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A clinical report of treatment of Alexei Navalny in the Charité Clinic in Berlin reveals that the atropine treatment by Russian doctors at the Omsk Emergency Hospital Number 1 was the same as provided to Navalny by the Germans. No evidence was detected by the Germans of a poison attack on Navalny in the Omsk hospital, as Navalny and the western press have recently alleged.

The British medical journal, The Lancet, published a four-page clinical case report on December 22. It is signed by fourteen doctors, including Kai-Uwe Eckardt (lead image, centre), the head of the Charité clinic's treatment unit who was publicly thanked by Navalny on October 7. Eckardt and David Steindl (lead image, right) are the principal authors; Eckhardt is a specialist on diabetes and kidney transplants. Steindl is a specialist on musculo-skeletal pathologies.

Although the German doctors refer in passing to the treatment of the Salisbury incidents involving Sergei and Yulia Skripal in March 2018, there has been no comparable clinical evidence from the British doctors in public. The German doctors do not report communicating with the British.

The Berlin medical report also reveals that a German doctor was at Navalny's bedside, making tests and reporting the results back to Berlin, without Russian government interference or control, on the afternoon of August 21, the day after after Navalny's hospitalisation in Omsk.

The Berlin doctors now admit they did not detect organo-phosphate poisoning in Navalny's blood, urine or on his skin; they tested no water bottle or clothing evidence which had been brought to Berlin by Navalny's staff on the evacuation aircraft. They also acknowledge they did not know what might have caused "severe poisoning with a cholinesterase inhibitor" until the German armed forces laboratory in Munich reported the Novichok allegation "2 weeks later".

Introducing the Navalny case, the German doctors' report provides a slightly different timeline for the first symptoms and admission to hospital in Omsk from the claims Navalny's staff and press reports have previously suggested. Click to read the BBC timeline here.

The new report claims that Navalny was admitted to the Omsk hospital in mid-morning of Thursday, August 20 "approximately 2 h[ours] after symptom onset". The earlier Russian timeline suggests that treatment for Navalny began in the Omsk ambulance sooner and hospital treatment later. Forensically, these details are of less significance than the disclosure in the German report that "approximately 31 h after symptom onset, a doctor from the German air ambulance crew had temporary access to the patient." This means that the German aircraft had arrived in Omsk on Friday, August 21; and that a German doctor was with Navalny in the Omsk hospital by late afternoon.

Deutsche Welle, the German state media organ, had reported that at "11:28 [Greenwich Mean Time; 17:28 Omsk time, August 21] a group of German doctors have been seen arriving at the hospital. Earlier, the press service of the Omsk Ministry of Health said that Omsk doctors had invited the German medical team into the hospital. 'We also invited German specialists, who arrived in Omsk by air ambulance, to get acquainted with the patient's condition and study the results in our clinic. At present, they are on their way to us', quotes head doctor Alexander Murakhovsky as saying."

The timing now confirmed in the Charité doctors' report suggests that planning for despatch of the air ambulance from Germany must have commenced at about the same time Navalny was reporting symptoms on board his flight between Tomsk and Moscow. Notification of the flight plan to Omsk by the Germans, and authorisation by the Russian authorities, followed swiftly; the German aircraft was on the ground in Omsk when Navalny's staff were telling the press they had been denied permission to have him treated by the Germans.

The new report reveals that on the next day, Saturday August 22, "16 h later when the patient was handed over [sic] to the German air ambulance crew for transportation to Berlin, his condition had slightly improved (pupils constricted, heart rate 59 bpm)." This appears to be evidence that the Omsk hospital treatment had not only stabilised Navalny's condition - as the hospital doctors told the press - but had demonstrated the effectiveness of the Russian antidote medication.

The German medical report flatly contradicts recent allegations by Navalny and his associates that a second attempt to poison him had been made at Omsk hospital. Only by concealing the presence of the German medical team at the Omsk intensive care unit on August 21 can the Navalny group make their fabrication appear credible.

There is also no reference to contamination precautions by the German doctor in Omsk; by the German air crew; the Berlin ground ambulance; or the Charité Clinic staff. By omitting these details, the German doctors appear to concede they did not suspect a nerve agent threat to anyone in close proximity to Navalny himself.

