New in Russian medicine: treatment with the right to make mistakes

After this public statement by the minister, apparently, we should expect the abolition of civil legislation on compensation for harm to life and health due to defects in the provided medical care.

Irina Mishina

The Minister of Health made his loud statement in a video message to the participants of the online forum "World Quality Day". It was also published by the portal of Russian doctors "Medvestnik".

“It is necessary to rethink the attitude of society towards the work of doctors, to recognize the reality of the risks associated with medical care and the right of medical workers to make mistakes, since they are experiencing extreme stress,” the minister said. Mikhail Murashko also proposed to reconsider the role of the patient in the healthcare system, "including the responsibility of people for their health." According to the minister, the relationship between the doctor and the patient should become "partnership", which will require "mastering the skills of effective communication". In general, it's time for patients to learn to take responsibility for their own health.

Sad statistics

According to unofficial data, the frequency of deaths from medical errors in Russia can reach 40-50 thousand annually. This figure is given in its publication "Rossiyskaya Gazeta", referring to the statistics of the public organization "League of Patients' Defenders". Similar figures, citing data from the Ministry of Healthcare and Social Development , are also cited by the director of the Center for Medical Law, Alexander Panov, noting that the real figure can reach one hundred thousand deaths a year. There is reason to believe that after the statement of the Minister of Health, this sad statistics will increase many times over.

Not a single doctor, even the most ingenious, is immune from medical errors. “Thousands of difficult and complex operations and... quite a few deaths. There are many among them in which I am directly guilty, no, no, these are not murders! Everything in me shudders and protests. After all, I deliberately took the risk to save my life”, - the great surgeon Nikolay Amosov admitted.

Medicine has always been fraught with risk, the progress of medicine without this is inevitable. But at the same time, doctors' mistakes are one of the main reasons for the decline in trust in medicine. We are offered to legalize a medical error, to make it a “right” of doctors.

The minister’s approval has already caused controversy in both medical circles and among patients. “If we recognize the right to a medical error, it turns out that doctors cannot be punished. And thus patients are deprived of their right to compensation, moral damage. According to the logic of the minister, if a person dies through the fault of a doctor, he will not even be reimbursed for the funeral expenses. The statement of the Minister of Health also nullifies Article 1095 of the Civil Code of the Russian Federation, whichprovides for compensation for damage caused to life or health, ” Doctor of Medical Sciences, member of the Public Council for the Protection of Patients' Rights at Roszdravnadzor Alexei Starchenko told Novye Izvestia.

"In no case should this be allowed, otherwise the constitutional norms, the Civil Code will be violated, and we will return to the times of the USSR, when in the event of a medical error it was impossible to sue a hospital or a specific doctor. The guilty doctor under the Soviet health care system was most often simply reprimanded, and in extreme cases, quietly dismissed without trial or expelled from the Communist Party. It is unacceptable to return to such practice”, - says Alexey Starchenko.

It is noteworthy that the minister's statement was made at the height of the coronavirus epidemic, when patients make many legitimate claims about the lack of doctors, medicines, hospital beds, when the mortality curve continues to rise; when the authorities admit that hospitals in some regions are 95 percent full. When it is already clear to everyone: the Russian healthcare system cannot cope with the influx of cases and is about to collapse under the pressure of the coronavirus.

The minister referred to doctors' "professional burnout". Yes, the burden on medical institutions is really big now. But there is another side of the coin: it is the refusal of the doctors of the district polyclinics to come to the house of seriously ill patients, the refusal of hospitalization. Heartbreaking scenes are published on social networks, such as the one in which an ambulance doctor in Abakan vainly pleads with doctors to put a 90-year-old patient in a crowded ward for treatment. "Why do I have to beg you about this?" - she shouts in the emergency department to the doctor. And consultation of children with confirmed coronavirus by phone according to the principle: "Drink warm water and air the rooms, there is no medicine available." There is also a confession of a representative of the Ministry of Health that from 30 to 40% of tests for coronavirus give a false result. “In about 30-40%, this [false negative] occurs. Why is this happening? The problem is not the quality of the tests - the problem is in taking the materials. If the material is taken of poor quality, unfortunately, we have a chance to get a false-negative result”, - said Sergey Avdeev, chief freelance pulmonologist of the Russian Ministry of Health.

