RESOLUTION

on not initiating criminal charges

City of Moscow                                            December 31st, 2002

The prosecutor's office received a statement by a member of the Russian parliament, representative of the Union of Right-Wing Forces B. E. Nemtsov, which asked for the creation of a commission to investigate the events during the ending stages of the hostage rescue operation in Moscow on October 26th, 2002.  A public commission inquiry by the SPS (Union of Right-Wing Forces), after questioning numerous eyewitnesses and participants in the events studying audio and video materials, came to the conclusion that the large number of casualties among the hostages was caused by negligence on the part of officials who were responsible for organizing first aid to the casualties and their transport to hospitals, as well as the overall coordination of rescue activities following the assault.

Their statement noted the following deficiencies in the work of responsible officials and services that participated in organizing the rendering of first aid and the evacuation of casualties from the GPZ (Government Ball-Bearings Factory, also known as the DK AO “Moscow Bearings”):  an inadmissibly long wait by the victims for medical assistance and transport to medical facilities; the absence of director-coordinator by the building's exit from among the medical personnel; the absence of an area for temporarily arranging the casualties so that several medical units present could provide on the spot resuscitation; the absence of organization to allow timely, free and uninterrupted movement of ambulances, bus, and resuscitation vehicles; casualties were transported in mass on board buses without the proper quantity of accompanying doctors, medics, and rescuers, who were trained in resuscitative measure; the absence of sufficient coordination between the special forces, rescuers, and ambulance workers; the absence of specialists in the field of military medicine who had experience and knowledge of special (resuscitative) methods; the absence of organized and uniform distribution of casualties to treatment facilities; the absence of information on the use of fentanyl, the possible effects of its use, the necessary measures to be used to avert danger to the peoples' lives and health, which as a result led to numerous deaths among the hostages.

Their statement concludes that the above-mentioned facts need to be examined to determine the need for a criminal complaint due to signs of crimes, as provided in articles 237 and 293 of the UK RF (Russian criminal code), as well as the possible application of other measures of prosecutorial intervention.

During the course of the examination (of the facts) the following materials, relating to the public commissions' above-mentioned hearings, were subpoenaed and included:

— the SPS public commission's conclusions concerning the problems of medical assistance to the injured hostages.

— minutes of the SPS public commission's inquiry into the problems of medical assistance to the injured hostages, held on October 29th, October 31st, and November 1st, 2002, as well as minutes of a conversation with Echo of Moscow radio correspondent S. A. Kravchenko from November 13th, 2002.

— a videocassette.

All the above-mentioned documents were presented in an unsigned and uncertified form.   From the documents it was determined that the commission consisted of 9 persons, but information on the completed forms, identifying them or giving their contact telephone numbers, was not indicated.  The list of experts participating in the commission’s sessions consists of 11 persons, 7 of whom are indicated only by numbers, and as such their personal data is absent.

The shorthand record presented contains only portions of speeches and remarks made by members of the commission and the so-called «experts».   Information on persons who allegedly directly participated in evacuating the hostages  and rendering their first aid is not indicated in the minutes, and thus prevents proving the authenticity the information they allegedly reported by them, or the commentaries recorded in the minutes.

In the commissions' conclusions, which are undated, it states that the sessions took place on October 29th and 31st, and November 1st, 2nd, and 4th, 2002.  However, minutes of the meetings for November 2nd and 4th were not present.  S. A. Kravchenko, a so-called «expert»,  was questioned by SPS employee A. S. Trapeznikova on November 13th, 2002, when she was no longer a member of the commission — i.e.: the questioning was performed outside the time limits of the commission's work.

The presented videocassette has 3 partial video recordings.  The first is a long-distance survey of the entrance to the DK AO (Palace of Culture for the joint-stock traded firm) «Moscow Bearings» building, at the moment when hostage evacuation was starting.  There is no time indicated on the video.  The second block is long-distance survey of the entrance to the DK AO «Moscow Bearings» building.  The time indicated on the cassette shows 0655 as when the first hostages are brought out, 0657 as when MChS (Disaster Ministry) vehicles arrive at the square in from of the building and rescuers go inside the building.  On the videocassette it is evident that at 0725 a bus leaves the building, and at 0740 another bus leaves.  The third block (of the video cassette) is a partial report by television station NTV (‘Independent Television’).

The indicated video materials, due to the distance of video operator from the scene, do not allow one to draw any specific conclusions concerning the organization of medical assistance to the former hostages.  From the video recordings, it is evident that some of the hostages left building on their own, accompanied by MChS workers.  Casualties were carried out in different positions, including «on their back», were placed in front of the building entrance for the rendering of medical assistance.  Visibly evident is how these former hostages are immediately after removal from the building are given an injection, and artificial respiration.  Any serious obstacle to the movement of the vehicles evacuating the former hostages, is not observed on the video recording.

Statements from those persons who participated in the organization of direct assistance to the casualties on October 26th, 2002, were received.

According to the statement by the L. G. Kostomarova, director of the Moscow TsEhMP (Center for Emergency Medical Assistance), on October 26th, 2002, the TsEhMP received information at 0530 about assault on the DK AO «Moscow Bearings» by the forces of the special services, and they immediately warned the following hospitals:  GKB (municipal clinical hospitals) numbers 1, 7, 13, 15, 53, and 64, the Sklifosovsky Research Institute, DKB (children's clinical hospitals) numbers 9, 13, and 20, and the Morozov Children's Hospital.  At 0537 the order came to place 100 ambulance teams in reserve at the nearest substation.  At 0550 they sent to the Proletariat subway station the TSEhMP's 3rd team (unit 6813), which was to accompany a column of ambulances.  At 0700 to 0705 began the mass evacuation of hostages by ambulance teams and their attached buses accompanied by medical personnel.  At 0815 the evacuation of the hostages was complete.  Ambulance teams, due to the specific character of their work, were ready to render assistance no matter what the nature of the injury, and were equipped with all necessary equipment and medical preparations, including Naloxone, which is an antagonist against various narcotics, and it was used in rendering assistance to casualties from the DK.  On the whole, the organization of assistance to the casualties and their evacuation was good. Since there was the threat of an explosion, it was not possible to render aid to the casualties in immediate vicinity of the DK building, and so the use of buses was justified.  The absence of specific information about which substance the casualties were under the influence of, was not important in the proper rendering of assistance to the casualties.  The participation of military physicians in rendering assistance to the casualties, in her opinion, was unnecessary, since ambulance teams were able to render assistance to the casualties with maximum effectiveness.

