At 10:05 am Omsk time, Alexei Navalny was brought from the airport to the City Clinical Emergency Hospital No. 1 in Omsk (BSMP-1). He was immediately placed in the toxic intensive care unit. Kira Yarmysh arrived in an ambulance together with Navalny, Ilya Pakhomov brought his things by taxi. Kira and Ilya managed to talk to the ambulance crew, and they said that in terms of symptoms, Alexei's condition was similar to toxic poisoning.
Kira and Ilya stayed at the hospital to await the test results. Alexander Sabaev, head of the department of acute poisoning of Emergency Hospital No.1, promised at 10 am that the results would be ready in about two hours. Then he said to wait another two hours. At some point, information began to appear in Telegram channels that Navalny was in a coma and on a ventilator. Doctors have confirmed this information.
At 13:30 Anatoly Kalinichenko, deputy chief physician of BSMP-1, spoke to reporters and said that Alexei was connected to a ventilator, his condition was consistently serious, and there was no diagnosis yet. When asked whether his condition could be caused by poisoning, Kalinichenko replied that different versions are being worked out, including an exacerbation of previously existing diseases.
Companions of Alexei immediately assumed that he had been poisoned, and soon after arriving at the hospital they demanded to call the police. First, officers of the Omsk Ministry of Internal Affairs came and took statements from Kira and Ilya. Then the transport police arrived, also took statements, said that they were seizing Navalny's things that were with him at the time of hospitalization, and made an inventory of them. As it turned out later, these things were handed over to the FSB officer and chemist Konstantin Kudryavtsev, so that he could remove traces of poison from Navalny's clothes (see the “Investigation” section). The transport police also wanted to confiscate things from Alexei's luggage. After long wrangling and attempts by the police to take them by deceit, Alexei's wife Yulia took them with her.
Yulia Navalnaya flew in from Moscow on the same day, August 20. FBK director Ivan Zhdanov and Alexei's doctor Anastasia Vasilyeva arrived with her. Maria Pevchikh and Georgy Alburov flew from Tomsk. By 19:00 they were all in Omsk. At first Yulia was not allowed into the intensive care unit — they said that “the patient did not give his consent to visits” and demanded a marriage certificate, but in the end they let her in. She saw Alexei connected to a ventilator and talked to his doctors, who confirmed that Navalny was in a consistently serious condition. They didn’t tell Yulia the diagnosis.
On the evening of August 20, Alexei's family decided to transport him to a European clinic for treatment. Doctor Yaroslav Ashikhmin, who has been observing Alexei since 2013, also spoke in favor of this, in particular because Western clinics have more opportunities to search for a potential toxic substance. The choice fell on the Charité clinic in Berlin, which confirmed its readiness to immediately begin treatment of Navalny. Angela Merkel expressed her readiness to accept Navalny for treatment in Germany. On the night of August 21, a medical plane flew from Germany to Russia.
On the morning of August 21, FBK lawyer Vyacheslav Gimadi and Oleg Navalny, Alexei's brother, arrived in Omsk. Gimadi brought to the hospital all the documents required for travel abroad and transportation. Simultaneously, all supporting documents from Charité were also received and submitted.
In the morning, a council was arranged at BSMP-1, which was supposed to make a preliminary diagnosis and give permission to transport Navalny to Germany. In addition to Kalinichenko and Sabaev, it was attended by the Head of the Department of Anesthesiology and Resuscitation Number No. 1 of the Pirogov National Medical and Surgical Center B. A. Teplykh, Acting Head of the Department of Reanimation and Intensive Care of the Burdenko Neurosurgery Institute, Ph.D. A. A. Polupan, Physician of Functional Diagnostics, Laboratory of Clinical Neurosurgery of the Burdenko Neurosurgery Institute K. N. Lapteva, Head of the Department of Neurology of Omsk State Medical University, Doctor of Medical Sciences, Professor A. S. Rozhdestvensky, Professor of the Department of Anesthesiology and Reanimatology of the Omsk State Medical University Y. P. Orlov, doctor Z. M. Zolotareva, Chief Intensivist of the Omsk Oblast A.E. Litvinov, Deputy Chief Physician for Anesthesiology and Reanimation A. V. Glushchenko, Head of the Therapeutic Department endocrinologist A. V. Mokhov and head of the ICU for acute poisoning S. V. Mishchenko. The council ruled out the diagnosis of acute poisoning of chemical etiology.
