Fake disability. S.I
Program and materials of the meeting
On May 18, 2018, a meeting on improving the state system of medical and social expertise was held on the basis of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia.
PROGRAM
MEETINGS TO DISCUSS ISSUES
QUALITIES OF MEDICAL AND SOCIAL EXAMINATION
Presidium: Afonina K.P., Kozlov S.I.
09.00 - 10.30 Registration of participants
10.30-10.40 - Opening of the meeting and introduction Deputy Director of the Department of Disabled Affairs of the Ministry of Labor and Social Protection Russian Federation Afonina Kira Pavlovna
10.40-11.00 - Clinical manifestations and features of the manifestation of diabetes mellitus in children "Deputy Director of the National Medical Research Center Endocrinology” of the Ministry of Health of Russia for scientific work - Director of the Institute of Pediatric Endocrinology. Academician of the Russian Academy of Sciences, Professor, Doctor of Medical Sciences, Chief Freelance Pediatric Specialist Endocrinologist of the Ministry of Health of Russia Valentina Aleksandrovna Peterkova
Deputy Head for Improving Medical and Social Expertise and Rehabilitation of the Disabled, Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia, Ph.D. Kozlov Sergey Ivanovich
11.20-11.40 “New approaches to the conduct of medical and social expertise according to . Head of the Scientific and Methodological Center of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia, Doctor of Medical Sciences, Lyudmila Leonidovna Naumenko
11.40-12.00 - “Peculiarities of application in determining medical indications and contraindications. Deputy Head of the Organizational and Methodological Department of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia, Ph.D. Mirzayan Eleonora Israilovna
12.00-12.40 - "Ensuring the uniformity of application in the conduct of medical and social examination of persons under the age of 18 years." Head of the expert staff of the pediatric profile of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia Ph.D. Malova Natalya Evgenievna, Head of the expert staff of the pediatric profile of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia Miroshnichenko Elena Vitalievna
12.40-13.00 - “Reliability, completeness and timeliness of providing information from ITU EVIIAS to FSIS FRI Head of the Center for documentary support of the activities of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia Lesina Viktorovna.
13.00-14.00 - Lunch (canteen FGBU FB ITU Ministry of Labor of Russia, 1st floor)
14.00-14.20 - "Actual issues of ensuring information security in federal state institutions of medical and social expertise" Head of the Information Security Department of the Center for Information Technology Support and Interdepartmental Electronic Interaction of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia Dmitry Saitgaleevich Nuriahmetov
14.20-14.40 - "Peculiarities of conducting an audit of institutions of medical and social expertise by the Accounts Chamber of the Russian Federation"
14.40-15.00 - "Review of court decisions in the field of medical and social expertise for 2017" Head of the Center for organizing the activities of expert teams and especially complex methods of expert rehabilitation diagnostics, improving technologies and the quality of ITU implementation Ph.D. Kurbanova Valentina Subkhanovna, Leading Legal Counsel Shatrova Natalya Viktorovna, Head of the ITU Technology and Quality Improvement Department Galina Petrovna Karaseva.
15.00-15.40 - "Organizational aspects of the work of institutions of medical and social expertise in ITU EASIAS". Project Director of Software Product LLC Burylin Sergey Anatolyevich, Leading Software Engineer of Software Product LLC Sergey Popov
15.40-16.40 - "Questions and answers". Deputy Head for Improving Medical and Social Expertise and Rehabilitation of the Disabled, Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia, Ph.D. Kozlov Sergey I.
Why are children denied disability? How will ITU be reformed? Who can complain about the experts? Deputy Head of the Ministry of Labor Grigory Lekarev and Deputy Head of the FB ITU Sergey Kozlov answered these questions
The Ministry of Labor continues to reform the system of medical and social expertise. The Federal Register of Disabled Persons will soon be created, the requirements for expert doctors are changing, public councils are being created at the ITU bureau, audio and video recording of the examination procedure is being introduced. Despite the changes, the work of the ITU still raises many questions: what kind of assistance can seriously ill people who have been denied disability receive from the state; what is being done to increase the accessibility of the premises where the examination is carried out; why the number of denials of disability for children has increased, how corruption schemes operate in the ITU, etc.
Reforms of medical and social expertise
Grigory Lekarev, Deputy Minister of Labor and Social Protection of the Russian Federation
– Tell us more about public councils at ITU. How will citizens be able to influence the situation with their help?
– We assume that the public councils at the main bureaus will include regional public figures, representatives of human rights organizations, commissioners for human rights, commissioners for children's rights. The council must be made up of people who rely on public institutions represent the interests of a large category of citizens.
I am far from thinking that we will be able to analyze the essence of the decision made (on the disability group) in the public council, because this is a highly professional area. But in terms of keeping order, the public council can do a lot.
We want to prescribe the powers of the public council so that its decisions have serious weight. Most likely, this will require the development of special regulations.
- Who will take care of improvement methodologies ITU?
- First of all, it Federal Bureau medical and social expertise. This is not only the highest authority, where they are considered especially difficult cases or the decisions of lower bureaus are appealed, but also the clinical base. Professionals in the field of cardiology, pulmonology, nephrology, etc. work there.
Secondly, a number of educational and scientific institutions are subordinate to the ministry. For example, the St. Petersburg Institute for the Advanced Training of Medical Experts (SPbIUVEK) is an educational organization that organizes advanced training of experts or retraining of doctors to work in medical and social expertise.
Another organization is the Albrecht Institute (St. Petersburg Scientific and Practical Center for Medical and Social Expertise, Prosthetics and Rehabilitation of the Disabled named after G.A. Albrecht).
The Novokuznetsk Scientific and Practical Center for Medical and Social Expertise and Rehabilitation of the Disabled specializes in spinal injuries and issues related to vascular dysfunction. He also performs surgeries.
These institutions have the largest concentration of candidates and doctors of medical sciences who did their scientific work in the field of ITU.
- YouI will mentionwhether about need raise qualifications experts. What them will learn in first queue?
- First of all, of course, it is normative base, classifications and criteria. The second is the development of an individual rehabilitation program, including the appointment of technical means of rehabilitation. The third aspect is organizational issues, personnel and logistical support.
- How disabled person maybe prove, what medical expert led myself unethical?
- When we talk about the examination procedure, we must not forget that the expert does not make decisions alone, he is not alone in the office. There are always witnesses who can confirm or deny the fact of unethical behavior. In the project " roadmap» video and audio recording of the examination procedure was laid down. If the patient wants the recording not to be kept, he can always declare it, but the expert will not have such a right.
We understand that in order to store these records, it will be necessary to increase the capacity of the servers. All data will be protected, access to them by third parties will be as limited as possible. Even an expert will not be able to modify, change or shorten the entry. In case of appeal or in cases of violation of the rights of a disabled person, the recording can be used as evidence base. It is planned to provide access to the public council, judicial or investigative bodies.
Deputy Head of FGBU FB ITU Sergei Kozlov clarified in an interview with Mercy.ru: “In many regions, audio recording is already underway. This disciplines both parties. For experts, this is a kind of guarantee that, if necessary, they will be able to prove their innocence. And if audio and video recording is not carried out by the institution, the applicant himself can come with a voice recorder. It is not prohibited. But the person must notify us of this in advance. Otherwise, the record cannot be used as evidence of certain violations during the survey.
- How be, if Human hard is ill, but disability him not install?
- Now the experts of the Bureau of Medical and Social Expertise must not only explain the decision, but also inform the person who has not been diagnosed with a disability what support measures he is entitled to. Our main bureaus, together with the regional authorities, have developed relevant leaflets.
For example, drug provision, according to government decree No. 890, does not apply only to people with disabilities. There is a list of nosologies for which it is provided. Our task is to guide a person where to go, how to get help, at what address, phone, e-mail he should apply.
What to do about corruption
- What kind workers moments and spaces in legislation usually are used employees, inclined to corruption?
- "Loopholes" for corrupt officials are found at almost every step, because in the examination there is always a certain amount of subjectivity. For example, it may be the recognition of a person with a disability who has no signs of disability. True, in this case, medical organizations are also involved, which write that there is a disease that actually does not exist.
Help in the fight against corruption would be the establishment of interdepartmental electronic interaction with medical organizations. We have such plans. In particular, we would like to receive form 088 / y (direction for examination) in electronic form. Because in the course of checks it sometimes turns out that such a form is not in the file or the seal on it is incomprehensible.
Already, a single ITU automated system is a good tool. Since 2013, institutions of medical and social expertise have completely switched from paper examination to electronic.
All changes made by the expert are recorded in the system. Moreover, access to this information is available both in the main bureau and in the federal bureau of the ITU. Why is it important? Sometimes, with corruption schemes, there is a desire to correct or change something, to make some clarifications. Sometimes experts are in such a hurry that they don’t fill out anything at all: there is a certificate of disability, but there is no file. The system fixes it.
I will say that the system also disciplines ITU staff in terms of deadlines. As soon as a person submits an application for examination or for a change in the IPRA, the deadlines established by the administrative regulations are included. They oblige us, in particular, not to delay sending information to Pension Fund so that the disabled person immediately begins to receive payments.
This year, we are completing the formation of secure communication channels for transmitting data about a person, since they are not only personal in nature, but also contain information about medical confidentiality. Now such channels have been formed between the Federal Bureau and all subjects, with the exception of Crimea and Sevastopol, which will also soon join the system.
- When planned creation Federal registry disabled people and why This is being done?
- From January 1, 2017, the federal register of disabled people will begin to work, which will consolidate a wide variety of information about a disabled person.
