0:00:08 > 0:00:12Star surgeon Paolo Macchiarini was the first in the world
0:00:12 > 0:00:17to surgically implant a plastic trachea in a human being.
0:00:17 > 0:00:18The ground-breaking surgery
0:00:18 > 0:00:21gave the man back his trachea and his life.
0:00:25 > 0:00:29He promoted a future with more organs made of plastic,
0:00:29 > 0:00:31such as hearts and lungs.
0:00:31 > 0:00:33..a few years away from this all happening,
0:00:33 > 0:00:35all organs being built in a lab.
0:00:35 > 0:00:39But privately, Macchiarini started to discover faults
0:00:39 > 0:00:40with his tracheas...
0:00:46 > 0:00:49So I think that we need to redo everything again.
0:01:02 > 0:01:04..and patients were beginning to die.
0:01:18 > 0:01:21I didn't do anything wrong.
0:01:21 > 0:01:23I...just did my job.
0:01:25 > 0:01:26But despite the faults,
0:01:26 > 0:01:30Macchiarini made plans for new operations with plastic organs.
0:01:31 > 0:01:35If he succeeded, he would be revolutionising the medical world.
0:01:37 > 0:01:41But if not, it would be one of the most spectacular falls
0:01:41 > 0:01:44in the history of international medicine.
0:01:56 > 0:01:57You are crazy.
0:02:03 > 0:02:05Does a human life have a price?
0:02:08 > 0:02:09I didn't do anything wrong.
0:02:23 > 0:02:26I...just did my job.
0:02:53 > 0:02:55By spring 2012,
0:02:55 > 0:02:58the atmosphere was tense in Macchiarini's lab
0:02:58 > 0:03:00at the prestigious Karolinska Institute
0:03:00 > 0:03:03in Stockholm, Sweden, home of the Nobel Prize.
0:03:05 > 0:03:07It was here, amongst other places,
0:03:07 > 0:03:09that Macchiarini tried to solve the problems
0:03:09 > 0:03:13that had recently been discovered with the plastic tracheas.
0:03:13 > 0:03:15Paolo was now fighting to succeed.
0:03:17 > 0:03:20In his view, it wasn't the plastic trachea
0:03:20 > 0:03:22which had caused the death of the patient,
0:03:22 > 0:03:25but the patient had simply been too ill.
0:03:27 > 0:03:28For clearer results,
0:03:28 > 0:03:33he wanted to try his method on stronger, healthier subjects.
0:03:34 > 0:03:36People who were not fatally ill.
0:03:38 > 0:03:41Despite the method having been tested so little,
0:03:41 > 0:03:45Paolo had managed to achieve something nearly impossible.
0:03:45 > 0:03:49He was granted permission to start a clinical study on humans.
0:04:00 > 0:04:04The first trials would take place in Russia.
0:04:04 > 0:04:07For some time, they had searched for the right volunteers here.
0:04:09 > 0:04:12Many candidates pitched their case for treatment
0:04:12 > 0:04:14and the Karolinska Institute in Stockholm
0:04:14 > 0:04:17had assisted in making the final selection.
0:04:21 > 0:04:25Julia Tuulik had been chosen to be the first experimental subject.
0:04:30 > 0:04:32She was asked to record a video,
0:04:32 > 0:04:35explaining why she wanted the operation.
0:05:33 > 0:05:36Both Julia and Paolo were now heading towards the hospital
0:05:36 > 0:05:38in Southern Russia.
0:05:39 > 0:05:44At this point, Paolo's international reputation was at its peak.
0:05:45 > 0:05:48A German TV crew was recording a documentary about him
0:05:48 > 0:05:50and his operation on Julia.
0:05:50 > 0:05:54This footage is taken from their unedited material.
0:05:55 > 0:05:59The recordings give a unique insight into Paolo's medical experiments.
0:06:02 > 0:06:06The more I saw, the more questions I had for Paolo.
0:06:09 > 0:06:13But I would have to wait a long time before I could put them to him,
0:06:13 > 0:06:17and only after I had looked through all his past experiments.
0:06:20 > 0:06:23It all began four years earlier for Julia.
0:06:25 > 0:06:28She and her husband at the time were driving
0:06:28 > 0:06:31when a truck crashed into them.
0:06:31 > 0:06:33Miraculously, they survived.