They promised to invite Yulia Navalnaya to the council, but did not do so. She was not provided with the protocol of the council either. After the council, Chief Physician Alexander Murakhovsky stated that Alexei was not transportable, although not long before that, the hospital had already prepared equipment for the transportation of Navalny, and the doctors kept saying until the last moment that they were ready to authorize the transportation.
At 12:10 the plane from Germany with a medical team landed at the Omsk airport. The plan was to have an ambulance with Navalny on the runway by the time it arrived. The doctors would take Alexei aboard and immediately fly back, but the Omsk doctors prevented this.
A lot of representatives of power structures flocked to BSMP-1. On August 20, police officers, National Guard, the Criminal Investigation Department, the Investigative Committee and the FSB arrived at the hospital. On August 21, they were joined by unknown people in civilian clothes, who even occupied the office of the chief physician. Later, investigators from The Insider and Bellingcat were able to identify some of them. On the photo below, the man in the center is Vyacheslav Kryuchkov, head of the Ministry of Internal Affairs for the Omsk Oblast, the one on the right is Mikhail Evdokimov, head of the Omsk FSB department for combating terrorism. It was he who handed over to Konstantin Kudryavtsev Navalny's clothes received from the transport police (for details, see the “Investigation” section).
Ivan Zhdanov told the press that before his eyes, a transport police officer came into the Chief Physician’s office and said that they had found some deadly substance that poses a threat not only to Navalny, but also to those around him, and therefore everyone around him should be in protective suits. Murakhovsky ignored her words. Later, the identity of this woman was established: she turned out to be Natalya Tukhtametova, an investigator of the Omsk Line Department of Internal Affairs.
At about 2 pm Anatoly Kalinichenko told the reporters that no poisons were found in Navalny's samples. “The diagnosis 'poisoning' remains somewhere in the subcortex of our consciousness, but we do not believe that the patient suffered from poisoning,” he said. Two hours later, Alexander Murakhovsky stated: “The main provisional diagnosis, to which we are most inclined, is a violation of the carbohydrate balance, that is, a metabolic disorder. It can be caused by a sharp drop in blood sugar.” Navalny's attending physician questioned this diagnosis. In the evening, Murakhovsky made another statement, saying: “The diagnosis of poisoning was finally ruled out on the basis of a chemical and toxicological examination.”
In the afternoon, pickets in support of Navalny began in Omsk and other cities. Yulia Navalnaya sent an official appeal to Vladimir Putin demanding permission to transport Alexei to Germany. Navalny's associates sent a request for urgent measures to transport him to the ECHR, and the court confirmed the request at an unprecedented speed — within a few hours.
During the day, Alexei's associates and relatives tried to contact the German doctors who had flown in with a medical plane, but they failed to do so. At the end of the day, a group of German doctors suddenly appeared at the Omsk hospital, accompanied by a large group of people consisting of local doctors, the hospital administration and representatives of the special services. In the hospital, the special services officers forcibly pushed the FBK employees and Navalny's relatives away from the doctors and did not allow them to talk to the medics. Alexander Murakhovsky, in turn, told the press that the decision not to transport Navalny was made at a council with the participation of colleagues from Germany. When Alexei's associates and Yulia Navalnaya were able to find out to which hotel the German doctors were taken and went to see them, they denied Murakhovsky's statements and said that they saw no obstacles to Navalny's transportation. According to the doctors, Alexei's condition at that time was extremely difficult, critical, his life was in serious danger.
Late in the evening, Yulia Navalnaya, who was at a meeting with German doctors, was invited to return to the hospital. There, a meeting was held with doctors and the administration, who, following the results of the next council, unexpectedly changed their minds and decided that Alexei was transportable. At about 10 pm, Anatoly Kalinichenko officially announced this. Now Omsk doctors insisted that Navalny should be transported as soon as possible. However, due to the requirements of the German trade union of air carriers, the flight had to be postponed until the morning. On August 22, at 5:40 am, Navalny was handed over to the resuscitation team, who took him to the airport. At 8 am, the medical plane with Alexei Navalny on board took off to Germany.
The diagnosis made by Navalny in the Omsk hospital is as follows: “The main one is a violation of carbohydrate metabolism, concomitant chronic pancreatitis with impaired exogenous and intrasecretory function, exacerbation.” It was told to the journalists in the press service of the transport department of the Ministry of Internal Affairs of the Russian Federation for the Siberian Federal District. The same diagnosis appears in the request sent by the Prosecutor General's Office of Russia to Germany. That said, experts have repeatedly pointed out that a violation of carbohydrate metabolism is not an independent diagnosis, but a condition that can be caused by one reason or another, and doubted that Navalny could fall into a coma because of it. As for pancreatitis, Alexei himself denied that he had this diagnosis.