I will immediately answer the question why it is needed. States that have signed the Convention on the Rights of Persons with Disabilities are required to establish end-to-end statistical records of persons with disabilities in order to record their needs, demographic composition and develop balanced, correct management decisions. But we went a little further.
In the federal register will be created Personal Area each disabled person, in which he can at any time see what support measures are provided for him, what has been done, who is responsible for their implementation. A person will be able to compare the information posted in the register with the activities actually performed and, if something does not suit him, file a complaint.
Among other things, the register will contain information relating to vocational education. We want to see how many children with disabilities enter the labor market every year. This will allow both employment services and employers to know in advance which jobs can be offered to them.
Unfortunately, we have sad statistics: half of the children with disabilities who enter vocational educational organizations drop out of school for some reason. We have to figure out why they left the race ahead of schedule.
The register should start working from January 1, but not all, but only part of it, since not all cases in the ITU institutions have been transferred to electronic form. I have already said that all ITU institutions have been working in a single system for only the last three years, and those paper files that are stored in the archives need to be digitized.
By January, cases concerning children with disabilities will be fully digitized. Next year, at the second stage, we will process and upload all the rest to the registry.
– The premises where the ITU bureaus are located are not always accessible to the disabled. What is being done about it?
– The ITU network is very extensive, it is about 2600 branches throughout the country. We try to keep the main offices in their own premises. For such institutions, funds are annually provided for repairs and additional equipment.
But ITU offices are often located in rented premises or in the buildings of medical organizations, such as polyclinics. Therefore, when they do not have accessibility conditions, we cannot re-equip them at the expense of the federal budget to meet the special needs of people with disabilities. In our opinion, the public council can provide significant assistance in resolving these issues through agreements with local authorities.
At the same time, it is important that local authorities understand that not only the premises must be accessible, but also the territory adjacent to it, whether it be a public transport stop, sidewalks, parking lots.
Of course, on-site surveys are carried out, especially in hard-to-reach areas, in mountainous areas. Sometimes experts have to travel many hundreds of kilometers. For this, ITU offices are provided with vehicles. This work is not visible to anyone, but it is being done.
- Previously rose question about transfer ITU Ministry of Health. how you comment this initiative?
- It's not for us to decide. The Ministry of Labor of Russia is endowed with its powers by an act of the government. But from my professional point of view, this would not be the right move. Issues of medical and social expertise are mainly in the plane of rendering social support person in a difficult life situation. In addition, ITU agencies are federal agencies, while hospitals are mostly regional. Are the regions ready to assume such powers? This will be an additional burden for them - both financial and organizational.
Why is disability denied?
Sergey Kozlov, Deputy Head of the Federal Bureau of Medical and Social Expertise
- Howwill changeresponsibilities employees ITU soon?
– On behalf of the Minister of Labor and Social Protection in job descriptions of ITU specialists, changes were made regarding compliance with the rules of ethics and deontology, correct behavior in relation to the persons being examined. The duty of ITU specialists to explain the adopted expert decisions and inform the person about the benefits that should be provided regardless of the status of "disabled" has been established.
– Federal Bureau ITU suggested for raise quality expertise provide "observation behind children outside expert situation." O how goes speech? O video camera?
– The stay of a child in an expert setting (passing an examination) is always a stressful situation for a person, and especially for a small child. Therefore, his behavior during the examination may not be quite the same as in a normal daily situation.
But a playroom with a mirror wall allows specialists to observe the actions of children in their usual surroundings and objectively evaluate how the child has mastered the basic movements, that is, how he moves in the playroom, climbs, rides down a hill, and gets up.
At the same time, one can also note the presence or absence of shortness of breath, the level of development of fine motor skills.
Unfortunately, not all institutions have the opportunity to organize such game rooms. But in most bureaus that accept people under 18, there is either a hall with a game function or a game room where a specialist in social work, a rehabilitation specialist or just a doctor can come in and see how the child is behaving. The time of such observation depends on the workload of specialists.
In the age group over 14 years, the influence of the pubertal period with the peculiarities of hormonal regulation of metabolism and psychological aspects behavior of adolescents that affect the ability to independently control the course of the disease and maintain optimal blood sugar levels.
During this period, children can behave in completely different ways. But we are also guided by the records of the observing doctors. If they indicate that the child independently calculates and performs injections, we take this into account.
A. NASIBOV: The Ekho Moskvy radio station is operating. Moscow time 22 hours 11 minutes. Ashot Nasibov at the microphone. Greetings dear listeners! This is the Back to the Future program. Today we are talking about disability, more precisely, about the so-called fake disability. This topic has been “on hearing” in recent days, especially in connection with the problem of the appearance of various kinds of fake certificates when entering a higher educational institution. At least, this is how it was reported in our Russian press. We will touch on this topic and talk about disability in general, about what is being done to help people with disabilities. Guest expert in the studio: Sergey Kozlov, Head of the Department of Medical and Social Expertise and Social Support of the Federal Medical and Biological Agency. Sergey Ivanovich, good evening!
S. KOZLOV: Good evening!
A. NASIBOV: Sergiy Ivanovich, before we start the program, I would like to read you an excerpt from the message that we received on the Internet before the start of the program.
Waldemar Grin, a doctor from Sudan, - as he introduced himself - expresses the following point of view: "The very concept of disability or disability group does not indicate the degree of health or illness, but says that a person needs some degree of social protection." – Do you agree with this statement?
S. KOZLOV: To some extent, we can agree, because today there is a normative document that provides for the establishment of disability in accordance with the restriction of life that occurred as a result of impaired body function, and whether a person needs social protection measures. If you are aware, in accordance with the order of the President, which was given when bringing the Council for the Disabled, it was entrusted to the Ministry of Health social development and the Federal Medical and Biological Agency to develop a new concept in improving the medical and social examination of disabled people in accordance with functional impairments. Currently, we are working in accordance with ICD-10 - this is a violation of diseases. Therefore, the transition to a new concept, depending on the impairment of functions and health status, will represent the state of disability in more detail than it does now.
A. NASIBOV: Approximately when can we expect the appearance of a new concept?
S. KOZLOV: In accordance with the President's instructions, it should be submitted before December 1, but I think that we will try to do it earlier, in order, in addition to the concept, to prepare a number of regulatory documents that must comply with the adopted concept, so that in some then due projects already carry out work from January 2010.
A. NASIBOV: What is new in this concept?
S. KOZLOV: Most likely, we believe that a new concept of "rehabilitator" should appear. And from our point of view, it should come out through citizens who, in order to receive rehabilitation measures, they first have to establish a disability, then they receive a rehabilitation measure, which is paid for by the state.
S. KOZLOV: We take the disabled person beyond the scope. Therefore, according to the current government decree, persons should be sent to us after the entire complex of rehabilitation measures has been completed. From our point of view, groups of people who need long-term or permanent substitution maintenance therapy should leave. Persons who, say, have the disease phenylketonuria, which is diagnosed practically in the maternity hospital, and so that the child does not become disabled - in addition to all the fact that this is a rather severe mental trauma in the family, because a severely disabled person - if this child is given a specific baby food, then he will not be disabled. To date, we determine the indications for nutrition after we are forced to establish the category of "disabled" for him. – These are the main approaches.
A. NASIBOV: About a year ago, the medical and social expertise was transferred to the Federal Medical and Biological Agency. What did you achieve this year, what did you fail to accomplish? Where did you start?
S. KOZLOV: Yes, literally in June last year, a presidential decree was adopted, then a government decree, and in accordance with the government’s decree of September 10, departments of the Federal Medical and Biological agencies. So it is impossible to say that the FMBA of Russia was not engaged in medical and social expertise, because in many medical institutions subordinate to the Federal Medical and Biological Agency there were institutions of medical and social expertise that were engaged in the examination of persons with especially dangerous professions, and they were quite good results. And, apparently, it was considered that the results of the work of these institutions are quite decent, and thus the department was transferred to the FMBA. And first of all, we took part even before the transfer stage, this is in the preparation of the 240th government decree, this is the provision of technical rehabilitation means, as a result of which a number of positions have changed. New ones appeared de jure: disabled children got the opportunity to receive technical means, the terms and conditions for the payment of compensations were determined, and various other provisions. And also the 247th government decree, dated April 7, 2008, which determined the procedure and conditions for establishing a disability group of the “disabled child” category without a re-examination period. - These are two main documents. The main talk of the town is a long examination and difficulties in preparing a document for a medical and social examination.
A. NASIBOV: There are a lot of questions related to this: “Why is it necessary to undergo a new medical and social examination every year, and, moreover, with general practitioners?”
S. KOZLOV: We have prepared a draft at the Ministry of Health and Social Development, it is now being approved, which regulates the timing of examinations in medical institutions. We offer - we have form 88 - a referral for a medical and social examination, one within a month. This means that, from our point of view, from the moment of applying to medical institutions, out of turn, he must be examined, a referral for a medical and social examination is filled out, if there are grounds for this, and must be examined in the near future. The issue that you mentioned, just now, Resolution 247 has been sent, which currently regulates the procedure for establishing a disability group of the “disabled child” category for persons under the age of 18 according to the observation period. You see, the situation is such that when various diseases, well, basically, about two years is the minimum recovery period that is necessary in order to restore or compensate for functions through rehabilitation measures, treatment.
A. NASIBOV: Well, the question concerns, for example, people with amputations. It is clear that an arm or a leg will not grow by itself, but why should they undergo new examinations every year?