According to the statement by TsEhMP worker A. P. Nezamayev, on October 25th, 2002, he, in accordance with his pre-determined work schedule, was a member of team #1 and left for his duty station at GVV (veteran's hospital) #1, building 13, on 2nd Dubrovka Street, Moscow.  He received no additional instructions; he was, however, informed by his chain of command about which hospitals had been activated and how many beds they had available for casualties.  Furthermore, he was informed about the arrangement of ambulance teams and their degree of readiness to rendering first aid to casualties.  At 2 or 3 am October 26th, 2002, A. P. Seltsovsky relayed information about removing of two casualties from the DK AO «Moscow Bearings» building.  He, together with an FSB representative and the chairman of the public health ministry selected two doctors who agreed to evacuate the injured.  They carried them from the DK building and sent them for surgery at GVV #1.  The casualties, Pavel Igorevich Zakharov and Tamara Mihailovna Starkova, were admitted with gunshot wounds.  At 0545 on October 26th, 2002, he received information from A. P. Seltsovsky that the assault had started, and that he, as assistant to the chairman of the Moscow public health commission, was ordered assemble 20 ambulance teams on Volgograd Prospect.  Five minutes later A. P. Seltsovsky radioed him to send 20 ambulance teams to Koptelsky Alley #1, and 20 teams to Tagansk Square.  Around 6 am on October 26th, 2002, A. P. Seltsovsky reported that the DK building had been liberated from the terrorists, and that he (Nezamayev) and 5 of his assigned ambulance teams was to move to the DK building.  The 60 teams readied previously received the same command.  On arrival at the scene, Nezamayev observed law enforcement officers, firemen, rescue service workers, and other persons carrying casualties out from the building.  The public health workers all had prior training and instruction on how to operate during a ChS (emergency situation), so he did not need to make fundamental changes in their rendering of first aid to the casualties, or their organization.  They had been given instructions on how to provide various, necessary medicines to one of another casualty.  The general clinical picture of the hostages' condition appeared as follows: disturbed respiration, decreased arterial pressure, many were in a comatose state.  All this indicated intoxication by a gas, and so the first priority in rendering aid to such casualties consisted of evacuation from the locus of the poisoning into fresh air, injections of Cardiomin, and opening the respiratory tract, i.e., all actions, directed toward the restoration of respiration and heart function.

According to the statement by TsEhMP physician E. A. Krugovoi, on October 25th, 2002, he was summoned to duty at 12:30 pm, arriving at his duty site of Melnikov #2, Moscow, at 12:51 pm.  At 5:37 am on October 26th, 2002, the first shots were fired, and at 5:50 am he sent ambulance teams to the PTU (polytechnic university) and sent medic A. N. Gavrilov to Volgograd Prospect to meet with Y. K. Volkov.  They were to reconnoiter routes of approach (to the DK).  At 7:02 am, on Seltsovsky's orders, they advanced to the DK AO «Moscow Bearings» building, where they arrived at 7:05 am.  On their arrival the evacuation of the hostages had already been organized, though he did not know by whom.  He arranged for the loading of casualties onto buses, their preliminary sorting (triage), outfitted the buses with medical staff, added accompanying vehicles, and sent them to the hospital.  Clinically the casualties appeared to be suffering from opiate intoxication.  The casualties were sent to hospitals dependent on their level of severity and the distance of the hospital.  Accordingly, the buses were sent to GKB #13.

According to the statement by TsEhMP physician V. K. Volkov, on October 26th, 2002, at 5:50 am he was in the TsEhMP building on Koptelsky Alley #1, Moscow.  At this time the dispatcher summoned him to depart for Volgograd Prospect, where he was to join a column of ambulances.  His assignment included forming up of column and waiting for further instructions.  At 7: 05 am A. P. Seltsovsky ordered him to depart as part of the column for the DK building, the order relayed to him via E. A. Krugovoi.  He arrived at the DK building at 7:13 am.  On his arrival at the scene, the evacuation of casualties had already been organized by MChS workers, firemen, soldiers, the police, and other persons, who carried out the casualties and placed them in area in front of the building, or put them into buses standing in front of the building. The preliminary sorting of casualties was by TsEhMP workers.  Ambulances were assigned to accompany the buses.

From the statements of ambulance physicians T. I. Puchkova, T. N. Krainova, A. M. Karaush, V. V. Fedotov, I. M. Polyakova, T. P. Troperina, E. I. Fedosov, I. V. Chursin, G. I. Krugovoi, A. A. Zhukov, K. A. Bennikov, A. Y. Krylov, V. F. Moiseev, N. I. Budnina, M. A. Smirnov, A. V. Nedoseikina, E. V. Konyahin, N. K. Tuarsheva, D. N. Osipov, L. N. Sushnikova, V. I. Dimnich, A. V. Koleninkov, L. O. Safronova, A. I. Karchev, M. Y. Zakharenkov, E. V. Larin, V. V. Gorbunov, A. S. Astahova, Y. V. Yershov, L. N. Drozdova, and O. V. Belyakova, it follows that they participated in rendering medical assistance to casualties at the DK AO «Moscow Bearings» under supervision of TsEhMP employees, that this assistance was administered at the proper time, essentially in the form of cardiopulmonary resuscitation, and injections of Naloxone.  (The above) noted no shortage of medical personnel or medicines, or the existence of obstacles to the movements of ambulances.  The absence of information about the name of the substance used in the assault, as well as the absence of military physicians on the scene, did not play any role.  O. V. Belyakova, M. Y. Zakharenkov, and V. V. Fedotov stated that they accompanied buses of casualties to city clinical GKBs #1, 7, 13, respectively, and that no deaths occurred in route on their buses.

