Who is Responsible for the Death of a 27 Year-Old Pregnant Woman? Marineh Nersisyan, a 27 year-old resident of the village of Oshakan, died on June 7 of this year. She died during an operation to remove a dead fetus at the Ashtarak hospital. The news quickly spread throughout the region. Expectant mothers have stopped going to the Ashtarak maternity ward, where the services are free. They’d rather travel to Yerevan hospitals and pay. Marineh was three months pregnant and had been going to get regular pregnancy checkups. The last was on May 11 in Ashtarak. The pregnancy was going well. On June 5, Marineh started to experience bleeding and the next morning she and her sister Gayaneh went to the Ashtarak hospital. The examining doctor, Rima Kizakyan, told her that the fetus wasn’t growing. The doctor then took 2,000 AMD and wrote out a permission slip for Marineh to go to Yerevan for a checkup with the proper equipment. At the Republic Hospital, Marineh and Gayaneh entered the examination room while their mother, Hasmik Hakobyan, waited outside in the hallway. Diagnosis – Fetus Must be Removed “After the exam, Marineh came out crying. She said that the fetus had died and must be promptly removed. The nurse suggested that the operation be performed at the hospital in Yerevan, but Marineh said she knew no one there and that Kizakyan was waiting for her in Ashtarak. She wanted to go there and have it done,” Hasmik Hakobyan told Hetq. On the same day, June 6, they saw Doctor Rima Kizakyan and presented her with the exam results. “We presented the echo cardiogram results and told them to apply a local anesthetic and remove the dead fetus, given that there might be bleeding. The doctor said she wouldn’t since nothing would happen. Later, she said that the anesthesiologist wasn’t present and nothing could be done. We later learnt that the anesthesiologist had been drunk at the time and that Rima knew about it. They told us to pick up some “Vikasol” at the pharmacy and that Marineh should drink it. Rima told us that Marineh should show up at the hospital the next morning for the operation,” says Mrs. Hakobyan. Before sending them home, Rima Kizakyan told them to bring Marineh’s passport and 20,000 AMD. The doctor explained that 10,000 was her fee and that the rest was for the anesthesiologist. Mrs. Hakobyan says Marineh cried all that night over losing the child she had long for. The next morning, Marineh had a cup of coffee and kissed her 8 year-old daughter Asya good-bye, telling the child she’d return home soon. Before the operation got underway, Doctor Kizakyan asked for the 20,000 AMD but Mrs. Hakobyan refused, saying she would pay after the operation. “A little bit later, the nurse Lala arrived with the anesthesiologist. I asked that they take good care of my girl like it was their own and Lala said everything would be fine,” recounts Mrs. Hakobyan. Marineh’s mother also remembers the anesthesiologist yelling at Lala in the operating room – Lala, what have you done? Little did Mrs. Hakobyan realize that she would never see her daughter alive again. Death Due to Anaphylactic Shock “They sent me to get a copy of the passport. When I returned, I saw all the doctors in a state of panic. They put me in a room and told me to stay put. One hour passed and I asked why the operation hadn’t finished. They told me they had sent for some good specialists to assist. About two hours later they told me that Marineh had died,” Hasmik recounts. The official cause of death was noted as “anaphylactic shock after general anesthetic”. Marineh held two college degrees, studying medicine. During her college years, she had an abortion and had undergone anesthetic and the operation was successful. Her relatives are stymied why Marineh should have gone into shock from the medicine given that the young showed no signs of allergic reaction. Three months have passed since Marineh’s untimely death but the police have yet to question any of her family members. It was only on the day that Marineh died that someone named Mourad (the family doesn’t remember his last name), a police operative from Ashtarak, visit the house and speak to Marineh’s husband Sargis. He signed a letter of protest on the spot. “If it weren’t for my kid, I’d take care of business in my own way. The doctors destroyed my family and the first in line was Rima. How could a doctor do something like that just for money? She told Marineh, who was carrying a dead fetus to go home and bring 20,000 AMD with her the following day. These are the type of doctors we have. Who can I complain to? The cops will beat some poor guy to a pulp to get a confession just for stealing a chicken. Three months have passed. Why haven’t the police made any arrests? Why are those doctors still working?” asks Sargis. Grieving Husband - “Those doctors killed Marineh” To find out the actual cause of death, Marineh’s relatives took the body to Yerevan for an autopsy. The doctors told the family the same thing; that Marineh died from shock. “My Marineh died at the hands of the doctors. I can’t sleep at night, I have no peace, because I was the one who took Marineh to her death,” says Hasmik, crying. Both Hasmik and Sargis don’t believe the autopsy doctors. “I repeat; the doctors killed my wife. I’ve spoken to different people who tell me that Marineh received an unsafe dose of anesthetic,” notes Sargis. The autopsy findings are with Armen Khachatryan at the Ashtarak police. He was the one who told Sargis about the autopsy findings. It remains a riddle why the report hasn’t been handed over to the family. Surprisingly, the police state that they have yet to receive the autopsy report. When asked if this is the case, how was it that Khachatryan told the dead woman’s husband about certain of the findings, Moushegh Kroyan, Deputy Director of the police department’s public relations office, responded that he had no idea what report Khachatryan had referred to. He also couldn’t explain why the forensic investigation had been dragging