S. KOZLOV: Today, the first two years of a person with such a pathology are almost gone. For example, a serious injury: the first six months, a year, as if physiological and rehabilitation measures that are aimed, they allow you to somehow compensate and prepare a person for prosthetics. Let's say the first year - it could be the second group. And in accordance with the convention signed by the Russian Federation, disability is an evolving condition. Through rehabilitation measures, either compensation or restoration of functions can be achieved. In the absence of limbs, for example, restoration of functions is impossible, but by making a prosthesis, teaching a person to use this prosthesis, and having him in the field of rehabilitation specialists, a disability group is established for this period of rehabilitation measures. Then a disability group is established for a person indefinitely.
A. NASIBOV: Sergei Kozlov, head of the Department of Medical and Social Expertise and Social Support of the Federal Medical and Biological Agency, is a guest of the Back to the Future program on Ekho Moskvy radio. Send your questions and comments by SMS to +7 985 970-45-45. We continue our conversation. difference Russian system medical and social expertise from foreign systems - what is the main difference?
S. KOZLOV: For example, as part of the preparation of a concept for improving social expertise, we got acquainted with the work of a number of organizations that deal with the establishment of disability. And, nevertheless, I must say that over time we got acquainted with the Canadian system. When we talked about the conditions in which our specialists work and what determines it, it was highly appreciated that we have a high social orientation. The main difference is that in other states in Europe, in America, Canada, the establishment of disability is of a registration nature, and the person then decides for himself whether to contact him, say, for rehabilitation, if he has insurance, whether to apply for employment. Today we have interaction between the medical institution, because a large complex of institutions and organizations is engaged in the provision of rehabilitation services, these are health care, employment, culture, education, prosthetic and orthopedic enterprises. There, a person is forced to walk with insurance. Here, according to the results of the examination, an individual rehabilitation program is being developed for him. And we try to interact. Here is another change in the concept, which we propose, is to get away from the 94th law in providing disabled people with technical means of rehabilitation. According to the results of the survey, there should be (inaudible) and the cost of expressions, that is, a certificate.
A. NASIBOV: And the person himself decides?
S. KOZLOV: The person himself decides which manufacturer to go to. There must be clearly defined amounts transferred, for example, for a prosthesis. If a person has a desire, he can add funds and buy a new prosthesis.
A. NASIBOV: Or vice versa, cheaper.
S.KOZLOV: Or vice versa, yes. Here, if we have state-owned or private prosthetic enterprises, then we supply them with information about the person’s consent, and it is no longer a person who goes to this enterprise, but an enterprise comes and says that I will install a prosthesis for you at home, I will bring it today. And the person will have a choice. When there is competition, there will be quality. Indeed, today often those technical means that we recommend, which are supplied to a person, a person cannot use them, because they fail rather quickly. Such a fact exists.
A. NASIBOV: Pensioner Alexander Bevzyukov writes: “When will the practice of annual confirmation of disability be abolished?” And another question. Wait a second… Grigory Mazurenko, a social worker, believes that in our country the main motive for getting a disability group is getting an addition to a pension.
S. KOZLOV: Well, it's hard to say here, because the disability pension does not always exceed that salary. And so to say that people, as a rule, apply in order to compensate for some financial costs, is difficult here. But, considering that in our country, after all, medical and social expertise is socially oriented.
A. NASIBOV: You know, he is a social worker, he is “closer to the ground”, as they say. Here he writes: “In pursuit of material gain, our fellow citizens storm polyclinics and quarrel with doctors.”
S.KOZLOV: I can't say that about everyone. There are separate episodes when you want something more than it should be. But the bulk, nevertheless, turns for examination when it is already completely unbearable! If we compare before the crisis broke out - this year we had an increase in the number of examinations - this indicates that people somehow kept to work, coped with their illness with all the possibilities. As soon as they lose their jobs, in order to receive some kind of compensation, means of subsistence, they turn to examinations. Although, I say that there are cases when the desire of citizens does not always coincide with what they are supposed to.
A. NASIBOV: Valery Valeev, a pensioner, is interested in: “Why are wheelchairs for the disabled constantly being extended?” - You, in my opinion, partially answered the question about technical means.
S. KOZLOV: As of today, the deadlines have not been changed, they remain. Another issue is that the wheelchairs that disabled people receive do not always meet these deadlines. And the question should not be raised about whether or not to increase the shelf life of wheelchairs, but the question should be raised that attention should be paid to the quality of technical means of rehabilitation so that they can withstand the deadlines for which they are designed.
A. NASIBOV: That is, if, according to your concept, a person himself will determine where to buy the same wheelchair and where to give this certificate. Am I saying right?
S. KOZLOV: Yes. He chooses himself, and the best quality. And the firm will be interested. When there are two firms, and one will go bust because it has worse quality, this will put the question for manufacturers: either the firm goes bust, or they have to do something. If the quality does not match, either lower the price or raise the quality level so that this stroller is competitive.
A. NASIBOV: And how will you correlate the cost of this certificate with the average cost of these technical means on the market?
S. KOZLOV: We believe that we have now prepared, with the participation of the Ministry of Health, medical contraindications for providing technical means for rehabilitation. We believe that there should also be medical and social indications: for example, people of retirement age in rural areas who need the same prosthesis to restore the function of movement. There should be funds for the purchase of this prosthesis, or a somewhat smaller amount of technical means of rehabilitation, for example, if a person of working age, goes in for sports, has an active life position, then the percentage of wear of this technical means of rehabilitation will, as a rule, be higher, and he you need to change it more often. - Here is the intersection of these two indicators - medico-technical and medico-social - should determine the average cost. Plus, there should also be a pricing policy that should take into account the delivery of this technical equipment, because we have a large country, this should also be taken into account.
A. NASIBOV: Alexander from Volgograd believes that the degree of disability, in fact, is a ban on the right of a Russian citizen to work. He proposes to abolish the concept of the degree of disability.
S. KOZLOV: I think the question here is not about the degree of disability, but the degree of limitation labor activity. Currently, disability is established depending on seven categories of disability, the component, which is the limitation of the ability to work. The pension is currently paid depending on the degree of restriction to employment. And therefore, visually impaired people of the first group, who have restrictions in communication, movement, self-service, they have the first group of disability. But, given that they can work in specially created conditions, they have a second-degree restriction on labor activity and they receive a pension under the second group. At the suggestion of the Ministry of Health and Social Development, a rationale has been prepared. And if you have read in the press, a draft law is being prepared that will be amended from the new year, if everything goes well, and the disability pension will be paid depending on the disability group, and not on the degree of restriction to work. – This is also a proposal that came from us.
A. NASIBOV: Sergei Kozlov, head of the Department of Medical and Social Expertise and Social Support of the Federal Medical and Biological Agency, is a guest of the Back to the Future program on Ekho Moskvy radio waves. Feel free to send your comments and questions via SMS to +7 985 970-45-45. In the second half of the hour, we will perhaps start with the question of medicines for the disabled. Let's try to start with this question and then we will continue the topic of the very certificates that are now used when entering a higher educational institution. There are many interesting things here.
(News).
A. NASIBOV: The Ekho Moskvy radio station is operating. Ashot Nasibov at the microphone. This is the Back to the Future program. Today we are discussing assistance to the disabled and the so-called fake disability. Sergei Kozlov, head of the Department of Medical and Social Expertise and Social Support of the Federal Medical and Biological Agency, is a guest in the studio. Send questions and comments to +7 985 970-45-45. There are already several questions about medicines for the disabled. Could you say a few words about this?
S. KOZLOV: Well, this group of questions is indirectly related to our management, because we are organizing medical and social expertise. But, depending on the disability group, a number of categories have certain preferential terms to receive medicines. The main group is those with disabilities who have not renounced the social package - they have the right to be provided with medicines in the prescribed manner, when applying to medical institutions.
A. NASIBOV: Sergey Ivanovich, in recent days, the topic of the so-called “fake” disabled people has been “on hearing”, thanks to my fellow journalists. Only today I saw one report on one of the federal TV channels, where a person said that two categories of applicants almost completely apply for state-funded, when entering higher educational institutions: the category of winners of summer school olympiads and people who provided certificates of disability. As for the second half of this question, we are familiar with this situation.
S. KOZLOV: Yes, we are familiar with this situation, this is a rather painful issue for us. I believe that representatives of higher educational institutions and the press formulated the question rather incorrectly. If we get together, this situation was predictable. If in past years, disabled people, including, like all beneficiaries, took exams on a general basis, and if they received an unsatisfactory grade, they did not go to enrollment, then at present, you all know, we have the Unified State Examination, a new grading system knowledge of students, which lay on the old informative base. According to the head of Rosobrnadzor, there are one hundred and fifty-three preferential categories for admission upon admission to a university.
A. NASIBOV: One hundred and fifty-three categories of beneficiaries for enrolling in a university?
S. KOZLOV: Yes, including beneficiaries with disabilities. Those statements that the leaders do not see, including that they are beneficiaries. And we analyzed this situation: there were multiple accusations that the number of disabled people who received disability in May and June increased, that the group of the category “disabled child” was set for several months, only for a period, is not true. To date, we have received information from sixty-nine of our main bureaus in the constituent entities of the Russian Federation.
