Reasoning diagnosis
At the disposal of “Kommersant” was the reasoning of the decision of the court in the case of the head of the Hematology service of the Moscow city clinical hospital No. 52 Elena Mishurina. The document contains details which are earlier in the discussion of the case were not disclosed. In particular, the procedure that the court considered the cause of death of the patient, was flawed “methods, tactics and technology” made by Mrs. Misurino in a private clinic, the CEO of which is her husband, and in medical documents absent the voluntary informed consent of the patient. At the same time, contained in document forensics say that the patient’s death could have been avoided if not for a series of medical errors after his hospitalization.
We will remind, Elena Mishurina convicted January 22, 2018, according to the article 238 of the criminal code — services that do not meet safety requirements, and entailing by negligence the infliction of grievous bodily harm or death. In 2013, Ms. Misurina made 55-year-old patient diagnostic procedure — trepanobiopsy. Four days later the man died. In the summer of 2013 Alexander Bobkov discovered adenocarcinoma of the prostate, in July-August of the same year it was planned the operation under the quota. According to one of the daughters of the patient (the document was handed to “Kommersant”, without specifying the names of the participants in the trial) to make free trepanobiopsy (bone marrow puncture), “had to wait” so that “the father decided to do a spinal tap on a paid basis in the company “Genotechnology””. CEO of the clinic is Andrey Misurin, the husband of a convicted hematologist. In court, he pointed out that more than ten years working as head of laboratory Department of the Russian oncological center named after Blokhin.
Trepanobiopsy MS Misurina spent in the clinic OOO “Genotechnology” July 25, 2013. From the sentence that it imposed, a biopsy needle “in the rump, not in the crest of the right Ilium”, “breaking the technique, the tactics and technique of trepanobiopsy”.News
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The nurse, as noted in the sentence, “did you see where the needle came in”. Her testimony about what the needle was introduced into the sacrum, the court “regarded as an effort to help Elena Mishurina to avoid responsibility for their actions because it works the treatment the sister company “Genotechnology” for a long time knows Misurina and is interested in the outcome of the case”. “After trepanobiopsy Alexander Bobkov for another 30-40 minutes under its observation, stated in court Elena Mishurina, the words of which are quoted in the judgment.— Bleeding he had, no complaints were expressed, he was given advice and he went to work in a satisfactory condition”.
According to the testimony of colleagues of the patient, “at 10:30 Alexander Bobkov arrived at work, felt bad, saying that sore buttocks and leg. The chief let him go home, but he left only at 16:00, as I didn’t want to lose a working day”. The patient’s daughter also reported that on the evening of the day of the procedure he complained of pain in the area of the puncture and the stomach. According to the testimony of the widow Valentina Bobkova, along came the ambulance, she reported that her husband had trepanobiopsy, “but the doctors did not react, said that a suspected appendicitis, and was hospitalized in KB № 3”. Recall, clinical hospital No. 3 (the former hospital № 47 on Michurinsky Prospekt, 56) had belonged to sue “Medical Control center of Affairs of the mayor and government of Moscow”, after the consolidation of the PMG and JSC “Group of companies “Medsi”” came under the control of the group and took patients, in particular in OMS. Now the hospital is closed, in its place build a residential complex.
Mr. Bobkov took the surgeon on duty said in court that he had conducted a primary inspection, palpation, “found a small infiltration (seal.— “B”) in the inguinal region”, “the Situation was as the state of the tumor disease. At the time of the initial examination reliable signs of bleeding was not pulse and pressure were normal, emergency surgical intervention was not required”. On the morning of 26 July the patient was examined by another surgeon and patients computed tomography: “it Was revealed the damage to the branches of the right internal iliac artery, a large hematoma, the decision on call vascular surgeon and the surgery”. Was caused surgeon from Moscow hospital № 1 im. N. I. Pirogova (in difficult cases doctors special teams of vascular surgeons may cause any Moscow hospital) to do the surgery, the surgeon of the group assisted him. The patient’s daughter reported that when they with the mother after the call of the father arrived at the hospital, he was transported to the operation: “He said to his mother: “Val, she stabbed me””. Both surgeons said that during surgery found “a hematoma volume of more than two liters of blood in the pelvis”. “The Protocol operation damage (blood vessels.— “”) Are not reflected because they were not seen and if to look for them, you can hurt even more”, — the document says. The doctor says that “by the color of blood and the intensity of bleeding were observed leakage of venous and arterial blood from the pelvic venous plexus. Also discovered the flow of arterial blood from the channel of the upper gluteal artery”. According to the surgeon, “meds”, “after the operation Bobkov was transferred to the intensive care unit, was in serious condition, he developed DIC (disrupted blood clotting.— “”)”. 28 Jul 2013 the patient died.
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An autopsy was performed at clinical hospital № 1. It did the doctor-pathologist at clinical hospital № 1, who worked part-time in KB № 3 JSC “Group of companies “Medsi””. The opening was also attended by the surgeon of the group, his assistant in surgery. At the autopsy the coroner found “in the sacrum, close to the rear upper iliac crest trail from trepanobiopsy 0.2 cm”. “The results of the pathologist concluded that the death was caused by severe bleeding from damaged blood vessels of small pelvis after trepanobiopsy, — stated in the testimony of the witness.— Vascular pathologies that would lead to spontaneous bleeding, not detected”. The document notes that photos and video recording of the autopsy was not performed “due to the lack of technical capabilities”.
Elena Mishurina the court stated that “trepanobiopsy did the right thing”: “to get to the sacrum, it is impossible in connection with the anatomical structure of man, as the sacrum is the iliac bone”. According to her, in case of entering the needle into the sacrum “the patient came to the strongest pain syndrome”.
In the sentence contained the results of two sudmedekspertiza. The first was completed on 31 July 2014. Experts conducted a repeated forensic-histological study and found that “damage to blood vessels formed as a result of a single mechanical impact diagnostic needle”, “signs of spontaneous rupture of blood vessels do not exist”. According to their findings, “available at Alexander Bobkov disease (diabetes insipidus, adenocarcinoma of the prostate and chronic myeloproliferative disease) did not matter in the event of death.” Experts believe that the provision of medical care to the patient in CB # 3 was underrated facts made of trepanobiopsy and complaints of abdominal pain, is not considered clinical manifestations of bleeding (weakness, dizziness) and mandatory methods of instrumental diagnostics (abdominal ultrasound). “Correct diagnosis at admission of the patient to the hospital and timely surgical intervention could prevent a lethal outcome”, — the document says. Almost the same conclusions are contained in results of examination of 14 October 2015: experts believe that the “meds” to “inadequate and untimely” was held “infusion-transfusion therapy” (blood transfusion), the patient was also late was connected to the ventilator.
The verdict is the test results of the territorial body Roszdravnadzora across Moscow and Moscow region LLC “Genotechnology”, according to which the medical records of the patient Alexander Bobkov is no voluntary informed consent to medical intervention. The document also has testimonies of representatives of the medical community. The medical examiner of the Center of medical and forensic studies said that in the act post-mortem examinations “does not describe the precise localization of the trace of trepanobiopsy”. Chair of the Department of Hematology and Transfusiology of the Russian medical Academy of continuing professional education, academician Andrei Vorobyov said that “if a trephine had hit an artery, would be whistling the blood stream and the patient would immediately lose pressure.” He believes that “the disease, the patient, could cause spontaneous bleeding and the development of DIC in no way connected with trepanobiopsies”: “If upon admission to the emergency Department of the KB No. 3 Alexander Bobkov did an ultrasound, then treatment could begin earlier and fatalities could have been avoided”.
Nikita Aronov, Valeria Mishina