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APPENDIX 26. Conclusions given by forensic medical examination:
Written by Administrator   
Ïÿòíèöà, 29 Äåêàáðü 2006

26.1. Letyago, Alexandra Nikolayevna

MINISTRY OF HEALTH, RUSSIAN FEDERATION

Establishment name – SME Bureau (Forensic Medical Examiners)

Committee of Health, Moscow

Address: ¹ 12 Svitsev Vrazhek

C O N C L U S I O N

(of the examination of the materials relating to the case)

# 148

On the basis of the resolution by investigator of extremely important cases, bureau of investigation of organized crime and murders, Moscow city attorney general’s office, Attorney 2nd class A. E. Bebchuk, dated December 25th, 2002, from February 17th to 25th, 2003, a commission of forensic medical examiners met on the premises of the bureau of forensic medical examiners, Moscow city health committee, including:

V. V. ZHAROV, chief of the bureau of SME, Moscow KZ (forensic medical examiners, Moscow city health committee), distinguished physician of the Russian Federation, doctor of medical sciences, and professor with over 40 years of service.

V. I. ALISIEVICH, professor and chair of the department of forensic medicine RUDN (Russian University – Friendship of Peoples), distinguished man of science of the Russian Federation, doctor of medical sciences.

E. A. DAMIR, professor and chair of the department of anesthesiology and resuscitation RMAPO (Russian Medical Academy of Postgraduate Education), distinguished man of science of the Russian Federation, doctor of medical sciences.

I. E. PANOV, deputy chief of the bureau of SME, Moscow KZ, master of medical sciences, more than 40 years of work of a highly qualified category.

V. K. VASILEVSKIY, deputy chief of the bureau of SME, Moscow KZ, more than 30 years of work of a highly qualified category.

F. Z. SIROTINSKIY, department manager of the commission of forensic medical examiners, bureau of SME, Moscow KZ, more than 40 years of work of a highly qualified category.

The above commission carried out a forensic medical examination

of matters relating to case initiated after the death of:

Alexandra N. Letyago, year of birth: 1989

Rights and responsibilities stipulated under Art. 82, UK RF, were explained; warning was given of criminal liability in the case of issuing a false conclusion, in accordance with Art. 307, UK RF

(Signed) Zharov, Alisievich, Damir, Panov, Vasilevskiy, Sirotinskiy

Questions subject to solution by the examiners, and other subsections of the “Conclusion” are stated in the following (11) pages.

CONCLUSION OF THE COMMISSION OF FORENSIC MEDICAL EXAMINERS IN THE CRIMINAL CASE INITIATED AFTER THE SEIZURE OF HOSTAGES ON THE PREMESIS OF THE DUBROVKA THEATER, “MOSCOW BEARINGS, INC.” AND THE DEATH OF ALEXANDRA NIKOLAEVICH LETYAGO, YEAR OF BIRTH: 1989

The following questions were assigned to the commission of experts:

1. What were the injuries on the corpse? What were their quantity, location, length of time, and causes? What was their mechanism of formation and their degree of seriousness?

2. What could be the causes of A. N. Letyago’s injuries, the characteristics of the traumatizing objects, and directions of the wound channels?

3. What was the possible location of the victim at the moment of receiving the injuries?

4. Could the victim have injured himself by falling from her own height?

5. Could a victim with such injures have moved without assistance, performed any actions, spoke or shouted? If yes, then precisely which actions could the victim have performed, and when?

6. Were the injuries received while alive or posthumously?

7. At what length of time after receiving the injuries did death occur?

8. How long did death take? What were the causes of death?

9. Did the victim ingest food, alcohol, or narcotic substances shortly before death? If yes, then what substances, in what quantities, and how long before death did he ingest these?

10. In what condition were the internal organs at the time of autopsy? Did the victim's body contain any traces of chemical substances, decomposition or disintegration, not typically found in the human body? Did the given chemical substances have any influence or effect on the victim's body? Did they cause any harm to her health, and could they have a causal relationship in death of the victim?

11. Are there any signs of asphyxia on the corpse? If yes, then what were the reasons for asphyxia as such? Could asphyxia have been caused by the action of chemical substances, including gaseous substances, and do they have a causal relationship in the death of the victim?

12. Does the corpse have any signs of previously present, chronic illnesses? If yes, then exactly which signs are evident? Did these illnesses have a causal relationship in the victim's death?

13. Does the corpse have any other signs of previous present negative factors, such as stresses, physical exhaustion, starvation, dehydration, or long-term immobilization? If yes, then exactly which signs are evident? Did these negative factors have a causal relationship in the victim's death?

14. Was any medical aid given to the victim shortly before death? If yes, then precisely what medical aid was given, and was it performed correctly and in sufficient amount, based on standards of practice and established requirements for the rendering of aid in similar events?

CIRCUMSTANCES OF THE CASE

From the report of A. E. Bebchuk, major crime investigator of organized crime and murder for the Moscow city prosecutor's office (December 25th, 2002):

On October 23rd, 2002, at approximately 21:00 hours, an organized group of the armed persons took not less than 800 persons hostage on the premises of the DK (Dubrovka Theater) of Moscow Bearings, Inc. located at ¹ 7 Melnikov St., Moscow. They held the hostages until October 26th, 2002, when the hostages were freed as a result of a special operation carried out by law-enforcement agencies. During the course of the special operation A. N. Letyago, who was among the hostages, perished. A medical examination was later performed on the victim. This examination, however, was not sufficiently complete for obtaining answers to all the above-presented questions. Taking into account the need for resolving the emergent questions, a further forensic medical examination taking into account the complexities of the case must bear the nature of a commission of inquiry.

Materials from the criminal case were presented for examination.

I N V E S T I G A T I O N S

From the questioning of V. V. KRUGLIKOVAYA, December 9th, 2002:

«During the days while we were hostages, our psychological state was poor. We were in constant fear. Our physical condition was satisfactory, but I felt a cardiac insufficiency. I didn't feel like eating. We had enough water and juices. I dozed off a little. Later, my sister gave me a kerchief to cover my face. In the hall I heard the word: “Gas.” After this I lost consciousness. I came to in the veteran's hospital.»

From the questioning of A. S. KRUGLIKOVAYA, December 16th, 2002:

«I was in a state of semi consciousness. I had a sensation that there wasn't enough air. During the three days I was morally worn out, and had lost all hope for a good resolution to the prevailing situation. On October 26th I detected the smell of gas. I started to inhale intensively in order to more rapidly lose consciousness, and to not see what was going to happen. After this I fell asleep. I came to in War Veteran's Hospital ¹ 1, where I stayed until October 28th, 2002.»

From the questioning of A. S. GRISHIN, October 30th, 2002:

«I fell asleep, since I so tired and wanted to sleep. I awoke and saw smoke in the hall, of a yellowish-brown shade. Frightened, I hid my head in my arms and forced it against my knees. After awhile I heard a voice, which said: “Will you look at that! Everyone sleeps!” I raised my head a bit, and saw that many people were situated in unnatural poses, as if they had lost consciousness. After this, my eyes darkened, and I lost consciousness.»

From the questioning of I. A. FATAFUTDINOVA, October 30th, 2002:

«At about 5 A.M. on October 26th, 2002, I saw wisps of yellow smoke coming from the fan vents to the right and left of me. I smelled something caustic. I was almost unconscious at the time. I think that I then lost consciousness temporarily. I didn't see anything on the way to the exit. I was like a robot. When I reached the street, they put me in an ambulance and took me to War Veteran's Hospital ¹ 1, where I stayed until October 28th, 2002.»

From the questioning of A. V. USHAKOV:

«During the night of October 25-26th, 2002, the atmosphere in the building began to glow. Sometime or another, I don't recall precisely, I noted the appearance of a gray-white cloud, coming from the lower edge of the stage to the right. It had a specific smell. About 10 minutes after the appearance of this gray-white cloud of smoke, I lost consciousness. I came to in War Veteran's Hospital ¹ 1, at about dinnertime, on October 27th, 2002.»

From the questioning of P. V. LAPIN, December 17th, 2002:

«Before the morning of the October 26th, 2002, I was in a half-asleep state, I was physically weakened. Psychologically, I was very tired from the prevailing situation. Nervous exhaustion was evident. I think that the other hostages were in a similar state. Only vaguely do I remember the moment of the assault. I remember that I smelled the gas, and lost consciousness. A member of the Special Forces helped me to the street and placed me in an ambulance, which transported me to War Veterans Hospital ¹ 1.»

From the questioning of N. V. SKOPTSOVAYA, December 12th, 2002:

«On the eve of the assault my physical state was satisfactory, though my mood was depressed. Before the terror act I suffered from no chronic illnesses. I remember well the moment when into the gas began to enter the building. I breathed through a kerchief. I lost consciousness and later came to when I heard voices next to me. They sent me by ambulance to the hospital for war veterans, where I stayed until October 27th, 2002.»

From the questioning of A. A. REBROVA, October 26th, 2002, while still in the resuscitation unit at general hospital ¹ 44:

«I fell asleep. After some time, I do not remember precisely, someone shouted: “Gas!” What happened afterwards, I do not remember, and I came to in the ambulance which took me to the hospital.»

From the questioning of A. A. REBROVA, October 29th, 2002:

«I heard one of the terrorists yell: ‘Gases!’ I covered myself with my coat and bent down to the floor. Then I lost consciousness, and came to in the hospital. Right after being freed they put me in the resuscitation unit, and they transferred me to the general ward only on October 28th of this year.»

From the questioning of N. G. SVIRIDOV, October 26th, 2002:

«Someone shouted: “Gas!” and I no longer remember what happened afterwards. I came to in the hospital.»

From the questioning of N. G. SVIRIDOV, October 29th, 2002:

«I do not remember being freed, since I was asleep at the time. I only came to in the hospital.»

From the questioning of A. A. ARAKELYAN, October 20th, 2002:

«At about 5 in the morning of October 26th, 2002, a white smoke began to appear in the hall. The smoke came from somewhere up above. I did not understand exactly. A minute later I lost consciousness. I woke up in Hospital ¹ 84 at about 10 A. M. At first I did not understand what happened, or where I was located. Later, I began to gradually recall what had happened.»

From the questioning of E. A. REZEPOVA, October 30th, 2002:

«After the gas attack I fell asleep, and Special Forces soldiers took me from the hall. At the hospital they gave me an injection and let me go home.»

Additional examination from December 25th, 2002:

«At about 11 A.M. they let out of the hospital, and no one offered to hospitalize me.»

From the questioning of K. SALZERMAN, on November 20th, 2002:

«Early in the morning of October 26th, 2002, I saw a smoke screen in the hall, which entered the hall from the side of stage. I did not detect the smell of gas. I hid my face in my clothing, and immediately lost consciousness. I came to in the ambulance. I was taken Children's Hospital ¹ 15, where I stayed about 15 minutes. Then I was released. Before being taken hostage I suffered from no illnesses. While a hostage in the hall I felt doomed, and I prepared myself for death. Physically I felt satisfactory.»

From the questioning of A. A. RUDBERG, October 10th, 2002:

«The leader shouted: “Gases!” I sat bent over, with my head between my knees. Covering myself with my jacket, I held onto the arm of the fellow sitting next to me, but I felt my hand go numb and fall. At this time wheezing was heard in the hall. It seemed me that I sat in this position for a very long time. I decided to get out. I decided to leave, but right here I lost my vision and fell to my knees. They brought us to the exit and put us in the ambulances.»

From the questioning of E. V. BARANOVSKAYA, while still hospitalized in Therapy Chamber ¹ 514 of Hospital ¹ 7, October 27th, 2002:

«My husband and I went there at 19:00 hours on October 23rd, 2002. I don't know how I left the building, since I lost consciousness. I noticed an aroma and after this ceased to understand a thing.»

From the questioning of S. A. GOROKHOLINSKIY, December 27th, 2002:

«Together with my wife, Yuliya Yevgen'evna GOROKHOLINSKAYA, I arrived to the theatrical center at 18:30 on October 23rd, 2002. At 5 A.M., on October 26th, 2002, the hall smelled of gas. I fell asleep. My wife was next to me. I tried to cover her head with my arms, after which I came to in the hospital.»

From the questioning of YELENA VIKTOROVNA MIKHAYLOVA, while still located in Room 514 of Hospital ¹ 13, October 28th, 2002:

«My husband, MAXIM AL'BERTOVICH MIKHAYLOV, and I arrived together at the show. Where my husband presently is located, I do not know. The last time I saw him was during the gas attack. On the night of October 26th, 2002, I was asleep. I came to in the hospital.»

From the questioning of YURI NIKOLAEVICH OL'KHOVNIKOV, while still at Hospital ¹ 13, October 28th, 2002:

«On October 23rd, 2002, I went to the musical together with my wife, son, and daughter. My wife is now located in the WW II veteran's hospital. My son, SERGEY YUR'EVICH OL'KHOVNIKOV, is located at Hospital ¹ 13. My daughter, DAR'YA YU'REVNA OL'KHOVNIKOVA, perished. At about 5 A.M. I smelled the gas. The gas had a yellowish color, and then I understood that there would soon be an attack. I had time to moisten a handkerchief with water, and I pressed this to the mouth of my son. I didn't hear any shots, and lost consciousness. I only came to in the hospital.»

From the questioning of N. P. LETYAGO, on November 1st, 2002:

«Alexandra Nikolaevna Letyago, born on July 16th, 1989, is my daughter. I found out that my daughter and former wife had been taken hostage by armed Chechen terrorists on October 27th, 2002. I found the corpse of my daughter in Morgue ¹ 2.»

From the questioning of S. N. GUBAREVA, on November 11th, 2002:

«I was hostage in the Dubrovka theater complex of Moscow Bearings, Inc. from the 23rd to the 26th of October, 2002. I was there with my daughter Alexandra Nikolaevna Letyago. My daughter was taken to Hospital ¹ 1, where she passed away on October 26th, 2002. „

From the statements of MChS (emergency and disaster relief ministry) member V. S. KRYLOV:

“On October 26th, 2002, it was reported that the Dubrovka building had been stormed and that it was necessary to go into the building and carry out victims. I had some stretchers with me. Together with other service members I entered the building and went to the third floor, from where I began carrying victims who were alive but unconscious on stretchers. I carried them to the street, where ambulances were located at the entrance of the building. Doctors took the victims from the stretchers, after which I returned to the third floor. Then at the entrance of building, instead of ambulances, appeared buses, into which I carried and placed victims. In my opinion, aid to the victims was organized correctly and timely. At the entrance I saw doctors who were giving the victims injections.»

From the statements of MChS member M. V. PSHENITSYNA:

«On October 26th, 2002, the team advanced on the building. Our assignment was the fastest evacuation possible of victims from the building. I evacuated the living first, which after being carried out were transferred to the physicians. I'd like to add that five people located in the building looked like corpses.»

From the statements of MChS member V. L. BAKHAREV:

“On October 26th, 2002, we got the order to advance on the building. The battalion commander ordered us to take stretchers and evacuate victims from the building into the ambulances. I can state with complete confidence that all those evacuated by me were alive, since the physicians determined their condition. They gave them some type of injections."

From the statements of MChS member A. U. CHIKIN:

«On October 26th, 2002, we got the command to advance to the building. After entering the building we began to carry out victims. I was told by the physicians whom to carry out.»

From the statements of MChS member P. V. KUCHMA:

«On October 26th, 2002, they sounded the alarm and we drove to the Dubrovka building. On arrival, we received the order: grab stretchers and to carry out victims from the building. After being taken out, the victims were placed in an area before the building, where the physicians rendered them aid. They gave them some kind of injections, most likely an antidote. There was no feeling that there was a shortage of personnel. In my opinion, the evacuation work was organized properly.»

From the statements of MChS member R. F. KUCHAYEV:

«On October 26th, 2002, towards the beginning of 8 A.M., we arrived at the scene from the rescue center. There was a briefing from which it was clear that an assault had taken place and that gas was used. My tasks included the evacuation of victims from the building on stretchers. First, I evacuated people from the third floor, after this, from the first. In my view, the recovery operation occurred rapidly and was coordinated between different departments. The victims were given first aid on leaving the building: an injection, heart massage, and artificial respiration. After this we carried and placed them in buses and ambulances.»