0:07:02 > 0:07:04Julia was pregnant
0:07:04 > 0:07:07and she would put up with just about anything to protect her child.
0:08:38 > 0:08:39In order to speak,
0:08:39 > 0:08:42Julia had to cover the hole in her throat with her hands.
0:08:46 > 0:08:49You can live a long life with a tracheostomy.
0:08:51 > 0:08:53But the hole in her throat bothered her...
0:08:55 > 0:08:57..and she wanted to be her old self again.
0:09:08 > 0:09:10During the last leg of the journey,
0:09:10 > 0:09:14Julia was interviewed by the interpreter for the German crew.
0:11:56 > 0:11:58- Come in.- Come in.
0:11:58 > 0:12:02This is the German physician Philipp Jungebluth -
0:12:02 > 0:12:04Macchiarini's right-hand man.
0:12:05 > 0:12:08It was he who prepared the plastic tracheas.
0:12:13 > 0:12:17First, bone marrow was extracted from Julia's hipbone.
0:12:20 > 0:12:23The cells were mixed into liquid,
0:12:23 > 0:12:27which was then poured over Julia's new plastic trachea.
0:12:29 > 0:12:32The trachea was left to rotate for several days.
0:12:32 > 0:12:35A number of tracheas were prepared as extras.
0:12:37 > 0:12:39LAUGHTER
0:12:48 > 0:12:51With one day to go before the operation,
0:12:51 > 0:12:52Paolo arrived.
0:12:57 > 0:12:58Let's go.
0:13:40 > 0:13:42- Here you go.- OK.
0:13:42 > 0:13:45Do you want something? Cup of tea, coffee, water?
0:13:45 > 0:13:48- No, no.- No? - I just want to talk to...
0:13:48 > 0:13:50- To...?- Igor.
0:13:50 > 0:13:52Igor, OK. Please take a seat.
0:13:52 > 0:13:57Igor Polyakov was going to operate together with Macchiarini.
0:13:57 > 0:13:59Nice to meet you.
0:14:29 > 0:14:30Let's go, then.
0:16:04 > 0:16:06This was beginning to sound worrying.
0:16:08 > 0:16:10It seemed like all the plastic tracheas
0:16:10 > 0:16:13had something wrong with them.
0:16:13 > 0:16:18And yet, no-one seemed to consider cancelling the operation.
0:16:18 > 0:16:20Instead, everything continued as planned.
0:16:25 > 0:16:29Now Julia was going to find out how the plastic trachea works.
0:16:32 > 0:16:35David Green, the president of the American company
0:16:35 > 0:16:39which made the bioreactor, would explain this to Julia.
0:16:42 > 0:16:44- Hello.- Hello.- Is it OK to come in?
0:16:44 > 0:16:46- Yes.- Yes?
0:16:51 > 0:16:53- I'm David.- Julia.
0:16:53 > 0:16:55David Green. Nice to meet you. Can I sit here?
0:16:57 > 0:17:00So, Olga and Victor told me that you would like to see
0:17:00 > 0:17:04the trachea scaffold and the bioreactor.
0:17:04 > 0:17:05So...
0:17:10 > 0:17:12So, these are sterile.
0:17:16 > 0:17:22But this is exactly the same as what will go into you tomorrow.
0:17:22 > 0:17:25So when the doctors came two months ago...
0:17:25 > 0:17:28You can touch it. You can feel it.
0:17:28 > 0:17:31When the doctors came two months ago,
0:17:31 > 0:17:35they took the scans, the CAT scans of your neck...
0:17:36 > 0:17:39..and this is made to the exact dimensions.
0:17:39 > 0:17:42But this has no cells.
0:17:42 > 0:17:45Your trachea has cells and blood vessels.
0:17:45 > 0:17:51So, when this has the cells on it, it will look like normal tissue.
0:17:58 > 0:18:00It is plastic.
0:18:00 > 0:18:03It is the same plastic that this bottle is made from.
0:18:03 > 0:18:07It says on the bottom here, for recycling, it says PET.
0:18:07 > 0:18:09This is the same plastic.
0:18:09 > 0:18:12But this is food grade.
0:18:12 > 0:18:13This is medical grade.
0:18:13 > 0:18:15So this is much, much purer.
0:18:15 > 0:18:16This is just...
0:18:17 > 0:18:19..for industrial use.
0:18:19 > 0:18:21So we know this material is very safe.