From statements by employees of the Moscow GU GO ChS (main directorate of emergency situations), D. A. Chizhov, A. M. Chistyakov, Y. B. Petrov, and A. A. Zhebelev, it follows that they participated in evacuating hostages from DK AO «Moscow Bearings».  The casualties in this case were carried in such a way so that their tongues would not block the throat and cause them to choke.   Before exiting the building, medical workers injected the casualties with some type of medication, after which they were places in buses and ambulances and immediately sent on to hospitals.  At the building entrance, their leaders coordinated the activities of medical workers.  Buses and ambulances worked without interruption, and cooperation between the special forces, rescuers, and physicians was very good.

According to a statement E. A. Yevdokimov, chief anesthesiologist & resuscitative physiologist of Moscow, on October 23rd, on orders of A. P. Seltsovsky, chairman of the Moscow public health committee, he was located at the headquarters located at GVV #1. In accordance with A. P. Seltsovsky's statement, the following measures were taken: the state of GVV #1 was surveyed relative to the possibility of receiving large numbers of casualties in grave condition, the organization of reinforcement of resuscitative assistance at GVV #1, the hospital was fully outfitted with the necessary resuscitative equipment, needed specialists in the fields of surgery and resuscitation arrived from the Sklifosovsky Research Institute, and 8 portable resuscitation tables were set up.  The Moscow public health committee provided other city medical facilities with the necessary drugs and equipment.  From October 24–25, on A. P. Seltsovsky's orders, he carried out inspections of GKB #7, 13, & 53, of their readiness to receive patients.  On his arrival at those hospitals, they had already performed measures directed at freeing up resuscitation units and increasing the number of open beds. He verified the available of medicine, and the readiness and proper working order of the equipment. He determined during the course of his inspection that:

GKB #7 could accept up to 30 patients for resuscitation, and #13 — up to 50. On October 26th at about 6 am he learned about the assault from media reports, at 7:20 am he arrived at the Sklifosovsky Research Institute, where he began forming additional teams to work at the scene of the terrorist attack. About 10:00 he arrived in GVV #1. By this time the sorting of casualties was already complete, and the most critical patients had determined.  He carried out an inspection of patients in the hospital to determine those who were possibly getting worse.  Essentially, the patients had respiratory, cardiac, and post-aortic insufficiencies on a background of dehydration, electrolyte disorders, high levels of blood enzymes and myoglobin, and severe psychogenic traumas.  That gas had been used in the course of (hostage) rescue, he learned from the media, though he had concluded this from the clinical picture.  First of all, the patients were provided with full resuscitative assistance — mechanical ventilation of lungs, cardiacc support, and the like.  In course of 2–3 hours the situation in the hospital stabilized, after which at 1–2 pm he left for Moscow GKB #13, where there were a large quantity of resuscitative patients. In his view, given the state (of health) of hostages at the time of the assault, it was extremely difficult to predict the possible effects of any (chemical) substances on them, as well as the effects of the subsequent antidote therapy. Naloxone is a specific antidote to opiates, and was widely used from the very start of providing medical assistance to the hostages, since the fact that they were suffering the effects of opiates was clear from the clinical picture.  In his opinion, however, the use of Naloxone in this situation was not vital, and no essentially positive effect was observed from its use.  Before anything, in the prevailing situation it was necessary to evacuate the hostages, to deliver them to hospitals, and perform the necessary resuscitative procedures.  He did not directly witness the evacuation of hostages from the building and could not evaluate the effectiveness of the organization of the given procedures and the rendering of first aid to the hostages.  The main task was removal of the hostages from the auditorium and their subsequent delivery to the medical facilities.  To render assistance to the casualties, the best specialists from various fields were brought in, including toxicologists who were in no way less qualified than military physicians, so the need for bringing in military medical specialists to render medical assistance to the former hostages was unnecessary.  Assistance to the casualties was organized at the high level, and everything possible was done.  This is confirmed by the low mortality rate among the patients who were resuscitated in the medical facilities.

According to the statement I. S. Elkis, of the Moscow SNMP (ambulance service), on October 26th at 5:48 am he received a message from L. P. Kostomarova at the TsEhMP concerning possible mass casualties, so they reserved 458 ambulance teams.  The TsEhMP would determine where to send the vehicles and to which medical facilities they were direct the casualties.  At approximately 6 am on October 26th, 2002, after shooting began at the DK building, it was decided to begin moving the ambulance teams to the DK building.  Some of the hostages received medical assistance directly in front of the building and were subsequently accompanied on buses to the medical facilities.

According to the statement by A. Y. Alabov, on October 26th, 2002, between 6:30 am and 6:40 am, after the completion of the special (hostage rescue operation), he entered the DK AO «Moscow Bearings» building.  There was no lighting in halls and corridors of the DK, and the auditorium where the hostages were located was weakly illuminated.  When he entered the auditorium, the hostages were in an unconscious state, and he saw special forces soldiers carrying them out of the auditorium into the hall and corridors on the second floor, which were well ventilated since the windows there had been broken.  As far as he could tell only one exit was used to carry out the hostages, since the bodies of the terrorists and their explosive devices were piled by the second exit.  After hostages were carried from the auditorium, they were placed on the floor, where they received a preliminary inspection and first aid.  He personally witnessed physicians shining small flashlights into the casualties' eyes, apparently to check pupil reaction, removing the lower clothing (of the hostages) and performing injections into the buttock muscles.  The evacuation of hostages from the auditorium was carried out very rapidly.