A. NASIBOV: Sixty-nine regions, in fact, right?
S. KOZLOV: Yes. Sixty-nine regions received data. And we have practically no increase, compared to last year, access to disability. We instructed to check to compare the number of disabled children who were categorized as "child with disabilities" from 16 to 18 years old, and groups of people aged 18 and over - these are the categories for which disability groups are established. And we have a clear ratio, we have no increase compared to last year for this period. This is the first situation that there is no increase. We also analyzed qualitatively the numerical composition. Most of the people represented in this contingent are disabled people who were diagnosed as disabled at the beginning of the category “disabled child” - this is in 2004-2005. And their next examination coincided: May-June, or January. Rosobrnadzor presented us with lists of students for two higher educational institutions in Moscow: these are the Higher School of Economics and the Financial Academy - 80 and 42 people. We asked our institutions, the main bureaus for the constituent entities of the Russian Federation provided us with information: the main array - the disability group was established justifiably. The fact that purely physically they do not see that this is a disabled person, this indicates that more than 80 percent are people who have been diagnosed with a disability with somatic diseases. This is basically bronchial asthma, diabetes. That is, purely visually, it is not visible on a person, a few percent are persons with paralysis, with children's cerebral palsy, what we, ordinary people, see as a manifestation of disability. To say that the certificates are fake: we checked, we do not have confirmation for only three persons.
A. NASIBOV: From what quantity?
S. KOZLOV: Out of 122.
A. NASIBOV: Out of 122.
S. KOZLOV: Yes.
A. NASIBOV: There is no confirmation on three persons?
S. KOZLOV: There is no confirmation for three persons, but we were provided with very brief information, that is, the last name, first name and patronymic, and the certificate series number, and the subject. So, these three people - one in Moscow, one in the Moscow region, the other from the Chelyabinsk region - did not pass the examination. We will now make an inquiry about our other institutions in the Russian Federation, because inaccurate information could be provided, these persons could go to another of the subjects. The abundance of disabled people, as well as in general, the number of people who applied to higher educational institutions, is due to the fact that this year it is allowed to apply to several educational institutions. So, that's why the list, say, of the 16 people from Kalmykia who have a disability who applied to the Higher School of Economics, they also applied to the Financial Academy. Thus, it seems that a large number of disabled people. Therefore, I would ask you to be very correct in this regard, because disabled children who have now acquired the opportunity to receive an education - we nevertheless signed a convention, including, there are points on education without discrimination, and to create equal opportunity. If today the regulatory framework allows them to go to college, then, as a rule, I want to answer that such children are more assiduous, more demanding both in work and in study, therefore, the situation that is now being played out, from my point of view , is very incorrect.
A. NASIBOV: Tell me, please. But did representatives of Rosobrnauka, representatives of those same universities, the same developers of new rules for entering higher educational institutions, address you before this whole situation began to develop? Has anyone consulted with you? Perhaps you offered your advice to the Higher School in order to prevent such misunderstandings?
S.KOZLOV: I understand the question. No, we didn't receive any such requests. We had an appeal after this situation took place. Here is the orientation of the lists of two universities of the Higher School of Economics through Rosobrnadzor. Well, in our letter, which we prepared to Rosobrnadzor, we communicated these instructions to the heads of the main constituent entities of the Russian Federation: in case of appeals from representatives of universities, justified appeals, to confirm the validity of the issuance of a certificate. - Whether this certificate is, as it were, reasonably issued, whether such a person passed, and whether it is false, - to provide all possible assistance. I can say that in parallel, the social security authorities applied to the main bureau for the Krasnodar Territory: the Kuban Academy also submitted a list of 36 people. As if all decisions are also correctly justified. That is, such work is already underway for the subjects. And, if doubts arise, then, say, there was a very large appeal to the Moscow State Technical University. Bauman, a large number, but, as a representative of the university said: "Not a single false certificate has been identified." And before making such statements that the dominance of false certificates, after all, one could contact the Federal Medical and Biological Agency.
A. NASIBOV: Do you have a database of all issued certificates?
S. KOZLOV: We can give instructions on subjects, our subjects have this base, and we can issue instructions to check it as soon as possible. And if there is such a need, indicating passport data, place of residence, because the Russian Federation is large, and, naturally, some of the applicants and disabled people want to study in the capital's universities.
A. NASIBOV: As far as I understand, the situation boils down to the fact that the Unified State Examination was introduced this year, and all the flaws, “fleas”, shortcomings surfaced - this is not only due to a large number of disabled people entering universities, but also with the appearance of one hundred percent USE results in some cases. This is probably a trial year.
S. KOZLOV: Yes.
A. NASIBOV: Have you drawn any conclusions for yourself?
S. KOZLOV: We have drawn conclusions for ourselves, and we are preparing appeals to Rosobrnadzor in order to jointly meet, discuss, so that the proposals made - after all, there was a proposal to reduce the number of beneficiaries - that is, so that this does not happen to the detriment of those persons whom we called to protect. There should be reasonable reductions, some kind of reasonable approach, so that this procedure is simplified for the next entrance exams at universities, and there is no such hype.
A. NASIBOV: Waldemar Grin asks one more question: “What areas in medical and social expertise should be developed to exclude the possibility of false disability?” - You mentioned one thing - this is the development of this very database, and checking against databases, in case you are contacted. What else can be?
S.KOZLOV: What else? So, again, the concept provides for a change in the very procedure for sending for certification in the use of computer electronic equipment. We are now preparing a regulation based on the fact that our medical institutions should have electronic medical records, electronic outpatient cards. And in the case of a referral for examination, neither the doctors of medical institutions nor our specialists had the opportunity, well, to put it mildly, to fool around. Because electronic documents have an access level, and if someone entered and changed some results in one direction or another, you can always trace who did it. From our point of view, the procedure for referral for examination will change again. Apparently, and we are proposing to simplify the procedure - in a number of cases this will be done in absentia, without inviting a person, and the examination procedure itself will change, it will be simplified. “Therefore, all this will make it possible to make a transparent procedure for submitting an examination and obtaining results, thereby eliminating the possibility of any falsifications. Literally on the tenth day, as part of the delegation of the Ministry of Health and Social Development, together with Minister Tatyana Alekseeva Gulikova, we were in Krasnoyarsk, where, as a pilot project, a room was opened for a branch of the main bureau of Krasnoyarsk Territory, based on the Siberian clinical center. This institution is the prototype of what we want to see - it is a large, spacious hall, a large playroom, bright. To be honest, our institutions do not always meet the standards that should be. There are no ramps, sometimes they are replaced on the upper floors without elevators, so now a lot of attention is being paid to this by both the Ministry of Health of the Russian Federation and the Federal Medical and Biological Agency.
A. NASIBOV: But I also know from the side of the municipalities that Moscow also has a corresponding program.
S. KOZLOV: Well, at the moment we have a problem in accommodation, and in the majority of subjects in the Russian Federation. Provision of premises for our institutions is a very big issue, a very painful issue. So, in Krasnoyarsk, in addition to everything that there is a room, we are moving to a fairly new level: reference terminals have been installed, a single reference service with a telephone number has now been launched in Krasnoyarsk, it is announced, a person can call during working hours by phone. We proposed that the operators in this reference service should be disabled people, including those with limited mobility, who have remote access - a computer, a telephone line, - specially trained, who have, say, a legal education - there are also such persons. And on issues of medical and social expertise of pension provision, revolutionary services can be contacted, and if the operator cannot answer some questions, then you will be transferred to specialists of an already appropriate level. Further means an electronic cabinet, and based on the results of the examination, a person will receive a login and password, can enter his personal account via the Internet, look at the results, can instruct this service to remind him in the form of either email, or sms-messages that, say, he needs to pass a re-examination in advance, - different situations can be. If in the case of a written appeal on disagreement with the decision of the institution, a person will be able to trace the movement of the complaint: when the complaint was received, who is under consideration, when he received the answer. “That's what we're working on. Several entities have now been selected to participate in the pilot project. And I think that by the time the concept is prepared, which we will have to report to the president, we will already be able to show some concrete results in the implementation of individual elements of this concept.
A. NASIBOV: Phone live broadcast radio studio "Echo of Moscow": 363-36-59, year of Moscow 495. We begin to receive your calls. Ask questions to Sergey Kozlov, Head of the Department of Medical and Social Expertise and Social Support of the Federal Medical and Biological Agency. We are discussing the so-called fake disability. - 363-36-59. The first phone calls came. Put on your headphones, Sergei Ivanovich. First call, we listen to you. Hello!
LISTENER-1: Hello, good afternoon!
A. NASIBOV: What is your name? Where are you calling from?
LISTENER-1: I'm from Moscow, my name is Oleg.
A. NASIBOV: Listen, Oleg
OLEG: I would like to ask the guest a question. Can you tell us about the practice of teaching disabled people in higher educational institutions?
A. NASIBOV: More specifically. What does practice mean?
OLEG: Well, how do you actually work with them in practice, how comfortable are they learning? Because as far as I know, in fact, everything rests on individual people who, on their own initiative, somehow pull these people, often in spite of the administration of higher educational institutions, and so on.
A. NASIBOV: Thank you!
OLEG: No way!
S. KOZLOV: I must agree somewhere that in some cases it is quite difficult for people with disabilities to study in our universities, just purely physically: somewhere there are no ramps, somewhere there are no elevators. Persons with disabilities simply cannot come and rise to this university. Currently, there are groups at MSTU. Bauman, who work quite extensively with people with disabilities, new distance learning systems are being developed. So, I have already said that the Russian Federation has signed the convention, including, there are points in education. And therefore, all steps should be taken now, and the situation should be corrected in a similar case, and conditions should be created for normal study. If a person cannot attend, say, higher educational institutions, institutions of medical and social expertise may be offered, various forms. For people with disabilities, full-time, part-time, for example, homeschooling, distance learning can be offered. And now there are all opportunities to make these proposals in the concept, which will be aimed at improvements.
