Protecting the rights of patients is the work of the patients themselves

What to do if you are "healed"Online magazine "Third Age"
We all face Russian healthcare in one way or another.

There is even a joke, which, by the way, is not devoid of truth: "There are no healthy people – there are under-examined ones." And if you are now full of energy and are absolutely sure that there is no need for you to go to the doctors – read this article by the lawyer of the Consumer Protection Society carefully – you will learn a lot of interesting things.

So, before we talk about the "pitfalls" in the relationship between a doctor and a patient from the point of view of law, let's answer the question: what are "patient rights"?

The patient's rights are a set of tools legally fixed and protected by the state that allow the patient to receive high–quality medical care.

The rights of the patient are most fully set out in the "Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens", Article thirtieth of which reads:

When seeking and receiving medical care, the patient has the right to:

1. respectful and humane attitude on the part of medical and service personnel;
2. the choice of a doctor, including a general practitioner (family doctor) and the attending physician, taking into account his consent, as well as the choice of a medical and preventive institution in accordance with compulsory and voluntary medical insurance contracts;
3. examination, treatment and maintenance in conditions that meet sanitary and hygienic requirements;
4. conducting a consultation and consultations of other specialists at his request;
5. relief of pain associated with the disease and (or) medical intervention, by available methods and means;
6. keeping secret information about the fact of seeking medical help, about the state of health, diagnosis and other information obtained during his examination and treatment;
7. informed voluntary consent to medical intervention;
8. refusal of medical intervention;
9. obtaining information about their rights and obligations and the state of their health, as well as the choice of persons to whom information about the state of their health can be transmitted in the interests of the patient;
10. obtaining medical and other services within the framework of voluntary health insurance programs;
11. compensation for damage in case of injury to his health during the provision of medical care;
12. admission of a lawyer or other legal representative to him to protect his rights;
13. the admission of a clergyman to him, and in a hospital institution for the provision of conditions for the performance of religious rites, including the provision of a separate room, if this does not violate the internal regulations of the hospital institution.

In case of violation of the rights of the patient, he can file a complaint directly to the head or other official of the medical institution in which he receives medical care, to the relevant professional medical associations or to the court.

Actually, the Lisbon Declaration on the Rights of the Patient, adopted by the World Medical Assembly, contains, in a more abbreviated version, all the same points. So we can assume that the rights of patients are protected in the same way as in Europe.

Only for some reason, the World Health Organization (WHO), assessing the health systems of different countries by many criteria, in its 2000 ranking, assigned Russia the "honorable" 130th place. Honduras is right behind us. And our neighbors in the CIS are far ahead: Belarus ranks 74th, Kazakhstan 64th, and so on. The French healthcare system is recognized as the best. Of course, in the eight years since the release of the WHO report, a lot has changed for the better. But why, then, are the courts literally "inundated" with claims of deceived and offended patients?

Dry statistics show that almost every third diagnosis in Russia is made incorrectly (in the USA, the percentage of medical errors does not reach four).

According to the Federal Compulsory Health Insurance Fund, up to a million people complain about the quality of medical services every year. In the capital, every fifth paid medical advisory center makes false diagnoses to its patients in order to cash in on expensive “treatment".

The amounts recovered in court from a medical and preventive institution for harm caused to patients reach one and a half million rubles.

About 10% of civil cases concerning substandard treatment are initiated after plastic surgery.

So how to protect yourself in the medical services market? How to get quality treatment? Let's talk.

I will immediately note that we will casually touch upon receiving medical care under the compulsory medical insurance program, but the main part of our conversation will be about paid medical care.

The Law of the Russian Federation "On Consumer Protection" contains legal norms regulating the provision of medical services. So, in particular, the patient has the right to proper quality of medical services, and the medical institution is obliged to ensure this quality.

Article 4 of the above-mentioned Law gives a legal interpretation of the quality of the service:

1. The contractor is obliged to perform the work (provide the service), the quality of which corresponds to the contract.
2. In the absence of conditions in the contract on the quality of the work (service), the contractor is obliged to perform the work (provide the service), in accordance with the requirements usually imposed and suitable for the purposes for which the work (service) of this kind is usually used.
3. If the contractor, at the conclusion of the contract, was informed by the consumer about the specific purposes of performing the work, (rendering the service), the contractor is obliged to perform the work, (rendering the service), in a form suitable for use in accordance with these purposes.
4. If the laws or in the manner prescribed by them provide for mandatory requirements for work, (service), the contractor is obliged to perform the work, (provide the service), in accordance with these requirements.

Which clinic should I go to?

We all already understand that the abundance of advertising does not always guarantee quality. Therefore, when choosing a medical institution, focus primarily on the reviews of friends, acquaintances, colleagues, as well as for the period that the clinic operates on the market. Internet search gives very good results. Enter the name of the clinic in the search engine and see the ratio of positive and negative reviews.