The medical testing at the Charité Clinic has now been documented in detail. This was limited to Navalny's blood, urine, skin, and rectum. According to The Lancet "toxicological analysis and drug screening in blood and urine samples [were] obtained on admission...In skin swabs obtained on admission to the intensive care unit at Charité, we noted colonisation with five different multidrug-resistant bacteria: Staphylococcus aureus, Acinetobacter baumannii complex, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae. Microbial characterisation of subsequent rectal swabs...and urine samples showed two different variants of K pneumoniae. Based on these findings, we used antibiotics very reluctantly. A urinary tract infection with K pneumoniae was treated with co-trimoxazole."

Although the Navalny staff, including his wife Yulia Navalnaya and Maria Pevchikh, have publicly claimed that they delivered clothing and at least one water bottle from the Tomsk hotel room, the German doctors appear to have ignored them. The Germans have not reported their diagnosis of Navalny's pre-existing medical conditions which the bacterial report indicates; Navalny's family deny there were any.

Nor do the clinic doctors now claim that they identified a nerve agent on Navalny's admission on August 22 or for days afterward. "Identification of an individual organophosphorus compound is a complex and time-consuming process. In fact, ascertaining the involvement of a novichok agent and its biotransformation products in this case was only achieved several days after establishing the diagnosis of cholinesterase inhibitor poisoning and did not affect therapeutic decisions" (emphasis added).

"Testing for cholinesterase status [was undertaken] in a specialised external laboratory," Eckardt, Steindl, and their colleagues now say. They are referring to the German Army laboratory in Munich - the Institut für Pharmakologie und Toxikologie der Bundeswehr (IPTB). A report from that source was first announced publicly by the German government on September 2, though no details have been published.

Earlier, on August 24, a press agent for Charité had publicly declared that the "clinical findings indicate poisoning with a substance from the group of cholinesterase inhibitors. The specific substance involved remains unknown, and a further series of comprehensive testing has been initiated. The effect of the poison - namely, the inhibition of cholinesterase in the body - was confirmed by multiple tests in independent laboratories."

The German doctors now report that "based on clinical and laboratory findings, severe cholinesterase inhibition was diagnosed and the patient was started on atropine and obidoxime... cholinergic signs returned to normal within 1 h[our] after the onset of this antidotal therapy."

This clinical phrase of the doctors this week — "severe cholinesterase inhibition" - is not what the Charité press agent intended on August 24, four months ago, when she spoke of "poisoning with a substance from the group of cholinesterase inhibitors". The clinic spokesman not only misrepresented what the doctors knew; the clinic also concealed that the atropine treatment was effective within one hour. For more details, read this.
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Left, Manuela Zingl, spokesman for the Charité Clinic responsible for the August 24 disinformation; centre, Steffen Seibert, head of the German Government's Press and Information Office; right, Colonel Professor Doctor Thiermann, who was responsible for the IPTB identification of a Russian Novichok.
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The treating doctors in Omsk - left, Alexander Sabaev, head of the acute poisoning department of the Omsk Emergency Hospital No. 1, chief toxicologist of the Omsk region and of the Siberian Federal District. Centre, Alexander Murakhovsky, head doctor at Omsk Emergency Hospital No. 1. Right, Anaoly Kalinichenko, deputy head doctor at the Omsk hospital.
The reference to the normalisation of "cholinergic signs... within 1 h[our] after the onset of this antidotal therapy" is German confirmation that the Omsk hospital treatment had been necessary, appropriate, sufficient - and not different from the German treatment. The Germans refuse to acknowledge this. Instead, Eckardt, Steindl, and their colleagues announce: "We gratefully acknowledge the support from many colleagues in the assessment and interdisciplinary management of this case, including members of the Bundeswehr Institute of Pharmacology and Toxicology in Munich, Germany, who did repetitive measurements of butyrylcholinesterase, acetylcholinesterase in red blood cells, and cholinesterase status and gave toxicological advice."

In other words, the Germans did not communicate at all with the Russians. In European protocols of patient care and in medical professional terms, this is unprecedented. It suggests the German doctors were under German government orders not to communicate with their Russian colleagues or review their pathology reports. In the small print of The Lancet publication, the doctors have added this declaration:
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© Lancet
By their own acknowledgement of the role played by the German Army laboratory in Munich and the refusal to communicate with the Russians, the doctors know they are lying when they claim to have had "no competing interests."