0:18:24 > 0:18:26And this, you cannot get, naturally.
0:18:26 > 0:18:29So we have to make it. But I can show you.
0:18:30 > 0:18:32So, this is Mr Andemariam Beyene.
0:18:33 > 0:18:35Did you hear about this?
0:18:35 > 0:18:38He received his trachea one year ago.
0:18:39 > 0:18:41Very similar.
0:18:41 > 0:18:43Very similar to this.
0:18:43 > 0:18:45We all went to Iceland with all the surgeons
0:18:45 > 0:18:47to make a celebration,
0:18:47 > 0:18:49like, a one-year birthday party for him.
0:18:49 > 0:18:52One week earlier, David Green had been to Iceland,
0:18:52 > 0:18:55where he took the photo he showed her.
0:19:00 > 0:19:02In the photo was Andemariam Beyene,
0:19:02 > 0:19:05Paolo's first plastic trachea patient.
0:19:06 > 0:19:08Green and Macchiarini's team had travelled there
0:19:08 > 0:19:12to celebrate the one-year anniversary of the operation.
0:19:12 > 0:19:16It is, of course, a big moment for both us,
0:19:16 > 0:19:18the team here in Iceland,
0:19:18 > 0:19:21and, of course, the team in Karolinska...
0:19:21 > 0:19:24They had held a press conference about the operation.
0:19:24 > 0:19:27Back then, nobody knew that we would be here,
0:19:27 > 0:19:30one year later, in Iceland, to celebrate this anniversary.
0:19:30 > 0:19:32So it's a huge clinical milestone.
0:19:32 > 0:19:34When I saw him the first time,
0:19:34 > 0:19:37he asked me, "What you want to do with me?"
0:19:37 > 0:19:42I explained to him.
0:19:42 > 0:19:44His first reaction was just to look at me
0:19:44 > 0:19:46and say, "Well, you are crazy."
0:19:46 > 0:19:47And he said...
0:19:47 > 0:19:50Well, I said, "Yes, I am.
0:19:50 > 0:19:53"But this is the only chance you have right now."
0:19:53 > 0:19:57But at this point, one week before Green's visit to Julia,
0:19:57 > 0:20:02Macchiarini knew there was also a fault with Andemariam's trachea.
0:20:02 > 0:20:06He had made this discovery earlier that spring.
0:20:25 > 0:20:28But this seriousness of the situation
0:20:28 > 0:20:30was covered up during the press conference.
0:20:31 > 0:20:34Was there a wish to portray the operation
0:20:34 > 0:20:36as a greater success than it really was?
0:20:43 > 0:20:46In fact, Andemariam had not been very well at all.
0:20:49 > 0:20:53His wife Merhawit remembers that it seemed to have been a success
0:20:53 > 0:20:56right after Andemariam had received his new trachea.
0:20:56 > 0:21:01But slowly it had become clear that all wasn't as it should be.
0:21:03 > 0:21:05These events have been so painful for the family
0:21:05 > 0:21:09that Merhawit doesn't want herself or the children
0:21:09 > 0:21:11to be shown in this documentary.
0:21:29 > 0:21:31COUGHING
0:22:00 > 0:22:03Merhawit also remembers the one-year anniversary
0:22:03 > 0:22:06and how the operation was portrayed as a success.
0:22:36 > 0:22:40In reality, shortly before the press conference,
0:22:40 > 0:22:44Andemariam had been forced to fly to Sweden for treatment.
0:22:45 > 0:22:48The examination filmed from the Karolinska Hospital
0:22:48 > 0:22:50shows inflammation
0:22:50 > 0:22:53and an increasingly problematic trachea.
0:22:55 > 0:22:58He'd had trouble keeping his airways open,
0:22:58 > 0:23:00and he had coughed up blood and mucus.
0:23:01 > 0:23:06They had to insert a steel net in order for him to breathe.
0:23:08 > 0:23:11Paolo was the responsible consultant at Karolinska.
0:23:11 > 0:23:14Surely he couldn't have missed this?
0:23:18 > 0:23:21What we saw in Karolinska is that, um...
0:23:22 > 0:23:28..after so many hours, the scaffold are very, very...soft,
0:23:28 > 0:23:30so they need to be dry before implanting,
0:23:30 > 0:23:34because otherwise they will collapse completely.
