Not at our service - Newspaper Kommersant No. 218 (7419) dated 11/24/2022

The State Duma recommended that the Ministry of Health exclude the concept of “service” from the law “On the Fundamentals of Protecting the Health of Citizens”. A supporter of the initiative, the head of the committee for the protection of the health of citizens, Dmitry Khubezov, explained that this was one of the steps to make the profession of a doctor respected. In addition, he argues, this will help protect doctors from prosecution under the article of the Criminal Code related to the provision of services. Industry experts with whom Kommersant spoke, however, believe that abandoning the wording will not solve the problem of decriminalizing medical activity, and there is nothing wrong with the term “service” itself. The Ministry of Health of Russia adheres to the same position.

The State Duma published approved recommendations based on the results of parliamentary hearings that took place back in June 2022. It follows from them that the Ministry of Health, as well as the relevant committees of the State Duma and the Federation Council, are recommended to prepare amendments to the 323-FZ “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” and other legislative acts in order to exclude the concept of “service” from there.

This proposal was made by the rector of the First Moscow State Medical University. I. M. Sechenov, Chairman of the Council of Rectors of Medical and Pharmaceutical Universities Petr Glybochko. He explained the initiative as follows: doctors "provide medical care." State Duma Chairman Vyacheslav Volodin supported Mr. Glybochko, noting that "this is the least we can do for medicine." In September, the head of the State Duma Committee on Health Protection, Dmitry Khubezov, announced that the deputies were engaged in the development of an appropriate bill. “Undoubtedly, we provide assistance, not a service,” Mr. Khubezov noted. “This is one of the steps to make the profession of a doctor respected.” Such an amendment, according to the deputy, will help protect doctors from applying Art. 238 of the Criminal Code of the Russian Federation "Provision of services or performance of work that does not meet safety requirements."

The Ministry of Health of the Russian Federation, however, did not support the initiative. Kommersant's department said that the term "medical service" essentially means a unit of billing for medical care and in most cases is used for financial and economic calculations, medical statistics. In order to avoid any other interpretation, the concept of a medical service should be legally clarified accordingly. “Today, extensive consultations on the development of a package of relevant proposals for finalizing legislation are being held with the involvement of leading lawyers at the site of the United Russia party, the State Duma, and the National Medical Chamber,” the press service of the department said.

According to the law on the fundamentals of protecting the health of citizens, a medical service is a medical intervention or a complex of medical interventions aimed at the prevention, diagnosis and treatment of diseases, medical rehabilitation, and having an independent complete value. Thus, any individual who applied for medical assistance is a consumer (Law "On Protection of Consumer Rights"). Accordingly, explains the lawyer of the Yakovlev and Partners legal group, teacher at the Samara State Medical University Evgenia Ryzhkova, consumer protection legislation applies to the provision of medical services to citizens, provided by medical organizations within the framework of voluntary and compulsory medical insurance.

Deputy Chairman of the Health Committee Sergei Leonov (LDPR) told Kommersant that he was skeptical about the bill being developed by the United Russia faction: “When talking with doctors, I did not hear them say through one that they did not want to provide services but want help. In medicine, in his opinion, there are “a huge number” of problems, and this one “is clearly not on the list of priorities.”

Andrey Konoval, co-chairman of the Action trade union, nevertheless notes that the term “service” is extremely unpopular among the professional community. Some doctors, according to him, are “calm” about this, but others see “a belittling of the profession of a doctor” and believe that the patient, because of such wording, referring to consumer rights legislation, forms the opinion that “the client is always right” . Mr. Konoval does not deny that in the minds of many physicians, the rejection of the term “medical service” should reduce cases of criminal prosecution. “But from the point of view of the design of the legal system, it is hardly possible to remove this concept just like that,” he agrees with the Ministry of Health. “Besides, this still will not cancel the criminal prosecution of medical workers.”

Lawyer Yevgenia Ryzhkova confirms that if the term “service” is abandoned, there will be no less criminal prosecution of doctors. She recalls that health workers, in addition to Art. 238 of the Criminal Code, a number of other articles are also charged, including, for example, “causing death by negligence” and “failure to provide assistance to the patient in case of inaction, which led to negative consequences.” “At the same time, the law and judicial practice have not developed an unambiguous approach to qualifying medical crimes, so it is impossible to say in advance which particular article will be charged in a particular case,” says Ms. Ryzhkova.

A source in the government confirmed to Kommersant that the exclusion of the concept of "medical service" will not protect doctors, but it will require changes to several thousand regulations at various levels.

Director of the HSE Institute of Health Economics Larisa Popovich also does not see anything reprehensible in the term “service”, which, as she notes, comes from the word “service”. According to Ms. Popovich, the application of legislation on poor-quality provision of services to consumers is quite reasonable if the legal norms are supplemented with the concept of "quality of medical services" and "quality of conditions for the provision of assistance (services)".

In the All-Russian Union of Patients (VSP), the initiative is completely “cautious”. “According to authoritative experts, such a radical decision will not achieve the declared goals. And it will not solve the problem of the increase in the number of criminal prosecutions of doctors, - Yuri Zhulev, co-chairman of the Supreme Court of Justice, is sure. - Our experience shows that the protection of the rights of doctors and patients must, first of all, be balanced. It's like a scale that can't tip in favor of either side."

Natalia Kostarnova

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