From the statements of MChS member A. V. PROSHKIN:

«At 8 O'clock on the morning of October 26th, 2002, I arrived at the scene. I began to evacuate victims from the foyer on the first floor of the building. We put some people on the porch. Some were carried directly to buses and ambulance vehicles, which were arriving continuously. They evacuated people on stretchers. There were enough medical workers, in my opinion. The medical workers injected some kind of medicine into the victims. In my opinion, the operation went quickly, without interruption. Coordination between members from different departments was observed. The evacuation of the former hostages took about one hour.

From the statements of MChS member E. A. BELAN:

»About 7 in the morning of October 26th, 2002, I was in a group that was signaled to come to the scene. We began to take stretchers and evacuate wounded from the building, which we placed on the landing in front of the theater. The evacuation proceeded as it was supposed to. My medical colleagues injected the victims with substances unknown to me, and then they were transferred to buses and ambulance vehicles that were in the vicinity. I performed direct evacuation of hostages from the third floor of the Dubrovka complex. In my opinion, there were sufficient colleagues from the medical service on the scene for the rendering of first aid to the victims."

From the statements of MChS member N. N. KABANOV:

«I arrived on the scene, i.e., the Dubrovka Theater building, after assault, i.e., on the morning of October 26th, 2002. At the main entrance, to where they carried hostages from the building were working many medical workers and transport. I mean that the buses and ambulances worked operationally. I did not see them ever stop. Physicians coordinated our actions, i.e., they showed us whom it is possible to put into buses and ambulances. On the whole, I believe that the evacuation of hostages went successfully and rapidly.

From the statements of MChS member A. M. AKULOV:

»On October 26th, 2002, at 7 in the morning, they gave the command to advance to the Dubrovka Theater building. At approximately 7:15 we arrived at the building. I commanded personnel to take stretchers, and we broke into a run towards the building. We climbed to the second floor and started the hostage evacuation. On the first floor were waiting medical workers, who were giving the antidote. After this we carried victims to the street, where the medical workers looked at the victims' condition and, depending on the condition, indicated where to carry the victims: to the buses or to the ambulance vehicles. The entire evacuation lasted approximately 40–60 minutes.

From the statements of MChS member M. S. ANTONYUK:

«On October 26th, 2002, at approximately at 7 A.M., I arrived with others at the Dubrovka Theater. We took stretchers and advanced to the building. The other rescue workers and I moved the victims to stretchers and carried them to the street. There we transferred victims to the hands of medical personnel, who were providing medical aid on the porch and in the ambulances and buses into which the victims were being loaded. I believe that the evacuation of the victims was organized normally. All the services worked harmoniously together. All the victims we carried out were transferred to medical workers, who gave them injections.»

From the statements of MChS member A. V. SHMIGAL':

«On October 26th, 2002, at approximately at 7 A.M., I arrived with others at the Dubrovka Theater, where we took stretchers and upon command ran to the building, where we were ordered to climb to the third floor. I went to that floor, and there the rescuers put victims on stretchers for us, and we took the people down to the first floor, where medical workers met us. They rendered aid to the victims: checked the pulse, performed injections, and then carried them out to the ambulance or bus depending on where there was room, and as instructed by the senior medical workers.»

From the statements of MChS member A. A. KURILOVICH:

«At approximately 7 A.M. of October 26th, 2002, we received an alarm and were commanded to deploy to the Dubrovka building. After 10 minutes, we arrived at Melnikov Street. There we were told that we were to take stretchers and enter the building. When we entered the building, a colleague of the disaster ministry told us to climb to the third floor. We transferred all the victims to ambulance workers. It seemed to be that there were sufficient ambulances.»

From the statements of MChS member A. I. SHARKO:

«At the time of our group's arrival, the majority of the victims that were located in the hall were already evacuated and placed in the Dubrovka Theater's first floor foyer, or to an area in front of the building. During the evacuation, if it was necessary, the rescuers performed a complex of resuscitative measures without the use of drugs: artificial respiration, indirect heart massage, and a majority of these had positive outcomes. The victims also received injections of Nalaxone.»

From the statements of MChS member S. N. PIGAROV:

«On entering the Dubrovka Theater, I saw many people who were in a state of unconsciousness. Colleagues from the disaster relief ministry, Special Forces soldiers, and Moscow rescue service workers were carrying people first to the foyer, and when this became too crowded, out to the street. Physicians dealt with them there. I saw physicians giving injections, performing artificial respiration, and other first priority actions for correct lifesaving. Intratracheal tubes were used. The living were separated from the dead, and were carried from the hall first.»

From the statements of MChS member A. A. SUKHOMLINOV:

«Colleagues from a special sub-unit evacuated the hostages, who were in a state of unconsciousness. In the hall were many hostages. Practically all were unconscious. Those who were conscious were suffering from oxygen starvation. At the edge of the center worked doctors, who gave of Nalaxone to the hostages, performed mechanical ventilation of the lungs, and other measures necessary in rendering first aid to the victims. On the square in front of the Dubrovka building, colleagues from the DPS (Highway Patrol) organized free movement of ambulances and buses. Therefore, there was no interruption in the work.»

From the statements of MChS member R. V. KAPKANSHCHIKOV:

«We evacuated victims from the first floor balcony. A woman was carried from the balcony in a state of semi consciousness, and she was transferred to the medical workers. Two of the victims whom I carried seemed to me to be corpses. In the foyer on the first floor were women in camouflage uniforms who were giving injections to the victims.»

From the questioning of S. B. SUKHOV (physician at Hospital ¹ 1), March 12th, 2003:

«On October 26th, 2002, at about 8 A.M., a bus drove up to the doors of the resuscitation unit. A girl was among the victims delivered to us, a girl with no signs of life: absence of respiration, no cardiac activity. Her pupils were wide and dilated, and there was no pulse present in the main arteries. The girl appeared to be from 10 to 12 years of age, of normal build and medium height. Without first establishing if there was a state of biologic death present, a decision was made to perform treatment using full resuscitative measures. Tracheal intubation was performed, IVL (artificial ventilation of the lungs), infusion therapy, and cardiopulmonary therapy. The measures, however, did not have a positive effect. The time of biological death was not determined, since we did not know precisely at what time it occurred. I would like to correct myself: it was not cardiopulmonary therapy, but cardiopulmonary resuscitation. „

From call sheet ¹ 7034 (from the corpse transport service), dated October 26th, 2002, A. N. Letyago's death occurred on October 26th, 2002.

From the autopsy protocol, performed 18:20 on October 27th, 2002, by Inspector M. V. Ganshina, with the participation of forensic medical expert A. A. Grechkina:

“The corpse of a woman, at the moment of autopsy located in dissection morgue ¹ 2 of the Forensic Medical Examiner’s bureau, Moscow health committee. She is laying on her back on a table. Livor mortis, spots of a cyanotic-violet color and engorged with blood, are located on the rear surface of the neck, spine, and in part on the dorso-lateral upper and lower extremities of the corpse. On being pressed, the spots disappear and their color does not return for 12 to 13 min. Rigor mortis is well expressed in all groups of muscles investigated. The rectal temperature is 12.5 degrees C at an ambient temperature of +19° C (the corpse was taken from a cooler). When struck by a metal rod on the ventral surface of the left thigh, a dent is evident. Putrid phenomena were fixed at 18:45. No injuries were discovered upon inspection of the corpse.»

On October 27th, 2002, the corpse was identified as Alexandra Nikolaevna Letyago, year of birth: 1989.

From the report of expert ¹ 5724, forensic medical examiner O. V. Kriger (Morgue ¹ 2), October 27th, 2002:

EXTERNAL STUDY: The corpse is dressed in a sweater, t-shirt, jeans, pantyhose, and panties. Removal of the clothing reveals the corpse of a child of the feminine sex, of correct build, slightly malnourished, with a body length of 162 cm.

The skin is pale, dry, and cold to the touch in all regions. The skin of the palms of both hands is covered with a thin film of a powdery substance gray in color. The fingertips are wrinkled, pointed, and slightly thickened.

The skin of the hairy part of the head and face is undamaged; the bones of the dome of the skull and facial skeleton are by palpation noted to be unbroken.

The eyes are closed, the corneas are dried out, the eyeballs feel soft on palpation, are easily dented by digital pressure, and the connective tissue of the eyelids and eyes are of a pale cyanotic color, with a thin network of congested blood vessels. Dark red, isolated petechial hemorrhages are noted in the sclera of right eye. The corneas are dried out. The pupils have a diameter of 0.2 cm.

The openings of the nose and ears are unobstructed and exudations are absent from them. A plastic intubation tube juts from the oral cavity. No are no exudates contained in the tube opening. The tube is fixed to the neck by a single bandage. The front border of the lips is of a pale violet color, and the mucosal boundary with is dry and undamaged. The mucous membranes of the oral threshold and cavity are dry, pale, cyanotic, and undamaged.

The ribs feel entire on palpation. Mammary glands are hemispherical, nipples externalized, and pressure on the perimammillary regions does not obtain discharge from the nipples.

The abdomen is indented, symmetrical, and undamaged. The abdominal skin with respect to iliac regions is painted a diffuse pale-green color.

The external sex organs are normal in shape. The hymeneal membrane is undamaged. There are no exudates from the vagina or the external opening of the urethra. There is no damage or morbid changes to the external sex organs. The anal passage is closed and the skin of the perineum is clean.

The bones of the extremities are by palpation noted to be intact.

INJURIES: A rounded abrasion, 0.7 cm in diameter, on the edge of the 9th rib in a line with the left shoulder blade. Its surface is dense, lusterless, reddish-brown to black, and it is level with the surrounding skin.

On the ventral surface in the right elbow region is an oval bruise 1 x 2.5 cm in size with a clear demarcation. The center is cyanotic gray with a yellowish periphery. Against the background of the bruise, above the center of the vein, are 3 puncture wounds with reddish-brown, raised crusts.

On the dorsal surface of right elbow region is a rounded bruise, cyanotic-red with a slight red-brown nuance, 0.8 cm in diameter, and with relatively clear boundaries. Two-thirds of the way down the right forearm, on the ventral surface, is a cyanotic-gray bruise, oval in shape and oriented vertically, 1 x 3 cm, and analogous to the bruise described above. Against the background of this bruise is a puncture wound, covered with a reddish-brown raised crust. The skin of the region has several blots of brownish-red blood.

On the ventral surface of this same region is an intermittent, vertical linear abrasion, 1.5 cm in length, with a dense, indented, brownish-red surface. The cuticle on the lower end of this abrasion is in the form of thin, grayish skin tag, torn away in a downward direction.

On the dorsal surface in the region of the left elbow, on the projection of the ulnar tuberosity, is a vertical, oval abrasion, 0.5 x 1.4 cm in size, with a dense, lusterless, indented surface of a brownish-red color. 1.5 cm inwards from this abrasion is an analogous form, a rounded abrasion with a diameter of 0.5 cm.

There are several (up to ten) reddish-brown bruises on the ventral interior surfaces of both shins, sharply demarcated and oval in shape, from 0.7 x 1.5 cm to 2 x 3 cm in size.

INTERNAL STUDY: The internal surface of the musculo-cutaneous cranial tissue is slightly dry and of a grayish-pink color, with a thin network of congested blood vessels. There are no hemorrhages. The bones of the dome and base of skull are intact.

The dura mater is under pressure, has a mother-of-pearl color, and the vessels and sinuses contain dark, liquid blood. There are no hemorrhages above or below this shell. The soft meninges are smooth, shiny, transparent, tightly adhered to the brain matter, their vessels acutely congested. There are no hemorrhages under these shells.

The brain is correctly shaped, its hemispheres symmetrical and evenly smoothed. The vessels at the base of brain are indented, their walls semi-transparent and not thickened. The horns of the hippocampus have transversely striped depressions. The waist of the cerebellar amygdalae is sharply emphasized. On incised sections, the brain matter is edematous with a clear delineation between gray and white matter. On the surfaces of the incisions blood flows in points and streaks which are easily scrapped away by the pick of the knife. The brain matter adheres to the knife.

The ventricles of the brain are widened somewhat, and contain a transparent, yellowish liquid. The epidermis of the cerebral ventricles is smooth and shiny.

The subcortical nuclei and structure of the intermediate brain have no pathologic changes. In cross sections the cerebral bridge (corpus callosum), medulla oblongata, and cerebellum have the correct anatomical structures. There are no hemorrhages, cysts, or centers of softening in the substance of the brain. The mass of brain is 1510 grams.

The soft tissues of the neck, breast, and abdomen are without hemorrhages, and a dim light-red color. The thickness of subcutaneous fatty cellular tissue on the breast is 1 cm on the stomach in the region of navel it is 1.5 cm.

The lungs fill less than 2/3 of the volume of the pleural cavities, the parietal and visceral pleurae are smooth, shiny, and transparent.

The stomach and bowel loops are covered by the greater omentum, which contains a small quantity of adipose tissue. The parietal and visceral peritoneum is smooth, shiny, and transparent. There are no foreign liquids or matter in the pleural and abdominal cavities.

The mucosa of the tongue is covered with a thin, grayish-yellow film, and the papillae are well evident.

On incision the muscles have a red-brown color, are congested with blood and without hemorrhages.

The wings of the thyroid gland are not increased in size, the surfaces are smooth, shiny, with a red color, and feel elastic on palpation. On incision the glandular tissue is of an analogous color and has a grainy form.

The entrance into the esophagus is unobstructed, its opening is empty, and the mucosa are a grayish-pink color and longitudinally pleated.

The hyoid bone and cartilages of the larynx are intact.

The entrance into the larynx is unobstructed, and the glottis is not entrapped.

The openings into the larynx, trachea, main and longitudinal bronchi, have a scant, white mucous distributed along their walls. The mucous membranes show areas of a dull, red-pink color.

In the region of the tracheal bifurcation is a round defect in the mucous membrane, 0.3 cm in diameter, with uneven scalloped edges. The peritracheal (tracheal), bifurcational (internal tracheobronchial), and broncho-pulmonary (external tracheobronchial) lymph nodes are not enlarged, on palpation have an elastic consistency, and in cross section the tissues are a uniform reddish-gray color.

The lung surfaces are pink and the unexpanded tissue has a doughy consistency on palpation, with no nodular areas. Local areas of subpleural hemorrhage are evident on the rear surfaces of the lower lobes of the right and left lungs, measuring 0.5 x 1 cm to 1 x 1 cm in size. On incision the tissue of the lungs is dry, bright pink, and a small quantity of clear-red blood can be forced from the cut surfaces when squeezed firmly. The walls of the incised bronchi are not thickened and do not stand above the surfaces of the incisions, and their openings are unobstructed. The weight of the right lung is 210 g, the left lung 200 g.

The thymus gland has a mass of 60 g, its surface grayish-pink and softly elastic on palpation. On cross section the glandular tissue is lobulated and congested with blood.

The heart is reduced in size, has a conical shape, 10×8 x 3.5 cm in size with a mass of 200 g. The epicardium is smooth, transparent, shiny, and there are no hemorrhages beneath it. Subepicardial fat is faintly evident and distributed only along the channel of coronary vessels. The coronary arteries are uncoiled, and the cardiac blood supply is mixed main arterial. On incision the openings of the coronary arteries have dark, liquid blood, the walls are not thickened and the openings are not narrowed. The ventricles of the heart are not enlarged, and contain dark, liquid blood. The endocardium is smooth, transparent, shiny, and there are no hemorrhages beneath it. The (atrio-) ventricular, aortic, and pulmonary valves are correctly shaped, their folds are not deformed, are semitransparent, thin, and elastic. The chordal tendons are thin, not shortened or deformed. The papillary muscles are not thickened or stout. The cardiac muscle on incision has a grayish-red color, with small areas of uneven blood congestion of a cyanotic-red color against the general background. The variety of colors in the cardiac muscle is most evident in the subepicardial regions. The muscle thickness of the left ventricle is 1.1 cm, the right 0.5 cm.

The perimeter of the aorta and pulmonary trunk over the valves is 5.0 cm. The inner surface of the aorta is light yellow, and smooth. The main arteries leaving the aorta are unobstructed.

The spleen has a mass of 180 g, 13×7 x 4 cm in size, and is dense on palpation. Its capsule is smooth; the surface a cyanotic-red color and on incision the tissue of the spleen has an analogous color, with prominent follicles, and blood, in the parenchyma.

The adrenal glands have an irregular, triangular shape, with very evident divisions between the yellow cortical and grayish brown, engorged, medullary substances. The fibrous capsule of the kidneys is easily removed, baring a smooth surface, reddish-brown in color. The kidneys are 9×4 x 3 cm in size and have a mass of 130 g. The renal parenchyma on incision does not stand out above the capsule, its division into the layers is very evident, the cortical substance is a grayish-red color, the medullary substance is darker, and the intermediate zones are engorged with blood. The renal papillae and calyces are correctly shaped, undilated, and empty. The mucosa is smooth, shiny, and grayish.

