Last year, the administration of the President of the Russian Federation received more than 130 thousand complaints about the work of medical and social examination: about the incompetence and bias of specialists, about corruption and frequent mistakes. Every week, the Public Chambers of the regions register dozens of appeals from citizens.
The situation in the ITU system is out of control - according to the chairman of the Commission on social policy, labor relations and the quality of life of the OPRF Vladimir Slepak. The head of the Interregional Center for Independent Medical and Social Expertise, Doctor of Medical Sciences Svetlana Danilova, agrees with this. Before the interview, Svetlana Grigorievna sent a letter to the editor from a young disabled woman talking about her trip to the next commission. Showed that journalists understood what people with disabilities face disabilities health. There are no generalizations or analysis of problems, but there is resentment, frankness, and just real life... We immediately contacted the author: is it possible to publish? "Why not? “I don’t mind,” answered wheelchair user from Bashkiria Lyudmila Simonova.
“Grandma is disabled, she has diabetes, and she’s been in line for 7 hours...”
“I have been disabled group I since 2008. Injury cervical spine spine, dysfunction pelvic organs, explains Lyudmila Simonova. — I live in a village. I recently went to see my doctor and got tested. He wrote a messenger letter and sent it to the city to a urologist, neurologist, and so on.
I’m going to the city of Beloretsk, a hundred kilometers away. Doctors accept different time and in different days- whoever is lucky enough to sign up. I had to live in the city for a week to get around everyone. I couldn’t find a proctologist, so I went to the next city – Magnitogorsk. Another hundred kilometers... The building is not suitable for wheelchair users, the room is old, the plaster is falling off, it’s damp and cold inside. People wait in line for hours. From one o'clock in the afternoon until seven in the evening we sat with the thought: “When will we be invited?” One grandmother came at 11 and left eight hours later. She said: “I plowed my shift.” Another was crying, begging to be accepted. The old woman is disabled, she has diabetes, she wanted to eat, but she stood in line for 7 hours. ITU workers walked by with stone faces and pretended not to notice anything.
Recently, there is no ITU in Beloretsk; experts from Ufa come to us on certain days. I had to live in Beloretsk and wait for the specialists to arrive. Well, my relatives let me in, and it’s good that I have a friend who dragged me to the 3rd floor. Otherwise, I can’t imagine how long it would take to travel from village to city on off-road roads (we don’t have asphalt), and hire a car, because our buses are not equipped for wheelchairs.
This time, workers from ITU Bureau No. 6 in Ufa came to us. According to my ideas, I should have been invited to the office at the appointed time. Ask what problems I have, give advice and recommendations about the entire list technical means rehabilitation that would make life easier and help one adapt. It’s not for nothing that the word “habilitation” was added to the individual rehabilitation program. I thought that ITU should work for people with disabilities, but I was mistaken. I sat in line, they called me in, looked at me and said: “If we are redoing the IPR, then we will remove half of what you have written in; according to the new rules, you are not allowed to do this. Better leave the old program and go home.”
How do they clean it? By what law? It turned out that I wasn’t eligible for an electric wheelchair, but I’m a “neck” and my hands don’t work well. Yes, I use an active stroller around the house, it’s easy to put it in the trunk, take me up the steps to the third floor when I’m visiting my sister in the city, but for walking around my village without asphalt with holes and bumps, I need an electric stroller. And in 2012 it was added to my program. Now they said: “We don’t care where you live.”
The experts did not agree with many of the decisions of the attending physicians and ignored their recommendations. They treated me and other disabled people as if we had come to them to beg, they were rude. The commission gave a friend a disability group, and then called her to Ufa for a re-examination. I was given a month to appeal the decision to the main bureau of the region. But this will be a huge problem - you will have to travel not a hundred, but three hundred kilometers, spending your money by hiring a car. This is how people with disabilities are helped to live in our country, everything is for them.”
