How much is life worth? Russian doctors are ordered to pay for medical errors

Irina Mishina

...When a medical malpractice case is heard in court, the defense often makes an "iron" argument: "We all die sooner or later". Yes, we will die. But it matters when and how.

In our country, there is no tradition of punishing doctors for mistakes. It is believed that since the doctor just made a mistake, he cannot be blamed, because everyone makes mistakes. The absence of malicious intent distinguishes a non-professional doctor from a criminal. But the consequences of this mistake are no less tragic.

Is every third person in Russia a victim of medical errors?

There are no official statistics on medical errors in Russia. The fact is that not all cases end in death for the patient. Often the doctor manages to correct his mistake, and the patient eventually recovers. In Russian legislation, there is no concept of "doctor's mistake" at all, so it is very difficult to prove that a doctor is to blame for wrong actions that caused harm to a patient. However, there are statistics. According to some experts, the percentage of medical errors in the Russian Federation is very high.

Almost every third patient is misdiagnosed. Because of this, 12% of patients with pneumonia die. Russia also holds the record for the number of strokes. Due to the fault of doctors, we have many children with disabilities - one in four. According to unofficial data, in 2015–2016, an incorrect diagnosis and improper treatment caused the death of about 3 thousand patients. Almost half of them are children.

The world has long been statistics of medical errors in various fields of medicine. According to these statistics, the largest percentage - 25% - is due to errors in surgery. 15% each - for errors in obstetrics, gynecology, and dentistry. But if we take into account how big the difference between the level of healthcare in developed countries and in Russia is, then we can assume how much more cases of doctors' mistakes can actually be. This figure can reach 200-300 thousand dead Russians per year.

Is the presumption of medical innocence the basis of Russian medicine?

The Criminal Code of the Russian Federation does not define clear penalties for medical staff for a low-quality error. The concept of "medical error" in the Criminal Code of the Russian Federation does not exist at all. In practice, a mistake is the inaction or incorrect action of doctors, which caused damage to health.

But the law has not yet been determined: medical error and negligence - are they different things or the same thing? Or is a medical error an accident that is committed through ignorance or negligence? At the same time, there are concepts in the Criminal Code of the Russian Federation that can be applied to the actions of doctors. The flaws of doctors can be attributed to the following concepts of the Criminal Code:

causing harm to health through negligence;

failure to provide the patient with the necessary assistance;

causing death by negligence.

But to achieve any compensation and punishment of the perpetrators is almost impossible. The punishment for medical malpractice is usually negligible.

I remember the tragedy of Yekaterina Sumina, Vice-Miss Russia, who became the heroine of one of my films. During liposuction at the Laser Center in Samara, due to the fault of the doctors, she fell into a coma. It was not possible to get Katya out of this state... The doctors of the cosmetology clinic took all measures to forget about Sumina as soon as possible. The doctors rewrote her medical record: where it says that the patient was disconnected from the ventilator, it was later written that the patient was constantly supplied with humidified oxygen. “The law was on the side of the criminals”, - says Yekaterina's husband Sergey Okunev. - The doctors who killed Katya got off with a slight fright. They brought certificates of beggarly wages. The clinic "Laser Center", which was supposed to answer, was liquidated. And when the court ruled on compensation in the amount of 5 million rubles, there was no one to recover this money from”.

Users of social networks every day before their eyes and the tragedy of Tatyana Uyusova-Bengraf, whose daughter, Olivia, was injured during childbirth in the 27th maternity hospital in Moscow, and then offered to abandon her, because the child was born with cerebral palsy. During childbirth, doctors under the guidance of doctor Marina Sarmosyan used extremely aggressive methods, which caused irreparable harm to the health of the child: at first, the doctors allowed an overdose of epidural anesthesia, and then they resorted to squeezing the fetus, which is dangerous for both the woman in labor and the child. As a result, the girl survived clinical death. All this happened within the framework of childbirth under a contract that cost the family 160 thousand rubles ... Tatyana did not abandon her daughter, and for several years she herself has been nursing a disabled girl with severe cerebral palsy. Doctors did not help the family with a single ruble.