The urinary bladder is reduced in size, and there is no urine. The mucosa of the bladder is grayish-pink, and pleated.

The uterus and its appendages are correctly shaped. The uterus is pear-shaped, 2.5×3 x 1 cm, the surface smooth and gray, the uterine cavity is slit-shaped, the endometrium edematous, and grayish-pink in color. The myometrium is dense, uniform and grayish-pink. The external opening of the uterine cervical canal is pointed.

The ovaries are 1.5 x 0.7 cm in size and dense on palpation, their surfaces grayish yellow and smooth. On incision into the tissue of the ovaries, many spherical, thin-walled cavities containing a transparent liquid are found. The diameters of the indicated cavities are 0.2 to 0.4 cm.

The stomach is reduced in size, shaped like a hooked tube, and contains in its cavity a thick and turbid, whitish-yellow mucous, which is distributed along the walls. The mucosa of the stomach are dull, extremely pleated, and grayish-pink.

The opening of the duodenum has scant masses of whitish mucous. By sequential pressure to the neck and body of the gall bladder, a semi-transparent light-brown bile liquid enters the duodenum. The duodenal mucosa is grayish-pink and transversely pleated. Within the remainder of the small intestine are scanty, yellowish-white masses, distributed along the walls. The mucous membranes of these intestines are transversely pleated and grayish-pink.

Within the large intestine is a small quantity of gray-green viscous fecal masses; in the sigmoid colon and rectum are densely formed feces, gray-green in color. The mucous membrane of large intestine is grayish-pink and smooth.

The liver is 24×18×15 x 6 cm, weighs 1300 grams, with a smooth capsule, and the surface is red-brown. On incision the liver tissue has an analogous color and is engorged with blood.

The pancreas is 16.5×2 x 1.5 cm, with an elastic consistency; on incision the tissue is grayish-pink, lobulated, and congested with blood.

No injuries were revealed on internal study of the corpse. No strange odors were detected from the cavities and organs of the corpse.

FORENSIC MEDICAL DIAGNOSIS: Sudden Death Syndrome. Sharply pronounced morphological signs of a disturbance in the hemolymphatics of the brain matter, an increase in the size and mass (1510 g) of the brain, sharply pronounced smoothness of the gyri, and a flattening of the fissures of the brain, morphological signs of barrel wedging (cerebral edema) — a depressed fissure on the base of the cerebellar amygdalae and in the region of the hippocampal horns, congested blood vessels of the pia mater, and a dearth of vessels at the base of brain. Generalized circulatory disturbances expressed by the liquid state of the blood and marked venous congestion of the organs. Dys-atelectasia of the pulmonary tissue and a clear-red coloration of lung tissue. Splenomegaly. Catarrhal tracheobronchitis. Dryness of the skin and tissues of the corpse, flaccid eyeballs, a hook-shaped, drooping stomach, absence of urine, and stagnant mucous contents of the stomach. The condition after artificial lung ventilation: a defect in the mucosa in the region of the tracheal bifurcation. Abrasions of the upper extremities, an abrasion on the back, and a multitude of bruises on the lower extremities.

DATA FROM A REPEAT HISTOLOGICAL STUDY

Analysis of blood from the corpse of A. N. Letyago established that the blood is O negative.

A forensic-chemical study of the blood did not detect ethyl, methyl, or propyl alcohols.

A flame photometric the study of samples of cardiac muscle showed an insignificant decrease in the ratio of K/Na from the norm. (The K/Na ratio within the standard must not be less than 2.5) The top of the heart had a ratio of 2.2, and the caudal papillary muscle of 2.2. The remaining sections of heart muscle, which were examined, showed no reduction of the K/Na ratio with respect to the norm.

Histological diagnosis: sharply pronounced acute microcirculatory disturbances in the examined organs, with the presence of perivascular diapedal hemorrhages in the subcortical region of brain, evidence of cardiomyocytic damage, bronchospasm, the focal pulmonary emphysema, pulmonary edema, and cerebral edema. There is chronic bronchitis with evidence of eosinophilia. Hyperplasia of the thymus. Splenic hyperplasia.

An analysis of lung tissue of lung did not detect:

Acetone, chloroform, carbon tetrachloride, dichloroethane, benzene, toluene, acids, propyl, butyl or amyl alcohols. The liver and kidney contained no detectable amounts of the derivatives of barbituric acid, morphine, codeine, dionine, hydrocodone, heroin, promedol, papaverine, pachycarpine, anabasine, nicotine, cocaine, atropine, scopolamine, hyocyanine, strychnine, Elenium sp., diazepam, seduxen, aminazine, dicrazine, triftazine, tisercine, Maxseptila sp., or imizine. The blood contained no detectable amounts of morphine or its derivatives.

In view of the complexity of the incident, and in order to determine the cause of death of Alexandra Nikolaevna Letyago, 1989 year of birth, the data from the forensic medical study is being sent to the division of complex examinations, forensic medical examiner bureau, Moscow health committee."

From the expert’s report (forensic histological study) ¹ 15252/5724, November 20th, 2002:

«Seventeen sections stained with hematoxilieneosin were examined.

Brain: peracute congestion of the blood vessels, hemostasis and plasmatization in the walls of some vessels in edemic pia mater and brain tissues. Acute perivascular and pericellular edema, diffuse edema in the interstitial tissue in the region of the subcortical nuclei, perivascular diapedal hemorrhages, dystrophic changes in nerve cells, and dystrophy of Purkinje cells in the tissue of the cerebellum.

Heart: acute congestion of the blood vessels, hemostasis, small hemorrhages, polymorphic nuclei in cardiomyocytes, centers of myolysis, local contractional changes, edema of interstitial tissue and areas of muscular replacement by connective tissues, and vacuolar dystrophy of cardiomyocytes.

Lungs: acute congestion of the blood vessels, hemostasis, intermittent intra-alveolar hemorrhages, dystelectasia of the pulmonary tissue, uneven contraction of bronchial openings, epithelial exfoliation, in some bronchi there are homogeneous basophilic masses, thickening of the bronchial walls, diffuse infiltration with lymphoid mesothelial elements and eosinophiles. Proliferation of the bronchial epithelium, lymphoid infiltration of interstitial tissues, and subacute edema of pulmonary tissue.

Liver: congestion of the blood vessels, hemostasis, grainy local hepatocytic dystrophy, while portal areas are without the visible pathologic changes.

Kidneys: acute congestion of the blood vessels and hemostasis, while glomeruli are absent any visible pathologic changes. There is grainy vacuolar dystrophy of the epithelium of the convoluted tubules.

Spleen: acute congestion of the blood vessels, hemostasis, and perivascular diapedal hemorrhages; the follicles have wide reactive centers and there is moderate reticular hyperplasia of the pulp.

Adrenal glands: acute congestion of the blood vessels, hemostasis, and the cortex is well differentiated into zones. The cells are predominantly hyperchromic, while the medullary layer is without special features.

Thymus: acute congestion of the blood vessels, hemostasis, lobules are edematous, the cortical layer has follicular-like structures of compacted thymic cells, while the thymic bodies are small and laminar (thymic hyperplasia).

Pancreas: acute congestion of the blood vessels, hemostasis, small hemorrhages, and a quantity of connective tissue in the interlobular divisions which corresponds to the age-dependent norm.»

On repeat study of the histological preparations by L. A. Sergeeva, head of the department of forensic histology, forensic medical examiner’s bureau, Moscow city health department, additional microcirculatory disturbances were discovered: local bronchitis, local arachnofibrosis, and finely disseminated pancreatic sclerosis.

C O N C L U S I O N S

Based on a study of the representative case materials and medical documents, including medical examiner report ¹ 5724, dated October 27th, 2002, prepared using additional reports (forensic chemical, biochemical, and histological), and in accordance with the questions presented, the commission of forensic medical experts arrived at the following conclusions:

1. A forensic medical study of the corpse of A. N. Letyago had the following corporal injuries:

Abrasions: 0.7 x 0.7 cm on the spine above the surface of the 9th rib on a line along the left shoulder blade, 1.5 cm on the internal surface of the lower third of the right forearm, 1.4 x 0.5 cm and 0.5 x 0.5 cm on the rear surface of left elbow region on the projection of the elbow; these injuries could have arisen during the agonal period, or after the onset of death, from the action of hard, blunt objects, not excluding the process of moving the body during transport.

Bruises: 0.8 x 0.8 cm on the rear surface of right elbow region, and up to ten bruises, ranging in size from 0.7 x 1.5 cm to 2 x 3 cm, on the front and internal surfaces of shins; these injuries could have arisen, taking into account of their nature and localization, not long before death or during the agonal period, from the pressure of hard, blunt objects of limited surface areas, not excluding the process of transport or during the rendering of medical aid.

The enumerated injuries in living persons would not cause harm to health, so the death of A. N. Letyago is not related to these injuries.

2. Not long before the onset of death, A. N. Letyago did not use any alcoholic or narcotic substances; this is proven by the negative results of the forensic chemical tests of his blood, urine, and internal organs.

3. On forensic medical study of the corpse of A. N. Letyago, the following was discovered: dryness of skin and tissues of the corpse, the stomach is reduced in size, inside the stomach is a thick, turbid, whitish-yellow mucous located along the interior surfaces, the interior of the duodenum and other small intestines contain scant mucous masses of a whitish color along their surfaces, which attests to the fact that food and liquid were not consumed for a long time.

4. Macroscopic data (petechial hemorrhages in the sclera of right eye, local areas of subpleural hemorrhaging, edema and swelling of the brain, atelectasia in the lungs, dehydration of the tissues, the liquid state of the blood, internal organs congested with blood) and microscopic data (sharply pronounced acute microcirculatory disturbances in the brain and internal organs, bronchospasm, foci of emphysema and edema of the lungs, damaged cardiomyocytes, dystrophic parenchymatous organs) from the examinations give grounds for the conclusion that the death of A. N. Letyago stemmed from acute respiratory and cardiac insufficiency caused by a combination of factors that were dangerous to life and health: prolonged, heavy psychoemotional stress, reduced oxygen content in air of the building (hypoxic hypoxia), a prolonged period in an immobile position which accompanies the development of oxygen starvation (circulatory hypoxia), hypovolemia (dehydration) connected to a long absence of food and water, prolonged sleep deprivation which reduces the body’s compensatory mechanisms, and respiratory disorders caused by the action of the unidentified chemical substance (or substances), which, based on a study of the materials of the case, led to the rapid loss of consciousness.

A. N. Letyago’s unconsciousness in a sitting position increased the disturbances to the body’s vital functions, and could have included an infringement of airway patency, which aggravated the hypoxic condition already present. Contributing to the of death of A. N. Letyago were previously present, chronic diseases and morbid changes which were discovered upon examination of her corpse: the lungs (chronic focal bronchitis), the brain (focal fibrosis of the arachnoid membrane) and the pancreas (extensive pancreosclerosis), which during the course of her life could continue without expressing any clinical manifestations, but decreased the body’s ability to compensate for the actions of any injurious, external damaging factors.

The multifactor nature of the cause of A. N. Letyago’s death rules out a direct cause-effect relationship between the action of the gaseous chemical substance (or substances) used on her, and death.

In this case the relationship is of an incidental nature, since the main objective for considering the application of the gaseous chemical substance (or substances) was that it would not lead to death in the absence of other factors enumerated above.

Signs of mechanical asphyxia (aspiration of emeses) were not noted during the study of the corpse of A. N. Letyago.

According to the statements of Dr. Sukhov, the physician at Hospital ¹ 1, the onset of death in A. N. Letyago began at about 6 or 7 A.M. on October 26th, 2002, and this does not contradict the postmortem changes noted upon inspection of the corpse at 18:45 on October 27th, 2002.

5. The forensic-chemical studies of the internal organs from the corpse of A. N. Letyago did not disclose any chemical substances not typically found in the human body, nor the products of their decomposition (or disintegration).

6. The statements of Dr. S. B. Sukhov of Hospital ¹ 1 indicate that A. N. Letyago received a complex of cardio-pulmonary resuscitation, including intubation of the trachea, mechanical ventilation of the lungs, the infusion of fluids, and indirect cardiac massage, which was provided correctly, and “in the sufficient volume, going beyond the normal requirements for the provision of similar assistance.”

On examination of the corpse of A. N. Letyago, puncture wounds caused by injections with medical needles were found in the regions of the inner elbow, and lower third of the forearm. Besides this, a plastic intubation tube, fixed to the neck by a bandage, was noted in the oral cavity, and, on examination of the corpse, a rounded defect in the mucous membranes with a diameter of 0.3 cm was noted, without signs of associated with ante mortem injuries, which could occur during intubation of the trachea.

Signed

26.2. Karpov, Alexander Sergeyevich 

MINISTRY OF HEALTH, RUSSIAN FEDERATION

Establishment name – SME Bureau (Forensic Medical Examiners)

Committee of Health, Moscow

Address: ¹ 12 Sivtsev Vrazhek

C O N C L U S I O N

(of the examination of the materials relating to the case)

#130

On the basis of the resolution by investigator of extremely important cases, bureau of investigation of organized crime and murders, Moscow city attorney general’s office, Attorney 2nd class A. E. Bebchuk, dated December 25th, 2002, from March 17th to March 21st, 2003, a commission of forensic medical examiners met on the premises of the bureau of forensic medical examiners, Moscow city health committee, including:

V. V. ZHAROV, chief of the bureau of SME, Moscow KZ (forensic medical examiners, Moscow city health committee), distinguished physician of the Russian Federation, doctor of medical sciences, and professor with over 40 years of service.

V. I. ALISIEVICH, professor and chair of the department of forensic medicine RUDN (Russian University – Friendship of Peoples), distinguished man of science of the Russian Federation, doctor of medical sciences.

E. A. DAMIR, professor and chair of the department of anesthesiology and resuscitation RMAPO (Russian Medical Academy of Postgraduate Education), distinguished man of science of the Russian Federation, doctor of medical sciences.

I. E. PANOV, deputy chief of the bureau of SME, Moscow KZ, master of medical sciences, more than 40 years of work of a highly qualified category.

V. K. VASILEVSKIY, deputy chief of the bureau of SME, Moscow KZ, more than 30 years of work of a highly qualified category.

F. Z. SIROTINSKAYA, department manager of the commission of forensic medical examiners, bureau of SME, Moscow KZ, more than 40 years of work of a highly qualified category.

The above commission carried out a forensic medical examination

of matters relating to case initiated after the death of:

Alexander Sergeevich Karpov, year of birth: 1971

Rights and responsibilities stipulated under Art. 82, UK RF, were explained; warning was given of criminal liability in the case of issuing a false conclusion, in accordance with Article 307 of the Russian Criminal Codex.

(Signed & stamped) Zharov, Alisievich, Damir, Panov, Vasilevskiy, Sirotinskaya

Questions subject to solution by the examiners, and other subsections of the “Conclusion” are stated in the following 11 pages.

CONCLUSION OF THE COMMISSION OF FORENSIC MEDICAL EXAMINERS IN THE CRIMINAL CASE INITIATED AFTER THE SEIZURE OF HOSTAGES ON THE PREMESIS OF THE DUBROVKA THEATER, “MOSCOW BEARINGS, INC.” AND THE DEATH OF ALEXANDER SERGEEVICH KARPOV, YEAR OF BIRTH: 1971

The following questions were assigned to the commission of experts:

1.  What were the injuries on the corpse? What were their quantity, location, length of time, and causes? What was their mechanism of formation and their degree of seriousness?

2. What could be the causes of A. S. Karpov’s injuries, the characteristics of the traumatizing objects, and directions of the wound channels?

3. What was the possible location of the victim at the moment of receiving the injuries?

4. Could the victim have injured himself by falling from his own height?

5. Could a victim with such injures have moved without assistance, performed any actions, spoke or shouted? If yes, then precisely which actions could the victim have performed, and when?

6. Were the injuries received while alive or posthumously?

7. At what length of time after receiving the injuries did death occur?

8. How long did death take? What were the causes of death?

9. Did the victim ingest food, alcohol, or narcotic substances shortly before death? If yes, then what substances, in what quantities, and how long before death did he ingest these?