“When I first heard that disability group II costs 450 thousand rubles, I didn’t believe it”
We are talking with the head of the Interregional Center for Independent Medical and Social Expertise, Doctor of Medical Sciences Svetlana Danilova .
— Svetlana Grigorievna, is everything that Lyudmila Simonova writes about true?
- Certainly. Russian disabled people They overcome so many obstacles to pass the commission, obtain status, or receive preferential medications that mom doesn’t worry. Nowadays it’s impossible to get an appointment with a specialist without going through a therapist—he gives referrals. First you go to him, then to the doctors, then again to him with the results. A disabled person travels 100 kilometers to one city, another hundred kilometers to another. And, in theory, he should be examined and receive help at his place of residence. The task of the ITU is not to challenge the diagnoses established by clinicians, but to determine the limitations of life activity. In our country, experts change diagnoses, cancel doctors’ recommendations, and say: “The patient has no obvious disorders.”
In the Federal Law of November 24, 1995 No. 181-FZ “On social protection of disabled people in Russian Federation“disability is interpreted as “social insufficiency due to health impairment with persistent impairment of body functions, leading to limitation of life activity and necessity social protection" In accordance with this, in addition to expert examination, ITU institutions are entrusted with the responsibility for developing individual programs rehabilitation of disabled people and determination of their needs for social protection measures.
- This is according to the law, but as in life ?
— And in life, the main problem of medical and social examination is the duration and complexity of obtaining a disability group and rehabilitation services for citizens with disabilities through the examination procedure at ITU institutions. Currently, people with disabilities often refuse to go through bureaucratic procedures and solve problems at their own expense. The legal rights of people with disabilities are violated. ITU forces people to undergo unnecessary examinations, collect unnecessary tests, arguing that they are supposedly disciplining a disabled person: “At least once a year he undergoes a medical commission, otherwise you won’t be forced to do so.” But, in fact, the ITU bureau today is a complex bureaucratic apparatus that creates various obstacles and problems for people with disabilities.
The entry into force of the Order of the Ministry of Labor of Russia dated October 11, 2012 No. 310n “On approval of the Procedure for the organization and activities of federal state institutions of medical and social expertise” called into question the need for the existence of the ITU itself as a separate structure.
According to paragraph 4 of this law a necessary condition Formation of the bureau composition is the presence of at least one ITU doctor. However, the doctor’s specialty is not indicated...
— Is there really only one doctor included in the bureau, and who are the rest of the experts? Officials?..
— When there were VTEK, there were three doctors on the commission. Then we tried to include 5 specialists. There are currently three experts working, one of them on medical and social issues. Moreover, clarifications about the doctor’s specialization were removed from the documentation. Specialists do not apply to the ITU because it is impossible to obtain a category; it is not taken into account.
ITU general bureaus will examine citizens with the most various diseases, and no matter how competent a doctor is in MSE, it is almost impossible to navigate well in all nosological forms. And the psychologist and rehabilitation specialist who are part of the bureau are not at all competent in the matter of establishing disability.
In addition, according to the rules approved by Decree of the Government of the Russian Federation of February 20, 2006 No. 95, the decision to recognize a citizen as disabled or to refuse is made by a majority vote of the specialists who conducted the MSA. If there is one doctor for medical and social examination, the objectivity of such a vote is questionable - the main condition for recognizing a person as disabled to this day remains the type and severity of impaired body functions, which can only be determined by a doctor according to the medical examination (with the exception of mental functions).
In other words, the ITU bureau is turning into a bureau for issuing disability certificates, which significantly increases the corruption component and significantly reduces the objectivity of the decision made.
— Disabled people complain about the low professional level of ITU specialists in the regions. They say that they even confuse the diagnoses. Mother of child with serious illness recently showed a copy of a document in which experts call adrenogenital syndrome... diabetes mellitus. Where are they prepared?