0:23:34 > 0:23:37What did Paolo's team here in Krasnodar know about the problems?
0:23:39 > 0:23:41Could they have told Julia about the risks?
0:23:42 > 0:23:43You can touch it...
0:23:43 > 0:23:47Did Green lead Julia to believe that everything was tried and tested?
0:23:47 > 0:23:50So we know this material is very safe.
0:23:50 > 0:23:53Could he have focused more on the risks?
0:23:58 > 0:24:01So this can turn like this, to turn it around,
0:24:01 > 0:24:03and this is mounted in here,
0:24:03 > 0:24:06and then the stem cells are poured in here,
0:24:06 > 0:24:08and this rotates very slowly.
0:24:08 > 0:24:11So they are in the bioreactor for two days.
0:24:11 > 0:24:14It is completely sterile and then it's done.
0:24:15 > 0:24:19And then tomorrow, they will put this into you,
0:24:19 > 0:24:22but after it goes in, it still has no blood supply,
0:24:22 > 0:24:24so it takes about seven days
0:24:24 > 0:24:28for your body to grow new blood vessels through the scaffold,
0:24:28 > 0:24:30and then it will be your new trachea.
0:24:34 > 0:24:36It will be just like this -
0:24:36 > 0:24:38you'll be sitting in bed, lying in bed.
0:24:38 > 0:24:40You are in very good hands for the next seven days.
0:24:40 > 0:24:42Paolo is the best surgeon in the world.
0:24:42 > 0:24:45There is no-one better who can do this surgery for you.
0:24:49 > 0:24:50- I know.- You know.
0:24:50 > 0:24:52You're right.
0:24:53 > 0:24:55Very nice meeting you, Julia.
0:24:56 > 0:24:59- Bye-bye.- Bye. Thank you.
0:24:59 > 0:25:01You're welcome.
0:25:16 > 0:25:20This is the final brainstorming before the transplantation.
0:25:20 > 0:25:24Julia, tomorrow, will be the first patient
0:25:24 > 0:25:26entering a clinical trial.
0:25:26 > 0:25:30We need to go through every single step.
0:25:32 > 0:25:37When I watched this, I wonder why it all seemed so rushed.
0:25:37 > 0:25:40This distance should be covered.
0:25:40 > 0:25:44We need to give credit to Professor Porhanov.
0:25:44 > 0:25:47The pressure that he and I have
0:25:47 > 0:25:53from different ministry authorities is extremely high.
0:25:53 > 0:25:56They want that this will be a success.
0:25:56 > 0:26:00And I am confident that we will do the best.
0:26:00 > 0:26:03Was it the pressure from ministers and financiers
0:26:03 > 0:26:06that made Paolo push on?
0:26:06 > 0:26:07If we could do the transplantation
0:26:07 > 0:26:11by just doing...through a cervical incision only,
0:26:11 > 0:26:13this would be a major achievement.
0:26:13 > 0:26:16I mean, she will be going, making interviews
0:26:16 > 0:26:19and so forth and so forth, and if...
0:26:19 > 0:26:21SPEECH FADES
0:26:26 > 0:26:30Shortly before the operation, Paolo and Julia finally met.
0:26:39 > 0:26:41- You look beautiful.- Thank you.
0:26:44 > 0:26:47Even if Julia had been informed that this was an experiment
0:26:47 > 0:26:50and perhaps also signed a document,
0:26:50 > 0:26:54she doesn't seem to have understood the risks she was about to take.
0:27:15 > 0:27:17Not even her Russian doctor, Polyakov,
0:27:17 > 0:27:19actually seemed to have been informed
0:27:19 > 0:27:22of the setbacks Paolo's method had had.
0:27:30 > 0:27:32We have to...we have to know their wishes.
0:27:47 > 0:27:53OK, so this is the zone...forbidden, OK? OK.
0:27:54 > 0:27:58Any scars, but...out of this zone.
0:28:29 > 0:28:31The time had finally come.
0:28:31 > 0:28:34Paolo would have the opportunity to implant the plastic trachea
0:28:34 > 0:28:40in a patient who quite possibly had a long life ahead of her.
0:29:56 > 0:29:57Suction.
0:29:57 > 0:29:59Stop ventilation.
0:30:00 > 0:30:02You just keep it...
0:31:28 > 0:31:30Good, good.
0:31:30 > 0:31:32Congratulations to everybody. Really.