According to the statement of D. G. Kirtadze, head physician GVV #1, he first learned of the seizure of hostages at DK AO «Moscow Bearings» building when a guard from the DK ran into the hospital and told them that the building had been seized by terrorists numbering about 20 persons.   Soon Pronin, chief of the Moscow GUVD (main directorate of internal affairs) arrived at the hospital, as did Moscow mayor Luzhkov and the head of Moscow public health committee, A. P. Seltsovsky.  On the Seltsovsky's orders they evacuated patients from the hospital. An operational headquarters was set up in the hospital, and the main building, closest to the DK, was for the most part occupied by the special services.  Eight operating tables were made ready in the surgical department, and additional personnel were drawn from the Sklifosovsky Research Institute.  E. A. Yevdokimov, chief of resuscitation procedures for the city of Moscow was also in the building, and he headed this service.  Ten or twelve additional mechanical ventilators were brought in, the laboratory was reinforced, and monitoring devices were procured.  It was assumed that the hospital would receive patients from among the former hostages with traumatic injuries. They freed up (through the evacuation of the previous patients) 300 to 350 beds, but could accept up to 600 if necessary.  On the first floor of the therapy building operating tables and hemorrhage control sets were prepared, a triage area was organized, and 20 to 30 personnel were placed on duty there. They received instruction and remained on duty according to a high-manpower schedule of 250–300 medical personnel, 100 of them being physicians.  Luzhkov and Seltsovsky were constantly in the hospital.  On the night of October 25–26, he (Kirtadze) was at his duty site.  At about 3 am, two hostages with gunshot wounds arrived from the DK.  At about 5 to 6 am, shooting started at the DK, and he understood that the assault was underway.  About 10 to 15 minutes after the shooting began, the first of the former hostages began arriving at the hospital.  The hostages from the DK were mostly brought in by ambulance, and numbered about 100 to 110.  The hostages were given necessary medical assistance on the first floor of the hospital, where room had been previously cleared for this purpose.  The patients arrived at the hospital generally in grave condition, and unconscious.  There was no information on the substance, to which the casualties had been subjected.  The presence or absence of information on the substance, to which the casualties had been subjected, however, did not play a role.  Reception of the patients was properly organized, and there was no shortage of personnel.  Altogether the hospital admitted 130 patients. This number of patients is explained by the fact that only the most seriously ill patients were sent to that hospital.  He (Kirtadze) did not know who made the decisions as to how many patients would be sent to each specific medical facility.

K. M. Burgova, the deputy chief physician of the medical section at GVV #1 gave a statement analogous to the one above by D. G. Kirtadze.

According to the statement by L. S. Mihalkova, manager of the department of anesthesiology and resuscitation at GVV #1, on October 23rd, 2002, at about 11 pm she arrived at her duty site upon learning of the seizure of hostages at the DK AO «Moscow Bearings» building, and at approximately this time the evacuation of patients from the hospital to other therapeutic facilities was started. As she understood it, an operational headquarters had already been set up in the hospital, in which A. P. Seltsovsky and Moscow's chief anesthesiologist-resuscitator E. A. Yevdokimov were already present.  The hospital was made ready to receive patients from the very first days of the capture (of the DK building).  On October 24th, 2002, they received reinforcements in the form of teams from the Sklifosovsky Research Institute and the Botkin Municipal Hospital. The patients who arrived on October 26th resembled opiate intoxication; so several casualties received Naloxone, which, in her opinion, had no result.  All other common resuscitative measures were performed.

E. A. Zubova, anesthesiologist-resuscitator and head nurse in the department of anesthesiology and resuscitation at GVV #1 gave a statement analogous to the one above by L. S. Mihalkova.

According to the statement of L. I. Aronov, head physician of Moscow GKB #13, he received information in advance, that GKB #13 might be activated to receive injured hostages from the DK AO «Moscow Bearings».  An official telephone message that medical facilities must use an intensive (high-manpower duty) schedule came from Moscow public health committee on the morning on October 25th, 2002, but there were no special instructions for GKB #13.  He assumed that a larger number of casualties could arrive at his hospital than other facilities, because of the proximity of his hospital to the scene.  On October 24th or 25th, in responce to a query from TsEhMP, he reported that the hospital would be able to accept 146–150 casualties. In order to ensure the needed number of beds, on October 25th, 2002, 114 patients, who on the basis of their condition did not need further hospital treatment, were discharged.  Also on October 25th, 2002, lists were prepared of patients who could be discharged if more than 150 casualties were admitted to the hospital.  On October 26th, 2002, in accordance with these lists, another 138 patients were discharged.  On October 24th, 2002, he ordered an increased number of surgeons, trauma specialists, and anesthesiologists to standby. The remaining employees of the hospital were given orders to reamin accessible, so that they could, if necessary, arrive at the hospital without delay.

The precise number of hostages who could be admitted to GKB #13 was not reported to him (Aronov).  On October 24th or 25th, 2002, the chief anesthesiologist of Moscow, E. A. Yevdokimov, arrived at the hospital for an inspection.  During the course of the inspection Yevdokimov made some non-essential recommendations, which were carried out.  Late in the evening of October 25th, 2002, Aronov left for home, leaving his deputy T. I. Vasileva on duty.  Later he learned from Vasileva that at approximately 6:20 am to 6:30 am she was called by the hospitalization division of the Moscow public health committee, and they reported that shooting had begun at the DK AO «Moscow Bearings».  Vasileva immediately called Aronov, and he ordered her to notify the hospital's entire medical staff.  At approximately 7:20 am he arrived at the hospital.  The first ambulance with injured hostages pulled up at 7:15 am, then three casualties from among the hostages were brought in by a police car at 7:25 am.  The bulk of the casualties began to arrive at about 7:45 am, when buses with hostages began to pull up at the hospital.  Arriving at the hospital simultaneously were 47 to 48 ambulances and 5 buses.  When the bulk of the victims arrived, all of the hospital's medical staff members were at their duty sites.  Later it was determined that 356 casualties were delivered to the hospital, of which 35 were found to be a state of biological and clinical death upon arrival.  More than 20 of these 35 were in such a state that resuscitative measures would have been senseless.  The others were in the state of clinical death and attempts at their resuscitation were without success.

