The National Medical Chamber may be involved in the investigation of criminal cases against health workers

President Putin instructed the Investigative Committee of the Russian Federation to consider the issue of involving the National Medical Chamber in the investigation of criminal cases against medical workers. A professional organization could provide expert advice in so-called medical malpractice cases. President of the National Medical Chamber Leonid Roshal says that he and his colleagues have been promoting the idea of ​​independent examination for a long time, and considers the president’s order an important step in this direction. However, legal experts doubt that such an initiative can now be implemented.

Last week, President Vladimir Putin approved a list of instructions on socio-economic issues. Among other things, he instructed the Investigative Committee of the Russian Federation and the Prosecutor General’s Office to consider the issue of “the advisability of expanding the practice of involving” the National Medical Chamber in the investigation of criminal cases of medical errors. It is assumed that the chamber can act as an expert organization.

It should be noted that since 2018, the departments of the Investigative Committee have had special departments to investigate iatrogenic crimes, that is, those related to the improper provision of medical services and medical errors. At the same time, the term “medical error” itself does not exist in the legislation of the Russian Federation, notes Evgenia Ryzhkova, lawyer of the Yakovlev and Partners legal group, teacher at Samara State Medical University. She points out that doctors in such situations are often accused under articles of the Criminal Code of failure to provide assistance to a patient, provision of unsafe services, or causing death or harm to health through negligence. “To pass a guilty verdict, there must be a direct cause-and-effect relationship between the actions or inactions of a medical worker and the consequences that occur,” comments Ms. Ryzhkova. “This connection is established by the totality of evidence. But despite the fact that all evidence is equal, in fact, forensic examination is “more equal.” The presence of a direct cause-and-effect relationship should be reflected precisely in the conclusion of forensic experts.”

In 2022, 1,860 criminal cases were initiated against health workers—almost every third of the 5,747 patient complaints. These statistics were presented at the conference “Regional Healthcare 2023” by the former head of the department for investigating iatrogenic crimes of the Main Investigative Directorate of the Investigative Committee of the Russian Federation, head of the consulting company “Yustum” Dmitry Zinin. At the same time, 174 cases reached the court; 193 health workers were charged, and only 19 of them (10%) achieved acquittal. Mr. Zinin named one of the reasons for the persecution of doctors as “patient extremism” – a deliberate attempt by a patient or his relatives to get money from a medical institution through threats (contact the media, write a statement about a crime to the Investigative Committee) or actual lawsuits. In his assessment, “many laws protect the rights of the patient, but the rights of the doctor are protected only by the Lord God and the doctor himself.”

The team of the Doctor’s Directory mobile application (a popular professional service that unites more than 915 thousand medical users) asked 1,681 specialists who they consider most effective in protecting the rights of doctors. The Ministry of Health of the Russian Federation was chosen by 7.1% of respondents, the regional Ministry of Health – 1.5%, the direct management of the medical institution – 15.2%. The state trade union was named by 1.9%, non-state medical trade unions – 3.9%, specialized medical association – 7.4%, National Medical Chamber – 2.2%. Deputies of various levels were named by 0.2%, journalists, social activists and civil activists – 1.5%, but lawyers and paid attorneys – 20.2%. But the largest share of respondents – 35.6% – considers all these options ineffective. At the same time, 92.1% of respondents believe that it is necessary to create a public or state institution that would specialize in protecting the rights of doctors, but would not be subordinate to the authorities of the state health care system.

President of the National Medical Chamber Leonid Roshal told Kommersant that not a single public organization in Russia deals exclusively with protecting doctors from criminal cases. This is what he explains the survey results. Trade unions protect exclusively labor rights, Mr. Roshal explained, and specialized and regional associations of doctors focus on developing clinical recommendations, introducing advanced medical techniques and other purely professional activities. At the same time, the NMP is trying to “create a full-fledged system of legal protection for doctors,” Mr. Roshal emphasized. He said that the Center for Independent Medical Expertise has been operating at the ward for 10 years. He prepares conclusions, but not at the request of doctors, but according to the decisions of the RF IC and court rulings. “Today, such cooperation is the only opportunity for us to conduct expert activities,” explained the president of the chamber. “Earlier, we raised the issue of the government approving the Regulations on Independent Medical Expertise. It would allow examinations to be carried out at the initiative of doctors, medical organizations and patients. Unfortunately, such a document has not yet been approved.”

Mr. Roshal calls the system of independent medical examination that the chamber has developed and applies “the best in the world.” “Its main principles are the impersonality of documents sent to experts to prepare an opinion; extraterritoriality; independence of experts from medical organizations and government agencies of the region where the controversial case occurred,” the surgeon listed. “And also high professional requirements for experts, collegiality, mandatory participation in the expert commission of health care organizers and lawyers.” Therefore, Leonid Roshal “fully welcomes” the idea of ​​involving the chamber as an expert organization in the investigation of criminal cases.

Now the role of public and professional associations in criminal proceedings is reduced to a minimum, says Associate Professor of the Department of Forensic Medicine and Medical Law at Moscow State Medical University. A. I. Evdokimova, partner of the expert legal group “Medica Proof” Ivan Pecherey. The main reason is “the fact that in criminal cases, mainly the forensic medical examination department of the Investigative Committee is appointed as experts,” says Mr. Pecherey. Therefore, he doubts that the initiative to involve the chamber will be implemented in practice, since it “requires large-scale changes that no one will agree to.”

Natalia Kostarnova