10. In what condition were the internal organs at the time of autopsy? Did the victim's body contain any traces of chemical substances, decomposition or disintegration, not typically found in the human body? Did the given chemical substances have any influence or effect on the victim's body? Did they cause any harm to his health, and could they have a causal relationship in death of the victim?

11. Are there any signs of asphyxia on the corpse? If yes, then what were the reasons for asphyxia as such? Could asphyxia have been caused by the action of chemical substances, including gaseous substances, and do they have a causal relationship in the death of the victim?

12. Does the corpse have any signs of previously present, chronic illnesses? If yes, then exactly which signs are evident? Did these illnesses have a causal relationship in the victim's death?

13. Does the corpse have any other signs of previous present negative factors, such as stresses, physical exhaustion, starvation, dehydration, or long-term immobilization? If yes, then exactly which signs are evident? Did these negative factors have a causal relationship in the victim's death?

14. Was any medical aid given to the victim shortly before death? If yes, then precisely what medical aid was given, and was it performed correctly and in sufficient amount, based on standards of practice and established requirements for the rendering of aid in similar events?

CIRCUMSTANCES OF THE CASE

From the report of A. E. Bebchuk, major crime investigator of organized crime and murder for the Moscow city prosecutor's office (December 25th, 2002): “On October 23rd, 2002, at approximately 21:00 hours, an organized group of the armed persons took not less than 800 persons hostage on the premises of the DK (Palace of Culture) of Moscow Bearings, Inc. located at ¹ 7 Melnikov St., Moscow.  They held the hostages until October 26th, 2002, when the hostages were freed as a result of a special operation carried out by law-enforcement agencies.

“During the course of the special operation Alexander Sergeevich Karpov, who was among the hostages, perished.

“A medical examination was later performed on the victim.  This examination, however, was not sufficiently complete for obtaining answers to all the above-presented questions.  Taking into account the need for resolving the emergent questions, a further forensic medical examination taking into account the complexities of the case must bear the nature of a commission of inquiry.”

Materials from the criminal case were presented for examination.

I N V E S T I G A T I O N

From the questioning of V. V. KRUGLIKOVAYA, December 9th, 2002:  «During the days while we were hostages, our psychological state was poor.  We were in constant fear.  Our physical condition was satisfactory, but I felt a cardiac insufficiency.  I didn't feel like eating.  We had enough water and juices.  I dozed off a little.  Later, my sister gave me a kerchief to cover my face.  In the hall I heard the word: “Gas.”  After this I lost consciousness. I came to in the veteran's hospital.»

From the questioning of A. S. KRUGLIKOVAYA, December 16th, 2002:  «I was in a state of semi consciousness. I had a sensation that there wasn't enough air.  During the three days I was morally worn out, and had lost all hope for a good resolution to the prevailing situation. On October 26th I detected the smell of gas. I started to inhale intensively in order to more rapidly lose consciousness, and to not see what was going to happen. After this I fell asleep.  I came to in War Veteran's Hospital ¹ 1, where I stayed until October 28th, 2002.»

From the questioning of A. S. GRISHIN, October 30th, 2002:  «I fell asleep, since I so tired and wanted to sleep.  I awoke and saw smoke in the hall, of a yellowish-brown shade.  Frightened, I hid my head in my arms and forced it against my knees.  After awhile I heard a voice, which said: “Will you look at that! Everyone sleeps!”  I raised my head a bit, and saw that many people were situated in unnatural poses, as if they had lost consciousness.  After this, my eyes darkened, and I lost consciousness.»

From the questioning of I. A. FATAFUTDINOVA, October 30th, 2002:  ”At about 5 A.M. on October 26th, 2002, I saw wisps of yellow smoke coming from the fan vents to the right and left of me.  I smelled something caustic.  I was almost unconscious at the time.  I think that I then lost consciousness temporarily.  I didn't see anything on the way to the exit.  I was like a robot.  When I reached the street, they put me in an ambulance and took me to War Veteran's Hospital ¹ 1, where I stayed until October 28th, 2002."

From the questioning of A. V. USHAKOV: «During the night of October 25-26th, 2002, the atmosphere in the building began to glow.  Sometime or another, I don't recall precisely, I noted the appearance of a gray-white cloud, coming from the lower edge of the stage to the right.  It had a specific smell.  About 10 minutes after the appearance of this gray-white cloud of smoke, I lost consciousness. I came to in War Veteran's Hospital ¹ 1, at about dinnertime, on October 27th, 2002.»

From the questioning of P. V. LAPIN, December 17th, 2002:  «Before the morning of the October 26th, 2002, I was in a half-asleep state, I was physically weakened.  Psychologically, I was very tired from the prevailing situation.  Nervous exhaustion was evident. I think that the other hostages were in a similar state.  Only vaguely do I remember the moment of the assault.  I remember that I smelled the gas, and lost consciousness.  A member of the Special Forces helped me to the street and placed me in an ambulance, which transported me to War Veterans Hospital ¹ 1.»

From the questioning of N. V. SKOPTSOVAYA, December 12th, 2002: «On the eve of the assault my physical state was satisfactory, though my mood was depressed.  Before the terror act I suffered from no chronic illnesses.  I remember well the moment when into the gas began to enter the building.  I breathed through a kerchief. I lost consciousness and later came to when I heard voices next to me.  They sent me by ambulance to the hospital for war veterans, where I stayed until October 27th, 2002.»

From the questioning of A. A. REBROVA, October 26th, 2002, while still in the resuscitation unit at general hospital ¹ 44: «I fell asleep. After some time, I do not remember precisely, someone shouted: “Gas!”  What happened afterwards, I do not remember, and I came to in the ambulance which took me to the hospital.»

From the questioning of A. A. REBROVA, October 29th, 2002: «…I heard one of the terrorists yell: ‘Gases!’  I covered myself with my coat and bent down to the floor.  Then I lost consciousness, and came to in the hospital.  Right after being freed they put me in the resuscitation unit, and they transferred me to the general ward only on October 28th of this year…»

From the questioning of N. G. SVIRIDOV, October 26th, 2002:  “…someone shouted: “Gas!” and I no longer remember what happened afterwards. I came to in the hospital…"

From the questioning of NIKOLAI GENNADEVICH SVIRIDOV, October 29th, 2002:  «…I do not remember being freed, since I was asleep at the time.  I only came to in the hospital…»

From the questioning of A. A. ARAKELYAN, October 20th, 2002:  «…At about 5 in the morning of October 26th, 2002, a white smoke began to appear in the hall.  The smoke came from somewhere up above.  I did not understand exactly.  A minute later I lost consciousness.  I woke up in Hospital ¹ 84 at about 10 A.M.  At first I did not understand what happened, or where I was located.  Later, I began to gradually recall what had happened.»

From the questioning of E. A. REZEPOVA, October 30th, 2002:  «…After the gas attack I fell asleep, and Special Forces soldiers took me from the hall.  At the hospital they gave me an injection and let me go home.»

Additional examination from December 25th, 2002:  «At about 11 A.M. they let out of the hospital, and no one offered to hospitalize me.»

From the questioning of K. SALZERMAN, on November 20th, 2002: «…Early in the morning of October 26th, 2002, I saw a smoke screen in the hall, which entered the hall from the side of stage. I did not detect the smell of gas. I hid my face in my clothing, and immediately lost consciousness.  I came to in the ambulance. I was taken Children's Hospital ¹ 15, where I stayed about 15 minutes. Then I was released.  Before being taken hostage I suffered from no illnesses.  While a hostage in the hall I felt doomed, and I prepared myself for death. Physically I felt satisfactory…»

From the questioning of A. A. RUDBERG, October 10th, 2002:  «…The leader shouted: “Gases!”  I sat bent over, with my head between my knees.  Covering myself with my jacket, I held onto the arm of the fellow sitting next to me, but I felt my hand go numb and fall.  At this time wheezing was heard in the hall. It seemed me that I sat in this position for a very long time.  I decided to get out.  I decided to leave, but right here I lost my vision and fell to my knees.  They brought us to the exit and put us in the ambulances…»

From the questioning of E. V. BARANOVSKAYA, while still hospitalized in Therapy Chamber ¹ 514 of Hospital ¹ 7, October 27th, 2002:  «…My husband and I went there at 19:00 hours on October 23rd, 2002.  I don't know how I left the building, since I lost consciousness. I noticed an aroma and after this ceased to understand a thing…»

From the questioning of S. A. GOROKHOLINSKIY, December 27th, 2002:  «…Together with my wife, YULIYA EVGENEVNA GOROKHOLINSKAYA, I arrived to the theatrical center at 18:30 on October 23rd, 2002.  At 5 A.M., on October 26th, 2002, the hall smelled of gas.  I fell asleep.  My wife was next to me. I tried to cover her head with my arms, after which I came to in the hospital…»

From the questioning of ELENA VIKTOROVNA MIKHAYLOVA, while still located in Room 514 of Hospital ¹ 13, October 28th, 2002:  «…my husband, MAXIM ALBERTOVICH MIKHAYLOV, and I arrived together at the show.  Where my husband presently is located, I do not know. The last time I saw him was during the gas attack.  On the night of October 26th, 2002, I was asleep.  I came to in the hospital…»

From the questioning of YURI NIKOLAEVICH OLKHOVNIKOV, while still at Hospital ¹ 13, October 28th, 2002:  «…On October 23rd, 2002, I went to the musical… I went with my wife, son, and daughter…  My wife is now located in the WW II veteran's hospital.  My son, SERGEY YUREVICH OLKHOVNIKOV, is located at Hospital ¹ 13…  my daughter, DARYA YUREVNA OLKHOVNIKOVA, perished…  At about 5 A.M. I smelled the gas.  The gas had a yellowish color, and then I understood that there would soon be an attack. I had time to moisten a handkerchief with water, and I pressed this to the mouth of my son…  I didn't hear any shots, and lost consciousness.  I only came to in the hospital…»

From the questioning of S. N. KARPOV, October 27th, 2002:  “My son A. S. KARPOV called home at 5:25 am on October 25th, 2002…  he said that he was at the musical ‘Nord-Ost’… among the hostages…”

From the statements of MChS (emergency and disaster relief ministry) member V. S. KRYLOV:  «…On October 26th, 2002, it was reported that the Dubrovka building had been stormed and that it was necessary to go into the building and carry out victims. I had some stretchers with me. Together with other service members I entered the building and went to the third floor, from where I began carrying victims who were alive but unconscious on stretchers.  I carried them to the street, where ambulances were located at the entrance of the building. Doctors took the victims from the stretchers, after which I returned to the third floor.  Then at the entrance of building, instead of ambulances, appeared buses, into which I carried and placed victims.  In my opinion, aid to the victims was organized correctly and timely. At the entrance I saw doctors who were giving the victims injections.»

From the statements of MChS member M. V. PSHENITSYNA:  «…On October 26th, 2002, the team advanced on the building.  Our assignment was the fastest evacuation possible of victims from the building.  I evacuated the living first, which after being carried out were transferred to the physicians.  I'd like to add that five people located in the building looked like corpses…»

From the statements of MChS member V. L. BAKHAREV:  “…On October 26th, 2002, we got the order to advance on the building. The battalion commander ordered us to take stretchers and evacuate victims from the building into the ambulances. I can state with complete confidence that all those evacuated by me were alive, since the physicians determined their condition.  They gave them some type of injections."

From the statements of MChS member A. U. CHIKIN:  «On October 26th, 2002, we got the command to advance to the building. After entering the building we began to carry out victims. I was told by the physicians whom to carry out.»

From the statements of MChS member P. V. KUCHMA:  «On October 26th, 2002, they sounded the alarm and we drove to the Dubrovka building.  On arrival, we received the order: grab stretchers and to carry out victims from the building.  After being taken out, the victims were placed in an area before the building, where the physicians rendered them aid. They gave them some kind of injections, most likely an antidote.  There was no feeling that there was a shortage of personnel.  In my opinion, the evacuation work was organized properly.»

From the statements of MChS member R. F. KUCHAYEV:  «On October 26th, 2002, towards the beginning of 8 A.M., we arrived at the scene from the rescue center.  There was a briefing from which it was clear that an assault had taken place and that gas was used.  My tasks included the evacuation of victims from the building on stretchers.  First, I evacuated people from the third floor, after this, from the first.  In my view, the recovery operation occurred rapidly and was coordinated between different departments.  The victims were given first aid on leaving the building: an injection, heart massage, and artificial respiration.  After this we carried and placed them in buses and ambulances.»

From the statements of MChS member A. V. PROSHKIN:  "At 8 O'clock on the morning of October 26th, 2002, I arrived at the scene.  I began to evacuate victims from the foyer on the first floor of the building.  We put some people on the porch. Some were carried directly to buses and ambulance vehicles, which were arriving continuously.  They evacuated people on stretchers. There were enough medical workers, in my opinion.  The medical workers injected some kind of medicine into the victims. In my opinion, the operation went quickly, without interruption.  Coordination between members from different departments was observed.  The evacuation of the former hostages took about one hour.

From the statements of MChS member E. A. BELAN:  «About 7 in the morning of October 26th, 2002, I was in a group that was signaled to come to the scene.  We began to take stretchers and evacuate wounded from the building, which we placed on the landing in front of the theater.  The evacuation proceeded as it was supposed to.  My medical colleagues injected the victims with substances unknown to me, and then they were transferred to buses and ambulance vehicles that were in the vicinity.  I performed direct evacuation of hostages from the third floor of the Dubrovka complex.  In my opinion, there were sufficient colleagues from the medical service on the scene for the rendering of first aid to the victims.»

From the statements of MChS member N. N. KABANOV:  "I arrived on the scene, i.e., the Dubrovka Theater building, after assault, i.e., on the morning of October 26th, 2002.  At the main entrance, to where they carried hostages from the building were working many medical workers and transport.  I mean that the buses and ambulances worked operationally.  I did not see them ever stop.  Physicians coordinated our actions, i.e., they showed us whom it is possible to put into buses and ambulances.  On the whole, I believe that the evacuation of hostages went successfully and rapidly.

From the statements of MChS member A. M. AKULOV:  «On October 26th, 2002, at 7 in the morning, they gave the command to advance to the Dubrovka Theater building.  At approximately 7:15 we arrived at the building. I commanded personnel to take stretchers, and we broke into a run towards the building.  We climbed to the second floor and started the hostage evacuation.  On the first floor were waiting medical workers, who were giving the antidote.  After this we carried victims to the street, where the medical workers looked at the victims' condition and, depending on the condition, indicated where to carry the victims: to the buses or to the ambulance vehicles.  The entire evacuation lasted approximately 40–60 minutes.

From the statements of MChS member M. S. ANTONYUK:  „On October 26th, 2002, at approximately at 7 A.M., I arrived with others at the Dubrovka Theater.  We took stretchers and advanced to the building.  The other rescue workers and I moved the victims to stretchers and carried them to the street.  There we transferred victims to the hands of medical personnel, who were providing medical aid on the porch and in the ambulances and buses into which the victims were being loaded. I believe that the evacuation of the victims was organized normally.  All the services worked harmoniously together.  All the victims we carried out were transferred to medical workers, who gave them injections.“

From the statements of MChS member A. V. SHMIGAL:  „On October 26th, 2002, at approximately at 7 A.M., I arrived with others at the Dubrovka Theater, where we took stretchers and upon command ran to the building, where we were ordered to climb to the third floor.  I went to that floor, and there the rescuers put victims on stretchers for us, and we took the people down to the first floor, where medical workers met us.  They rendered aid to the victims:  checked the pulse, performed injections, and then carried them out to the ambulance or bus depending on where there was room, and as instructed by the senior medical workers.“

From the statements of MChS member A. A. KURILOVICH:  „At approximately 7 A.M. of October 26th, 2002, we received an alarm and were commanded to deploy to the Dubrovka building.  After 10 minutes, we arrived at Melnikov Street.  There we were told that we were to take stretchers and enter the building.  When we entered the building, a colleague of the disaster ministry told us to climb to the third floor.  We transferred all the victims to ambulance workers.  It seemed to be that there were sufficient ambulances.“

From the statements of MChS member A. I. SHARKO:  „At the time of our group's arrival, the majority of the victims that were located in the hall were already evacuated and placed in the Dubrovka Theater's first floor foyer, or to an area in front of the building.  During the evacuation, if it was necessary, the rescuers performed a complex of resuscitative measures without the use of drugs: artificial respiration, indirect heart massage, and a majority of these had positive outcomes.  The victims also received injections of Nalaxon.“

From the statements of MChS member S. N. PIGAROV:  „On entering the Dubrovka Theater, I saw many people who were in a state of unconsciousness.  Colleagues from the disaster relief ministry, Special Forces soldiers, and Moscow rescue service workers were carrying people first to the foyer, and when this became too crowded, out to the street.  Physicians dealt with them there.  I saw physicians giving injections, performing artificial respiration, and other first priority actions for correct lifesaving.  Tracheal tubes were used.  The living were separated from the dead, and were carried from the hall first.“

From the statements of MChS member A. A. SUKHOMLINOV:  „Colleagues from a special sub-unit evacuated the hostages, who were in a state of unconsciousness.  In the hall were many hostages.  Practically all were unconscious. Those who were conscious were suffering from oxygen starvation.  At the edge of the center worked doctors, who gave of nalaxon to the hostages, performed mechanical ventilation of the lungs, and other measures necessary in rendering first aid to the victims.  On the square in front of the Dubrovka building, colleagues from the DPS (Highway Patrol) organized free movement of ambulances and buses.  Therefore, there was no interruption in the work.“

From the statements of MChS member R. V. KAPKANSHCHIKOV:  „We evacuated victims from the first floor balcony.  A woman was carried from the balcony in a state of semi consciousness, and she was transferred to the medical workers.  Two of the victims whom I carried seemed to me to be corpses.  In the foyer on the first floor were women in camouflage uniforms who were giving injections to the victims.“

From call sheet ¹ 06909 (from the corpse transport service), dated October 26th, 2002, the death of an unknown man (later identified as A. S. Karpov) occurred on October 26th, 2002.