Besides the persons indicated above who were dead on arrival at GKB #13, one patient — Elena Valentina Borisova — was diagnosed as brain dead on October 27th, 2002, and passed away on October 28th, 2002.  All of the casualties were delivered to GKB #13 in serous condition, many comatose.  All of the casualties were observed to suffer from grave respiratory and circulatory disturbances.  The hospital received no official information on what had caused the hostages' conditions.  From what the hostages and ambulance physicians stated, it was possible to conclude that the hostages were subjected to some kind of a gas.  The absence of information about the nature of this gas's effect the hostages did not have fundamental value.  All the casualties received necessary medical assistance in restoring respiratory functions and blood circulation.

N. L. Zabrodskaya, chief of admissions section #2 for GKB #13, gave a statement analogous to the one above by L. S. Aronov.

According to the statement of E. V. Kiryushina, manager of the department of anesthesiology and resuscitation at GKB #13, on October 24th, 2002, she found out from the hospital administration that GKB #13 could be activated to receive injured hostages from the DK AO «Moscow Bearings».  The administration also informed her that they might receive large numbers of casualties.  On October 25th, 2002, the hospital administration and E. A. Yevdokimov, chief anesthesiologist-resuscitator for the city of Moscow, reported the need of provide additional beds, start an intensive staffing schedule for medical personnel, make ready respiratory equipment, monitors, and surgical dressings as well as other expendable materials.  This was performed.  On October 26th, 2002, at 6:10 am the on-duty nurse in the admissions department reported that freed hostages would soon be arriving.  She did not say exactly how the hostages would arrive, or their numbers or diagnoses.  The on-duty admissions nurse also reported that the first ambulance and buses were heading towards the side of the hospital where the surgery department was located.  The hospital’s chief physician, L. S. Aronov, and the responsible on-duty surgeon, L. G. Kurtenok, led the work.  Emergency medical assistance was provided to the casualties, depending on their condition and the degree of its seriousness.  Patients in various degrees of unconsciousness, and respiratory and circulatory problems were brought to the department of resuscitation on gurneys.  Restoration of the airway, via tracheal intubation and oxygen masks, was performed on the casualties, after which they were transferred to mechanical ventilators and (intravenous) infusion therapy.   The medical personnel of that department provided medical assistance to the victims in a timely manner.  They did not know what substance was used in the course of the release of the hostages.  During the process of rendering first aid, it was noted that the clinical picture of the casualties was similar to intoxication with a narcotic-type of substance, so the antidote Naloxone was used in the course of rendering emergency assistance.

I. A. Paribak and V. V. Starovoitova, physicians in the anesthesiology and resuscitative department at GKB #13, gave analogous statements.

Moscow GKB #13 physicians V. V. Kuznetsova, A. G. Ryabov, and I. V. Ilina stated that on October 23rd, 2002, the hospital administration informed them that the hospital could be activated to receive injured hostages from the DK AO «Moscow Bearings».  The department prepared additional cots in advance, all medical personnel in the department were ordered into work, and a resuscitative team from ORIT #4 was brought in.  They found out from ambulance physicians that Naloxone had been used.  Casualties on admission were diagnosed with «poisoning by an unknown gas».  What substance had been used during the course of the hostage rescue operation was not known.  The injured hostages received resuscitative measures, intensive therapy, and symptomatic treatment.

According to the statement by V. A. Afanasev, chief physician at Moscow GKB #7, on October 23rd, 2002, he learned about the seizure of hostages in the DK AO «Moscow bearings».  The Moscow public health committee sent information that the hospital must be readied to receive patients from among the hostages.  On October 24th, 2002, they were assigned discharge the maximum number of patients, whose condition allowed this, from the departments of resuscitation and surgery, and by the first day they freed up about 200 beds.  Nothing special was undertaken to purchase drugs, since the hospital was sufficiently well stocked.  Hospital personnel were warned about the possible arrival of casualties from among the hostages.  There was no increased staffing on the operating schedule during the waiting period, since the hospital had sufficient medical staff (for this purpose).

In the period from October 24th to the 25th, emergency medical services under the control of the Moscow public health committee arrived at the hospital, together with E. A. Yevdokimov, the chief anesthesiologist-resuscitator of Moscow, for the purposes of inspecting the hospital's readiness to receive casualties.  There were no observations or recommendations made on the part of the inspectors.  On October 26th, 2002, at about 6:20 am, he arrived at work.  At the hospital they reported that the assault had begun.  At about 7:15 am he saw the first ambulances.  During the course of the next 40–45 minutes casualties arrived at the hospital, delivered by ambulance and, as he found out from conversations, on a bus.  Medical assistance was provided all who entered (the hospital), regardless of their condition, and medical cards (records) were started on patients entering (the hospital).  There proved to be 14 dead in the hospital, but whether they had died in the hospital or in route was difficult to determine.   The department of resuscitation rendered assistance to the casualties mainly in the form of restoration of respiration.  About 30 minutes after they began receiving casualties, the duty officer at the Moscow public health committee telephone and reported that they were sending Naloxone.   In his opinion, the work of medical staff for the reception of victims was well organized, nor was there a shortage of medical staff.  In his opinion, the absence of information about the substance used during the assault, by no means affected the effectiveness of rendering medical assistance.