“Courts on the fact of medical errors have not recently brought large compensations, in my experience”, - says Alexander Saversky, head of the League for the Protection of Patients' Rights. - For the death of a person due to an oversight or mistake of doctors, the court now awards, as a rule, 4-5 thousand rubles in compensation. There were successful trials, for example, in 2005 we managed to win a trial against a medical institution, which caused the death of women in labor with children. Then the victims of the actions of doctors were awarded 700-800 thousand rubles in compensation. The interests of the defendant were defended by the academician, but despite this, we won the process. There was also a case where 14 million in compensation was awarded for the death of a person, but this is rather an exception.

It also happens exactly the opposite. As you know, the case of hematologist Yelena Misyurina, who on January 22, 2018, was sentenced by the Cheremushkinsky Court of Moscow to 2 years in prison in a penal colony. This happened after the death of her patient, whom the doctor performed a bone marrow biopsy. However, over time, the criminal prosecution against Ms. Misyurina was discontinued, and she was even paid compensation in the amount of 4,282,221 rubles 90 kopecks.

Forbidden topic

Now almost no one writes or talks about medical errors. When I inquired about the reasons for this among medical lawyers, they told me an unexpected thing: it turns out that recently investigators have been giving a non-disclosure receipt for cases of medical errors. Accordingly, this extinguishes informational occasions, and we simply do not know about many cases against doctors.

Cases against doctors in case of their mistakes do not reach the courts for other reasons. “At the end of the 2000s, a regional branch of the League for the Protection of Patients’ Rights was created in Sochi, and at first there were high-profile cases there, but at some point the courts returned to the practice of awarding 4-5 thousand rubles in compensation for medical errors due to the fault of the medical staff. When they began to understand, it turned out that the local head of the health department held a closed meeting with the local court, at which it was decided "not to ruin the local health department". Such small-town agreements often “extinguish” high-profile cases”, - Alexander Saversky, head of the League for the Protection of Patients’ Rights, told NI.

Candidate of Medical Sciences, pediatric geneticist Marina Zubkova said that individual cases related to medical errors are now reaching the courts: “There was a case recently when, due to a medical error, plaintiffs reached the presidium of the Moscow City Court. But in general, according to statistics, only 2% of cassation complaints reach the presidium of the court. The number of cassations for medical errors, satisfied by the court, is negligible”.

In its ruling, the Supreme Court decided to assign the obligation to prove the grounds for releasing doctors from liability for improper provision of medical care to a “medical organization”. In this regard, in the medical environment, they started talking about the need to insure doctors. Thus, in the courts they will have one more defender - the insurer. But it is unlikely that this will help to avoid compensation for the harm caused to health. “Patients will go to the investigators, and then, as part of a criminal case, they will file a civil lawsuit”, - Alexander Saversky believes.

At the same time, this decision of the Supreme Court was received ambiguously in the medical environment. "This decree makes it possible to claim compensation for moral damage without proving the fact of a medical error. But moral damage cannot be seen and tangible. In this sense, medical organizations will find themselves in a difficult position. Moreover, their budget does not include such amounts that are often required by victims "In general, in my opinion, this decision was adopted due to the growth of dissatisfaction with medical care in Russia. People were told, as it were, that we cannot improve the quality of medical care, but you can sue the money", - lawyer Asad Yusufov told NI.

Will the decision of the Supreme Court save us all from medical errors? “I think there will be fewer mistakes. In addition, in most cases, doctors do not allow them on purpose. There must be individual responsibility. In the meantime, a legal entity pays for mistakes, most doctors will think: “I personally am not responsible for anything.” As long as there is no personal responsibility, nothing will change”, - says Marina Zubkova, candidate of medical sciences, pediatric geneticist.

According to statistics, about 10,000 complaints against medical workers are filed in courts in Europe alone every year. Half of them are satisfied by the court, as the examination proves the fact of error. In our country, expertise in most cases does not prove anything, since it is subordinate to the same health department as the medical institution against which the lawsuit is filed. It is interesting that in Moscow, in cases of flagrant medical errors, justice was achieved by the plaintiffs only during the forensic medical examination in St. Petersburg.

A significant difference is that abroad between the patient and the doctor, an agreement is concluded, where all socio-economic, as well as ethical and legal aspects of their interaction are spelled out in detail. We don't have this in our country. Everyone knows that before the operation, at best, a few minutes before it, they will slip you a signature sheet, which you will not delve into too much. Because at this time you will most likely be busy thinking about how to bribe the anesthesiologist...