Attempts to write off Navalny's condition as an exacerbation of already existing diseases were made from the very first day in the Omsk hospital. In the future, such versions only multiplied. Chief toxicologist of the Omsk Oblast Alexander Sabaev spoke about this particularly actively: he pointed to the alleged digestive and nutritional problems with Alexei, said that shortly before hospitalization he was on various diets and that alcohol was found in his blood samples, suggested that Navalny could overheat, overcool, or simply not have breakfast. Sabaev repeatedly denied the fact of poisoning. At the same time, there is a document that proves that Omsk doctors have all the data to correctly diagnose navalny with organophosphate poisoning.
On August 22, upon discharge, Navalny's family was to be given his medical documents. From the very moment Alexei regained consciousness, his supporters sent numerous requests to the Omsk hospital to obtain these documents, but their requests were simply ignored. On November 2, Ivan Zhdanov and Vyacheslav Gimadi arrived in Omsk and went to the archive, where they managed to make copies of all Navalny's medical documents.
A month later, the Chief Physician of the hospital officially provided the same documents to them. Alexei’s associates compared the two versions of the medical card, and it turned out that they are different. Navalny's team compiled a table of inconsistencies between the two versions and recruited three independent Russian doctors to analyze it.
Most of the changes turned out to be insignificant, but one very important document was missing from the official medical card — the results of a biochemical blood test carried out at the Sklifosovsky Research Institute of Emergency Medicine. This document recorded a critical decrease in cholinesterase levels. Along with other symptoms, this clearly speaks of poisoning.
The results were obtained on August 25, the day after the Charité clinic announced that Navalny had been poisoned with cholinesterase inhibitors. Thus, the Omsk doctors already had all the data to give Alexei the correct diagnosis. However, they continued to speak publicly about pancreatitis and metabolic disorders. And they went to the length of forging documents in order to hide the real picture of the disease.
In June 2021, Navalny's team released a video in which they told, among other things, about the forgery of Alexei's medical documents.
On August 20, Moscow doctor Andrei Volna published his expert opinion on the results of a comparison of two versions of documents. He also drew attention to the fact the data allowing to draw a conclusion about the poisoning had been removed from the official version, and confirmed that the Omsk doctors had grounds for making such a diagnosis.
... When reading the medical history one gets the impression that there is a certain clearly visible border between the time when poisoning was not excluded, but rather, on the contrary, was one of the provisional diagnoses, and the time when poisoning was completely excluded.
Moreover, in the medical history on page 41 there is a clear and unambiguous indication of a consultant that it is possible and necessary to suspect first and foremost a poisoning with drugs that affect synaptic transmission. These include cholinesterase inhibitors, among other things.
This is the conclusion of the head of the department of anesthesiology and resuscitation of the Almazov National Medical Research Center (St. Petersburg) N. A. Lesteva.
I am quoting from the official medical history of patient A. A. Navalny: “Loss of consciousness, hypersalivation, need for mechanical ventilation, absence of an increase ... (unintelligible) of enzymes in the blood may indicate a toxic effect of predominantly synaptic level.”
This consultant was no longer involved in the diagnosis and treatment of A.A. Navalny after that. Moreover, even in a very detailed discharge summary, this consultation, unlike the others, is not mentioned.
A kind of “watershed” is the night telephone consultation on 08/21/2020 at 00:30 by two high-ranking toxicologists, namely the chief toxicologist of the Ministry of Health and Social Development of the Russian Federation and the chief toxicologist of the Northwestern Federal District, who de-facto removed the diagnosis of poisoning. A group of Moscow specialists, who arrived on the morning of August 21, 2020, headed by Dr. B. A. Teplykh (by the way, none of the consultants sent was a toxicologist) had already consistently pursued a policy of treating “metabolic disorders” and completely ruled out the existence of poisoning. Let me repeat that none of them were specialists in toxicology.
On March 23, 2023, reanimatologist Alexander Polupan, one of the participants of the consilium, gave an interview to the Meduza portal. He pointed out the facts that indicated poisoning and confirmed that the doctors had to declare that Alexei was not transportable by order from above.
My leadership called me and told me that a decision had been made at the top level that the patient should not be transported and that I should not dare to take him anywhere. When I objected that I wasn't going to take him anywhere that the Germans would take him, and that I was only being asked to evaluate his transportability, I was told that I had to tell the relatives that he [Navalny] was not transportable — and that absolutely everyone [in the consilium] would say the same thing. If I said something different, the consequences would be the most serious. What exactly was meant was not specified..