— In Russia, experts are trained in internships in St. Petersburg - there is an institute for advanced training of doctors there. And in the federal bureau of ITU. The level is really low. There are few professionals: the leaders are weak, sometimes it’s embarrassing to listen to them - they don’t know regulatory documents, are poorly versed in the legislation, and experts in the regions lack the knowledge and competencies to understand and implement the orders of the Ministry of Labor of the Russian Federation. This is sad because the ITU system is an absolute monopoly. Its decisions cannot be challenged. In the pre-trial procedure, an appeal is carried out in the service itself: one group, another, and then you have to contact the federal bureau, where often the sent documents are not opened at all. I defended my candidate’s and doctor’s thesis there and repeatedly saw how meetings were held, how the experts did not see the patient, did not study the documentation, but immediately took the decisions of the main bureau of the region as a basis. Decisions change extremely rarely. Sometimes courts, when considering claims of disabled people, rule: undergo an examination in any region of your choice. Which region will change its decision after the federal bureau?
No independent expert can approach the service, since by law there is no independent ITU - the license is given only to federal institutions. Therefore, no matter how objective and fair the independent expert’s conclusion is, changing the decision federal institution It will not affect the ITU.
— Public Chamber The Russian Federation proposes to consider “ITU errors from the point of view of the Criminal Code of Russia” and gives examples of corruption in the Ulyanovsk and Volgograd regions...
— And there is corruption, and, unfortunately, the regions have their own stakes. I’ll probably put the tariffs on the card soon - there are a lot of complaints from people with disabilities. I remember when they first told me that in Vorkuta, group II disability costs 450 thousand rubles, I didn’t believe it. And then people confirmed it. In the same Vorkuta, a surgeon was caught red-handed. It’s especially scary when they extort money from real disabled people. Alas, this is also part of the system. It needs to be changed, but I no longer believe the talk about reorganizing the ITU. Three years ago, this question was already raised; the Ministry of Economic Development of the Russian Federation was asked to calculate how much the reforms would cost. They counted a lot, wrote a lot, and didn’t offer anything concrete.
No reorganization of the ITU at this stage will be able to solve the problem. Examples are the largest regions such as Krasnodar region, Rostov-on-Don. The managers were removed several years ago, and the local specialists from the primary bureaus continued to work and continue to work. Nothing has changed in the service. The monopoly was and remains.
I believe that the determination of disability groups can be carried out by a medical commission of a medical organization on the recommendation of the attending physician based on data from the primary medical documentation, without filling out a referral to the ITU. Currently, the attending physician submits to a medical commission a patient with a temporary disability, a disabled person with a deteriorating condition, for the purpose of prescribing and correcting treatment, therapeutic and diagnostic measures. Therefore, the chairman of the commission is usually aware of the peculiarities of the course of the disease of such patients. And the specialists of the ITU bureau determine the disability group without knowing anything about the patient (unless we are talking about re-examination) and rely only on the data presented medical documents and a single examination of the patient within a few minutes.
I consider it advisable to abolish the MSA service, and to entrust the conduct of MSA to the medical commissions of healthcare organizations, especially since most of the functions are currently performed by the medical commission to one degree or another. Reform will require a change in order medical institutions for carrying out examination of incapacity for work, review functional responsibilities medical commissions medical organizations primary care. But it will shorten the route of travel for citizens with disabilities, simplify the examination procedure, improve the quality and expand the scope of medical and social rehabilitation services provided to disabled people.
MINISTRY OF LABOR AND SOCIAL PROTECTION OF THE RUSSIAN FEDERATIONThe liquidation of the ITU service by transferring its functions to medical commissions of medical organizations will allow:
reduce social tension among disabled people and citizens initially sent to MTU (the long procedure of filling out referrals to MTU and subsequent examination at the bureau will be eliminated);
reduce federal budget expenses for maintaining the ITU service;
reduce the burden on specialists of the medical commission and doctors of the medical organization by eliminating the need to fill out a referral for medical examination;
increase the availability of examination for the population, because medical commissions exist in all medical organizations, while the ITU bureau is created at the rate of 1 bureau per 90,000 people, and citizens of small settlements are forced to travel considerable distances at their own expense to get to the ITU office;
eliminate the corruption component on the part of ITU bureau specialists;
legislatively approve an independent ITU.