At the same time, doctors who took the test of poor quality, in violation of the rules, are not brought to justice. “Who will work?” - the officials keep repeating. And the healthcare system continues to build on mistakes.

Doctors will have to be responsible for the collapse in medicine

Failure to provide medical care to many seriously ill patients has increasingly led to lawsuits against medical institutions. Thus, the lawsuit of the Novosibirsk lawyer Irina Grebneva against the district clinic received a great response, where both she and her employees were, in fact, denied medical assistance. Having collected the facts, Irina Grebnyova, a Novosibirsk lawyer, managing partner of the law firm Grebneva & Partners, circulated a statement on local Internet resources. The lawyer states: “So what is happening: doctors do not come on calls; An ambulance does not arrive for days; district doctors, instead of visits, call patients, issue sick leave certificates without looking and send appointments via WhatsApp or SMS; medical institutions provide online consultations; pharmacies sell drugs on photocopies (photographs) of prescriptions. The doctors themselves are to blame for the collapse that has happened due to the coronavirus: when they diagnose ARVI patients with covid patients, they do not answer calls and do not issue sick leave certificates on time. And this is no exception, this is the rule", - Sibkray.ru publishes in detail the investigation of the lawyer Grebnyova.

“You've probably heard that our patients are shameless, arrogant, rude to receptionists and doctors in these difficult times? ... Today I just yelled at the reception desk. Because I got through to them after 186 calls. After 19 minutes of waiting, I heard that the doctor would come to me. Someday ... I've been expecting him since October 13. During this time, I managed to pass tests several times, find a doctor for observation (for a fee, of course), do a CT scan, establish lung damage, live to see the formation of G antibodies, and continue treatment. And at the reception they still tell me: expect a doctor. I am interested in one question: where is my sick leave? And let those who admire the feat of doctors forgive me. I sincerely believe that the current collapse was created by doctors. Since they, without shame and conscience, come to knowingly sick patients and diagnose them with ARVI, they do not prescribe either a diagnosis or appropriate treatment. And people go to work. And some don't come at all. And people, in order not to be fired, go to work sick. And infect the rest. For example, we paid the full salary of 14 patients in October. Because the sick could not get sick leave. And I didn’t have the conscience to leave people without money”, - says Irina Grebnyova, a Novosibirsk lawyer.

Irina Grebneva announced her intention to write complaints and seek the recovery of spent funds from medical institutions that did not provide medical care. “I will enthusiastically watch how the lost people will bring doctors to justice, and the amount of compensation will be collected from medical institutions”, - Irina writes. However, her claims in the light of the latest statement by the Minister of Health are unlikely to be satisfied.

Death by mistake

No compensation is promised to Christina Nosova, who has lost her two-year-old child. This tragic story has already bypassed social networks, causing a huge resonance. As it became known, a criminal case was initiated under Art. 109 of the Criminal Code of the Russian Federation (causing death by negligence to a minor). A preliminary investigation was launched by the Zamoskvoretsky Interdistrict Investigation Department of the Main Investigative Department of the Investigative Committee of the Russian Federation in Moscow.

The story that happened to Christina's son is short and scary. On November 6, the woman called her son emergency help: he developed eye swelling, the temperature rose to 39. Despite this, according to her, the child was mobile and played. The emergency doctor suspected kidney problems and called an ambulance. With a preliminary diagnosis of angioedema, the baby and his mother were brought to the admission department of the Morozov Children's City Clinical Hospital of the Moscow Health Department. There the child underwent a CT scan of the head. As a result, a small amount of fluid was found in the right sinus. The doctor of the admission department suggested an additional examination in the ENT department. That same evening, a council of doctors suggested that the child had sinusitis and prescribed an intravenous antibiotic. On November 7, CT of the head was done again - with a contrast agent and under anesthesia, while the catheter moved, the dose of the substance got under the skin, and the child was injected with additional contrast in the other hand. After that, the boy began to fade away in his mother's arms. Doctors attributed his condition to the "discharge of anesthesia." "According to the resuscitator:" In the department where you were lying with the child, there was some kind of catastrophe that led to organ damage, brain edema, cardiac arrest. " Despite the fact that the analyzes from the department are clean. Analyzes after the second CT scan were not carried out ... We arrived at the emergency room on our own feet, but in a short time the child was brought to this state, ”states the mother of the child who died in the Morozov Children's Hospital. The woman also said : “At the moment, we cannot be given a copy of the medical history. They pull. The investigator claims that a request has been filed with the forensic medical examination, and the term for extradition is up to 30 days. And I am very much afraid of forgery. A month to wait. And the cause of death has not yet been established. According to the investigator, both the Health Department and the insurance company are satisfied with the inspection.