Y. Y. Romanovsky, chief of the department of resuscitation at GKB #7 also gave a statement, analogous with that of V. A. Afanasev, explaining that the department of resuscitation received 27 casualties who were in extremely serious condition.  He was not told what was acting on the hostages, but everyone made the diagnosis «poisoning by an unknown substance».  About 50–60 minutes after the hostages began arriving, someone from the hospital's administration department said that Naloxone should be used as an antidote.  At that moment 40–50 ampules of Naloxone were located in the department, and they were used.  Approximately 40 minutes later the hospital received a large quantity of Naloxone.  Over the course of a half-hour 14 people died in the hospital, and over the next 3 days a patient named Yevlampieva died from a myocardial infarction.

According to the statement of leader E. A. Luzhnikov, chief of the department for treating acute poisonings at the N. V. Sklifosovsky Research Institute, on October 26th, 2002, at about 8:15 am, ambulance units carrying casualties diagnosed as «poisoned by an unknown gas» began arriving at the institute.  For the next 30 minutes 22 patients were delivered, and all the casualties received timely medical assistance.

According to the statement of I. S. Kashtanova, manager of the department of toxicological resuscitation at the N. V. Sklifosovsky Scientific Research Institute, on October 26th, 2002, she was the on-duty administrator at the Sklifosovsky Institute.  At approximately 7 am a call came from the public health department reporting that hostages from the DK were being transported to the Sklifosovsky Institute.  All hostages were delivered by ambulance.  Sorting took place in the admissions area of the facility's acute intoxication treatment center.  It was known that the hostages were poisoned by gas.  There was no use of special drugs or techniques in the rendering to the medical assistance to the victims; they were merely rescued from their hypoxic states.  Some of the casualties had already received medical assistance before being brought to the hospital.  In her opinion, information about the name and composition of the gas used had no value in the rendering of medical assistance.

According to the statement of E. S. Vedernikov, anesthesiologist-resuscitator and toxicologist in the department of toxicological resuscitation at the N. V. Sklifosovsky Scientific Research Institute, on the morning of October 26th, 2002, he was called into work by the manager of the department of toxicological resuscitation, I. S. Kashtanova in connection with the arrival of mass casualties from the DK.  After arriving at his duty site, he immediately began rendering medical assistance to the admitted casualties.  He performed general resuscitative measures on all the casualties.  He knew nothing the substance used during the assault.  In his opinion, the name of the substance used during the assault had no value in the rendering of medical assistance.

According to the chairman of the Moscow public health committee, A. P. Seltsovsky, in his report on the organization of medical assistance to those who suffered as a result of the act of terror in the DK, the following measures were undertaken:

From 5:48 am to 5:55 am on October 26th, 2002, 458 ambulance teams were brought in waves into the zone of the emergency situation.  Among these were 44 specialists, 17 pediatricians, 242 physicians, and 155 medics.  For the possible delivery of corpses to morgues, 21 corpse-transport teams were sent as well.

Casualties were brought from the building by special forces soldiers and the rescue workers.  The dead were carried «on their backs».

From the very first minutes after the hostages were removed from the DK building, preliminary medical sorting by the degree of the gravity of the casualty's condition was conducted in area near the exit from the building, and performed by duty medical personnel on the scene, from the VTsMK of the Russian public health service, and headed by the chief of the medical evacuation department, assisted by operational reaction teams from the city center of emergency medical assistance and the on-duty ambulance teams.  The first 20 ambulance teams, sent from reserve, arrived in the zone from 6:09 am to 6:14 am.

Teams of medical workers arriving at the scene came under the operational control of coordinators: colleagues from the (federal) VTsMK and (city) TsEhMP public health committee.

Control of organizing medical support for the entire duration of the emergency situation was performed by the chairman of the Moscow public health committee and chief of city emergency medical service, A. P. Seltsovsky, who had been on the scene since October 23rd, 2002.

Practically simultaneous with their evacuation, the casualties were provided with emergency medical assistance directed towards the maintenance of vital functions. Taking into account clinical picture, they injected Naloxone, which was in sufficient quantity, since this medicine is provided for in the equipment inventory of ambulance teams).  Casualties in a deep comatose state with the severe respiratory and circulatory disturbances were transported on medical vehicles by ambulance teams with accompanying personnel providing mechanical ventilation of the lungs and intensive symptomatic therapy.  Due to the presence of an emetic reflex, the casualties were required to be positioned «on their stomach».  Evacuation was completed in full 1 hour and 15 minutes from the beginning of the hostages' release.

Emergency hospitalization of casualties was performed at numerous GKBs, which had reported their readiness to receive mass casualties: GKB #s 1, 7, 13, 15, 23, 33, 53, 64, 68, and 79, the N. V. Sklifosovsky Scientific Research Institute, the Botkin Municipal Clinical Hospital, GVV #1, Filatov Children's Hospital (DKB #13), and Saint Vladimir's Children's Hospital.  About 644 casualties were hospitalized in city hospitals, and 20 were sent to Russian health ministry hospitals numbers 84 and 38, and a certain number of hostages left the DK on their own.

The largest numbers of hostages, taking into account the gravity of their conditions, were hospitalized in GVV #1 and GKB #13, which are located near the zone of the emergency situation, and had previously been considered as primary centers for hospitalization.

Secondary medical sorting took place In the receiving departments of the hospitals.  In terms of the gravity of casualties condition, they were divided into 4 groups: extremely serious, serious, mildly serious, and relatively satisfactory.

All hospitalized casualties received complex intensive therapy using contemporary medical technologies.  The rendering of all medical assistance took place without delay and the best specialists in the city were brought in, and specialists from the leading medical departments in Moscow universities were added to reinforced teams.

During both the prehospital and hospital stages therapeutic measures were directed toward correcting disturbed functions in vital organs, guaranteeing the patency of the upper respiratory tract, mechanical ventilation of the lungs, oxygen therapy, and correction of metabolic disorders as a result of hypoxia.