(MINISTRY OF LABOR OF THE RUSSIA)
DEPUTY MINISTER
Ilyinka street, 21, Moscow, GSP-4, 127994 tel.: 8 (495) 606-00-60, fax: 8 (495) 606-18-76
1 2 APR 2013
On the implementation of Decree of the President of the Russian Federation of May 7, 2012 No. 597 regarding the gradual improvement of the remuneration system for doctors, other medical and social workers federal government institutions for medical and social examination
To the heads of federal government institutions of medical and social expertise in the constituent entities of the Russian Federation of the Ministry of Labor and Social Protection of the Russian Federation
(according to the list, mailing by e-mail)
In accordance with Decree of the President of the Russian Federation dated May 7, 2012 No. 597 “On measures for the implementation of state social policy” (hereinafter referred to as the Decree), the average salary of doctors, employees of medical organizations with higher medical (pharmaceutical) or other higher education providing medical services (providing medical services), by 2018 should reach 200% of the average salary in the corresponding region; social workers, junior medical personnel, paramedical personnel (personnel providing conditions for the provision of medical services) - up to 100% of the average salary in the corresponding region.
Since medical and social examination institutions, in accordance with Federal law dated November 21, 2011 No. 323-FE “On the fundamentals of protecting the health of citizens of the Russian Federation” refer to medical organizations, the provisions of the Decree apply to the above-mentioned medical and social examination employees.
In pursuance of the Decree, the Ministry of Labor of Russia issued order No. 138 dated April 4, 2013 “On approval of the Action Plan for the implementation of road maps of changes in industries social sphere aimed at improving the efficiency of healthcare, education and science, social services population in 2013-2018 in federal government institutions subordinate to the Ministry of Labor of Russia" (hereinafter referred to as the "road map").
In accordance with the road map, wage increases should be carried out gradually, starting in 2013.
The corresponding budgetary allocations are provided to the Russian Ministry of Labor by the Russian Ministry of Finance.
According to the order of the Government of the Russian Federation dated November 26, 2012 No. 2190-r on the approval of the “Program for the gradual improvement of the remuneration system in state (municipal) institutions for 2012-2018”, the source of financial support for employees of state-owned institutions is exclusively budgetary allocations of the corresponding budgets of the budget system Russian Federation.
Decree of the Government of the Russian Federation dated December 28, 2012 No. 1454 approved the “Rules for the use in 2013 of budgetary allocations provided for by the Ministry of Health of the Russian Federation, the Ministry of Labor and Social Protection of the Russian Federation, the Ministry of Education and Science of the Russian Federation and the Ministry of Culture of the Russian Federation in order to implement subparagraphs “a” and “e” of paragraph 1 of the Decree” (hereinafter referred to as the Rules).
In accordance with clause 7 of the Rules, the conditions for the provision of appropriate additional amounts of financial resources are:
a) the federal government institution has an action plan to improve the efficiency of the institution’s activities in terms of providing public services (performing work) based on the institution’s performance targets, improving the wage system, including measures to increase wages for relevant categories of employees, optimization measures;
b) introducing changes to the regulations on remuneration of employees of a federal government institution in terms of implementing the provisions of the Decree and using additional funds for incentive payments to employees in accordance with the indicators and criteria of employee performance;
c) conclusion of an additional agreement to employment contract with the head of the federal government agency, which establishes his responsibilities on the need to achieve in 2013 the indicators of the ratio of the average wages of workers of the relevant categories employed in the federal government agency, and average wages in the corresponding constituent entity of the Russian Federation.
Thus, in accordance with subparagraph “a” of paragraph 7 of the Rules, part of the funds should be generated by optimizing the number of employees of institutions with the subsequent redistribution of wages.
