Patient Deaths Point to Depth of Russian Crisis

The three patients lay unconscious in the intensive care unit, kept alive only by the Siberian hospital’s life support system. Two were elderly; one was 39. None of them could know that the greatest threat to their lives was an unpaid bill.

On Wednesday, the hospital in the town of Prokopyevsk received a telegram from the local power company, Gorelektroset, warning that it would have its electricity shut off the next day if it did not pay its debt of $95,000. At 6 o’clock Thursday morning, the hospital’s power went off; 40 minutes later, all three patients were dead.

“The patients started dying one after another,” said Dr. Sergei V. Pushkaryov, chief of the intensive care unit, who led a desperate effort to keep them alive. “It was terrible. The nurses cried. We saw them dying, and we could not save them. I have seen a lot in my professional life, but three corpses in one morning is too much.”

Prosecutors were investigating the deaths Friday. The apologetic utility company called the outage an accident. Relatives called it murder. Yet it could just as well be said that the three patients fell victim to Russia’s seven-year effort to overhaul the Communist system and create a market economy.

Outside Moscow, Russians are witnessing the steady retreat of civilization as Soviet-era systems of health care, industry, trade and law enforcement decay and collapse.

Factories barely function, goods are exchanged by barter, and police are powerless against organized crime. In most places, the capitalism that many Russians wished for has yet to arrive.

Economic transformation has been especially hard on medical care.

Hospitals are chronically underfunded and understaffed. Outdated and broken equipment is not replaced. Patients must bring their own linens, medicines and syringes with them to the hospital. Doctors often face the choice of operating without anesthetic or not operating at all.

At the 600-bed Prokopyevsk Emergency Hospital, doctors worked six months last year without receiving their meager salaries of 800 rubles a month--the equivalent at the current rate of exchange of about $35. They began getting paid again in January but are still half a year behind. A backup generator is a luxury the hospital cannot afford.

“Sometimes, when I come home from work, I watch the American series ‘ER’ on television and I almost cry because what I see there is another world, another civilization,” hospital Director Anatoly P. Shutov said. “I can’t imagine that I will live to see my hospital even remotely approaching these standards.”

To comply with Western conditions for multibillion-dollar loans, Russia is trying to wean consumers from subsidized power and have them pay for what they use. However, it is difficult to put the energy system on a capitalist footing when institutions and individuals have little or no money to pay for utilities--and the temperature outside is below freezing for large parts of the year.

As part of the national power grid, Gorelektroset, the local company, has been under pressure itself from its supplier to pay for electricity it has distributed to homes and enterprises in Prokopyevsk, a city of 240,000 in the impoverished coal-mining region of central Siberia.

One of its biggest debtors is the hospital, which has not paid its bill since 1994. The company briefly cut off the hospital’s electricity several times before but always telephoned ahead to warn doctors so the power would not go out in the middle of an operation.

Shutov said the telegram he received from the utility Wednesday ordered the hospital to pay 2,187,202 rubles--the equivalent of $94,931--or “the electricity supply will be cut off on March 11.” The hospital heard nothing more before the power went off promptly at 6 a.m. the next day.

Gorelektroset chief Pavel M. Pichugin acknowledged sending the telegram but insisted that the company had not carried out its threat. The timing of the power outage was a coincidence, he said.

“This was a totally accidental cut,” Pichugin said. “We never really meant it. It was a technical cut in the power line, and it took us about an hour to repair it. We are very sorry that people died, but I assure you we didn’t cut off the supply deliberately.”

Pichugin said he issued the warning in the hope of triggering the kind of mutual cancellation of debts that has become commonplace in Russia’s barter economy.

Gorelektroset faces power shortages of its own, he said, because it cannot pay its supplier, the much bigger Kuzbasenergo. Because Kuzbasenergo owes money to the Kemerovo regional government, and the regional government owes money to the city, and the city owes money to the hospital, a debt swap could wipe Gorelektroset’s obligations off its books.

“I just wanted them to press their case with the city authorities so they would press their case with the regional authorities,” he said. “What happened yesterday is a tragedy that was not intended.”

Such explanations are lost on the families of the three victims: Filip I. Salnikov, 82, who was recovering from stomach surgery; Zoya V. Gasanaliyeva, 69, who was being treated for poisoning; and Alexander V. Gart, 39, who was recovering from a knife wound to the chest.

When the power went out, the doctors and nurses attempted to keep the patients alive with ancient manual resuscitation equipment. First Gasanaliyeva died, then Gart. Despite his age, Salnikov hung on for 40 minutes.

Salnikov’s granddaughter, Natalia V. Svetlakova, said he had begged family members the day before not to leave him in the hospital. She recalled that his last words to relatives were “Please don’t leave me. I will die here.”

“It was an ugly, violent death,” she said, crying. “I think you can call this murder. After all, we are not at war with anyone, but people are killed left and right. How can we trust our medical care after this? How can we trust the state that kills its citizens?”

Sergei L. Loiko of The Times’ Moscow Bureau contributed to this report.