on for three months. The relatives were thrown into a serious emotional state when they found out that Marineh’s ribs and chest bones had been broken. They learnt this later on. They had to cover her neck at the funeral to hide the black and blue marks. Hospital Director – “Why dredge up the past?” Ashtarak Hospital Director Artur Hovhannisyan wasn’t expecting Hetq reporters to turn up at his office. For ten straight minutes, he tried to talk us out of writing an article about this story. He argued that it would hurt the medical institution. “At this time, I am of the opinion that our doctors did nothing wrong. That incident has negatively impacted the hospital. People started spreading rumors and now the numbers of deliveries has gone down. It happened two months ago. Why do you want to dredge up that story again? What’s the point? You’ve arrived too late. Let’s not stir up emotions again. The forensic examination had concluded, showing that death was due to anaphylactic shock. The woman’s relatives probably believe that the hospital and doctors were at fault. That’s their problem. Law enforcement is dealing with that issue. They will issue a final judgment. A criminal case has been launched,” Director Hovhannisyan said. But police press officer Moushegh Kroyan told Hetq that no such criminal case had been launched. “An investigative committee has been set up. Materials are being collected and, if warranted, a case will be opened later.” Mr. Hovhannisyan didn’t want to call Doctor Rima Kizakyan to his office for questioning.”I will answer all questions. There’s no need to call the doctor in,” he claimed. After some give and take, the director did call for the doctor. Doctor Kizakyan – “I never even operated on Marineh” Rima Kizakyan was extremely distressed. She spoke of what had transpired from her point of view and some of what she said didn’t correspond to the narrative given by Hasmik, Marineh’s mother. “The patient told me she had experienced bleeding the day before. I examined her and said the fetus isn’t developing. It was June 6 when the family came. I examined her again and advised them to go to Yerevan, for a professional sonogram. They returned around 7-8 in the evening. They had the test results with them – undeveloped pregnancy. I said she would have toile down and come back for tests the next morning, since there was the possibility of more bleeding. I told them I was on duty and that if bleeding occurred during the night they should not hesitate to come to the hospital,” said Doctor Kizakyan When asked why she didn’t follow the patient’s request to terminate the pregnancy with a local anesthetic on Sunday, Doctor Kizakyan responded that they had requested a general anesthetic and that no one mentioned a local one. “The patient arrived at 9:20 the next morning and the necessary tests were done. The anesthesiologist was called in. The preparatory work had been completed so I went in to start the operation. Just then, the patient moved. It seemed to me that she hadn’t slept well. I looked up at the anesthesiologist standing next to the patient’s head. He told me not to do anything. That’s all. The patient’s condition worsened and they made several procedures. I don’t know about the rest. I didn’t operate on the patient,” Doctor Kizakyan went on. “I sent the patient home since her condition wasn’t serious” According to her, no medical procedures are performed on Sunday since certain test results are needed beforehand. Doctor Kizakyan really didn’t want to state whether she prescribed any medicine to Marineh for the bleeding. The medicine she mentioned differed from that noted by Hasmik. We asked Doctor Kizakyan why she sent the patient home that night if there was a risk of bleeding. “Didn’t you prescribe medicine to her for that,” we inquired. Doctor Kizakyan said she had given no “official” prescription. What about a non-official prescription, we asked. “I merely told her that if bleeding occurred she should take Ditsinol and come directly to the hospital; that I would be on duty. The patient’s condition wasn’t serious. She had no pain or complaints. The next day she walked in on her own two feet. Only if there is bleeding do I administer emergency aid,” added the doctor. Before Doctor Kizakyan showed up at his office, Director Artur Hovhannisyan said that the conclusions of the forensic exam were ready and that it was a case of instantaneous death. The doctor, however, said the underlying cause of death hadn’t yet been determined. Doctor Kizakyan was stunned when we asked her how Marineh’s bones had been broken. “Excuse me, but where did you find out about that? We have no official details. I didn’t even know the time of her death. I was there to terminate the pregnancy but I never got a chance to start,” said the doctor. “Broken Bones Not Unusual” -  Claims Hospital Director Director Hovhannisyan described the broken bones as nothing unusual. “Clinical death was registered and attempts were made to revive the patient. It just a sign. If the chest bones weren’t broken the evaluation could be made that there was an ineffective heart massage performed. You have to be a specialist to understand these things. I could go on explaining but you wouldn’t understand.” So it would seem that patients with heart problems, who receive medical treatment, have to leave the hospital with broken bones. Otherwise, the treatment might be viewed as ineffective. Doctor Kizakyan was amazed that Marineh’s relatives blame her for the woman’s death. “I have no idea why the relatives would blame me. In my opinion, everything was done to save her,” she said. As to the charge that the anesthesiologist wasn’t in a “ready” state on June 6 and that’s why the operation wasn’t performed that Sunday, Doctor Kizakyan responded that Harout, the anesthesiologist, is a teetotaler. “You people have crossed the line with that charge,” she said. “What do you think? Even if he was drunk, do you think Doctor Rima would tell you,” quipped the hospital director.