From the autopsy protocol, performed 18:20 on October 26th, 2002, by Inspector T. V. Shirokovoi of the Moscow city police, Lefortovo MRP, with the participation of forensic medical expert N. P. Glukh:

„The corpse of a man, at the moment of autopsy located in dissection morgue ¹ 10, laying on his back, on a gurney.  It is a man of heavy physique, with natural dentition and some missing teeth.  The body is wearing an undershirt, jeans with a belt, bikini briefs, socks, and shoes.  The face is blue-violet, and the eyes are closed.  The connective tissues of the eyes have numerous petecheal hemorrhages.  The right nostril has traces of dark, liquid blood, while the left nostril, mouth, and external openings of the ears are clear.  The mouth is open, and the tip of the tongue is clenched between the teeth.  The rib cage is barrel-shaped, the ribs are intact on deep palpation, and the abdomen extends above the level of the chest. The skin is pale-pink and on the open portions of the body, cold to the touch, while under the clothing slightly warm.  The skin on the anterior surface of the throat and the anterior surface of the upper part of the ribcage has numerous intra-dermal petecheal and small, dark-red, foci of hemorrhage. Areas of livor mortis are violet-purple, engorged, and located on the posterior surfaces of the neck, torso, and extremities.  On being pressed, the spots disappear and their color does not return for 45–50 seconds. When struck by a metal rod on the anterior surface of the middle third of the right shoulder, the muscle is dented about 1 cm.  Rigor mortis is well expressed in the muscles of mastication, somewhat expressed in the muscles of the neck, and upper and lower extremities.  The rectal temperature is 35 degrees C at an ambient temperature of 10 degrees C at the level of the corpse.  Putrid phenomena were fixed at 12:45.  Injuries: On the posterior surface of the upper third of the right shoulder there is an oval, pale-purple bruise.  On the posterior surface of the middle third of the right shoulder is an oval abrasion with a dark-red, sticky, base. On the posterior, external surface of the lower third of the right shoulder there is an oval, irregular, brownish-red abrasion.

On October 27th, 2002, citizen Sergey Nikolaevich Karpov identified corpse ¹ 2575 as his son, Aleksandr Sergeevich Karpov, who was born on March 23rd, 1971.

From the autopsy report of corpse ¹ 2575, performed by forensic medical examiner N. P. Glukh (Morgue ¹ 10) on October 28th, 2002:

EXTERNAL STUDY: The corpse is dressed in a t-shirt, jeans with belt, bikini briefs, socks, and shoes. It is the body of a man of correct build with a high level of nourishment, with a body length of 185 cm.  The teeth are natural, with some changes due to caries. The skin is pale-pink, and cold to the touch. The hands and cartilage of the nose are intact upon palpation.  The outer boundary of the lips is dry and cyanotic-gray.  The mucosal side of the lips and gums are pinkish-gray and shiny.  The teeth are undamaged.  The tip of the tongue is clenched between the teeth.  The right nostril has traces of dark, liquid blood.  The left nostril, oral cavity, and external auditory passages are unobstructed.  The ribcage is barrel-shaped and symmetrical.  The ribs are intact on palpation.  The abdomen extends above the level of the ribcage.  The external sex organs are normally developed.  The area around the sex organs is without ulcers, wheals, damage, or exudates from the urinary canal.  The rectal opening is closed, and the skin around the anus is clean.  The bones of the upper and lower extremities are intact on palpation.

INJURIES: On the dorsal surface in the upper third of the right shoulder there is a pale-purple, oval bruise, 3×2 cm in size. On the dorsal surface in the middle third of the right shoulder is a dark-red, oval abrasion with a sticky base and displaced epidermis on its leading edge, 4×2 cm in size.  On the dorsal, external surface in the lower third of the right shoulder is a pronounced, irregular, uneven oval-shaped, dark-brown abrasion of the skin, 7×2 cm in size.  No other injuries were noted on external examination.

INTERNAL STUDY: The internal surfaces of the soft tissues of the head are pink, moist, shiny, and full of blood, without hemorrhages.  The bones of the cranial vault on cross-section have a thickness of 0.3 to 1.0 cm, and are intact.  The Dura Mater is intact and has a light blue, mother of pearl color.  It is not distended, and there is liquid blood in the dural sinuses.  The Pia Mater is moist, shiny, and full of blood, with moderately expressed, whitish inclusions in the intra-hemispherical zones.

The hemispheres of the brain are symmetrical.  The convolutions are flattened, and the furrows between them are smooth.  The vessels at the base of the brain are dilated, thin-walled, elastic, and the openings contain liquid blood.  The ventricles of the brain contain a light-yellow, transparent fluid.  The vascular plexus is congested with blood. The brain material in all areas of the cerebrum is regular in structure, moist, shiny, and clings to the knife.  The boundary between gray and white matter is well defined, and the brain material is full of blood, edematous, but without hemorrhages or damage.  The sub-cortical nuclei are symmetrical.  No smell was noted coming from the brain material.  The bones of the base of the skull are intact.

The thickness of the sub-dermal fat layer at the level of the middle third of the chest is 3 cm, while at the level of the abdomen – 6.5 cm.  No foreign smells were noted on opening the peritoneal and pleural cavities.  The stomach and intestinal loops are lightly inflated, and lay loosely in the cavity.  The peritoneum is smooth, moist, and shiny.  There are no adhesion or fluids in the peritoneal cavity.

On opening the pleural cavity, the lungs lie freely and fill about two-thirds of the space.  The parietal pleura are smooth and shiny.  There are no adhesions or fluid in the pleural cavities.

The heart has normal configuration, is 12×11×7 cm in size, and weighs 420.0 grams. Under the epicardium are numerous dark-red petecheal hemorrhages.  Inside the cavities of the heart and its large vessels is dark, liquid blood.  The thickness of the right cardiac ventricle is 0.4 cm, and the left is 1.2 cm.  The width of the aorta and pulmonary artery on incision under the valves is up to 7 cm.  The endocardium is smooth and shiny.  The heart valves and large vessels are whitish, elastic, and not deformed.  The papillary muscles are not thickened, and the chordae tendoni are not shortened.  The muscle of the heart on palpation is moderately hard, and on cross-section has a brownish-red color with a scarcely visible, murky tinge, and diffuse isolates of rather tightly-packed, grayish-white layers of muscle, and is congested. The veins on cross-section gape open, and their walls are not thickened, and the openings are unobstructed.  The aorta is yellow and smooth.

The sub-dermal fat and muscles of the neck do not have any hemorrhages.

The tongue in the region of the base has no film, and has weakly-expressed buds.  The tissue of the tongue on cross-section is of a grayish-brown color, homogenous, and without hemorrhages.

The palatine tonsils are not increased in size, and their tissue on cross-section is of a grayish-pink color.

The entrances into the throat, esophagus, and larynx are unobstructed.  The vocal chords are moderately edematous.  The glottis is moderately narrowed.

The thyroid gland is 3.5×3×2 cm on each side.  The tissue on cross-section is brownish-red, granular, and congested.

The hyoid bone and cartilage of the throat are intact.

The mucous membrane of the esophagus has a pale-gray color, with poorly-defined striations, and its opening is unobstructed.

The mucosas of the trachea and main-stem bronchi are pink.  In the openings of the bronchi there is a limited amount of foamy, light grayish-pink fluid.

The lungs on palpation are doughy.  The visceral pleura are thin, smooth, and shiny.  Under the visceral pleura are numerous dark-red, foci of hemorrhage.  The tissue of the lungs on cross-section is grayish-pink, and when finger pressure is exerted on the tissues, a large quantity of foamy, bloody fluid flows from surface of the incision.

The ribs, sternum, and clavicles are intact.

The spleen is 13×7×2.5 cm in size, and its outer surface is lightly wrinkled and its capsule is intact.  On cross-section the tissue is raspberry colored with a small clumps on the knife.

The liver is 29×24×17×13 cm in size and its surface is smooth and the capsule is intact.  On cross-section it is brownish-yellow, of moderate density, homogenous, and full of blood.  The bile ducts are unobstructed.  Within the gall bladder is an olive-colored bile, and their mucosas are velvety in appearance.

In the stomach are traces of knotty mucous of a dirty-red color, and the mucosa are a pale pink, and the striations are moderately expressed.

The pancreas measures 17.5×3.5×3 cm, and the tissue on cross-section is yellow, with small lobulations, and it is congested with blood.

Within the small and large intestines the contents are clumpy with a clay-like consistency and of a dirty-gray and brown color, and regularly distributed; the mucosa are grayish-cyanotic.

The adrenal glands are leaf-like in shape, with well-defined boundaries between the layers.  The cortical layer is yellow, while the medullary layer is grayish-brown in color.

The kidneys measure 12.5×6.5×3.5 cm, and their fibrous capsules are easily removed.  Their surfaces are smooth.  The cortical layer is reddish-brown in color, and the renal pyramids are a dark-red color with a clear border between them.  The tissue of the kidney is engorged with blood. The renal pelvises are unobstructed, and their mucosas are shiny.  The ureters are unobstructed.  The bladder contains about 150 ml of pale-yellow, clear urine, and their mucosas are pale gray, and the openings of the urinary canals are unobstructed.

The prostate gland measures 4×3×2 cm, and its tissue on cross-section is grayish-white in color, lobulated, and congested.

The vertebrae and bones of the pelvis are intact.

The weights of the internal organs: brain – 1420.0 g; right lung – 610.0 g; left lung – 570.0 g; liver – 1850.0 g; spleen – 175.0 g; right kidney – 170.0 g; left kidney – 170.0 g.

FORENSIC MEDICAL DIAGNOSIS:  Morphological signs of a hypoxic condition in the organism: the violet-cyanotic color of the face, the numerous petecheae and small focal hemorrhages in the tissues of the throat, the surface of the upper third of the ribcage, petecheal hemorrhages on the connective tissues of the eyeballs, under the epicedium, focal hemorrhages under the visceral pleurae, and the liquid state of the blood.  Pronounced cerebral and pneumonic edema.  Venous congestion of the internal organs.  Moderate fibrosis of the Pia Mater, disseminated foci of cardiosclerosis, moderate myocardial dystrophy, and fatty dystrophy of the liver.  There is abrasion and bruising of the right shoulder.

An analysis of the blood established that the type is AB negative.

Examination of the blood and urine did not detect ethyl, methyl, or propyl alcohols.  There were no volatile organic compounds found in the liver, including ether, chloroform, Fluothane, carbon tetrachloride, dichloroethane, dichloromethane, trichloroethylene, benzene, toluene, oxidants, acetone, or methyl-, ethyl-, isopropyl-, propyl-, isobutyl-, butyl-, isoamyl-, and amyl-alcohols.

HISTOLOGICAL DIAGNOSIS: Hemocirculatory disturbances in the organs with venous congestion and uneven perfusion of the myocardium, primary anemia in the aforementioned system; edema of the cerebral matter, diffuse foci of edema in the lungs with hemorrhagic components and diffuse, small intra-alveolar hemorrhages; foci of emphysema, small hemorrhages in the fatty layer of the epicardium, a fragment of visible peripheral cellular reaction, focal damage and fragmentation of several cardiomyocytes, vacuolar dystrophy of several nephrocytes.  A weakly pronounced coronary sclerosis, hypertrophy of several cardiomyocytes, perivascular fibrosis, and focal and reticular cardiosclerosis with preservation of the structure of the walls of the intramural arteries with several signs of cardiomyopathy.  Disseminated, pronounced fatty dystrophy of the liver.  Focal fibrosis of the meninges of the brain.

On forensic chemical examination of the liver and lungs, no detectable amounts of the derivatives of barbituric acid, anabasine, nicotine, cocaine, papaverine, pachycarpine, strychnine, scopolamine, atropine, hyocyanine, codeine, morphine or its analogues were detected.

In view of the complexity of the autopsy, and the necessity in bringing in specialists, the case is being sent to the department of commissioned forensic medical examiners of the Moscow health committee.

From the expert’s report (forensic histological study) ¹ 15460/2575, November 25th, 2002:

Nine tissue preparations stained with hematoxilin-eosin were examined.

Brain (1) – congestion of the blood vessels with filamentous, focal fibrotic changes of the Pia Mater.  Uneven development of the perivascular and pericellular spaces.

Lungs (2) – pronounced congestion of the parenchymal vessels.  Focal emphysema.  In various fields of view, the openings of many alveoli have unevenly defined serous, edema fluid with hemorrhagic components, with tiny, diffuse intra-alveolar hemorrhages.  Primary desquamatization of the bronchioles.  The bronchial walls are congested.  At the edge of one of the slides is a portion of a sub-segmented bronchus, which did not preserve the entirety of the bronchus, in the opening of which desquamated epithelial cells and an accumulation of erythrocytes.

Coronary artery (1) – The presented fragment of the coronary artery does not preserve the entire vessel wall.  In the intimal layer of the artery is uneven, weak sclerosis, insignificant narrowing of the arterial opening (no more than 10%).  Congestion of the blood vessels of the microcirculation of the fatty layer of the epicardium, with tiny hemorrhages without visible peripheral cellular reaction.

Heart (1) – foci of thickening in the walls of the intramural arteries in the myocardium were not discovered.  There is spasm in several blood vessels.  Uneven vascular filling of the myocardium with primary anemia.  Perivascular fibrosis, small foci and reticular cardiosclerosis.  Hypertrophy of several cardiomyocytes.  Uneven staining with twisting contours, focal damage and fragmentation of several cardiomyocytes.

Liver (1) – congestion of the veins.  Disseminated fatty dystrophy of varying degrees in many hepatocytes.  In solitary portal tracts are isolated lymphocytes.

Kidney (1) – pronounced congestion of the layers. The structure of the vessel walls and glomeruli are preserved.  Vacuolar dystrophy of several nephrocytes on the background of the autolytic changes.  The openings of the tubules are unobstructed.  Partial desquamation of the covering epithelium of the renal calyx, the wall of which is sharply congested.  In the fatty layer surrounding the wall of the renal calyx is a fragment of focal hemorrhage without evident peripheral cellular reaction.

The wall of the throat (1) – primary preservation of the epithelial covering with differing structures on the basal membrane.  Desquamation of the surface areas of the epithelium in separate fields.  Among the desquamated epithelial cells is an admixture of erythrocytes.  Congestion of the vessels on a filamentous submucosal  base.

The wall of the trachea (1) – primary desquamation of epithelial covering with preservation of at least several epithelial cells.  Congestion of the blood vessels in all layers of the wall, more pronounced in the submucosal layer.

A repeat examination of the histopathological preparations by L. A. Sergeeva of the forensic medical department of the Moscow City Health Department found severe hemocirculatory disturbances as well:  focal myocardiosclerosis, focal hypertrophy and atrophy of cardiomyocytes, perivascular lipomatosis of the myocardial stroma – as evidence of a secondary cardiomyopathy, uneven fibrosis in the arachnoidal membrane in the meninges; diffuse fatty hepatosis with vascular infiltration of the parenchyma and not sharply defined, persistent hepatitis.