When you come to the clinic, ask the administrator for a license, an appendix to the license (with a list of permitted activities), and the availability of specialist certificates.

The license, according to the "Regulations on licensing of medical activities" approved on January 22, 2007, is issued for a period of 5 years, with the possibility of subsequent extension. In the appendix to the license, all types of services that are allowed to be provided to this medical institution must be specified.

Very often, in the most prominent place, at the reception desk or the reception desk, a huge number of diplomas, certificates, certificates are posted. Come and look carefully at these papers. It may very well be that these certificates confirm the participation of the clinic's doctors in any seminar (most often useless, since it is arranged with the money of pharmaceutical companies) and have nothing to do with either experience or professional literacy.

Scroll through the book of reviews. Feel free to ask questions. Moreover, pay special attention to the issue of the cost of the services provided to you. If the doctor answers evasively or according to the type "look in the price list" – this is an excuse to refuse the services of this medical institution. The price lists in clinics are for an uninitiated person – a "Chinese letter", therefore, no matter how much you study it, you will not be able to estimate the volume and cost of the service.

The issue of choosing a clinic has been resolved – we sign the contract.

The conclusion of a contract is a prerequisite, so if you are not offered to sign it, run away from this clinic without hesitation.

Never sign a contract without reading it. Refer to the lack of glasses, legal illiteracy and say that you will sign the contract at home, after carefully reading it and consulting with a lawyer (it does not matter if you have a lawyer friend – the main thing is that with this phrase you will put yourself in a more advantageous position).

At home, reading the contract – in parallel, mark on a separate piece of paper the points that you do not understand or seem controversial. At the next visit, be sure to ask the doctor and eliminate all questions. Moreover, the answers to your questions should be extremely clear and to the point, without "verbiage".

What exactly should be in the contract?Information about the parties (about you as a patient and about the clinic).

2. Information about the patient's health status, chronic diseases, known allergic reactions and individual intolerance to medicines
3. Start date of treatment and end date (planned)
4. List of medical services provided
5. Rights and obligations of the parties
6. Responsibility of the parties
7. Payment procedure for services rendered (including possible options for providing installments)
8. Information about discounts and benefits for certain categories of persons
9. Conditions for making possible changes to the contract, the procedure for approving these changes
10. Options for the settlement of disputes, the procedure for compensation of possible losses
11. The procedure and deadlines for filing claims.
12. Warranty obligations (if the clinic provides them), the conditions for which the warranty is not provided
13. Signatures of the parties. Please note that the contract on the part of the clinic was signed by a person authorized to conclude such contracts. As a rule, this is the CEO. It is the General Director who represents a legal entity, performing actions on its behalf aimed at establishing, changing and terminating the civil rights and obligations of a legal entity.

In addition, the contract must have the seal of the medical institution.

Of course, it is unlikely that any clinic creates a contract with the entire list of these items (this is an ideal option), but you have the right to demand changes to the points of the contract, making additional points.

On your part, it is also necessary to formulate specifically what exactly you expect from a medical institution.

Ask the doctor to make a treatment plan and an approximate estimate. In accordance with paragraph 1 of Article 33 of the Law of the Russian Federation "On Consumer Rights Protection": "A firm or approximate estimate may be drawn up for the performance of work (provision of services) provided for in the contract for the performance of work (provision of services). Drawing up such an estimate at the request of the consumer or the contractor is mandatory."

Of course, in medicine it is impossible to simulate the treatment process by 100% (if the doctor guarantees you an absolute result, he is lying). It may be necessary to expand the scope of medical intervention and, as a result, increase the payment. But – with the estimate made, the difference in the cost you have named and the actual cost will not differ several times. In addition, "The contractor, who did not warn the consumer in a timely manner about the need to exceed the approximate estimate, is obliged to fulfill the contract, retaining the right to pay for work (services) within the approximate estimate."

Pay attention to the section "warranty obligations" (especially in dentistry). Actually, the clinic may not give any guarantee at all, or it may declare it as "lifelong" – it does not play a special role, it is rather an advertising trick. In medicine, the concept of "guarantee" takes on a slightly different meaning than it is laid down in the Law on Consumer Protection, so there can only be one recommendation here – if a clinic gives an excessively large guarantee for its services, look for another clinic.

In the course of treatment, you may be asked to sign some entries in your outpatient card (and sometimes half-empty pages), appendices to the contract. Never do this without reading it! In a decent clinic, they do not "slip" contracts and other documents for signature to a patient lying, for example, in a dental chair. All signatures – only after careful review and, if necessary, consultation.

According to Article 16 of the Law of the Russian Federation "On Consumer Rights Protection", "the terms of the contract that infringe on the rights of the consumer in comparison with the rules established by laws or other legal acts of the Russian Federation in the field of consumer rights protection are recognized as invalid.

