New treatment rules for compulsory medical insurance: it will be almost impossible to challenge medical errors

Irina Mishina

On the Federal portal of legal acts regulation.gov.ru a document "On approval of the procedure for maintaining a unified register of experts on the quality of medical care" was published for discussion. The florid name hides a de facto ban on serious fines against medical organizations that have made medical errors or provided poor quality medical care. Based on the new document, the Mandatory Health Insurance Fund has the right to remove an expert on the quality of medical care from work for life for serious fines in relation to medical organizations. An expert can avoid exclusion from the register only if his sanctions against clinics do not lead to more than 10% of the tariff for medical care.

The project has caused controversy both in the medical community and among patients. According to experts, this provision will primarily infringe on the rights of patients. After all, the purpose of the examination in medical institutions is, first of all, the elimination of medical errors. But in the Russian legislation there is no concept of “doctor's mistake”. Consequently, it is very difficult to prove that the doctor is to blame for the wrong actions that have harmed the patient. In the meantime, according to experts' estimates, almost every third patient today is being misdiagnosed. Because of this, up to 12% of patients with pneumonia die.

According to the rules in force earlier,many cases of medical errors were financially compensated to the victim or his relatives - thanks to the intervention of experts. So, recently, the court ordered the Yuzhno-Sakhalinsk hospital to pay 1.3 million rubles to a patient who, through the fault of doctors, lost a kidney. The woman went to the Sakhalin Regional Hospital with a controversial diagnosis. The day after hospitalization, the surgeons performed an endoscopic operation. During this operation, the surgeons touched the renal artery. To stop the bleeding, the vessel was clamped with a special clip, but they forgot to remove it. After the operation, the woman felt worse. Computed tomography showed that the clip, which the doctors put on the woman during the operation, clamped the renal artery, and the organ was dying off. The woman was operated on again, the kidney could not be saved. After a while, the woman turned to the regional Ministry of Health with a complaint. There, according to her statement, it was concluded that the doctors acted correctly, and the kidney was removed due to postoperative complications. Then the woman turned to medical experts. Only they proved that the decision on the primary surgical intervention was made without sufficient grounds and that the kidney lost its vitality due to the doctors' mistake. The doctors did not admit their guilt and appealed the court decision several times. However, the court ordered the hospital to pay the victim 1.3 million rubles.

“The patient community sees in the examination of the quality of medical care, which is now carried out in the compulsory medical insurance system, practical and professional assistance to patients, which is especially important in the pre-trial settlement of possible conflict situations. Since the examination will become a formal action, it will cause another wave of dissatisfaction among patients”, - said Nikolay Dronov, Chairman of the Coordinating Council of the Movement Against Cancer Movement.

But there are other opinions as well. “It is profitable for experts who work in private insurance companies to write out large fines for medical organizations, because insurers receive additional income for this. The current measure to limit the threshold of fines, perhaps, somehow reason with them. After all, the system of fines for violations of the quality of medical care often forces doctors to conceal violations in order to avoid punishment. In my opinion, fines are not an effective mechanism for improving the quality of medical care. Shortcomings should not be fined, but conditions should be created to correct them. Instead of fines, it is necessary to improve the qualifications of doctors. Our number of cases of nosocomial infection with the same volume of hospitalizations is 26 times lower than in the United States. This means that we simply do not detect these cases, which means we do not correct them. It is necessary to change the system of quality management of medical care”, - says the head of the Higher School of Organization and Management of Health Care (HSHOUZ), Doctor of Medical Sciences Guzel Ulumbekova.

We decided to ask professional experts for their opinion on the new document, who are faced with the inspection of medical institutions every day. According to the President of the NP "National Agency for Patient Safety and Independent Medical Expertise" Alexey Starchenko, there have been a lot of courts on claims of patients against doctors recently, and it is almost impossible to achieve justice for a patient on his own, without an expert and a representative of the insurance company.

“The ban on serious fines against medical organizations will lead to impunity. Already now we have to deal with egregious cases. Not so long ago, I was present at the court on the claim of a patient who, during a gynecological operation, burned her bladder, damaged the ureter, the consequence of this operation was sepsis and phlegmon. However, the defendant at the trial said literally the following: "Yes, she is as healthy as a horse!" If experts are fined for serious fines in relation to medical organizations, the meaning of control over the activities of doctors is lost. I have to do up to 30 examinations a day. Naturally, there are violations. And if, according to these rules, I should not exceed the limit of 10% of the tariff for paying for medical care, this actually means turning a blind eye to shortcomings. No more than 10% are complaints about documentation, nothing more. That is, the patient will be one-on-one with the medical institution to which he has claims. And when the hospital admitted that the treatment was not carried out correctly, that the doctor made a mistake? Do not remember that. The new rules regarding the examination mean that patients, in fact, will be deprived of protection”, - Alexey Starchenko told Novye Izvestia.

Medical errors and the lack of professionalism of medical workers indirectly lead to the death of more than 70 thousand Russians every year. Such statistics were announced at a meeting of the council of rectors of medical universities by the head of the Ministry of Health Mikhail Murashko. The minister gave examples when people die from mistakes when injecting lidocaine (this is an anesthetic that is also used against arrhythmias; in five years there were 80 such deaths). Patients die even with improper use of the gurney, which is why, according to the Minister of Health, there are cases of severe injuries. Murashko believes that the facts listed by him indicate that the safety of medical care is at a low level. But why, at the same time, the Ministry of Health actually prevents a full-fledged medical examination, remains a question.