0:33:37 > 0:33:40It's also plastic, so it's really tricky.
0:33:46 > 0:33:50Just a few days later, a press conference was called.
0:33:55 > 0:33:57APPLAUSE
0:34:03 > 0:34:05Julia? Julia...
0:34:13 > 0:34:15This is Julia.
0:34:15 > 0:34:17Eto Julia.
0:34:17 > 0:34:23When I met Julia, she was not able to play with her child.
0:34:23 > 0:34:28It was a very emotional moment for me.
0:34:28 > 0:34:30RUSSIAN INTERPRETER SPEAKS
0:34:30 > 0:34:33And I immediately said, "This is the right patient."
0:34:37 > 0:34:40And I still do not believe that a few days ago,
0:34:40 > 0:34:44she couldn't breathe and talk normally.
0:34:44 > 0:34:49So, um, she's a little bit afraid of you,
0:34:49 > 0:34:51so please be very sweet.
0:34:51 > 0:34:54INTERPRETER SPEAKS
0:34:54 > 0:34:55She can... She can...
0:34:55 > 0:34:58She can answer all the questions that you would like.
0:35:07 > 0:35:09APPLAUSE
0:35:43 > 0:35:45APPLAUSE
0:35:52 > 0:35:54It seemed like an all-round success.
0:35:56 > 0:36:01Julia was seemingly on the road to complete recovery
0:36:01 > 0:36:02and Macchiarini could show off
0:36:02 > 0:36:05a ground-breaking plastic trachea transplantation
0:36:05 > 0:36:08to the media, ministers and financiers.
0:36:11 > 0:36:14Now, he could continue doing research and performing operations.
0:36:15 > 0:36:16Igor?
0:36:21 > 0:36:23- Cheers.- Cheers.
0:36:23 > 0:36:25LAUGHTER
0:36:30 > 0:36:32Borscht, maybe?
0:36:40 > 0:36:45Another patient had been operated on almost immediately after Julia.
0:36:45 > 0:36:47His name was Alexander Zozulya.
0:36:53 > 0:36:57The operation was viewed on TV in an adjacent room.
0:36:57 > 0:37:02Here was American paediatric surgeon Mark Holterman.
0:37:02 > 0:37:04Together with Paolo,
0:37:04 > 0:37:08he would soon implant a plastic trachea in a child.
0:37:09 > 0:37:12Parallel with the trials in Russia,
0:37:12 > 0:37:15Paolo continued to implant plastic tracheas
0:37:15 > 0:37:17in patients who were seriously ill.
0:37:17 > 0:37:23The operation took place in the US on two-year-old Hannah Warren,
0:37:23 > 0:37:25born without a windpipe.
0:37:25 > 0:37:28- It's OK. - Don't worry about it.
0:37:31 > 0:37:34And then there was one more patient-in-waiting.
0:37:37 > 0:37:4122-year-old Yesim Cetir from Turkey.
0:37:43 > 0:37:47Yesim was not part of the Russian trials
0:37:47 > 0:37:51but was operated on at Karolinska Hospital in Stockholm,
0:37:51 > 0:37:55where Macchiarini's plastic trachea transplants had first begun.
0:38:00 > 0:38:03Yesim's operation to replace her own damaged trachea failed.
0:38:05 > 0:38:07The plastic trachea wouldn't take hold
0:38:07 > 0:38:08and it lost its shape.
0:38:10 > 0:38:12It had to be cleaned every four hours
0:38:12 > 0:38:14to prevent her from suffocating.
0:38:16 > 0:38:20After a year, Yesim had a new plastic trachea implanted,
0:38:20 > 0:38:22but matters didn't improve.
0:38:24 > 0:38:28In the end, Yesim stayed in hospital for over three years.
0:38:35 > 0:38:38Hannah Warren also remained in intensive care.
0:38:43 > 0:38:47She died three months after having received her plastic trachea.
0:38:54 > 0:38:56The condition of Andemariam,
0:38:56 > 0:38:59Macchiarini's first plastic trachea patient,
0:38:59 > 0:39:00also worsened.
0:39:03 > 0:39:05He felt that there was something wrong with his trachea,
0:39:05 > 0:39:07and he tried to reach Macchiarini.
0:39:56 > 0:39:58Not only the patients felt that Paolo wasn't there
0:39:58 > 0:40:00when they needed him.