March 17th, 2003.

By the experts:

(Stamped, 6 signatures).

C O N C L U S I O N S

Based on a study of the presented case materials and medical documents, including medical examiner report ¹ 2575, dated October 28th, 2002, prepared using additional reports (forensic chemical and histological), and in accordance with the questions presented, the commission of forensic medical experts arrived at the following conclusions:

1.  A forensic medical study of the corpse of A. S. Karpov had the following corporal injuries:

A 3×2 cm bruise along the rear portion of the upper third part of the right shoulder; an abrasion measuring 4×2 cm along the rear portion of the middle third of the right shoulder, and an abrasion measuring 7×2 cm on the rear external surface of the lower third of the right shoulder.

These injuries occurred not long before the onset of death or during the agonal period; they were from a blow and sliding action of hard, blunt objects, and, judging from the localization of the injuries on one side and their compact arrangement, could arise simultaneously upon contact with some type of object in the environment during a fall from a standing position (from standing height) or while seated.

The enumerated injuries would not cause harm to health in living persons, so the death of A. S. Karpov is not related to these injuries.

2.  Not long before the onset of death, A. S. Karpov did not use any alcoholic or narcotic substances; this is proven by the negative results of the forensic chemical tests of his blood, urine, and internal organs.

3.  On forensic medical study of the corpse of A. S. Karpov, traces of dirty gray mucous were found in his stomach, which attests to the fact that he did not eat for an extended period of time.

4. Macroscopic data (cyanosis of the face, petecheal and focal sub-dermal hemorrhages in the connective tissues of the eyes, beneath the visceral pleura and epicardium, edema of the brain and lungs, the liquid state of the blood, congested internal organs) and microscopic data (hemocirculatory disturbances in the brain and internal organs, disseminated foci of lung edema and hemorrhagic components, foci of emphysema in the lungs, ‘damaged’ cardiomyocytes, dystrophic changes in the parenchymatous organs) from the gives basis to the conclusion that the death of A. S. Karpov occurred due to an acute respiratory and cardiac insufficiency, caused by a combination of factors that were dangerous to life and health: prolonged, heavy, psycho-emotional stress, the reduced oxygen content in the air of the building (hypoxic hypoxia), a prolonged period in an immobile position which accompanies the development of oxygen starvation (circulatory hypoxia), hypovolemia (dehydration) connected with the long absence of food and water, prolonged sleep deprivation which reduces the body’s compensatory mechanisms, and respiratory disorders caused by the action of the unidentified chemical substance (or substances), which, based on a study a study of the materials of the case, led to the rapid loss of consciousness.

A. S. Karpov’s unconsciousness in a sitting position increased the disturbances to the body’s vital functions, and could have included an infringement of airway patency, which aggravated the hypoxic condition already present.

Contributing to the of death of A. S. Karpov were previously present, chronic, pathological changes which were discovered upon examination of his corpse: changes in the heart (cardiomyopathy), the brain (uneven fibrosis of the arachnoidal membrane) and the liver (persistent hepatitis), which during the course of his life could continue without expressing any clinical manifestations, but decreased the body’s ability to compensate for the actions of any injurious, external damaging factors — especially the liver, as one of the organs which performs a detoxification function, rendering harmless and acting against the toxic effect of the chemical substances (or substances) which were used.

The multifactor nature of the cause of A. S. Karpov’s death rules out a direct cause-effect relationship between the action of the gaseous chemical substance (or substances) used on him, and his death.

In this case the relationship is of an incidental nature, since the main objective for considering the application of the gaseous chemical substance (or substances) was that it would not lead to death in the absence of other factors enumerated above.

Signs of mechanical asphyxia (aspiration of emeses) were not noted during the study of the corpse of A. S. Karpov.

The early post-mortem changes noted during the examination of the corpse of A. S. Karpov at 12:45 pm on October 26th, 2002, attests to the fact that his death occurred between 6 and 9 am of October 26th, 2002.

5.  The forensic-chemical studies of the internal organs from the corpse of A. S. Karpov did not disclose any chemical substances not typically found in the human body, nor the products of their decomposition (or disintegration).

6.   There is no evidence showing that A. S. Karpov received medical assistance.

(signatures)

26.3. Booker, Sandy Alan 

MINISTRY OF HEALTH, RUSSIAN FEDERATION

Establishment name – SME Bureau (Forensic Medical Examiners)

Committee of Health, Moscow

Address: ¹ 12 Svitsev Vrazhek

C O N C L U S I O N

(of the examination of materials relating to the case)

# 182

On the basis of the resolution by investigator of extremely important cases, bureau of investigation of organized crime and murders, Moscow city attorney general’s office, Attorney 2nd class A. E. Bebchuk, dated December 25th, 2002, from February 17th to 25th, 2003, a commission of forensic medical examiners met on the premises of the bureau of forensic medical examiners, Moscow city health committee, including:

V. V. ZHAROV, chief of the bureau of SME, Moscow KZ (forensic medical examiners, Moscow city health committee), distinguished physician of the Russian Federation, doctor of medical sciences, and professor with over 40 years of service.

V. I. ALISIEVICH, professor and chair of the department of forensic medicine RUDN (Russian University – Friendship of Peoples), distinguished man of science of the Russian Federation, doctor of medical sciences.

E. A. DAMIR, professor and chair of the department of anesthesiology and resuscitation RMAPO (Russian Medical Academy of Postgraduate Education), distinguished man of science of the Russian Federation, doctor of medical sciences.

I. E. PANOV, deputy chief of the bureau of SME, Moscow KZ, master of medical sciences, more than 40 years of work of a highly qualified category.

V. K. VASILEVSKIY, deputy chief of the bureau of SME, Moscow KZ, more than 30 years of work of a highly qualified category.

F. Z. SIROTINSKIY, department manager of the commission of forensic medical examiners, bureau of SME, Moscow KZ, more than 40 years of work of a highly qualified category.

The above commission carried out a forensic medical examination

of matters relating to case initiated after the death of:

Sandy Alan Booker, year of birth: 1952

Rights and responsibilities stipulated under Art. 82, UK RF, were explained; warning was given of criminal liability in the case of issuing a false conclusion, in accordance with Art. 307, UK RF

(Signed) Zharov, Alisievich, Damir, Panov, Vasilevskiy, Sirotinskiy

Questions subject to solution by the examiners, and other subsections of the “Conclusion” are stated in the following (11) pages.

CONCLUSION OF THE COMMISSION OF FORENSIC MEDICAL EXAMINERS IN THE CRIMINAL CASE INITIATED AFTER THE SEIZURE OF HOSTAGES ON THE PREMESIS OF THE DUBROVKA THEATER, “MOSCOW BEARINGS, INC.” AND THE DEATH OF SANDY ALAN BOOKER, YEAR OF BIRTH: 1952

The following questions were assigned to the commission of experts:

1. What were the injuries on the corpse? What were their quantity, location, length of time, and causes? What was their mechanism of formation and their degree of seriousness?

2. What could be the causes of S. A. Booker’s injuries, the characteristics of the traumatizing objects, and directions of the wound channels?

3. What was the possible location of the victim at the moment of receiving the injuries?

4. Could the victim have injured himself by falling from his own height?

5. Could a victim with such injures have moved without assistance, performed any actions, spoke or shouted? If yes, then precisely which actions could the victim have performed and when?

6. Were the injuries received while alive or posthumously?

7. At what length of time after receiving the injuries did death occur?

8. How long did death take? What were the causes of death?

9. Did the victim ingest food, alcohol, or narcotic substances shortly before death? If yes, then what substances, in what quantities, and how long before death did he ingest these?

10. In what condition were the internal organs at the time of autopsy? Did the victim's body contain any traces of chemical substances, decomposition or disintegration, not typically found in the human body? Did the given chemical substances have any influence or effect on the victim's body? Did they cause any harm to his health, and could they have a causal relationship in death of the victim?

11. Are there any signs of asphyxia on the corpse? If yes, then what were the reasons for asphyxia as such? Could asphyxia have been caused by the action of chemical substances, including gaseous substances, and do they have a causal relationship in the death of the victim?

12. Does the corpse have any signs of previously present, chronic illnesses? If yes, then exactly which signs are evident? Did these illnesses have a causal relationship in the victim's death?

13. Does the corpse have any other signs of previous present negative factors, such as stresses, physical exhaustion, starvation, dehydration, or long-term immobilization? If yes, then exactly which signs are evident? Did these negative factors have a causal relationship in the victim's death?

14. Was any medical aid given to the victim shortly before death? If yes, then precisely what medical aid was given, and was it performed correctly and in sufficient amount, based on standards of practice and established requirements for the rendering of aid in similar events?

CIRCUMSTANCES OF THE CASE

From the report of A. E. Bebchuk, major crime investigator of organized crime and murder for the Moscow city prosecutor's office (December 25th, 2002):

On October 23rd, 2002, at approximately 21:00 hours, an organized group of the armed persons took not less than 800 persons hostage on the premises of the DK (Dubrovka Theater) of Moscow Bearings, Inc. located at ¹ 7 Melnikov St., Moscow. They held the hostages until October 26th, 2002, when the hostages were freed as a result of a special operation carried out by law-enforcement agencies. During the completion of the special operation, S. A. Booker, who was among the hostages, perished. A medical examination was later performed on the victim. This examination, however, was not sufficiently complete for obtaining answers to all the above-presented questions. Taking into account the need for resolving the emergent questions, a further forensic medical examination taking into account the complexities of the case must bear the nature of a commission of inquiry.

Materials from the criminal case were presented for examination.

I N V E S T I G A T I O N S

From the questioning of V. V. KRUGLIKOVAYA, December 9th, 2002:

“During the days while we were hostages, our psychological state was poor. We were in constant fear. Our physical condition was satisfactory, but I felt a cardiac insufficiency. I didn't feel like eating. We had enough water and juices. I dozed off a little. Later, my sister gave me a kerchief to cover my face. In the hall I heard the word: “Gas.” After this I lost consciousness. I came to in the veteran's hospital.»

From the questioning of A. S. KRUGLIKOVAYA, December 16th, 2002:

«I was in a state of semi consciousness. I had a sensation that there wasn't enough air. During the three days I was morally worn out, and had lost all hope for a good resolution to the prevailing situation. On October 26th I detected the smell of gas. I started to inhale intensively in order to more rapidly lose consciousness, and to not see what was going to happen. After this I fell asleep. I came to in War Veteran's Hospital ¹ 1, where I stayed until October 28th, 2002.»

From the questioning of A. S. GRISHIN, October 30th, 2002:

«I fell asleep, since I so tired and wanted to sleep. I awoke and saw smoke in the hall, of a yellowish-brown shade. Frightened, I hid my head in my arms and forced it against my knees. After awhile I heard a voice, which said: “Will you look at that! Everyone sleeps!” I raised my head a bit, and saw that many people were situated in unnatural poses, as if they had lost consciousness. After this, my eyes darkened, and I lost consciousness.»

From the questioning of I. A. FATAFUTDINOVA, October 30th, 2002:

«At about 5 A.M. on October 26th, 2002, I saw wisps of yellow smoke coming from the fan vents to the right and left of me. I smelled something caustic. I was almost unconscious at the time. I think that I then lost consciousness temporarily. I didn't see anything on the way to the exit. I was like a robot. When I reached the street, they put me in an ambulance and took me to War Veteran's Hospital ¹ 1, where I stayed until October 28th, 2002.»

From the questioning of A. V. USHAKOV:

«During the night of October 25-26th, 2002, the atmosphere in the building began to glow. Sometime or another, I don't recall precisely, I noted the appearance of a gray-white cloud, coming from the lower edge of the stage to the right. It had a specific smell. About 10 minutes after the appearance of this gray-white cloud of smoke, I lost consciousness. I came to in War Veteran's Hospital ¹ 1, at about dinnertime, on October 27th, 2002.»

From the questioning of P. V. LAPIN, December 17th, 2002:

«Before the morning of the October 26th, 2002, I was in a half-asleep state, I was physically weakened. Psychologically, I was very tired from the prevailing situation. Nervous exhaustion was evident. I think that the other hostages were in a similar state. Only vaguely do I remember the moment of the assault. I remember that I smelled the gas, and lost consciousness. A member of the Special Forces helped me to the street and placed me in an ambulance, which transported me to War Veterans Hospital ¹ 1.»

From the questioning of N. V. SKOPTSOVAYA, December 12th, 2002:

«On the eve of the assault my physical state was satisfactory, though my mood was depressed. Before the terror act I suffered from no chronic illnesses. I remember well the moment when into the gas began to enter the building. I breathed through a kerchief. I lost consciousness and later came to when I heard voices next to me. They sent me by ambulance to the hospital for war veterans, where I stayed until October 27th, 2002.»

From the questioning of A. A. REBROVA, October 26th, 2002, while still in the resuscitation unit at general hospital ¹ 44:

«I fell asleep. After some time, I do not remember precisely, someone shouted: “Gas!” What happened afterwards, I do not remember, and I came to in the ambulance which took me to the hospital.»

From the questioning of A. A. REBROVA, October 29th, 2002:

«I heard one of the terrorists yell: ‘Gases!’ I covered myself with my coat and bent down to the floor. Then I lost consciousness, and came to in the hospital. Right after being freed they put me in the resuscitation unit, and they transferred me to the general ward only on October 28th of this year.»

From the questioning of N. G. SVIRIDOV, October 26th, 2002:

«Someone shouted: “Gas!” and I no longer remember what happened afterwards. I came to in the hospital.»

From the questioning of N. G. SVIRIDOV, October 29th, 2002:

«I do not remember being freed, since I was asleep at the time. I only came to in the hospital.»

From the questioning of A. A. ARAKELYAN, October 20th, 2002:

«At about 5 in the morning of October 26th, 2002, a white smoke began to appear in the hall. The smoke came from somewhere up above. I did not understand exactly. A minute later I lost consciousness. I woke up in Hospital ¹ 84 at about 10 A. M. At first I did not understand what happened, or where I was located. Later, I began to gradually recall what had happened.»

From the questioning of E. A. REZEPOVA, October 30th, 2002:

«After the gas attack I fell asleep, and Special Forces soldiers took me from the hall. At the hospital they gave me an injection and let me go home.»

Additional examination from December 25th, 2002:

«At about 11 A.M. they let out of the hospital, and no one offered to hospitalize me.»

From the questioning of K. SALZMAN, on November 20th, 2002:

«Early in the morning of October 26th, 2002, I saw a smoke screen in the hall, which entered the hall from the side of stage. I did not detect the smell of gas. I hid my face in my clothing, and immediately lost consciousness. I came to in the ambulance. I was taken Children's Hospital ¹ 15, where I stayed about 15 minutes. Then I was released. Before being taken hostage I suffered from no illnesses. While a hostage in the hall I felt doomed, and I prepared myself for death. Physically I felt satisfactory.»

From the questioning of A. A. RUDBERG, October 10th, 2002:

«The leader shouted: “Gases!” I sat bent over, with my head between my knees. Covering myself with my jacket, I held onto the arm of the fellow sitting next to me, but I felt my hand go numb and fall. At this time wheezing was heard in the hall. It seemed me that I sat in this position for a very long time. I decided to get out. I decided to leave, but right here I lost my vision and fell to my knees. They brought us to the exit and put us in the ambulances.»

From the questioning of E. V. BARANOVSKAYA, while still hospitalized in Therapy Chamber ¹ 514 of Hospital ¹ 7, October 27th, 2002:

«My husband and I went there at 19:00 hours on October 23rd, 2002. I don't know how I left the building, since I lost consciousness. I noticed an aroma and after this ceased to understand a thing.»

From the questioning of S. A. GOROKHOLINSKIY, December 27th, 2002:

«Together with my wife, Yuliya Yevgen'evna GOROKHOLINSKAYA, I arrived to the theatrical center at 18:30 on October 23rd, 2002. At 5 A.M., on October 26th, 2002, the hall smelled of gas. I fell asleep. My wife was next to me. I tried to cover her head with my arms, after which I came to in the hospital.»

From the questioning of YELENA VIKTOROVNA MIKHAYLOVA, while still located in Room 514 of Hospital ¹ 13, October 28th, 2002:

«My husband, MAXIM AL'BERTOVICH MIKHAYLOV, and I arrived together at the show. Where my husband presently is located, I do not know. The last time I saw him was during the gas attack. On the night of October 26th, 2002, I was asleep. I came to in the hospital.»