If, as a result of the execution of a contract infringing on the rights of the consumer, he has incurred losses, they are subject to compensation by the manufacturer (contractor, seller) in full." The seller (contractor) is not entitled to perform additional work or services for a fee without the consent of the consumer. The consumer has the right to refuse to pay for such works (services), and if they are paid, the consumer has the right to demand from the seller (contractor) a refund of the amount paid." Analyzing judicial practice, we can say that it is quite long and difficult to invalidate the clauses of the contract with which dishonest clinics are trying to insure their unprofessionalism. Therefore, I strongly recommend paying special attention to the text of the Contract.

How to make payment?No matter how great the temptation is, it is not worth paying for the services rendered "in the pocket" of the doctor.

All financial transactions must be carried out only with the use of a cash register or strict reporting forms! Check whether the amount you deposited is indicated correctly on the receipt. Also, be sure to check the availability and correctness of the date and name of the medical institution.

Be sure to ask for a transcript – for which services you paid the money. And the point here is not only in "avoiding" taxes – the most important thing is that without confirmation of the facts of payment for the medical services provided to you, you will significantly complicate proving your relationship with this medical institution.

At the end of treatment, be sure to ask the clinic for a copy of all documents related to your treatment (extract, results of examinations, consultations of invited specialists, laboratory tests, etc.). You are required to provide these copies, on the basis of Article 31 of the Fundamentals of the Legislation of the Russian Federation on the protection of citizens' health:

" A citizen has the right to get acquainted directly with medical documentation reflecting his state of health, and to receive consultations on it from other specialists. At the request of a citizen, copies of medical documents reflecting the state of his health are provided to him, if they do not affect the interests of a third party"

Moreover, you are not obliged to tell for what purpose you need these documents. Believe me, they can be useful to you. Of course, you should not be charged for making copies.

A written request can be something like this:

To the chief physician of LLC "Healthy smile"Ivanov I.I.
From Petrov Ivan Vladimirovich,

Resident: (Your full home address).In accordance with Article 31 of the Fundamentals of the Russian Federation on the Protection of Citizens' Health, I ask you to provide me with copies of all medical documents,

concerning my treatment in your clinic during the period from "__"________200_ G. po "__"_________ 200_ G.

Date                                                                                                                                                        Signature.

Prepare the request in two copies, hand it to the authorized person of the medical institution (administrator), on one copy it is necessary to put the date of receipt and the signature of the person to whom you handed the claim. This copy remains with you.

The law does not explicitly provide for a deadline for preparing a package of copies of documents for you, but it is assumed that it will be as short as possible.

Where to complain about poor-quality treatment? First of all, talk to the chief physician and the general director of the clinic.

Express your position, listen to their answers. As a rule, most doctor–patient conflict situations are resolved through negotiations, in a pre-trial manner. The competition in the market of paid medical services is quite large, so the clinics adhere to the wise, in my opinion, position "it is better to lose money than reputation".

If the issue could not be resolved peacefully, write a claim in any form addressed to the head of the medical institution, in which, again, state your position and requirements. The claim is made in two copies. One copy is handed to the person representing the medical institution, on the second – in the clinic, the date of acceptance is put, the signature of the person who accepted it (preferably with a transcript). The presence of any seals, stamps on the claim is not necessary.

In the event that you are denied a claim, you send it by registered mail with a notification of delivery to the address of the clinic.

You must be answered in writing within ten days from the date of receipt of the claim.

When sending a claim by registered mail, please note that the maximum period for returning the notification to you may be one and a half months. These are the postal rules.

At the same time, write complaints about poor-quality treatment:

1. To the Territorial Administration Of Roszdravnadzor
2. To the Health Committee (Ministry of Health) of your city (region)
3. To a medical insurance company (if the payment for the service was carried out under a compulsory or voluntary medical insurance policy)

You can find out the addresses in the telephone help desk or in any medical and preventive institution. The address of the insurance company is indicated on the policy.

If there was no response to the claim, or the answer did not suit you, the next step is to appeal to the court.

According to statistics, up to two thirds of cases are won by patients in court on claims against medical institutions. The procedure for drawing up a statement of claim for violation of rights in healthcare is quite complicated, so I strongly recommend contacting specialists. It is desirable if it is a specialized organization in the field of patient rights protection, whose employees have both legal and medical education. However, you can also contact public organizations for the protection of consumer rights. In general, it will be very good if, already at the stage of writing a claim, a competent specialist will provide legal support for your problem.

I also want to warn you that "medical" cases are considered by the courts for quite a long time and their outcome is not always obvious, so pay more attention to the process of pre–trial negotiations and appeals to higher authorities, a lawsuit is the last argument.