Additionally, I inform you that in accordance with the “road map” in 2013, it is envisaged to bring the ratio of the average salary of employees of medical and social examination institutions by category of medical personnel to the average salary in the economy in the corresponding constituent entity of the Russian Federation, as follows: doctors - no less than 86 ,9 %; average medical staff- not less than 53.7%; junior medical personnel - at least 35.0%.
Hello! A doctor from the Moscow ITU Bureau is writing to you. Everyone, of course, knows what an atmosphere of evil rumors, and sometimes outright lies, has developed around doctors working in this department. Like, you sell disability groups, and take bribes, and the like. It’s a shame to hear this for medical experts who have dedicated their years to the cause medical and social rehabilitation and helping sick people. There is no need to talk about the meager salary: Everyone knows how ridiculous it is. I would like to talk about something else, namely about our leaders. Why should honest workers experience constant humiliation from their superiors? For example, why can Oleg Aleksandrovich Vasiliev, a lawyer at the FKU GB ITU in Moscow, afford to accuse almost everyone working in this system of corruption? Why does Oleg Aleksandrovich allow himself to speak inappropriately, if not rudely, with people who are much older than him? Has Oleg Aleksandrovich, a lawyer, really forgotten that there is such a thing as the presumption of innocence, and in this case he himself can be accused of libel? It’s simply pointless and useless to talk to our superiors: he has one answer to everything: “If you don’t like it, no one is stopping you!” And they leave. People who have devoted decades to helping the sick are leaving! It has even reached the point that, using their own funds from their meager salaries, MTU workers are forced to purchase office equipment necessary for their work! " No money left!" - our leadership has one answer to everything. In addition, in 20 17 the management loaded the ITU bureau with overwhelming work! Not only do the branches receive much more every day more people than provided for in the plan! Doctors were given the task of entering into the computer database all disabled people who had been examined since 2005 in new base data, the so-called FRI. And so older people are forced to sit literally until the night, doing something that is essentially unusual for doctors! Need I say that no compensation is provided for extracurricular time? And they gave me the task of manually entering several hundred thousand people! People working at a computer around the clock lose their sight and health, and all because the management, having decided to save on paying IT workers, entrusted doctors with a task unusual for them! Given this attitude, there are fears that almost all doctors will leave the system of medical and social examination! But then socially vulnerable people will suffer first of all! But the management probably needs to collapse the system, it feels like this is where everything is heading.
There is more than enough evidence for this. So, since 2016, the FKU GB MSE has been headed by a certain Sergey Petrovich Zapariy from Omsk. It is not known by what means Sergei Petrovich was appointed to this position, but there are suspicions that it was not entirely honest. It is known that for some of his actions Sergei Petrovich was taken under the increased control of journalists in Omsk,
Which hasn't been filmed yet.
With his arrival, unfounded accusations of corruption, systematic humiliation of expert doctors, both those working in the ITU MAIN BUREAU and in regional divisions, unjustified dismissals of employees without explanation and other illegal actions began with renewed vigor.
It is also known that Sergei Petrovich’s daughter, Natalya Sergeevna Zapariy, works at the Federal State Budgetary Institution FB ITU of the Russian Ministry of Labor. From a legality point of view, I think this is doubtful.
And the last thing: this is how Sergei Petrovich parks at the building of the FKU GB MSE. How can a wheelchair user get there? Do you think that this is also a manifestation of disrespect for sick people?
With sincere respect, Vitaly Sedov. Honored Doctor of the Russian Federation
On October 16, 2017, the hotline of the Public Chamber of the Russian Federation on issues related to the activities of medical and social examination, Izvestia, will begin operating in Russia. Russians who have problems passing the ITU, for example, with establishing or confirming a disability group, can apply there. This hotline will operate for 3 months.
Currently, the work of medical and social examinations raises many criticisms. Prosecutor's office, courts, various public organizations literally inundated with citizens' complaints about the operation of the MTU system. The Civic Chamber of the Russian Federation plans to collect such complaints, systematize them and prepare recommendations for improving medical and social examination. The management of the Federal Bureau of ITU agreed to cooperate on this issue with the Public Chamber.