The Moscow Department of Health, in turn, announced the start of a check on the death of the child. In particular, a forensic medical examination is being carried out. “Based on the results, information about the child's diseases, conditions and circumstances that could lead to an unfavorable outcome will be clarified. During the inspection, the actions of medical personnel will also be assessed, and all the circumstances of the incident will be established, ”the DZM said.

By the way, in early November, the Leninsky District Court of Ivanovo appointed a sentence of two years imprisonment with probation two years pediatrician clinic №10 Yarovikova Lyubov, who was found guilty in the death of an eight-year boy. The criminal case was investigated under Art. 124 of the Criminal Code of the Russian Federation (failure to provide assistance to the patient). The experts found that the child died of fulminant myocarditis, a rare disease that "proceeds very quickly and cannot be diagnosed when examined at home." Mistakes Yarovikova called incomplete filling out of the outpatient card and the fact that she did not offer to hospitalize the patient.

About compensation of losses to the injured party, mind you, in both cases, when children died, not a word. Apparently, we are returning to the Soviet system, when a medical worker who made a medical mistake got off with a reprimand, and in the worst case, if the case went to court, received a minor sentence, most often a suspended sentence.

“There will always be medical errors. But it is one thing to admit a mistake and make atonement to the injured party, another thing is to state the "right to make a mistake." In fact, it is more appropriate to talk about a set of measures to reduce risks and ensure patient safety. Just a month ago, on October 16, World Patient Safety Day was celebrated. From the rostrum, words were heard that the authorities should minimize risks, develop an algorithm for dealing with medical errors. Medical practice will always be fraught with errors. But we should not fix this as a law, but build a system that would minimize these mistakes”, - said Yuri Zhulyov, co-chairman of the All-Russian Union of Patients.

In connection with the statement of Minister M. Murashko about the right of doctors to make mistakes, controversy has also developed on social networks. People are perplexed why they should receive erroneous diagnoses, assistance not provided on time, and a lack of specialists for deductions and taxes. “ I have been working since I was 17, and deductions from the payroll, for medicine, were introduced in the early 90s (if I don’t confuse anything). When I worked for my uncle, my employer paid taxes for me. Almost 20 years ago I began to work “for myself”, so I know for sure all these amounts that I paid “for medicine ”. At first it was 3.2% of the payroll, now it is 5.1%. There is no way to get away from this business. Take it out and put it down! Otherwise - penalties, fines, arrest of the account and other joys. At the same time, I almost never used free medicine. She transferred all sorts of seasonal diseases on foot or lay down for a couple of days. The main doctors - a dentist and a gynecologist - were for the money, on the recommendation. I gave birth for a fee, I was observed during pregnancy - also for a fee. The first three years of the child also went with him to the doctors for a fee - massages, vaccinations, ultrasound - everything that is needed there as planned. And then the money ran out. Health, by the way, too. And - and that, and another - for reasons beyond my control. Money ran out with small business, and health with age”, - writes the author with nickname ONDATRA in Yandex-Zen. “Who among us has not recently experienced a feeling of helplessness, powerlessness and humiliation when seeking medical help from supposedly free, but in fact, many times paid by us medicine?!”, - the author is indignant.

A natural question arises: why a journalist pays for a mistake in court, a miner - with his own life, a politician - with loss of reputation and oblivion, and a doctor - infallible. Why?

The tendency to shift responsibility from doctors to patients is not outlined today. Its result was a deafening defeat for Russian health care in the fight against coronavirus. How else can one explain the fact that mortality in Russia in the first half of 2020, compared to the same period in 2019, increased by 3% ? This follows from the data provided by Rosstat. The increase in mortality by 3% means that the number of deaths increased from 918.5 to 946.5 thousand, that is, 38 thousand more people died than in the same period last year. Moreover, a significant increase in mortality occurred after the introduction of restrictions. This means that the reason is not in the ignorance of citizens and not in non-observance of anti-epidemic measures, but in our health care system, which is increasingly beginning to resemble one continuous mistake.