Part 8: Who killed Alexander Litvinenko?

Chapter 1: Introduction

¶8.1 This is the first of two Parts of the Report in which I will record my factual findings. In

this Part, I shall address the basic factual circumstances of Mr Litvinenko's death – when and where he died, the mechanism of his death, whether anyone else was involved and if so how and who. In the next Part (Part 9), I shall make my findings regarding any wider responsibility for Mr Litvinenko's death.

¶8.2 The analysis in these two Parts will be informed by all the evidence that I have heard;

that is, the open evidence that I have summarised at Parts 3-6 and the closed evidence that I have dealt with at Part 7.

184

¶The Litvinenko Inquiry

Chapter 2: Medical cause of death

¶8.3 I received detailed evidence regarding the decline in Mr Litvinenko's physical condition

during the last weeks of his life, and also regarding the care and treatment that he received during that period first at Barnet General Hospital and then at University College Hospital. I have summarised that evidence earlier in this Report, (see Part 3, chapter 4).

¶8.4 Mr Litvinenko died at University College Hospital on the evening of 23 November

He had suffered two cardiac arrests on 21 November, but had been successfully resuscitated. He had lost consciousness on 23 November and at 8.51pm that evening he suffered a third cardiac arrest from which the medical professionals were unable to resuscitate him. Mr Down, an intensive care consultant on duty at the hospital that evening, pronounced life extinct at 9.21pm. His view was that Mr Litvinenko had died from multiple organ failure including progressive heart failure.

¶8.5 Following Mr Litvinenko's death, his body and samples taken from it were examined

by a number of different scientists with a view to finding out as much as possible about the way in which he died. I have detailed that evidence in Part 3, chapter 5 above.

¶8.6 The post mortem into Mr Litvinenko's death was jointly conducted by two pathologists,

Dr Cary and Dr Swift. I heard evidence from both. The radioactivity present in Mr Litvinenko's body meant that special precautions had to be taken to protect the health of all those present. It also meant that the pathologists were unable to conduct all the tests that they might otherwise have undertaken. I have set all these matters out in Part 3.

¶8.7 Dr Cary, with whom Dr Swift agreed, expressed himself to be "entirely satisfied" that the cause of Mr Litvinenko's death was acute radiation syndrome.

¶8.8 The pathologists reached this conclusion taking into account a number of factors.

These factors included not only their physical examination of Mr Litvinenko's body, but also their review of the detailed medical notes recording Mr Litvinenko's worsening clinical condition in the weeks before his death, as well as the results of tests performed by other scientists on samples taken from Mr Litvinenko's body. The pathologists also relied on the fact that they had found no evidence of any possible alternative causes (such as natural disease) of Mr Litvinenko's death.

¶8.9 Although the pathologists were not in any doubt that Mr Litvinenko's final heart attack

had been the result of acute radiation syndrome, they were unable to reach a firm conclusion as to the precise mechanism by which this took place. They listed a number of possibilities in this regard, including sepsis, liver and/or kidney failure, and the primary effect of radiation on the heart itself.

¶8.10 I accept the evidence of Dr Cary and Dr Swift. I am sure that the cause of Mr Litvinenko's death was acute radiation syndrome.

¶8.11 I am fortified in reaching this conclusion by the evidence that I received from other

scientists who have conducted tests on samples taken from Mr Litvinenko's body in the years since his death. The scientists from whom I heard in this regard were witness A1, Dr Harrison, Dr Gent and Dr Black.

185

¶Part 8 | Chapters 1 to 6 | Who killed Alexander Litvinenko?

¶8.12 The evidence of the scientists, which I have summarised in Part 3 above, enables

me to make several more detailed findings regarding the medical cause of Mr Litvinenko's death.

¶8.13 First, it is clear on the evidence that the acute radiation syndrome described by the

pathologists was itself caused by the presence in Mr Litvinenko's body of very high levels of polonium 210. Tests conducted by Dr Harrison on tissue samples taken from Mr Litvinenko's body demonstrated that there had been a total intake of about 4.4GBq of polonium 210. Dr Harrison's evidence was that this quantity far exceeded survivability levels.

¶8.14 Dr Harrison, Dr Gent and Dr Black all subscribed to the opinion expressed at paragraph

25 of the joint experts' report that, "It can be stated with certainty that Mr Litvinenko died as a consequence of an intake of polonium-210."

¶8.15 Second, the scientists were also agreed that the polonium 210 entered Mr Litvinenko's

body either entirely or almost entirely by ingestion. If Mr Litvinenko inhaled any of the polonium 210, this was a minor route of intake, accounting for less than 5% of the total intake. It seems that the polonium 210 was probably ingested in the form of a soluble compound.

¶8.16 Third, there is compelling evidence that Mr Litvinenko ingested the fatal dose of

polonium 210 on 1 November 2006. The scientific evidence was not definitive on this point, but I heard that the medical records of the early stages of Mr Litvinenko's illness, and in particular the rise in neutrophil levels noted on 3 November and 5 November, were consistent with the poisoning having taken place on 1 November. More importantly, there is other evidence relating to the location of the poisoning (see chapter 3 below) that provides very strong evidence that it took place on 1 November.

¶8.17 In summary, I make the following findings regarding the medical cause of Mr Litvinenko's death. I am sure of each of these matters.

a. Mr Litvinenko died at 9.21pm on 23 November 2006 in University College Hospital, having suffered a cardiac arrest from which medical professionals were unable to resuscitate him

b. The cardiac arrest was the result of an acute radiation syndrome from which Mr Litvinenko was suffering

c. The acute radiation syndrome was caused by Mr Litvinenko ingesting approximately 4.4GBq of polonium 210 on 1 November 2006

¶8.18 To use everyday language, I conclude that Mr Litvinenko was fatally poisoned with polonium 210 on 1 November 2006.

186

¶The Litvinenko Inquiry