Boris Mendelevich: “Doctors are afraid to work in a situation of enormous control!”
The State Duma deputy from Tatarstan is preparing an initiative on the insurance of professional liability of medical workers
Boris Mendelevich, State Duma Deputy from Tatarstan, member of the Duma Committee on Health Protection, raises the issue of insurance of professional liability of medical workers. What it is and how it will affect the work of medical institutions and doctors themselves in the future — the deputy explains in the author's column, written specially for Realnoe Vremya.
More than 2k criminal cases against doctors
I will give just a couple of figures to explain why I am in favour of introducing professional liability insurance for medical workers and why I started working in the State Duma on this topic. According to the Russian Investigative Committee, 878 criminal cases were opened against medical workers in 2016, 1,791 — in 2017, and 2,229 — in 2018. The number of complaints and appeals related to medical errors has also increased. Two years ago, there were about 4,900, and in 2018 — 6,600.
In addition to the checks of the Investigative Committee of Russia, medical activities are actively covered in the media, and even in the case when initially all the stories and articles accused a medical worker, and after his or her guilt was not proven, not all the media write about the results of inspections. And in such a situation of total control, doctors are really afraid to work. Although the preservation of health is the concern of both the doctor and the patient: after all, a visit to the doctor is not a panacea if the patient does not follow the instructions of a specialist. However, according to our legislation, even if the patient was initially wrong, the doctor's activity will be checked by law enforcement agencies. This is where competent lawyers are needed.
What is professional liability insurance?
This is a type of insurance that is common among representatives of a number of professions: lawyers, architects, medical professionals. In simple terms, this is insurance for doctors and nurses against lawsuits. Statistics on the annual growth of inspections by the Investigative Committee indicate that this issue is overdue and even overripe!
What does insurance do?
Professional liability insurance will allow the health worker to safely perform their direct duties, without looking back at possible prosecution by law enforcement agencies. After all, in the event of legal claims against a doctor or nurse, the situation will be dealt with not by the health worker himself, but by a representative of his insurance company — a professional lawyer with experience in this field. This will allow, first, not to distract the health worker from his work and perform it more professionally. In case of minor errors on the part of the doctor, the insurance company will be able to compensate the patient.
Will doctors abuse it?
This is the first question that arises in many patients. But we must understand that there is the experience of such activities in many countries of the world and it has already shown its effectiveness. Besides, insurance companies do not distribute insurance to everyone: insured persons (i.e. doctors and nurses) must have the necessary level of knowledge, be fully competent in their field of activity and treat their duties in good faith, fulfilling all the requirements imposed on them as specialists in their field.
What is the current stage of professional liability insurance in Russia?
I have spoken and written a lot about the need to introduce a system of professional liability insurance for health workers. And this year, I have gathered initial consultation where we together with Chairman of the Duma Committee on Health Dmitry Morozov and representatives of the ministry of healthcare, ministry of finance, Central Bank, National Medical Chamber, Russian Union of Insurers discussed the issue.
It was a very heated and stormy discussion, from which I learned one thing: each of the participants in the meeting simply had diametrically opposite positions. There is not even a common understanding of the terminology we use!
Now the discussion is conducted mainly in several areas. First, there are disputes about whether insurance should be voluntary or mandatory. The majority of agencies, including representatives of insurers, oppose compulsory insurance. In this case, there are two types of voluntary insurance: voluntary and imputed insurance, when a medical institution is required to have this insurance when obtaining a license.
Second, the legal framework. So far, there are a huge number of legal regulations that do not allow the introduction of this type of insurance. But we must clearly understand that we should not wait in vain for something: we must at least write out a list of these bills and understand how we can change them.
Third, statistics. The ministry of finance, the ministry of healthcare, and the Central Bank noted the absence of any statistics that can be used to calculate the tariff. But there is a vicious circle arises: we can't enter insurance because of the lack of statistics, and there is no statistics because of the absence of insurance. At the same time, one of the proposals was to implement the project in the pilot regions. And Deputy Plenipotentiary Representative of the President of Russia in the Far Eastern Federal District Grigory Kuranov, who participated in the meeting, even offered his district to launch the experiment. However, Vice-President of the National Medical Chamber, Sergey Dorofeev, who made a report, said that voluntary insurance has been carried out in Novosibirsk for 7-8 years and there are statistics.
So, what's the result?
Of course, there are a huge number of issues, and not all of them are solved in a day. I suggested creating a working group with representatives of all the departments that participated in the meeting. In 1-1,5 months, we must develop a road map that would be adopted by all parties and help us to create a bill.
Of course, starting this way, putting forward the initiative, I knew that it would be difficult. In any case, all parties agree that medical liability insurance is necessary. It is necessary to move beyond words. You don't have to wait for quick results, but we learn by doing, achieve by pursuing!