A. NASIBOV: Is this the one you are developing?
S. KOZLOV: Yes.
A. NASIBOV: Are you going to include these provisions in the concept? Am I saying right?
S. KOZLOV: Yes.
A. NASIBOV: 363-36-59. Next call. Hello.
LISTENER-2: Hello!
A. NASIBOV: Hello! Turn down your receiver, please.
LISTENER-2: Hello!
A. NASIBOV: Hello! Turn down your receiver, please!
LISTENER-2: Clearly. Hello.
A. NASIBOV: What is your name, and where are you calling from?
LISTENER-2: Leningrad region, Kashinsky district.
A. NASIBOV: What is your name?
LISTENER-2: Georgy Alexandrovich.
A. NASIBOV: We are listening, Georgy Alexandrovich.
G. ALEKSANDROVICH: So, I am a disabled person of the third group, an injury at work. She was with me back in the 62nd year. Since 1962, I have been ordering something similar to a prosthesis at the Leningrad Prosthetic Enterprise. In general, in short, the function of the leg is completely impaired. Since 1962 I have been ordering this device. It was always without any problems, I came to the plant ... Yes, I have a permanent third group of disability.
A. NASIBOV: Georgy Aleksandrovich, what is the question?
G. ALEKSANDROVICH: I recently went through a rehabilitation program, it consisted only in the fact that I went through all the rooms. Four times I went from my village to the district center to see all the doctors. I have to go through all the doctors, so that they write me a certificate that the rehabilitation program is beneficial for me, so that I can harden this prosthesis. Do you understand what's the matter?
A. NASIBOV: Do you understand?
G. ALEKSANDROVICH: I asked the doctor: “What, will we meet in two years?” - By the way, it lasts me for two years, I can still fix it myself, and so on. In two years, should I go through the same system again?
A. NASIBOV: Thank you, Georgy Aleksandrovich. Now let's try to find out the answer. Thank you! This is where we started our conversation.
S. KOZLOV: Yes. Problems exist. And, say, with Government Decree 240, from April 7, 2008, it is provided that an individual rehabilitation program for a disabled person, a disabled child, can be developed for a year, for two, or indefinitely, or for children up to the age of 18. A rehabilitation program for the victim, it is currently being developed for the period of interest recovery.
A. NASIBOV: For a period?…
S. KOZLOV: For the recovery period, the degree of loss of professional ability to work in percent. So, in this case, either for a year or two is established for a person. We are now preparing documents stating that the PRP (Victim Rehabilitation Program), can be in such cases, and should be issued indefinitely. And upon contacting the same prosthetic company, we just have to change this tuter purely automatically, and exclude this “hellish” circle of going to medical institutions to fill out form 88, then visiting a medical and social examination institution. A PRP will be issued, say, indefinitely. If, in case of deterioration of the condition, there is a need for some additional measures, he can apply to the institutions himself.
A. NASIBOV: It is you who are laying in this very concept, which begins to operate from the 10th year.
S.KOZLOV: Well, as the government will accept.
A. NASIBOV: As the government will accept. Thank you! 363-36-59 - live phone. We listen to you. Hello.
LISTENER-3: Hello!
A. NASIBOV: Hello!
LISTENER-3: My name is Natalia.
A. NASIBOV: Where are you calling from, Natalya?
NATALYA: From Moscow.
A. NASIBOV: We are listening.
NATALYA: So I have such a problem: three years ago I lost my sight completely. Since the age of 16 I have been disabled of the first group of the second degree due to vision. Sorry, I'm worried.
A. NASIBOV: Don't worry, Natalia. Don't worry. We are here to answer your questions.
NATALYA: At the moment I have a disability of the second degree. The fact is that I have a prosthesis in one eye, and the other does not even see light completely. The group is placed in the second degree. Naturally, I can’t work, since I can’t get to work. I can't even walk with a stick.
A. NASIBOV: And what kind of work did you have?
NATALIA: I am an opera singer, soloist and vocalist, I worked in the theater.
A. NASIBOV: I understand.
S. KOZLOV: At the moment I'm trying to find opportunities to engage in my professional activities, but it's impossible to get a job at the Philharmonic. These are only some private concerts. Unfortunately, this is very bad right now.
A. NASIBOV: I understand correctly that your question still concerns work for those who have limited opportunities?
NATALIA: Yes. The matter here concerns not only work: I am now receiving a pension for the second group, that is, I have completely lost my sight, but nothing has changed for me. I receive the same pension as I received when I saw and when I had the opportunity to work. At the moment I am at home, I receive the same pension, I am dependent on my retired mother, who receives a minimum pension, she has a 2700 pension in Moscow. And, unfortunately, I have another question: I was given the opportunity for rehabilitation, in everyday conditions I myself rehabilitated, as it were, I believe that I can adapt myself at home. Walking with a cane is very difficult, I can’t get a guide dog either, because I live in a hostel, the conditions don’t help. I am given the opportunity to travel on a tour, but again, the first group of the second degree is not eligible to get the opportunity to accompany. That is, I can go by myself, but I cannot have an escort.
A. NASIBOV: I understand. A whole range of questions.
NATALYA: The complex is very large. Unfortunately, I am now in such conditions that I cannot go anywhere, go anywhere.
A. NASIBOV: Natalya, let's try to hear at least the answers to some of the questions you asked.
NATALIA: Thank you!
A. NASIBOV: First, about employment.
S. KOZLOV: This is not a question of employment, it is about what we talked about. That, being a visually impaired person of the first group, Natalia's ability to work is limited to the second degree, so she receives a pension, as in the second group before. That is, there is no difference here. - This is the most vulnerable contingent, which, due to the limited ability to work, it turns out that even if a person has found a job and works, it turns out that we kind of punish him. He can work with the first group of disability. But the rest, in the presence of even the second group, if they have the ability to limit the labor degree of the third degree, they receive a pension, like the disabled of the first group.
A. NASIBOV: Do I understand correctly? For me, as a person a little from the outside, after all, I want to understand for myself. Do I understand correctly that if a disabled person with a second disability group finds a job, or tries to find a job, does he lose part of his income?
S. KOZLOV: No.
A. NASIBOV: Wrong?
S. KOZLOV: Wrong. By limiting the ability to work Natalia the first group.
A. NASIBOV: Yes.
S.KOZLOV: But our pension is now paid to limit the ability to work, it can work in specially created conditions.
A. NASIBOV: Ah, that's it.
S. KOZLOV: Yes. And she receives a pension, just as the disabled of the second group received earlier. And in accordance with the current legislation ... Yes, she clearly said that these people, they are well socialized at home, in their district, but when they go to another region for treatment, they are completely independent. They cannot navigate. But, according to the current legislation, an escort is given not to disabled people of the first group, but to persons who have restrictions on labor activity of the third degree, and she has a second degree. That is, she loses this right. Here is what I said at the beginning: if everything works out and the draft law passes, then from the new year, disability pensions will be paid not depending on the degree of restriction on employment, but, as before, according to the disability group. That is, whether she will work or not, she will receive a disability depending on those functional impairments in the first group of disability. That is, her pension will increase and she will be entitled to an escort to go to the same san-kur treatment, with the same mother, or with another person who will accompany. “That's what we were talking about.
A. NASIBOV: Sergey Ivanovich, prepare your concept quickly! Quickly prepare a project on new laws! Judging by the number of calls and messages that we received via sms, people really need what you are doing now.
S. KOZLOV: These are very painful questions, always when it comes to the state of health. And now we are inspecting our institutions a lot and meeting with representatives of the disabled society, meeting with citizens, and as we discuss, we are refining these concepts. Therefore, we will try, well, as quickly as possible, taking into account all the comments and proposals that exist, to put them into practice. And the fact is that for people who are in trouble, in this misfortune, it is, after all, at least a little, but it is easier to live.
A. NASIBOV: Sergei Kozlov, head of the department of medical and social expertise and social support of the Federal Medical and Biological Agency, is a guest of the Back to the Future program on the waves of Echo of Moscow. Leave your comments and suggestions on the Ekho Moskvy radio website and on Tatyana Fengelgauer's blog. The program "Back to the Future" goes on air thanks to cooperation with the public council of the state corporation "Rosatom". I am Ashot Nasibov saying goodbye! See you in a week! Thanks, Sergey Ivanovich, for participation!
S. KOZLOV: Thank you! Goodbye!
On April 15, 2009 at 12:00 pm, an Internet interview was held with the head of the Department of Medical and Social Expertise and Social Support for the Population of the Federal Medical and Biological Agency Sergey Ivanovich Kozlov. ".
Medical and social expertise in the Russian Federation is one of the types of medical expertise, it establishes the cause and group of disability, the degree of disability, determines the types, volume, terms of rehabilitation, social protection measures, gives recommendations on the employment of citizens. These issues are regulated in sufficient detail by the Federal Law of November 24, 1995 N 181-FZ "On the Social Protection of the Disabled in the Russian Federation" (with subsequent amendments and additions).
In accordance with Decree of the President of the Russian Federation of May 12, 2008 N 724 "Issues of the system and structure of federal executive bodies", Decree of the Government of the Russian Federation of June 02, 2008 N 423 "On certain issues of the activities of the Ministry of Health and Social Development of the Russian Federation and the Federal Medical Biological Agency" the powers to organize the activities of federal state institutions of medical and social expertise are vested in the Federal Medical Biological Agency.