From the questioning of U. N. OL'KHOVNIKOV, while still at Hospital ¹ 13, October 28th, 2002:

«On October 23rd, 2002, I went to the musical together with my wife, son, and daughter. My wife is now located in the WW II veteran's hospital. My son, SERGEY YUR'EVICH OL'KHOVNIKOV, is located at Hospital ¹ 13. My daughter, DAR'YA YU'REVNA OL'KHOVNIKOVA, perished. At about 5 A.M I smelled the gas. The gas had a yellowish color, and then I understood that there would soon be an attack. I had time to moisten a handkerchief with water, and I pressed this to the mouth of my son. I didn't hear any shots, and lost consciousness. I only came to in the hospital.»

From the questioning of BRADFORD JOHNSON, October 28th, 2002:

“On October 24th, 2002, the mother of United States citizen Sandy Alan Booker called to report his disappearance. On October 26th, 2002, the girlfriend of S. A. Booker’s fiancée reported that he was at the Dubrovka Theater, and that she had been taken hostage by terrorists, and last reported that US citizen S. A. Booker was with her at Dubrovka. On October 28th, 2002, it was explained to us that he was probably located at Morgue ¹ 11 as body ¹ 2526. On arriving at the morgue, I identified the given corpse as S. A. Booker. “

From the questioning of S. N. GUBAREVA, on November 6th, 2002:

«I was a hostage from October 23rd to October 26th, 2002, in the Dubrovka building. My fiancé, Sandy Alan Booker was with me, Sandy Alan Booker, a citizen… right away they took him to the hospital morgue.”

From the statements of MChS (emergency and disaster relief ministry) member V. S. KRYLOV:

»On October 26th, 2002, it was reported that the Dubrovka building had been stormed and that it was necessary to go into the building and carry out victims. I had some stretchers with me. Together with other service members I entered the building and went to the third floor, from where I began carrying victims who were alive but unconscious on stretchers. I carried them to the street, where ambulances were located at the entrance of the building. Doctors took the victims from the stretchers, after which I returned to the third floor. Then at the entrance of building, instead of ambulances, appeared buses, into which I carried and placed victims. In my opinion, aid to the victims was organized correctly and timely. At the entrance I saw doctors who were giving the victims injections."

From the statements of MChS member M. V. PSHENITSYNA:

«On October 26th, 2002, the team advanced on the building. Our assignment was the fastest evacuation possible of victims from the building. I evacuated the living first, which after being carried out were transferred to the physicians. I'd like to add that five people located in the building looked like corpses.»

From the statements of MChS member V. L. BAKHAREV:

“On October 26th, 2002, we got the order to advance on the building. The battalion commander ordered us to take stretchers and evacuate victims from the building into the ambulances. I can state with complete confidence that all those evacuated by me were alive, since the physicians determined their condition. They gave them some type of injections."

From the statements of MChS member A. U. CHIKIN:

«On October 26th, 2002, we got the command to advance to the building. After entering the building we began to carry out victims. I was told by the physicians whom to carry out.»

From the statements of MChS member P. V. KUCHMA:

«On October 26th, 2002, they sounded the alarm and we drove to the Dubrovka building. On arrival, we received the order: grab stretchers and to carry out victims from the building. After being taken out, the victims were placed in an area before the building, where the physicians rendered them aid. They gave them some kind of injections, most likely an antidote. There was no feeling that there was a shortage of personnel. In my opinion, the evacuation work was organized properly.»

From the statements of MChS member R. F. KUCHAYEV:

«On October 26th, 2002, towards the beginning of 8 A.M., we arrived at the scene from the rescue center. There was a briefing from which it was clear that an assault had taken place and that gas was used. My tasks included the evacuation of victims from the building on stretchers. First, I evacuated people from the third floor, after this, from the first. In my view, the recovery operation occurred rapidly and was coordinated between different departments. The victims were given first aid on leaving the building: an injection, heart massage, and artificial respiration. After this we carried and placed them in buses and ambulances.»

From the statements of MChS member A. V. PROSHKIN:

«At 8 O'clock on the morning of October 26th, 2002, I arrived at the scene. I began to evacuate victims from the foyer on the first floor of the building. We put some people on the porch. Some were carried directly to buses and ambulance vehicles, which were arriving continuously. They evacuated people on stretchers. There were enough medical workers, in my opinion. The medical workers injected some kind of medicine into the victims. In my opinion, the operation went quickly, without interruption. Coordination between members from different departments was observed. The evacuation of the former hostages took about one hour.

From the statements of MChS member E. A. BELAN:

»About 7 in the morning of October 26th, 2002, I was in a group that was signaled to come to the scene. We began to take stretchers and evacuate wounded from the building, which we placed on the landing in front of the theater. The evacuation proceeded as it was supposed to. My medical colleagues injected the victims with substances unknown to me, and then they were transferred to buses and ambulance vehicles that were in the vicinity. I performed direct evacuation of hostages from the third floor of the Dubrovka complex. In my opinion, there were sufficient colleagues from the medical service on the scene for the rendering of first aid to the victims."

From the statements of MChS member N. N. KABANOV:

«I arrived on the scene, i.e., the Dubrovka Theater building, after assault, i.e., on the morning of October 26th, 2002. At the main entrance, to where they carried hostages from the building were working many medical workers and transport. I mean that the buses and ambulances worked operationally. I did not see them ever stop. Physicians coordinated our actions, i.e., they showed us whom it is possible to put into buses and ambulances. On the whole, I believe that the evacuation of hostages went successfully and rapidly.

From the statements of MChS member A. M. AKULOV:

»On October 26th, 2002, at 7 in the morning, they gave the command to advance to the Dubrovka Theater building. At approximately 7:15 we arrived at the building. I commanded personnel to take stretchers, and we broke into a run towards the building. We climbed to the second floor and started the hostage evacuation. On the first floor were waiting medical workers, who were giving the antidote. After this we carried victims to the street, where the medical workers looked at the victims' condition and, depending on the condition, indicated where to carry the victims: to the buses or to the ambulance vehicles. The entire evacuation lasted approximately 40–60 minutes.

From the statements of MChS member M. S. ANTONYUK:

«On October 26th, 2002, at approximately at 7 A.M., I arrived with others at the Dubrovka Theater. We took stretchers and advanced to the building. The other rescue workers and I moved the victims to stretchers and carried them to the street. There we transferred victims to the hands of medical personnel, who were providing medical aid on the porch and in the ambulances and buses into which the victims were being loaded. I believe that the evacuation of the victims was organized normally. All the services worked harmoniously together. All the victims we carried out were transferred to medical workers, who gave them injections.»

From the statements of MChS member A. V. SHMIGAL':

«On October 26th, 2002, at approximately at 7 A.M., I arrived with others at the Dubrovka Theater, where we took stretchers and upon command ran to the building, where we were ordered to climb to the third floor. I went to that floor, and there the rescuers put victims on stretchers for us, and we took the people down to the first floor, where medical workers met us. They rendered aid to the victims: checked the pulse, performed injections, and then carried them out to the ambulance or bus depending on where there was room, and as instructed by the senior medical workers.»

From the statements of MChS member A. A. KURILOVICH:

«At approximately 7 A.M. of October 26th, 2002, we received an alarm and were commanded to deploy to the Dubrovka building. After 10 minutes, we arrived at Melnikov Street. There we were told that we were to take stretchers and enter the building. When we entered the building, a colleague of the disaster ministry told us to climb to the third floor. We transferred all the victims to ambulance workers. It seemed to be that there were sufficient ambulances.»

From the statements of MChS member A. I. SHARKO:

«At the time of our group's arrival, the majority of the victims that were located in the hall were already evacuated and placed in the Dubrovka Theater's first floor foyer, or to an area in front of the building. During the evacuation, if it was necessary, the rescuers performed a complex of resuscitative measures without the use of drugs: artificial respiration, indirect heart massage, and a majority of these had positive outcomes. The victims also received injections of Nalaxone.»

From the statements of MChS member S. N. PIGAROV:

«On entering the Dubrovka Theater, I saw many people who were in a state of unconsciousness. Colleagues from the disaster relief ministry, Special Forces soldiers, and Moscow rescue service workers were carrying people first to the foyer, and when this became too crowded, out to the street. Physicians dealt with them there. I saw physicians giving injections, performing artificial respiration, and other first priority actions for correct lifesaving. Intratracheal tubes were used. The living were separated from the dead, and were carried from the hall first.»

From the statements of MChS member A. A. SUKHOMLINOV:

«Colleagues from a special sub-unit evacuated the hostages, who were in a state of unconsciousness. In the hall were many hostages. Practically all were unconscious. Those who were conscious were suffering from oxygen starvation. At the edge of the center worked doctors, who gave of Nalaxone to the hostages, performed mechanical ventilation of the lungs, and other measures necessary in rendering first aid to the victims.

On the square in front of the Dubrovka building, colleagues from the DPS (Highway Patrol) organized free movement of ambulances and buses. Therefore, there was no interruption in the work.»

From the statements of MChS member R. V. KAPKANSHCHIKOV:

«We evacuated victims from the first floor balcony. A woman was carried from the balcony in a state of semi consciousness, and she was transferred to the medical workers. Two of the victims whom I carried seemed to me to be corpses. In the foyer on the first floor were women in camouflage uniforms who were giving injections to the victims.»

From the questioning of SS & NMP (emergency and urgent medical aid station) physician A. N. PROKHOROV, February 20th 2002:

“On October 26th, 2002, at about 7 A.M. we arrived at the scene. They put three victims into our vehicle. The examination of the victims was conducted en route to the hospital. As a result of the examination, two men were declared dead, since they had all the signs of biologic death, these signs were entered into the call log of each victim. (One of the) dead was a man, about 60 years of age, and stout. We gave the accompanying documents to the corpse transport workers along with the death certification.”

From the questioning of SS & NMP medic P. E. YUSHKIN, February 18th, 2002:

“On October 26th, 2002, the brigade got a call to go to Dubrovka. We drove up at about 7 A.M. and right way they put two men in our vehicle. On the way to the hospital the two men were examined, about 60 years of age. The first victim had no documents. The doctor looked at the two, and after his examination they were certified dead. We transferred the two corpses with their accompanying documents regarding certification of death.”

From a Xerox copy of ambulance service call sheet ¹ 785129, dated October 26th, 2002, at 8:30 A.M.:

“(The victim) lies on the floor of the vehicle, no tendon reflexes detectable, no rigor mortis, or putrid color changes evident. The pupils are even, dilated, no corneal reflexes or reaction to light. Cat's eye symptom (+). No breathing activity, heartbeat, pulse in the major arteries, or arterial pressure detectable. The skin is cold. No signs of violent death. It is not possible to determine the length of time since death. Diagnosis: death before arrival. Probable cause of death: poisoned by an unidentified gas.”

From call registration sheet (corpse transport service), October 26th, 2002: the death of S. A. Booker was certified on October 26th, 2002.

From the autopsy protocol, performed on October 26th, 2002 by V. V. Suchkova, investigator of the Izmaylovsk MRP (inter-regional attorney general’s office), Moscow, with the participation of forensic medic S. O. Dolgov:

“The corpse of an unknown man was delivered to Thanatologic department ¹ 11 of the Forensic Medical Examiner’s bureau, Moscow health committee, by the SS & NMP corpse transport service. At the moment of examination, the corpse of the man is laying on his back on a gurney, in the dissection department. The corpse is dressed in the following clothes: a jumper, which is raised up to the upper third of the chest, the back of which is damp and has a small quantity of gray soil adhering, trousers, which are buttoned but pulled down to the upper third of the thighs, trunks, socks, a left sneaker-boot. The right one is missing. His belongings are not disturbed. The skin is pale and dry, moderately elastic, on touch the natural body folds are tepid, while the remaining portions are cold. The musculature is moderately developed. Rigor mortis is weakly expressed in the muscles of upper extremities and in the muscles of mastication, while in the muscles of the neck and lower extremities it is well expressed. Livor mortis, spots of a blue-violet color, in large islands located on the back of the neck, beneath the body and extremities, with the exception of those places directly in contact with the surface of dissecting table. On being pressed, the spots disappear and their color does not return for 1 minute and 25 seconds. The rectal temperature of the corpse is +32 degrees C with a room air temperature of +21 degrees C. Muscle stiffening is generated upon impact with a metal plate over the front surface of the left shoulder. Putrid phenomena are determined at 15:25 on October 26th, 2002. Injuries: on the boundary of frontal and parietal regions of the right side, 3 cm right of centerline and 8 cm above the edge of superciliary arc, there is a 4 x 3 cm ovoid abrasion with uneven, clear boundaries and a dark red indented surface without exfoliation. Soft tissues at the level of abrasion are not swollen. No other injuries were discovered. A repeated pressing of a livor mortis spot at 16:10 caused it to disappear, and the color returned after 1 min and 40 seconds. Rectal temperature of the corpse is +30 degrees C.”

From medical examiner’s report ¹ 2526, by forensic medical examiner S. O. Dolgov, (Morgue ¹ 11), dated October 26th, 2002: «The corpse was delivered to the 11th Thanatologic department by the SS & NMP corpse transport service at 10:14 on October 26th, 2002, with the accompanying form ¹ 06836…»

EXTERNAL STUDY: The clothing was removed from the corpse. The jumper was raised to the upper third of the chest, the back of which was damp and had small quantity of gray soil. The trousers were buttoned, but pulled down to the upper third of the thighs, trunks and socks. A left sneaker-boot, the right one is missing. His belongings are not disturbed. No injuries were discovered.

INJURIES: On the boundary of frontal and parietal regions to the right side, 3 cm right of the centerline and 8 cm above the edge of superciliary arc, there is a 4 x 3 cm ovoid abrasion with uneven, clear boundaries and a dark-red, indented surface without exfoliation. Soft tissues at the level of abrasion are not swollen; the subcutaneous fatty cellular tissue there has a corresponding dark-red, shiny hemorrhage impregnating a thickness of not more than 0.5 cm.

INTERNAL STUDY: The soft tissues of the head are a pale gray-pink, edematous and shiny, and without hemorrhages. Temporal muscles are grayish-pink, and without hemorrhages. The bones of the crown and base of the skull are intact.

The dura mater is not under pressure, its color is a pale cyanotic-gray, and there is dark-red, liquid blood in the sinuses. The pia maters are semi-transparent, with congested blood vessels.

The convex surfaces of the hemispheres are elevated above the brain by the accumulation of a small quantity of transparent liquid, for the remaining length they are tightly adjoined to the brain matter. In the region of interhemispheric slot, the meninges are thickened, whitish, but for the remaining length they are thin, smooth, and bright. The amygdalae of the cerebellum have an emphasized waist and are united one to the other. The cerebral hemispheres are symmetrical, with narrow convolutions and deep fissures. The cisterns of the brain are somewhat extended. The vessels of the base of brain are shaped normally; the inner meninges have a multitude of small, light-gray, very elastic plaques, which shine on cross section. The brain matter is dense on palpation, on symmetrical cross-section they have a well-defined boundary between the gray and white matter, and the knife does not stick to the cut surface. The subcortical ganglia, cerebellum, and medulla oblongata have no local changes. The ventricles of the brain are slightly dilated with a transparent, slightly yellowish liquid. The inner membrane of the ventricles is smooth and shiny, and the blood vessels are congested. The hypophysis is slightly elastic; on incision it is cyanotic-gray and without hemorrhages.

The thickness of subcutaneous fatty cellular tissue at the level of breastbone is 1.5 cm; at the level of the front of the abdominal wall it is 3.5 cm. There are no hemorrhages or adhesions in the abdominal and pleural cavities, or in pericardial sac. There are traces of a transparent, light-yellow liquid in the cavities. The leaves of pericardial sac, the parietal and visceral pleura are pale gray, edematous, and shiny. The lungs occupy two thirds of pleural cavities.

The loops of the bowels are not distended. The muscles of the neck, body and extremities are dark red. No hemorrhages were discovered in the soft tissues of neck.

A whitish film covers the tongue; the mucosa of the tongue is visible and there is well pronounced papillae. The tongue muscle on cross section is grayish-brown, without scars, and there were no hemorrhages into the mucous membrane or tongue muscles discovered.

The mucosa of the nasopharynx is cyanotic-gray, smooth, and bright. The entrance to the larynx and throat is unobstructed, the mucosa and epiglottis are pale-gray, thin, smooth, and bright, without hemorrhages or injury. The salivary glands are slightly pale-gray and lobulated.