Special forces soldiers performed Naloxone injections on a majority of hostages before evacuating the later from the DK building.  They passed on information about the injections to the medical workers as they transferred the casualties.  Those not receiving injections in the DK building received them from medical workers from the ambulance teams.  Early injections of Naloxone (from 0.4 to 0.8 mg) were justified, taking into account its pharmacological action as an antagonist of narcotic analgesics.  A positive effect on the clinical states of an overwhelming majority of the casualties was noted after the complex treatments were provided.

The Moscow public health committee fully provided therapy in the form of medicines, infusion solutions, medical apparatuses and other equipment.

An examination of the above was carried out, and established the following:

On October 23rd, 2002, the Moscow prosecutor's office initiated criminal case #229133 on the basis of Articles 205 and 206 of the UK RF (Russian criminal code). During the course of the investigation of the indicated criminal case it was established that on October 23rd, 2002, at approximately 9 pm an organized group of the armed persons took no less than 800 hostages in DK AO «Moscow Bearings», located at the address: Melnikov Street #7, Moscow.

On October 25th, during the course of carrying out a special hostage release operation, the hostages were subjected to the effects of a gas based on derivatives of Fentanyl, which acts by causing sleep.

As a result, 129 persons from among those seized as hostages passed away, in this case:

— one of the casualties, O. N. Romanova, who was killed by terrorists on the night of October 23–24, 2002.

— the deaths of 114 casualties was certified at the scene of the incident, in this case tow of them — D. P. Gribkov and K. I. Vasilev — were determined by investigation o have been killed by the terrorists before the beginning of the special operation.

Eight casualties were delivered to GVV #1 in an agonal (perimortem) state, or in a state of clinical death unaffected by resuscitative measures.  Biological death in these cases began from 10 to 40 minutes later.

Six casualties passed away in permanent medical facilities at different times following their admissions, in this case 1 of them — P. G. Zakharov — passed away on October 26th, 2002, from gunshot wounds caused by the terrorists before the beginning of the special operation.

The application of the indicated substance in the closed space of the auditorium at the DK AO «Moscow Bearings»" to no less than to 800 persons held hostages, who since October 23rd, 2002, had been subjected to the cumulative actions of a complex of factors (prolonged psychoemotional stress, expressed hypotonia as a result of insufficient oxygen in the inhaled air, prolonged   positioning in an uncomfortable manner that led to the development of circulatory hypoxia, hypovolemia connected with prolonged dehydration and starvation, disturbed sleep and wakefulness biorhythms, and the presence of chronic diseases), which were extremely dangerous for their health and had negative effects in the form of serious disturbances of their respiration, blood circulation and as well as other effects.

The rendering to emergency medical assistance during a disaster within the territory of Moscow is determined by order number 742 of the Moscow public health committee, dated December 20th, 1996, which is confirmed in the necessary documents, and in particular, the SEhMP (Special Medical Assistance Service) of the Moscow Public Health Committee.  Instructions for the SEhMP's actions during various levels of function are provided for.

Examining these materials were those officials responsible for the organization of medical assistance to those persons who were freed as a result of the special operation in the DK AO "Moscow Bearings» on October 26th, 2002: L. G. Kostomarova, the director of the Moscow TsEhMP (Center for Emergency Medical Assistance), and A. P. Seltsovsky, chairman of the Moscow public health committee.

An inquiry established that the persons indicated above were previously informed of the time the special hostage rescue operation was to take place, or about the use of gaseous substances during its course.  This was due to the need for observing operational security during the preparation and conduct of the operation.

In spite of the circumstances indicated above, L. G. Kostomarova and A. P. Seltsovsky undertook necessary and adequate measures on the basis of the prevailing situation and in accordance with the requirements of the indicated public health committee regulation.  The measures were directed towards the advance preparation of the city's medical facilities for the admission of mass casualties from among the former hostages at the DK AO «Moscow Bearings», as well as the rendering of the necessary medical assistance to the indicated persons from the moment of their evacuation from the building to their treatment in the hospitals.

Therefore it follows from the above statements that those fixed medical facilities closest to the scene of the incident (GVV #1, and GKBs #7 & #13) undertook advance measures to free up additional beds in order to allow for the admission of mass casualties, they prepared their resuscitation departments, and the medical facilities were fully stocked with the necessary drugs and equipment, as well as increased staffing levels of medical personnel during the waiting period.

Round the clock watch was carried out at the scene of the incident by teams from the ambulance service and the TsEhMP.  After receiving information that the assault on the building had begun, A. P. Seltsovsky formed operational units and directed them toward the scene columns of ambulance teams in sufficient numbers to render medical assistance to the casualties. At very beginning of the mass evacuation of hostages from the building by ambulance and TsEhMP specialists, they were correctly instructed to use conventional emergency therapy and rapid hospitalization, as recommended by World Health Organization (WHO) principles.  Casualties in critical condition were given first aid in the form of resuscitative measures and injections of Naloxone.  The measures were provided both inside the DK building and in the direct proximity to the scene at building exit, where preliminary sorting of casualties by TsEhMP specialists took place.  The effectiveness of the measures is confirmed by the low death rates among those entering medical facilities.

The casualties reached medical facilities by ambulance and buses drawn for this purpose.  As was established during the course of the inquiry, the buses carried ambulance physicians during transport.  During the course of the inquiry, no cases of victims dying on the buses could be established.

From the statements of management and medical staff at GKB #13, GKB #7, and GVV #1, and a study of extracts from medical records, it follows that an overwhelming majority of those who died were already in a state of clinical and biological death on arrival at the indicated medical facilities.

The assembled materials, in the absence of autopsies by forensic medical examiners, give grounds for to conclude that an overwhelming majority of those who died passed away at the scene of the incident before the beginning of transport to the medical facilities.

Thus, the inquiry carried out did not establish the facts confirming the statement by B. E. Nemtsov concerning carelessness, i.e.: nonperformance or improper performance by officials participating in the organization of first aid and evacuation of casualties from the GPZ, which was cited as the reason, or one of the reasons, of the mass loss of hostages.