Despite the fact that the issues of implementation on the territory of the Russian Federation of the functions of providing medical and medical social assistance, the organization of forensic and forensic psychiatric examinations are regulated in sufficient detail by the current Russian legislation, its norms need further regulation and improvement.
With the solution of problems in the field of medical and social expertise, the problems of carrying out rehabilitation measures for disabled people in order to restore their social status. However, at present, the creation of only social institutions"services of medical and social expertise", which slowed down the development of social and environmental rehabilitation infrastructure, which are the basis for restoring the body's working capacity and skills for independent household activities, providing the prerequisites for the competitiveness of people with disabilities in the labor market, acquiring relative independence, restoring the ability to adequately interact with society. It is up to the Department of Medical and Social Expertise and Social Support of the Population of the FMBA of Russia to change this situation.
During the online interview, it is planned to talk about new approaches to the organization of medical and social expertise in the Russian Federation, determine the procedure for organizing and passing it, analyze the issues of improving legislation in this area, and determine the role of the Federal Medical and Biological Agency in reforming the ITU system.
These and others topical issues will be touched upon during an online interview with the head of the Department of Medical and Social Expertise and Social Support for the Population of the Federal Medical and Biological Agency Sergey Ivanovich Kozlov.
By the time the interview began, several dozens of different interesting and problematic questions had been received, which we would like to propose to our distinguished guest today.
Leading Internet interview - Tsar Sergey Petrovich (Company "Garant").
Good morning ladies and gentlemen! Hello, dear Internet audience! We are starting our online interview. Allow me to introduce our guest - Sergei Ivanovich Kozlov, Head of the Department of Medical and Social Expertise and Social Support for the Population of the Federal Medical and Biological Agency.
Online Interview Topic: " Medico-social examination: organization and procedure for passing. Experience and new solutions".
Moderator: The first question came from Dmitry Malyshev from the city of Saratov. Sergey Ivanovich, please tell us about the procedure for organizing and passing a medical and social examination in Russia. What are the grounds for recognizing a citizen as disabled?
Kozlov S.I.:
I would like to briefly recall in what cases disability is established. The recognition of a citizen as a disabled person is carried out by federal state institutions of medical and social expertise during the medical and social expertise, based on a comprehensive assessment of the state of the citizen's body based on an examination of the citizen, an analysis of his clinical, functional, social, professional, labor and psychological data using classifications and criteria approved by the Ministry of Health and Social Development of the Russian Federation. With a persistent disorder of body functions, which is caused by diseases, the consequences of injuries or defects and leads to a limitation of life, that is, a complete or partial loss of the ability to self-service or, for example, orientation in space, learning. For each case of establishing disability, the decision is made on an individual basis. The UN Convention on the Rights of Persons with Disabilities recognizes the concept of disability as evolving. This means that many functional disorders can be corrected. For a certain period of time, specialists are engaged in the rehabilitation of a disabled person according to an individual program, which includes treatment, psychological assistance, and the development of recommendations for the best adaptation of the patient to life in new conditions for him. And in the case of the effectiveness of rehabilitation measures, compensation and elimination of impaired functions, disability can be changed.
Moderator: Is it true that the ITU has been instructed not to establish disability in order to save budget funds, and that the salaries of doctors depend on this?
Kozlov S.I.:
There are currently 13.2 million people with disabilities in Russia. This is just over 9% of the country's population. In total, 4.76 million people were examined in 2008, of which 1.20 million people were examined for the first time - to establish disability, to establish the degree of loss of professional ability to work, and repeatedly - incl. to establish disability, to change the cause of disability, the formation of an individual program for the rehabilitation of a disabled person 3.56 million. the indicator was 306 thousand people (subject to a festive 10-day decade), and in February - 450 thousand people, in March more than 418 thousand people, respectively. The number of citizens who in 2008 on average in the Russian Federation were first diagnosed with disability was 80.5 thousand people per month, again 206 thousand people per month, in January 2009 these figures were 68 thousand people, and 180 thousand people, and in February 2009 already 98 thousand people, and 253 thousand people, in March 90.4 thousand people and 240 thousand people, respectively, which indicates an increase in the number of citizens recognized as disabled, and not a decrease in the level of disability.
With regard to salaries and, in particular, incentive payments to ITU employees, first of all, attention is drawn to the absence of complaints about the work of the institution, the quality of decisions made, and there is no such criterion in determining salaries as the number of established, confirmed or unconfirmed cases of disability. .
Moderator: In September last year, Russia joined the international Convention on the Rights of Persons with Disabilities, which provides for the creation of a full-fledged environment for persons with disabilities, ensuring their rights to work, to medical service education, full participation in public life. What is being done to speed up its ratification? Asks Smolyakov Leonid Ivanovich from the Tambov region.
Kozlov S.I.:
Indeed, in 2008 the Russian Federation signed the UN Convention on the Rights of Persons with Disabilities. Its ratification involves a large amount of legislative, organizational and information work. First of all, it is necessary to develop and submit for approval to the Government of the Russian Federation an action plan to prepare for the ratification of the Convention. And you need to start this work with clarification and implementation for practical application a number of definitions, including definitions of such concepts as "disabled person", "habilitation", "rehabilitator".
The Convention introduces the following concept of disability: "Disability is an evolving concept and is the result of the interaction that occurs between people with disabilities, attitudinal and environmental barriers that prevent their full and effective participation in society on an equal basis with others." That is why we must move from our existing system of social protection for people with disabilities to a policy of removing barriers and obstacles that prevent their full and effective participation in society on an equal basis with others.
State support for the disabled cannot be limited solely to pensions and social benefits. The most important task is to enable persons with disabilities to lead an independent lifestyle and participate fully in all aspects of life, to create access on an equal basis with others to the physical environment, to transport, to information and communications, including information and communication technologies and systems, as well as to other facilities and services. open or provided to the public in both urban and rural areas.
We hope that the planned actions will allow Russia to speed up the ratification of the UN Convention on the Rights of Persons with Disabilities.
Moderator: What bodies control the organization of the activities of the Federal State Institution "Main Bureau of Medical and Social Expertise"?
Kozlov S.I.:
Control over the procedure for the organization and implementation of medical and social expertise, as well as the rehabilitation of disabled people and the procedure for establishing the degree of loss of professional ability to work as a result of accidents at work and occupational diseases in accordance with Decree of the Government of the Russian Federation dated June 30, 2004 N 323 "On approval of the Regulations on the Federal Service for Supervision in the Sphere of Health Care and Social Development" is carried out by the Federal Service for Supervision in the Sphere of Health Care and Social Development. In accordance with Decree of the Government of the Russian Federation of April 11, 2005 N 206 "On the Federal Medical and Biological Agency", the FMBA of Russia also exercises control over the activities of subordinate organizations.
Moderator: On April 7, 2008, Decree of the Government of the Russian Federation N 247 "On Amendments to the Rules for Recognizing a Person as a Disabled Person" was adopted. From the Decree of the Government of the Russian Federation it follows that people with incurable diseases and injuries are not required to undergo an examination annually. Please tell me, has the life of a person with disabilities become better in connection with its adoption?
Kozlov S.I.:
I have already drawn attention to the fact that a number of normative legal acts with a social orientation have already been adopted recently, including Decree of the Government of the Russian Federation of April 7, 2008 N 247 "On Amendments to the Rules for Recognizing a Person as Disabled", a List diseases, defects, and conditions under which disability is established indefinitely, which eliminates the need for both re-applying citizens to medical and preventive institutions to issue a referral for a medical and social examination, and the re-examination of citizens in federal institutions of medical and social examination.
The list of diseases, defects, conditions under which a disability group is established without specifying the re-examination period is adapted to ICD-10, taking into account the proposals of the All-Russian Public Organization of the Disabled. The period of observation by federal state institutions of medical and social expertise has been determined, according to the list - within 2 years, after which the disability group is established without specifying the period for re-examination. With the main forms of diseases, this period is necessary for the complex curative measures impacts aimed at restoring disturbed or lost health functions of patients and the disabled, or mitigating the consequences of illness, injury or injury until full or partial restoration or compensation of violations in the patient's condition.
This legal norm is addressed primarily to federal state institutions of medical and social expertise, and establishes for them deadlines for monitoring people with disabilities when making a decision to establish disability indefinitely and prevents unreasonable, untimely adoption of a decision to establish disability without specifying the re-examination period, which will ensure the implementation citizens of the rights associated with the recognition of their disabilities. In the Russian Federation in 2007 (May-December), the total number of all persons recognized as disabled ( adult population) amounted to 2,275,929 people, of which 21.84% of them were permanently recognized as disabled total number. In 2008, after the issuance of this Decree, the number of disabled people (for May-December) amounted to 2,222,359 people, of which 711,899 people or 32.03% were recognized indefinitely (i.e. more than in 2007 by almost 10% ).
Moderator: Please tell us about the judicial practice of challenging decisions on medical and social expertise? Can a citizen who does not agree with the decision of the ITU bureau immediately file a complaint with the court, or is he obliged to first appeal this decision to the main ITU bureau? What are the statistics of citizens appealing against the conclusions of the ITU Bureau in the courts, whose side the judiciary takes in this controversial issue more often? What regulatory legal acts regulate the issues of appealing against decisions of medical and social expertise in the Russian Federation?" Asks Vasily Lonovoy from Tyumen.
Kozlov S.I.:
The issues of appealing against decisions of the Bureau of Medical and Social Expertise are also regulated by Decree of the Government of the Russian Federation of February 20, 2006 N 95 "On the Procedure and Conditions for Recognizing a Person as Disabled".