The hyoid bone and cartilages of larynx are intact and there are no hemorrhages in the soft tissues surrounding them.

The thyroid gland has a well-defined isthmus and lobules, measures 5×2 x 1 cm, and is dark-red and grainy on cross section.

The Jugular veins are moderately distended. The lymph nodes of neck measure up to 1×1 x 0.5 cm, are slightly elastic, dark gray, uniform, and edematous. The carotid arteries are not obstructed and their inner layers have a multitude of flat, dense, gray-white plaques.

The esophagus is not obstructed, and its mucosa is a cyanotic-gray color and slightly pleated.

The mucosa of larynx are a pale, grayish-pink color, and smooth and shiny. The glottis is open. On incision, the trachea and large bronchi have traces of semitransparent, light-gray mucus; the mucosa is pale-gray, smooth and shiny.

The branches and root of the pulmonary artery are not obstructed. Their inner surfaces are thin, smooth and shiny.

The pulmonary pleura are thin, smooth and shiny, and without hemorrhages.

On palpation the lungs feel moderately air-filled. On cross section the front divisions are a rosy-red to an almost dark blue-red, with well-pronounced, gray reticulations. An incision into the surface yields a small quantity of slightly foamy pinkish liquid, and dark-red, liquid blood flows from severed vessels. The walls of the small bronchi are thickened; on cross section they gape and protrude above the surface of the incision from 0.1 to 0.2 cm. The ventral mediastinum is without pathologic changes.

The heart has an incorrect, conical shape, and measures 11.5×10 x 5 cm. The top is rounded. The outer covering is thin, transparent, and shiny, while beneath it is a large quantity of adipose tissue along the channel of the slightly coiled coronary vessels. It is dense on palpation. The inner surfaces of the coronary arteries have dense, gray-white plaques, which narrow them up to 25%. The blood supply of the heart is right-sided. The atria are unobstructed. The inner membrane of heart is pale-gray, semi-transparent, and smooth. The folds of the valves are thin, smooth and shiny, and not fused together. The valve chords are long and thin. Papillary and trabecular muscles are increased in size.

Within the cavity of the heart is dark red, liquid blood. The perimeter of aortic valve is 6.1 cm, above the aortic valve 6.5 cm. The pulmonary artery perimeter is 6.1 cm, the bicuspid valve 11.1 cm, and the tricuspid 12.5 cm. The muscle thickness of the left ventricle is 1.5 cm, while the right ventricle is 0.3 cm. The heart muscle is a uniform gray-red.

The perimeter of aorta at the level of the aortal opening of diaphragm is 4 cm. The inner surfaces of the aorta, celiac artery and its branches, and renal and mesenteric arteries, are a pale yellow color, with a single, flat, dense grayish-white plaque. The opening of the lower vena cava is empty, its perimeter is 6.3 cm, and the inner surface is smooth, gray, and shiny.

The adrenal glands are leaf-like. On incision, the yellow cortical and reddish-brown medullary layers are pronounced.

The Kidneys are 15×6 x 4 cm, a bit flabby, with easily removed capsules and a smooth surface. In section, the structure is pronounced: a grayish-red cortex and cyanic-red pyramid. The renal calyces, papillae, and ureters are unobstructed. Their mucosa are a pale gray color, smooth and shiny, and without hemorrhages.

There is approximately 150 ml of cloudy, light-yellow urine. The mucosa has a well-pronounced trabecular form, and is shiny.

The prostate gland is 5×4 x 4 cm, slightly elastic, pale-gray, and fibrous.

The testicles are 5×4 x 4 cm, slightly elastic, grayish-yellow, and without pathologic changes.

The stomach is retort-shaped. Within is greenish-brown semi-fluid mucus. The mucosa is pale gray, with pronounced longitudinal folding and without hemorrhages.

The bile ducts are not obstructed. The gall bladder contains about 30 ml of thick, dark-green bile. The mucosa is velvety.

The mucosa of the duodenum are transversely pleated, shiny, is slightly bile-stained. The mesentery of the small intestine has no hemorrhages or injuries. The small intestines have greenish-yellow semi-fluid contents.

The large intestines have brownish, partially formed fecal masses, and the mucosa of bowels, for their entire length, is gray, pleated, and shiny. The serosa is transparent, smooth, and shiny.

The liver is 28×18×12 x 8.5 cm, and somewhat flabby. Its forward edge it is slightly rounded, with a smooth, semi-transparent capsule. On incision it is a red-brown color with a weakly expressed yellowish nuance, and the boundaries of the lobules are poorly defined. The inner surface of the portal vein is thin, gray, smooth, and shiny.

The spleen is 12×8 x 3 cm, with a smooth capsule. It is somewhat flabby, a dark-cherry color, and bloody.

The pancreas is 17×3.5 x 2 cm; retroperitoneal, and shaped like a slightly elastic belt. On incision it is a cyanotic-red, with a pronounced, moderately lobulated structure. The interlobular spaces are acutely congested and broadened due to adipose tissue.

The lymph nodes of the abdominal and pelvic cavities are 2×1 x 1 cm, slightly elastic, grayish-black, uniform, and edematous.

The sternum, ribs, spine, and bones of the extremities and pelvis are intact. No strange odors were detected from the cavities and organs of the corpse.

FORENSIC MEDICAL DIAGNOSIS: Acute cardiac failure (I 46.1) on a background of shock of mixed genesis (R 57.9) (hypoxia, adynamia, hypovolemia, psychoemotional stress, hypoglycemia) and pronounced microcirculatory disturbances of the organs and tissues (severe congestion of the internal organs and liquid state of the blood).

There is non-mural coronary sclerosis, obesity of the epicardium, steatosis of the liver, and lipomatosis of the pancreas, weakly pronounced aortic atherosclerosis, and an abrasion on the face.

From corpse identification certificate, dated October 28th, 2002, by Police Inspector Kh.M. Kasimov of the Izmaylovsk MRP, Moscow: the unidentified man is identified as Sandy Alan Booker.

Blood from the corpse was identified as belonging to blood group AB (Group II).

Blood and urine from the corpse contained no ethyl, methyl, or propyl alcohols.

The glucose level in the blood was 9.7 mmole/liter (the standard is 3.5–5.8 mmole/liter). Blood urea nitrogen concentration was 8,4 mmole/liter (the standard is 2.5–8.9 mmole/liter). Liver glycogen composed 1.8% of the damp weight of the liver (the standard is 3-10%). Skeletal muscle and myocardial glycogen was not detected.

The findings of forensic histological study of ¹ 15236: “Circulatory disturbances in the organs: Edema of fibrous soft meninges, heart, lung, liver, and kidney tissues. Edema of cerebral cortex, and small «fresh» perivascular hemorrhages in the cortical and subcortical regions of greater hemispheres. There is pulmonary edema and numerous intra-alveolar hemorrhages. There is acute congestion of the organs, hemostasis and erythrocytic aggregations within the vessels of the organs, dystelectasis and foci of acute emphysema. Cardiomyopathy with non-mural liposclerotic coronary sclerosis, an uneven, moderate sclerosis of the intramural arteries, arteriospasm, perivascular, focal cardiosclerosis, centers of endocardial sclerosis, lipomatosis of the myocardial stroma, damage and fragmentation of polymorphous cardiomyocytes, arterial atherosclerosis and vacuolar epithelial dystrophy of the proximal renal ducts, sclerosis of the hepatic portal tracts with extensive vacuolar dystrophy, and disseminated hepatic steatosis.

No ethyl, methyl, or propyl alcohols were detected in the blood.

In view of the complexity of the incident, and in order to determine the cause of death, data from the forensic medical study of the corpse of Sandy Alan Booker, age 49, is being sent to the division of commissioned examinations, forensic medical examiner bureau, Moscow health committee."

From the expert’s report (forensic histological study), ¹ 15236, November 2nd, 2002:

“Twelve preparations, stained with hematoxilin and eosin, were examined.

Brain tissue from the cortical and subcortical regions of the large hemispheres and brain stem: within the cortical medium a fibrous, soft meningeal membrane is visible, gathered into the thickened folds. Extensive, congested meningeal vessels, and hemostasis and erythrocytic aggregations were noted in many vessels. The cortical and subcortical regions have a few perivascular hemorrhages, without cellular reaction from the brain tissue side. The perivascular and pericellular spaces are well defined in the brain tissue, and there are several small, separate, paraplastic corpuscles. Only the walls of arterial membranes are moderately ring-shaped, thickened and sclerotic.

The coronary artery is empty, its opening is narrowed to 1/3, and there are pronounced liposclerotic centers in the intima. Unevenly dilated and acutely congested vessels are adjacent to the epicardium, and there is stasis of capillary erythrocytes.

The heart (4 preparations): for the length of the section there are congested epicardial vessels, and edematous myocardium. The congestion of the blood vessels is even more pronounced, and hemostasis and erythrocytic aggregations were noted in both the veins and capillaries of the myocardial stroma. The intramural arteries are unevenly and moderately ring-shaped and thickened, and sclerotic. Their openings are slightly narrowed, but in certain other arteries the pichnotic endothelial nuclei of endothelium are reoriented into a palisade shape, and their interiors are not visible. About the blood vessels and among moderately unevenly hypertrophied and focally atrophied (muscle) fibers are individual lymphocytes and adipose cells, as well as slightly edematous, focally thickened, sclerotic endocardial cells. The edema is extensive and areas of atony, undulating deformation, fragmentation, and hyper-eosinophilia of the fibers are visible.

The lungs: along the length of two sections are extensively congested blood vessels, hemostasis and aggregation. There is sludging of erythrocytes in many vessels. Solitary bronchioles are dilated and empty, their walls without sclerotic or inflammatory changes. There is edematous stroma and pleura, with focal sclerosis around the vessels and bronchioles. Acute and unevenly dilated alveoli have thin, focally atrophied inter-alveolar septa with numerous local hemorrhages, and there is a quantity of faint, uneven, pinkish, homogeneous masses.

The liver has congested veins, while the remaining vessels are anemic. There is an even dilation of the perisinusoidal spaces, and edema of the portal tracts and capsule. The portal tracts are moderately unevenly dilated, sclerotic, and clearly delineated from the parenchyma. There is an uneven, moderate infiltration by lymphocytes and plasma cells. Extensive vacuolar dystrophy and disseminated medium-droplet steatosis is visible. Foci of transparent hepatocytes were noted in the periportal zones.

The kidney contains evenly congested blood vessels with stases of erythrocytes in the glomerular capillaries, arterioles, and venules. The stroma is edematous, without any sclerotic or inflammatory changes. The walls of arteries and arterioles are slightly thickened and sclerotic, the ducts are empty, and there is an extensive vacuolar dystrophy of the epithelium of the proximal and straight tubules."

DATA FROM A REPEAT HISTOLOGICAL STUDY

Lungs. Sharply pronounced acute venous congestion with pronounced microcirculatory disturbances: acute capillary congestion, diapedetic hemorrhages, and — in the majority of the cases — intra-alveolar hemorrhages (frequently significant). Many alveoli contain edematous liquid and exfoliated alveolar cells. There are foci of acute emphysema and atelectasia. There is bronchospasm, frequently in the bronchial openings, accompanied by exfoliated epithelia and a multitude of erythrocytes.

Liver. Pronounced acute venous congestion combined with hepatocytic lipodystrophy in varying degrees of manifestation (most frequently of the large droplet form). There is local fatty hepatosis, with foci of lympho-macrophagocytic portal tract infiltration.

Kidney. There is well-pronounced acute venous congestion and severe microcirculatory disturbances of the cortical and medullary substance. There is hydrolysis and necrosis of the epithelia of the convoluted tubules, and isolated, poorly pronounced sclerosis of the stroma and walls of small arteries, as well as hyalinization of isolated glomeruli.

Heart. There is acute congestion with uneven hyperemia of the arterial vessels and capillaries (from congestion to foci of anemia), as well as scattered centers of myolysis and a loss of transverse striation in myocytes. The stroma is edematous. There is non-mural coronary sclerosis, localized arterial and myocardial sclerosis, localized sclerosis of the parietal endocardium, and localized myocardial hypertrophy.

Brain. Acute venous congestion with microcirculatory disturbances, perivascular hemorrhages, pronounced edema, isolated areas of sclerosis in the walls of small arteries in the brain matter, pronounced arachnofibrosis with centers of productive inflammation (chronic arachnoid meningitis).

The histological study revealed acute venous congestion, extensive severe microcirculatory disturbances, dystrophic changes in the myocardium, liver and kidneys, and chronic arachnoid meningitis. There are also signs of hypertension of peripheral circulatory system.

Consultation on the slides was provided on March 13th, 2003, by Professor O. V. Zayrat’yantsev, chairman of the department of anatomic pathology, Moscow State University Medical School, and by L. A. Sergeeva, head of the department of forensic histology, Moscow city forensic medical examiner’s bureau.

C O N C L U S I O N S

Based on a study of the representative case materials and medical documents, including medical examiner report ¹ 2526, dated October 26th, 2002, prepared using additional reports (forensic chemical, biochemical, and histological), and in accordance with the questions presented, the commission of forensic medical experts arrived at the following conclusions:

1. A forensic medical study of the corpse of S. A. Booker disclosed an abrasion measuring 4 x 3 cm on the boundary of right frontal and parietal bones, with hemorrhage into subcutaneous fatty tissue.

This injury could have occurred just before death or during the agonal period due to the sliding action of a solid, blunt object, although a fall is not ruled out. While still alive, this abrasion would not be dangerous to health.

It is not related to the cause of death of S. A. Booker.

2. Not long before the onset of death, S. A. Booker did not use any alcoholic or narcotic substances; this is proven by the negative results of the forensic chemical tests of his blood, urine, and internal organs.

3. On forensic medical study of the corpse of S. A. Booker, a brownish-green semi-fluid mucous was discovered. This, in combination with the results of a biochemical study (a reduced liver glycogen and absence of myocardial and skeletal muscle glycogen), attests to the fact that he did not consume any food for an extended period.

4. Macroscopic data (signs of acute heart failure with a background of shock of mixed genesis, congested internal organs, and the liquid state of the blood) and microscopic data (severe, extensive microcirculatory disturbances in the brain and internal organs, bronchospasm, localized emphysema and dystelectasis in the lungs, injured cardiomyocytes, and dystrophic changes in the parenchymatous organs) from the examinations give grounds for the conclusion that the death of S. A. Booker stemmed from acute respiratory and cardiac insufficiency caused by a combination of factors that were dangerous to life and health: prolonged, heavy psychoemotional stress, reduced oxygen content in air of the building (hypoxic hypoxia), a prolonged period in an immobile position which accompanies the development of oxygen starvation (circulatory hypoxia), hypovolemia (dehydration) connected to a long absence of food and water, prolonged sleep deprivation which reduces the body’s compensatory mechanisms, and respiratory disorders caused by the action of the unidentified chemical substance (or substances), which, based on a study of the materials of the case, led to the rapid loss of consciousness.

S. A. Booker’s unconsciousness in a sitting position increased the disturbances to the body’s vital functions, and could have included an infringement of airway patency, which aggravated the hypoxic condition already present.

Contributing to the death of S. A. Booker were previously present, chronic diseases and morbid changes, which were discovered upon examination of his corpse: cardiovascular (signs of increased arterial pressure), brain (chronic arachnoid meningitis), and liver (local fatty hepatosis). These decreased the body’s ability to compensate for the actions of any injurious, external damaging factors, especially on the part of the liver, which is one of the organs functioning to detoxify (render safe) the utilized chemical substance (or substances).

The multifactor nature of the cause of S. A. Booker’s death rules out a direct cause-effect relationship between the action of the gaseous chemical substance (or substances) used on him, and his death.

In this case the relationship is of an incidental nature, since the main objective for considering the application of the gaseous chemical substance (or substances) was that it would not lead to death in the absence of other factors enumerated above.

Signs of mechanical asphyxia (aspiration of emeses) were not noted during the study of the corpse of S. A. Booker.

According to data from ambulance call sheet ¹ 785129, the death of S. A. Booker occurred at approximately 8:30 A.M. on October 26th, 2002.

5. The forensic-chemical studies of the internal organs from the corpse of S. A. Booker did not disclose any chemical substances not typically found in the human body, nor the products of their decomposition (or disintegration).

6. There is no data concerning the rendering of medical aid to S. A. Booker contained in ambulance call sheet ¹ 785129, or in the statements of the SMP physician or medic.

Signed

 
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