MOSCOW -- Prosecutors describe it as cold-blooded, premeditated murder, claiming a doctor deliberately killed a premature baby with a deadly dose of magnesium sulfate. Her colleagues across the country are crying foul, dismissing the criminal charge as absurd and as a symptom of dire problems in Russian health care.
The newborn's death, and the subsequent prosecution of Dr. Elina Shushkevich, are central to a controversy that has energized Russia's medical community, adding to growing discontent over stagnating real wages, increased scrutiny from law enforcement, and closures of provincial hospitals.
In recent days, hundreds of health-care workers across the country have protested in solidarity with Sushkevich, a specialist in high-risk pregnancies who was charged on June 30 with killing an infant delivered -- reportedly in the sixth month of pregnancy -- with a severely low birth weight.
Bearing posters reading "I am Elina Sushkevich," they allege that her prosecution is fueling a climate of fear among Russian doctors and driving people from a profession that desperately needs protection at a time of demographic decline.
"It's becoming ever more dangerous to work as a medic," Ilya Skachkov, a doctor in Perm, told Kommersant during protests in the Siberian city on July 6.
According to an indictment published by Russia's Investigative Committee, Sushkevich was called in November 2018 to maternity clinic No. 4 in Kaliningrad, the capital of Russia's eponymous Baltic exclave, to help provide urgent medical attention to a newborn weighing a mere 700 grams.
The boy was born to a woman from Uzbekistan, reportedly in the 23rd week of her pregnancy.
Acting in concert with Yelena Belaya, then the hospital's chief doctor, Sushkevich judged that efforts to keep the baby alive would come at too great an expense, and its inevitable death within days would worsen mortality statistics, prosecutors allege.
Belaya "discussed in advance possible ways to kill the infant" with Sushkevich, who arrived at the hospital from the city's main prenatal clinic. It was Sushkevich, the indictment alleges, who administered a lethal dose of magnesium sulfate to the baby, while Belaya "entered deliberately misleading information into medical records relating to fetal death in the mother's womb."
Last month Sushkevich was detained and placed under house arrest on a charge of premeditated murder. She has apparently not had the opportunity to publicly confirm or deny the allegations listed in the indictment, which her colleagues and supporters dismiss as absurd.
'I Am Elina Sushkevich'
Following the release of the indictment on June 30, a wave of online support broke out for Sushkevich, who many colleagues believe was simply doing her job. Belaya, whose relations with staffers were allegedly strained and who was arrested in November and charged with organizing the murder, has not received a similar show of solidarity.
On social media and video-sharing websites, many expressed solidarity with the doctor and portrayed her as a victim of an ill-judged legal campaign to hold doctors accountable for deaths beyond their control.
"The time has come when a doctor risks their freedom just for trying to save a child's life," wrote workers of a maternity clinic in Vladimir, a city 200 kilometers east of Moscow. "The case of Elina Sushkevich is a wild injustice and an absurdity."
In a video posted online from St. Petersburg, which residents refer to informally as "Piter," medical workers stood before a pair of ambulances with sirens blaring, holding letters spelling out the now familiar slogan "I am Elina Sushkevich" and the words "Piter is with you."
Sushkevich headed the Kaliningrad branch of the Russian Society of Neonatologists, a kind of labor union for members of the profession, and is described by colleagues as a respected medical professional.
In a statement on June 29, the group vehemently defended her, arguing that all possible emergency care was given to the infant after its death. The charge of premeditated murder, it said, was advanced only after investigators had failed to prove that Sushkevich and her colleagues had withheld life-saving medication from the child because they hoped to cut costs.
In a telephone interview with RFE/RL, Diana Mustafina-Bredikhina, the group's lawyer, described the indictment as "absurd." "We absolutely disagree with the charge," she said. "Why would a specialist who has saved the lives of thousands of children arrive at a different clinic to the one she works at and kill the child of a patient unknown to her?"
An investigation by the BBC's Russian service found that some 2,000 children are born each year in Russia weighing between 500 and 749 grams. Half of them die before leaving the maternity ward.
Resuscitation of dangerously premature babies is done with the help of synthetic surfactant, which is sprayed into the windpipe while oxygen flow is maintained through special equipment. Since provincial hospitals usually lack personnel with the skills to execute such operations, women who give birth prematurely are dispatched to perinatal centers. In 2013, Russia pledged to build 90 such centers by 2020.
Like many other doctors who have spoken out in Sushkevich's defense in recent days, Mustafina-Bredikhina said a climate of fear had emerged among members of the medical profession in Russia as the number facing criminal prosecution for actions taken at work appears to be on the rise.
"Our colleagues are very afraid. For many this is the hour of reckoning," she said. Since Sushkevich's arrest, she said, "many have decided to leave the profession. People are deciding for themselves whether they're willing to continue working under the current circumstances."
Doctors Singled Out
One of those people is Anastasia Vasilyeva, who quit her job as an ophthalmologist in Moscow last year in protest over low pay -- her monthly salary was 25,000 rubles, or less than $400 -- and excessive bureaucracy. The last straw, she said, was an order from superiors that she issue automatic passing grades to a group of students at Moscow State Medical University, where she was an assistant professor. Many of them would routinely skip classes, she said.
Shortly after her resignation, Vasilyeva joined forces with other Russian doctors angered over proposed cuts to health-care funding and meager wages -- as well as with leading opposition politician Aleksei Navalny and his supporters -- to create a medical workers' union called the Alliance of Doctors. Since then, she has helped organize over a dozen protests across Russia and the union has opened branches in at least 20 regions.
On July 6, Vasilyeva was in Kaliningrad to take part in a series of pickets in solidarity with Sushkevich. The following day, as she was en route to Kaliningrad airport, Vasilyeva was detained by police and taken back to the regional capital for questioning. On July 8 she was fined 20,000 rubles ($313) for participating in an unsanctioned public gathering.
In a telephone interview, she said she was prepared to "do everything" to stop a campaign that she and others allege is sowing fear among medical professionals and contributing to a climate that, according to calculations by the Alliance of Doctors, has produced a 23 percent increase in the number of criminal cases launched against medical professionals in Russia.
"Investigators have no education in medicine, so they don't know what mistakes doctors make," Vasilyeva said. "If doctors are afraid to treat patients, the medical help will worsen and patients will wait longer. And I'm afraid that doctors will no longer try to help patients."
According to Alliance of Doctors spokesman Ivan Konovalov, medical professionals are increasingly subjected to dubious charges.
"A person files a complaint against a doctor, and the police -- instead of siding with the doctor, place blame on him or her, and the doctor is left one-on-one against the system," he told RFE/RL.
"Doctors are a vulnerable part of society. Before our group came along, no one was actively protecting them," he said.
The Russian Society of Neonatologists has distanced itself from Vasilyeva and the Alliance of Doctors. Mustafina-Bredikhina expressed skepticism about the protests that have been staged across Russia in recent days.
In its statement, the group cited recent cases in Russia that have deepened long-standing suspicions about the objectivity of police investigators, including the June arrest of investigative journalist Ivan Golunov on a drug charge widely seen as fabricated and the hit-and-run death in April 2017 of a 6-year-old boy, Alyesha Shimko.
The charge against Golunov was dropped, with Russia's interior minister saying there was no evidence against him. A forensic expert who found alcohol in Shimko's blood was sentenced in May to 10 months of correctional labor after a subsequent assessment discredited his findings.
"We're for a fair trial," Mustafina-Bredikhina said of the Sushkevich case, adding that her group planned to collect evidence of similar cases in coming weeks, as it continues its campaign for increased transparency about Sushkevich's prosecution.