorders”, like Tatyana Bengraf’s daughter, occur in 6% of cases. The death of newborns in obstetric units occurred in 0.1% of cases. Moreover, directly from birth injuries, they died in 0.001% of cases.

“In my experience, in most cases after a difficult birth, the parents blame the doctors for everything. On the forums on the Internet there are many stories about the alleged mistakes of obstetricians. I can say for sure: often doctors are unfoundedly accused of doctors, ”said Lyubov Erofeeva, obstetrician-gynecologist.

A comprehensive forensic examination should distinguish a true medical error from a statistically probable injury to a newborn. It is still not posted. So far there is only the testimony of parents who, not being experts, blame the doctors for everything, as well as the testimonies of doctors who, while denying their guilt, may try to cover up the mistake.

Why was Sarmosyan arrested?

Tatyana Bengraf and other parents of the affected children more than once during the summer of 2019 complained about the actions of obstetricians of the maternity hospital at the State Clinical Hospital named after S.I. Spasokukotsky. The Department of Health and Roszdravnadzor conducted checks on the actions of doctors. In a conversation with RT, Tatyana Bengraf stated that she received “formal replies” from officials based on these checks.

Kirill Yudin received a response from the Department of Health (RT has a copy), which says that doctors are innocent of the meningitis of his son. The insurance company, at the insistence of Yudin, checked the treatment of the child.

The expert’s conclusion is contradictory: “the quality of the medical care provided is inadequate”, but at the same time “the defect in medical care did not affect the health status of the insured person”.

Marina Sarmosyan’s lawyer Gevorg Dangyan agreed to read part of the conclusion of the examination of Roszdravnadzor without handing the document to the RT correspondent: “When assisting, there were no medical errors that could have a direct causal relationship with the illness and complication of the child (Olivia, daughter Bengraf. - RT ). "

The lawyer said that the examination of Roszdravnadzor still mentioned shortcomings in the work of obstetricians of the former 27th hospital. There were questions about the hypothermia procedure - after giving birth, Olivia’s head was covered with ice in order to reduce the possible damage to the nervous system from a difficult birth.

Be that as it may, the inspection of Roszdravnadzor on the complaint of Tatyana Bengraf was held in April 2019. But Marina Sarmosyan lost her job much later, after the appearance of Tatyana's post - she wrote it in late November (the dismissal took place, recall, in early December). Moreover, the criminal case, according to Bengraf herself, was opened on October 14. Apparently, they said goodbye to Sarmosyan because of a wide public outcry.

Everyone left of their own accord

Now it is not clear whether the doctors made mistakes or not. Parents of the affected children posted scans of medical documents on the Internet, which, presumably, were corrected. Was it a clerical mistake or criminal intent, the investigation will now find out.

It is unclear why the UK sought the arrest of Marina Sarmosyan through the court. There is no evidence of guilt confirmed by experts. The indictment says that Sarmosyan “did not properly monitor the provision of medical care.” At the trial, the investigator stated that the former head of the hospital could commit new crimes or put pressure on witnesses.

The doctors dismissed from the former 27th maternity hospital were also given the opportunity to write statements of their own free will - lawyer Sarmosyan and the parents of the injured children told RT about this detail. That is, doctors were not dismissed under the article for gross errors discovered by the audit, as it could be.

The Moscow Investigative Committee commented on the investigation almost a month after the resignation of doctors:

“Citizens began to turn to the investigative units of Moscow and the Moscow region in connection with the improper provision of medical care in a medical institution during delivery, which resulted in indelible consequences for the health of babies. Currently, investigators are thoroughly investigating all the circumstances of what happened in the framework of the criminal case under investigation. Numerous appeals of citizens can not leave anyone indifferent. At the same time, we adhere to objectivity - a comprehensive forensic medical examination has been appointed and is being carried out, to which the best experts from Moscow and federal units have been involved, ”said Vladimir Menshov, deputy director of the first department for the investigation of especially important cases of the capital’s headquarters of the UK, on the official channel of the department in Youtube

Marina Sarmosyan spent almost two weeks in a pre-trial detention center - on December 19, 2019, the court again, at the request of the investigator, transferred the obstetrician to house arrest.

The arrest and prosecution had a bad effect on the defendant’s health, said lawyer Gevorg Dangyan to RT. In mid-January 2020, a woman was hospitalized due to serious leg problems. She practically stopped walking, the defender emphasizes. Now she was discharged, she is at home. According to doctors, the legs failed because of nerves, the lawyer said.

The Moscow Department of Health declined to comment on the RT Sarmosyan case. Doctors who conducted tests on the instructions of the city also do not make contact with reporters.

But, according to fragmentary information, we believe that the medical community insists on the innocence of Marina Sarmosyan.

Forensic examination should clarify a lot. With a lack of verified information from official sources, it’s still too early to clearly talk about someone else’s fault.