The statement about an inadmissibly long wait by the victims for medical assistance and transport to medical facilities did not find confirmation, since it follows from the material of the inquiry that the evacuation of hostages was carried out within an extremely short period.  Taking into account the number of hostages and the remaining danger of an explosion, medical assistance to the casualties occurred directly after the completion of the active phase of hostage rescue operation at the scene of the incident, and transport to medical facilities was achieved in a timely fashion.

The statement about the absence of a leader-coordinator from among the medical workers at the exit of the building is groundless, since it follows from the materials that TsEhMP specialists performed coordination of the medical workers on the scene.

From the materials of the inquiry, it follows that casualties could not be given resuscitative assistance at the scene of the incident, including at area organized for the resuscitation of casualties near the DK building, because of the continuing threat of explosion.

The statement about the poorly organized traffic management, which did not allow for timely free and uninterrupted movement of ambulances, buses and mobile resuscitation vehicles, is also without confirmation, since no objective facts to confirm the indicated circumstances were revealed during the inquiry.

The transport of victims in buses to fixed medical facilities, as was established by inquiry, was achieved in the company of physicians who were trained in methods of resuscitation.

The assertion about the absence of coordination between the special services, rescuers, and ambulance teams is unfounded, since it follows from the materials of the inquiry that these different groups fulfilled different functions in rendering assistance to the hostages.

The absence of specialists in the field of military medicine with special training, experience, and knowledge, does not mean there was an absence of qualified medical assistance to the freed hostages.  The absence of military physicians did not play any role in rendering assistance to the victims.

The statement about the absence of proper organization for uniformly arranging victims in treatment facilities is unfounded, since it follows from the material of the inquiry that, based of the nature of the casualty's injuries, they needed the quickest hospitalization at the nearest fixed treatment facility, which prepared in advance for the admission of mass casualties. The absence of a relationship between the distribution of casualties in the treatment facilities and the deaths of the people is confirmed by low death rates at the hospitals. The absence of information about the use of Fentanyl, in the opinion of an overwhelming majority of specialists who were questioned, did not play any role in providing assistance to the victims.

Evaluating as a whole the presented materials relating to the work of the so-called public commission of the SPS, it should be noted that their nature is superficial and uncertain, especially taking into account the presence in the commission of those without any specialized education or training, and the work of so-called «experts» who remained anonymous.  The findings of the commission are essentially abstract (relating to the absence of «proper» coordination, «proper» numbers, «timely» motion), and does not consider the situation that actually prevailed on the scene of the incident, which was characterized by large numbers of victims and the need for their evacuation under the continuous, real threat of an explosion, which would entail the unavoidable loss of all persons located inside and near the DK building.  The commission's conclusions of a causal connection between the actions of those officials responsible for organizing medical assistance to the former hostages, and their deaths, cannot be seen (from the materials).

Article 293 of the UK RF stipulates liability for negligence, i.e.: nonperformance or improper performance by an official of his responsibilities as a result of a careless or negligent attitude towards that service, entailing an essential violation of the rights and legitimate interests of citizens or organizations either protecting the legitimate interests of society or the state.  Part 2 of the indicated article stipulates liability for the same act, entailing carelessness leading to the death of a person, or other serious consequences.

Article 237 of the UK RF stipulates liability for concealment or distortion of information about events, facts, or phenomena, which endanger the life or health of people or the environment, and are committed by persons obligated to provide the public with this information. Part 2 of the indicated article stipulates the liability for the same acts, if they are committed by a person who occupies Russian government office, or the state office of subject republic, if he causes, as a result of such acts, harm to human health or other serious consequences.

Taking into account the entire inquiry outlined above, one comes to the conclusion that there is an absence of data on the nonperformance or improper performance of responsibilities as a result of careless or negligent attitudes toward their service by the chairman of the Moscow public health committee, A. P. Seltsovsky, or the director of the Moscow center for emergency medical assistance, L. G. Kostomarova, or other officials responsible for organizing the provision of medical assistance to persons from among the former hostages taken prisoner at the DK AO «Moscow Bearings», and correspondingly, any lack of action on their part, which would be a crime under Article 293 of the UK RF.  The actions of the indicated persons also contain nothing criminal under Article 237 of the UK RF, regarding not promulgating information on the substance used in the course of the special operation, and the ensuing consequences in the form of the deaths of the hostages, i.e.: the absence of the given information played no role in the rendering of assistance to the casualties.

On the basis of the materials stated above, and in accordance with paragraph 2, part 1, Articles 144, 145, and 148 of the UK RF:

RESOLVED

1. To refuse to initiate a criminal case relative to the commission of a crime as stipulated by B. E. Nemtsov in Article 293, parts 1 & 2, and Article 237, parts 1 & 2, relative to dereliction of duty by A. P. Seltsovsky, representative of the Moscow Health Commission, and L. G. Kostomarova, director of the Moscow Center for Emergency Medical Assistance, as well as other officials responsible for organizing the rending of medical assistance to persons from among the former hostages who had been held at the DK AO “Moscow Bearings”, where the indicated crimes took place.

2. A copy of this resolution to be sent to the Moscow city prosecutor’s office and the plaintiff, B. E. Nemtsov to inform them of this decision, and to explain to the later that they can challenge the given resolution at the prosecutor’s office or in a court of law, as stipulated in Articles 124 and 125 of the UPK RF (Russian criminal code).

Investigator and acting head of the directorate for investigating banditism (organized crime) and murder for the Moscow city prosecutor’s office,

R. B. Ibragimov     ____________(signed)

A copy of this resolution was sent to the Moscow city prosecutor’s office and the plaintiff B. E. Nemtsov to inform them of this decision

Date ______________ Time ______ Investigator _________ (not signed)