0:40:04 > 0:40:07While Macchiarini travelled across the world,
0:40:07 > 0:40:11the hospital staff back in Stockholm were left to deal with the patients
0:40:11 > 0:40:13and their severe complications.
0:40:15 > 0:40:19One of the doctors dealing with Paolo's patient was Thomas Fux.
0:40:53 > 0:40:56Now, even the management started to have issues
0:40:56 > 0:40:58with Macchiarini's methods.
0:40:59 > 0:41:01In October 2013,
0:41:01 > 0:41:04his transplantations were stopped at Karolinska Hospital.
0:41:07 > 0:41:10But since Paolo's experimental work had been suspended,
0:41:10 > 0:41:13his patients were left without specialist help.
0:41:14 > 0:41:17Thomas Fux tried to fill the void.
0:41:19 > 0:41:23He and his colleagues would now make a very surprising discovery.
0:42:14 > 0:42:17Their suspicions about Paolo's reports
0:42:17 > 0:42:18were about to be confirmed.
0:42:27 > 0:42:30Andemariam returned one last time to Karolinska.
0:43:12 > 0:43:14SHE CRIES
0:43:34 > 0:43:39Andemariam Teklesenbet Beyene passed away in January 2014.
0:43:41 > 0:43:43From the autopsy report,
0:43:43 > 0:43:47the doctors now discovered the truth about his plastic trachea.
0:43:49 > 0:43:53There were no signs that a new organ had been created -
0:43:53 > 0:43:55only inflammation and dead tissue.
0:43:57 > 0:44:01The plastic trachea was so loose that it could simply be lifted out.
0:44:04 > 0:44:07It was far worse than the doctors had ever imagined.
0:44:08 > 0:44:11They decided to compare the test results
0:44:11 > 0:44:14of the plastic trachea patients in Sweden
0:44:14 > 0:44:19to the way they had been described in Macchiarini's scientific reports.
0:44:20 > 0:44:22They soon discovered a pattern.
0:45:33 > 0:45:37There is information about certain problems in Macchiarini's work,
0:45:37 > 0:45:39but nothing about the many times
0:45:39 > 0:45:42Andemariam needed emergency treatment
0:45:42 > 0:45:45and nothing about a chronically infected trachea
0:45:45 > 0:45:48that eventually came loose,
0:45:48 > 0:45:51or about the fact that Yesim had endured
0:45:51 > 0:45:54more than 7,000 examinations and operations.
0:45:56 > 0:45:59The doctors now alerted their superiors at the Institute
0:45:59 > 0:46:01and the University Hospital.
0:46:21 > 0:46:24Macchiarini's operations had been stopped in Sweden.
0:46:26 > 0:46:30But Fux and his colleagues were worried that the flawed procedures
0:46:30 > 0:46:32would still take place in other countries,
0:46:32 > 0:46:35placing more lives at risk.
0:46:38 > 0:46:40The doctors asked their superiors
0:46:40 > 0:46:43to alert the medical world to what had really been going on.
0:46:46 > 0:46:50Otherwise, other patients risked receiving Paolo's plastic trachea.
0:46:52 > 0:46:54Others like Julia.
0:46:58 > 0:47:02She was one of the patients meant to prove that the method worked.
0:47:03 > 0:47:06How was her recovery after the operation?
0:47:08 > 0:47:12This is something Macchiarini has said very little about publicly.
0:47:13 > 0:47:17A few days ago, she couldn't breathe and talk normally.
0:47:17 > 0:47:20APPLAUSE
0:48:57 > 0:49:02This is the last footage I saw from the German recordings.
0:49:02 > 0:49:04Watching this footage
0:49:04 > 0:49:06had generated many questions I wanted to put to Paolo.
0:49:08 > 0:49:11But first, I had to follow this story to the end.
0:49:13 > 0:49:17I suspected that I would only get one more chance to interview Paolo.
0:49:22 > 0:49:25When he and his team flew off to the next operation,
0:49:25 > 0:49:27everything went back to normal...
0:49:30 > 0:49:34..for everybody except for Julia.
0:49:38 > 0:49:42Julia spent as much time as she could with her son,
0:49:42 > 0:49:44but everything wasn't as it should be.
0:50:27 > 0:50:30Julia had to be rushed back to the hospital in Krasnodar
0:50:30 > 0:50:31to get help.