The legislation provides: if a citizen or his legal representative does not agree with the decision of the branch of the Bureau of Medical and Social Expertise, then he can appeal this decision to the main ITU bureau in his region, and if he disagrees with the decision of the main bureau, to the Federal Bureau. Decisions of the bureau, the main bureau, the Federal Bureau may be appealed to the court by a citizen (his legal representative) in the manner prescribed by the legislation of the Russian Federation. According to the monitoring data of the Federal Medical and Biological Agency, in 2008 2764 cases were appealed in court, or 0.06% of total examinations of 4.76 million people. 210 lawsuits were satisfied, which is 0.004% of the total number of examinations, or 7.6% of the number of appealed decisions of medical and social expertise institutions. At the same time, I note that due to abuse of official position, not a single claim was satisfied.
Host: There is a Letter from the Ministry of Health and Social Development of the Russian Federation dated May 5, 2006 N 2317-VS, which sends Methodological recommendations for providing disabled people with technical means of rehabilitation. Then Letter N 3092-ВС dated April 18, 2007 was sent, which, in turn, withdraws the previous letter from execution, but does not provide new recommendations. Question: what is the status of the Letter of May 5, 2006 N 2317-VS and Methodological recommendations, "valid" or "lost force". If "active", then what does the status "withdrawn from execution" mean?
Kozlov S.I.:
The letter of the Ministry of Health and Social Development of Russia dated May 5, 2006 N 2317-VS was withdrawn from execution by institutions of medical and social expertise, therefore, the Methodological Recommendations for Providing Disabled Persons with Technical Means of Rehabilitation are an act that has lost its legal force.
Moderator: In the course of the implementation of the functions of the FMBA of Russia in the part of the ITU, are representatives of the public involved in the discussion of various projects and initiatives? To what extent is the opinion of public associations of the disabled, human rights organizations taken into account when making a decision? On what issues has this cooperation already been established, is there a positive return?
Kozlov S.I.:
Recently, a number of normative legal acts with a social orientation have been adopted. Thus, in the preparation of Decree of the Government of the Russian Federation of 07.04.2008 N 247 "On Amending the Rules for Recognizing a Person as Disabled" and Decree of the Government of the Russian Federation of 07.04.2008 N 240 "On the procedure for providing disabled people with technical means of rehabilitation and certain categories of citizens from number of veterans with prostheses (except for dentures), prosthetic and orthopedic products" public organizations of the disabled took an active part. The active participation of public organizations of the disabled is also expected in the preparation of the Concept for reforming the state system of medical and social expertise and rehabilitation of the disabled, and to widely discuss it with all interested civil society institutions.
Moderator: Additional program drug supply suffers from gaps and shortcomings in the legislation. The needs of beneficiaries for medicines are determined in an unskilled way, almost "by eye", inventory management is poorly established, prescriptions for medicines are often unsystematic, funding from the federal budget is insufficient. When will appropriate measures finally be taken to regulate DLO?
Kozlov S.I.:
This issue does not fall within the competence of the FMBA of Russia, but I can say that in 2008 the scheme of drug provision for beneficiary categories of citizens completely changed. The powers to provide them with the necessary medicines have been transferred to the constituent entities of the Russian Federation. And patients with diseases according to seven nosologies (hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher's disease, myeloid leukemia, multiple sclerosis, as well as after transplantation of organs and (or) tissues), who need expensive therapy, began to be provided with the necessary medicines at the expense of the federal budget.
Moderator: Now we are determining the degree of restriction of labor activity. Tell me, please, what is the difference between a disability group and this very degree? What is taken into account first of all when determining it?
Kozlov S.I.:
A medical and social examination is carried out to establish the structure and degree of restriction of a citizen's life (including the degree of restriction of the ability to work). Depending on the degree of disability caused by a persistent disorder of body functions resulting from diseases, the consequences of injuries or defects, a citizen recognized as disabled is assigned I, II or III disability groups. When establishing a disability group for a citizen, the degree of restriction of his ability to work (III, II or I degree of restriction) is simultaneously determined, or the disability group is established without limiting the ability to work. Thus, limitation of the ability to work is one of the seven types of disability. At present, pensions for persons with disabilities are generally determined by the degree of the OSTD, and not by the group of disability.
Moderator: Please tell us how things are now with the material support and financing of the activities of workers of medical and social expertise? What are the problems?
Kozlov S.I.:
In order to further improve the quality and efficiency of the activities of federal institutions of medical and social expertise, we consider it appropriate, within the framework of the Concept for reforming federal state institutions of medical and social expertise and rehabilitation of the disabled, to provide for the strengthening of the material and technical base of federal state institutions of medical and social expertise, to develop modern models of functioning institutions of medical and social expertise at various levels, a single integrated information system.
The material and technical equipment, first of all, is connected with the solution of the issue of providing federal state institutions of medical and social expertise with the necessary premises that meet safety regulations, sanitary and hygienic standards, fire safety requirements, conditions for a comfortable stay of persons with disabilities, provide free access disabled people to them. The analysis showed that at present the federal state institutions of medical and social expertise occupy 209,551 square meters, which is just over 33%. It is also necessary to resolve the issue of transferring, in accordance with the established procedure, to federal ownership of the premises necessary for the implementation of the functions of federal state institutions of medical and social expertise. In some cases, it is advisable to consider the acquisition of office space in the ownership, given the constant increase in rent. Thus, the issue of acquiring buildings in seven constituent entities of the Russian Federation is currently being resolved.
Partially, the issue of providing space for federal state institutions of medical and social expertise is resolved through participation in the federal target program "Social Support for the Disabled for 2006-2010", approved by Decree of the Government of the Russian Federation of December 29, 2005 N 832. Construction of a building for a federal state institution is envisaged Main Bureau of Medical and Social Expertise for Rostov region"(Rostov-on-Don), in the Chita region and the Aginsky Buryat Autonomous District (Chita), in the Yaroslavl region (Yaroslavl), in the Smolensk region (Smolensk), in the Ryazan region (Ryazan) , in the Tyumen region (Tyumen), in the Bryansk region (Bryansk), in the Republic of Ingushetia (Magas).
In order to improve the quality of services provided to the disabled and to facilitate the procedures for determining disability and re-examination of disabled people, in 2009 more than 500 units of special vehicles will be purchased for institutions of medical and social expertise. We hope that the availability of such vehicles in the regions will make it possible to promptly provide expert and rehabilitation services to disabled people.
Moderator: Please tell me, are there any problems with the training and advanced training of personnel for institutions of medical and social expertise and rehabilitation of the disabled? And which specialists are most needed?
Kozlov S.I.:
The main burden of training specialists for institutions of medical and social expertise is borne by the St. Petersburg Institute for Advanced Training of Expert Physicians and the Federal Bureau. In 2006-2008, 471 specialists underwent primary specialization, 96 specialists underwent retraining during the same period, and 6203 specialists underwent advanced training. Among the specialists in demand: doctors, various profiles, psychologists, social work specialists, etc.
Moderator: The next question is from Alexandra Pupkina. "I was re-examined for the 3rd disability group, I was assigned the same group for a period of 1 year. I do not agree with the definition of the period, because I have been a pensioner since the age of 50 and have now reached the general retirement age. I have a condition after the transferred pancreatic necrosis with peritonitis, cholecystectomy, gastroduodenitis and with a bunch of concomitant diseases.The courses of anti-inflammatory treatment are constant at intervals of no more than 2-3 weeks and with constant intake of enzymes.Doctors' forecasts about the disease for life.I applied to the main bureau of the region with a question about disagreement with by the decision of the ITU commission regarding the term, i.e. to change the term to indefinite, and not to 1 year.The commission in the main bureau of the region refused me, referring to the fact that in my application I did not ask for the definition of the term indefinitely. Please explain to me :
1) Do I have to indicate the desired term and degree of restriction on work in my application?
2) Can I count on the determination of the term indefinitely, and according to which document should the frequency of re-examination be determined?
Kozlov S.I.:
Let me remind you that disability is established with a persistent disorder of body functions, which is caused by diseases, the consequences of injuries or defects and leads to a limitation of life, that is, a complete or partial loss of the ability to move, self-service or, for example, orientation in space, learning. For each case of establishing disability, the decision is made on an individual basis. Retirement age is not a basis for establishing disability without a period of re-examination. The frequency of the examination, as well as the possibility of establishing disability without indicating the period of disability, is regulated by Decree of the Government of the Russian Federation of February 20, 2006 N 95 "On the procedure and conditions for recognizing a person as disabled", wishes are not indicated in the application.
Host: Please tell us about the procedure for establishing disability in children and adults in the absence of an eye.
Kozlov S.I.:
Visual disturbances leading to disability may be due to various pathologies, which is a consequence of diseases, developmental anomalies, damage to various structures of the eyeball. Visual impairment has an adverse effect on almost all manifestations of life, however, the degree of this influence is different. The main characteristic reflecting the severity of the pathology of the organ of vision, and determining its impact on the life and social insufficiency of a person, is the state of visual functions, the main ones being: visual acuity and field of vision. When conducting a medical and social examination, the severity of the violation is assessed taking into account the International Classification of Visual Disorders (ICD 10th revision. WHO, Geneva), according to the state of the functions of the better seeing or the only eye under tolerable (optimal) correction (spectacle or contact). Thus, according to the International Classification of Visual Disorders, most people with anophthalmos or monocular blindness, including children, with a structurally and functionally complete second eye, do not have restrictions on the main categories of life activity associated with the state of health, and, therefore, do not have grounds for determining disability. On 05/19/09 on another forum I came across this opinion:
ICD-10 is about the worst seeing eye! And the table on page 462 of ICD-10 has more than 10 differences from the one that the ITU clandestinely uses, imprinting there the only better seeing eye and four degrees of functional disorders. And also, the head of the ITU FMBA department did not explain why a citizen with one eye, as having no restrictions, cannot exercise his right to work by serving under a contract in the army, the Ministry of Internal Affairs, the FSB and other 17 ministries where military service is provided. Can't drive vehicles. As having no restrictions, he cannot, like everyone else, master the course of descriptive geometry, engineering graphics, certain sections of higher mathematics (for example, the intersection of planes and a vector) and physics (for example, Gauss's theorem, for various volumes), etc., related to volumetric perception of space in a technical university
Host: Thank you. Vartseva Nadezhda Gennadievna from the city of Bryansk asks. Tell me, please, for which diseases are most often given disability?