This project has several objectives. The main task is to advise citizens on issues related to the examination procedure, registration of disability, establishment or confirmation of disability group, provision of rehabilitation means, etc. In addition, the hotline will help conduct public monitoring of the work of the MSE system and its interaction with healthcare institutions, the Social Insurance Fund, the Compulsory Medical Insurance Fund and other structures.
Instructions:
How can people with disabilities prepare for the ITU?
“The Public Chamber will perform the functions of a dispatcher,” explained Ekaterina Kurbangaleeva, deputy chairman of the RF OP Commission on Social Policy. – We will begin to record problems and contacts. Then, if necessary, ask the applicant Required documents– for example, acts of denial of disability. Next we plan to resolve the issue with the help of the Federal Bureau of ITU of the Russian Ministry of Labor.”
Who works at Medico Social Expertise? Do you think people? I’m not sure, but the fact that you won’t be considered human there is a fact! Now they have the goal of “reducing the number of livestock.” The cattle are you and me, who have worked for 30 years, given our “sacred debt to the Motherland” and now need (!) help from the state.
ITU workers, respond! I would like to ask you only one question - all three of you and only one question!
What forces you to work in the ITU troika? Threes like in 1937.... Well? Need? Salary? Well, I don’t believe it.... Every day you condemn people to beggary, to starvation, or drive people to despair or suicide by denying them the legal right to receive a disability group, i.e. even a penny, but state help. It's even more interesting....
Therapist, neurologist and orthopedist general practice dare to challenge the professional conclusions of a pulmonologist and thoracic surgeon, but this is not your profile! You decide “for three” the fate of a suffering person based on body functions in %. According to your “bible” - order No. 1024, you do not take into account a person’s loss of ability to work, you do not take into account the underlying disease and you do not care about seniority person. Then why do you ask about all this every time? Are you sadists? Carrying out instructions “from above” to “reduce the number of livestock” is hard work! What motivates you? Well? After all, you are not afraid of anything.... Don’t you understand that you will have to pay for everything in this life and you will pay for your actions! Do you hear? You will burn in HELL together with V. Matvienko....
And now a few photos:
These are the consequences of "injury to the left half chest"received by me in the army in 1988 - I was giving a "sacred debt to the Motherland".... Including the photo you can see a giant bulla with a septum of 120x65x55mm (result of the last CT scan). Relapse ( spontaneous pneumothorax) happened in July 2014....
According to their “bible” (order No. 1024), the third group MUST be given if the Tiffno index is less than 70, and FEV 1 is in the range from 50 to 70....
The main diagnosis is moderate COPD, bullous emphysema, respiratory failure second degree - according to their “bible” - definitely third group disability!
I had to complain, but where should I go? I haven’t been able to get a group for TWO years and I also can’t work fully - I have severe shortness of breath (I can’t stand the heat and stuffy rooms - I start to suffocate, so the metro is “closed” for me, like most shops (unless they have a good ventilation and air conditioning system )....
And now photos of the names and positions of officials in white coats - the country should know its “heroes”!
Be happy, your children and your loved ones - I forgive you all!
But you won’t be able to “downsize” me - I won’t give up!
And to complete the picture, this is from their “bible” of order No. 1024.
It’s cleverly invented and written - it can be interpreted in different ways, which is what these officials in white coats use....
Question for the Internet community - what to do? If they refuse again, should I complain to the Russian Ministry of Health? After all, this is some kind of chaos. Do you know on what basis I was denied last time at the Federal level? They tell me - you didn’t stay in the hospital this year (you already spent time in City Clinical Hospital No. 57 in pulmonology - all the diagnoses were confirmed...) and you don’t have documents confirming the calls of the ambulance to you (you had to go to the archives of the ambulance and take the relevant papers - after all now the NSR leaves no “traces” behind itself....). Ready for battle, but what other abomination are these inhumans capable of?