0:50:36 > 0:50:38Her surgeon told me what had gone wrong.
0:50:39 > 0:50:42First, the problem with the scaffold.
0:50:42 > 0:50:44It collapsed.
0:50:46 > 0:50:48It collapsed over time.
0:51:09 > 0:51:13Polyakov had to insert a steel net into Julia's trachea
0:51:13 > 0:51:15to prevent her from suffocating.
0:51:18 > 0:51:20She remained in Krasnodar for months.
0:51:24 > 0:51:26Without the plastic trachea,
0:51:26 > 0:51:29Julia might have had a normal lifespan.
0:51:31 > 0:51:34But the situation continued to be life-threatening.
0:51:56 > 0:51:58Julia was able to return home.
0:51:59 > 0:52:02But she was constantly suffering from infections.
0:52:09 > 0:52:12Macchiarini's team had no other solution
0:52:12 > 0:52:15than to insert a new plastic trachea.
0:52:22 > 0:52:23But it didn't help.
0:53:00 > 0:53:04It was here in her apartment that Julia spent her last days.
0:53:19 > 0:53:22Julia's sister-in-law remembers her final days.
0:54:02 > 0:54:08Julia Tuulik died at home alone in September 2014.
0:54:25 > 0:54:26It had been seven months
0:54:26 > 0:54:30since the doctors of Karolinska had warned their superiors
0:54:30 > 0:54:34that Paolo's methods could result in the death of his patients.
0:54:36 > 0:54:39One might think that such serious warning signs
0:54:39 > 0:54:43would have made the management at Karolinska act a long time ago.
0:54:44 > 0:54:49But despite several meetings, e-mails and conversations,
0:54:49 > 0:54:51they did not share these warning signs.
0:54:53 > 0:54:54And in Russia,
0:54:54 > 0:54:59Paolo's trials on almost completely healthy patients continued
0:54:59 > 0:55:01with Dmitri Onogda.
0:55:06 > 0:55:09The doctors got more and more frustrated
0:55:09 > 0:55:12with their superiors' lack of reaction.
0:55:12 > 0:55:15Therefore they decided to take drastic action.
0:55:15 > 0:55:18They documented all the faults they could find
0:55:18 > 0:55:21in a 400-page-long report
0:55:21 > 0:55:23and filed it with the Vice Chancellor
0:55:23 > 0:55:25at the Karolinska Institute.
0:55:53 > 0:55:55Although lives were at stake,
0:55:55 > 0:55:59it wasn't until nine months after the doctors' warning
0:55:59 > 0:56:02that the Vice Chancellor of the Karolinska Institute
0:56:02 > 0:56:05commissioned an independent enquiry.
0:56:35 > 0:56:38What was going on in Karolinska Hospital
0:56:38 > 0:56:40and the Karolinska Institute?
0:56:41 > 0:56:43Were they trying to silence the doctors?
0:56:44 > 0:56:47Did they not want to investigate Macchiarini's operations
0:56:47 > 0:56:48and his research?
0:56:56 > 0:56:59I had seen patient after patient die,
0:56:59 > 0:57:01but according to Macchiarini,
0:57:01 > 0:57:04the tracheas had nothing to do with the deaths.
0:57:04 > 0:57:07He had presented all the facts correctly
0:57:07 > 0:57:10and always been there for his patients,
0:57:10 > 0:57:12but was this really the case?
0:57:12 > 0:57:17In part three, Paolo will get to answer all of my questions.
0:57:17 > 0:57:20Perhaps there's something I have missed.
0:57:21 > 0:57:23Your profession is...?
0:57:24 > 0:57:26Because she had so much...
0:57:26 > 0:57:28Answer my question. Your profession is...?
0:57:30 > 0:57:32- How do you mean? - What are you doing as a job?
0:57:34 > 0:57:36You have to explain what you mean.
0:57:36 > 0:57:40You are... You are a producer, a TV producer, right?
0:57:40 > 0:57:42How can you understand, possibly understand,
0:57:42 > 0:57:45all the details of a medical evaluation?
0:57:45 > 0:57:48- Now, I...- You know all the details of a medical evaluation?
0:57:48 > 0:57:50No, of course not.
0:57:50 > 0:57:53But I've read all the documents with the investigation...
0:57:53 > 0:57:57This is totally wrong, totally wrong.
0:57:57 > 0:57:58You should revise your English.