Kozlov S.I.:
According to the data of statistical observation, the structure of disability of the adult population by classes of diseases in the Russian Federation in 2008 is presented as follows: diseases of the circulatory system, malignant neoplasms, diseases of the musculoskeletal system, injuries. Further, ranking places are occupied by disabled people due to diseases of the eye, respiratory organs, mental disorders, diseases of the nervous system.
Moderator: Thank you for your answer, Sergey Ivanovich. The next question came from Viktor Sidelshchikov from the Moscow region: “I am a disabled person of the second group. Social worker. However, I do not live at the place of my registration and I cannot get to the district medical and social examination. How to be?"
Kozlov S.I.:
In accordance with the Rules for Recognizing a Person as Disabled, if a citizen cannot come to the bureau (main bureau, Federal Bureau) for health reasons, which is confirmed by the conclusion of the organization providing him with medical and preventive care, a medical and social examination can be carried out at home, or in a hospital where a citizen is being treated, or in absentia by decision of the relevant bureau.
Host: Please tell me, is there any requirement for the frequency of re-examinations of disabled people and determining their degree of limitation of the ability to work?
Kozlov S.I.:
In accordance with Decree of the Government of the Russian Federation of February 20, 2006 N 95 "On the procedure and conditions for recognizing a person as disabled," disability of group I is set for 2 years, II and III groups - for 1 year. The degree of limitation of the ability to work (no limitation of the ability to work) is established for the same period as the disability group. The category "disabled child" is set for 1 or 2 years, or until the citizen reaches the age of 18. Re-examination of disabled people of group I is carried out 1 time in 2 years, disabled people of II and III groups - 1 time per year, and disabled children - 1 time during the period for which the category "disabled child" is established for the child.
Moderator: Sergey Ivanovich, in your opinion, how justified is the determining value of limiting the ability to work? Asks Leontiev Viktor Semenovich from the Moscow region.
Kozlov S.I.:
Retirement of disabled people depending on the degree of limitation of the ability to work (OSTD), and not the disability group, to a large extent masks the very picture of the state of disability, the degree of severity of disability. This is most clearly manifested in relation to the visually impaired (blind). The establishment of this category of 1st group of disability in the presence of pronounced restrictions on self-service, movement, orientation with a preserved partial ability to work, the ability to perform work in specially created conditions (2nd degree OST) significantly reduces the economic insufficiency of these citizens.
In addition to assigning a labor pension to a visually impaired person, providing him with other social benefits, such as receiving a second voucher for Spa treatment, free transportation to the place of treatment and back for the accompanying person and other services are also directly correlated with the degree of limitation of the ability to work, and not with the disability group, which significantly limits the rights of this category of disabled people.
Moderator: Question from Voronova Irina Lvovna from the Moscow region. "My son Gurtovenko Dmitry Alexandrovich was born on January 12, 2004, a disabled child with cerebral palsy, spastic diplegia, from the age of 1. The child attends Kindergarten, swimming pool, We undergo rehabilitation in the children's rehabilitation center "Childhood" and in the sanatorium according to the profile, when we are provided with vouchers, in addition, we treat ourselves - exercise therapy, swimming, exercise equipment, physiotherapy, etc. Accompanying illnesses- Allergy, tonsillitis. Is it possible to apply for a disability under the age of 18 for this disease, and not go through the VTEK commission annually? Passing the commission injures the psyche of the child. Can the VTEK commission refuse to grant disability with this diagnosis?
Kozlov S.I.:
Decisions by institutions of medical and social expertise are made individually during the medical and social expertise, based on a comprehensive assessment of the state of the citizen's body using classifications and criteria approved by the Ministry of Health and Social Development of the Russian Federation. If you indicated the diagnosis correctly, then at the next examination, the question of establishing the category "disabled child" in this case should be established for Dima under 18 years old.
Host: Thank you very much. And the next question sounds like this: “Dear Sergey Ivanovich! I head a charitable educational foundation that informs parents and specialists about the methods of rehabilitation of disabled children through the Internet. high level(including hearings in the State Duma and other meetings, publications in newspapers and online magazines), I raised the question of the need for purposeful work in this direction. I proposed the creation of: 1) a specialized publishing house for the publication of a journal and books on medical, pedagogical, social rehabilitation 2) universal (at least in regional centers) the creation of qualified early intervention centers, the methodology for which was developed by the Institute of Correctional Pedagogy and others. In addition, I believe that in the IPR of any child born with a developmental pathology, it is necessary to prescribe the opportunity for parents to receive education as a defectologist for free. Only then can we begin to solve this problem. I would like to know your opinion on this matter. Is it possible for our foundation to cooperate with your department?"
Kozlov S.I.:
I believe that the issues you raised are very relevant and deserve detailed study. FMBA of Russia is open for cooperation with scientific, public and other organizations operating in the field of medical and social expertise and rehabilitation of disabled people.
Moderator: The next question came from Alina Vitalievna Kravchenko from Samara. By law, the patient or his legal representative has the right to involve any specialist at his own expense to participate in the medical and social examination with the right of an advisory vote. Is this right used or is it only declared? How do you assess the impact of the presence of a third-party specialist on decision-making in this case, is it becoming more objective and not biased?
Kozlov S.I.:
The right of a citizen (his legal representative) to involve any specialist at his own expense to participate in the conduct of a medical and social examination is not provided for by the current legislation. This norm rights was provided for by the Decree of the Government of the Russian Federation of August 13, 1996 N 965 "On the procedure for recognizing citizens as disabled", which has become invalid.
The current Rules in the conduct of a medical and social examination of a citizen at the invitation of the head of the bureau (main bureau, Federal Bureau) provide for the participation in an advisory vote of representatives of state, extra-budgetary funds of the Federal Service for Labor and Employment, as well as specialists of the relevant profile. Of course, in cases requiring clarification of the structure and degree of disability, rehabilitation potential, as well as obtaining other additional information, the presence of specialists with the right of an advisory vote in some cases makes it possible to comprehensively assess the existing restrictions on the life of a citizen, the need for measures of social protection, rehabilitation.
Host: Thank you. And the next question is from Artur Poloskov from the Leningrad Region. Currently, a fairly large number of migrants live in the Russian Federation. Sergey Ivanovich, please tell us how the issues of conducting ITU, establishing disability are resolved in relation to this category of persons? Are there any restrictions placed on them? At what expense is this all done?
Kozlov S.I.:
Article 4 federal law dated July 25, 2002 N 115-FZ "On legal status foreign citizens in the Russian Federation" foreign citizens shall enjoy the rights and bear obligations in the Russian Federation on an equal basis with citizens of the Russian Federation, with the exception of cases provided for by federal law. Institutions of medical and social expertise at the place of stay of foreign citizens registered in the Disability for this category of citizens is established on the terms and according to the norms of the legislation of the Russian Federation.I would like to note that the issues of disability payments do not fall within the competence of the FMBA of Russia, but at the same time, foreign citizens who have a work permit have the right to a labor pension. residence and permanent residents on the territory of the Russian Federation, the scope of rights and benefits of foreign citizens on the territory of the Russian Federation may also be determined by international regulatory legal acts.
Host: Mikhail Anatolievich Potapov from the city of Chekhov asks: "Often, medical institutions lose outpatient cards of patients who subsequently have serious difficulties with passing ITU. Where can a citizen apply for the protection of his rights in this case, and what responsibility should he bear medical institution for this kind of action?
Kozlov S.I.:
This issue falls within the competence of the health authorities in the relevant subject of the Russian Federation.
Moderator: The next question came from Alexander Ivankovsky: "Sergey Ivanovich, please answer, if the examined person disagrees with the conclusions of the medical and social examination and the person wishes to appeal it in court, in which institution can an alternative examination be carried out, especially to verify the criteria social adaptation?
Kozlov S.I.:
It should be noted that the current legislation does not provide for an "independent" medical and social examination. According to the Federal Law of November 24, 1995 N 181-FZ "On the Social Protection of the Disabled in the Russian Federation", medical and social expertise is carried out only by federal institutions of medical and social expertise. In accordance with the Rules for Recognizing a Person as Disabled, a citizen has the right to appeal to the court the decisions of the bureau, the main bureau, the Federal Bureau in the manner prescribed by the legislation of the Russian Federation. By a court ruling, a forensic medical and social examination is appointed, the conduct of which is entrusted to the federal government agency medical and social expertise.
Moderator: Thank you, Sergey Ivanovich. The next question came from Sergey Anatolyevich Kudryakov from the city of Novosibirsk. "I ask you to clarify the procedure for establishing the degree of disability for military personnel (including former ones). Currently, the ITU authorities refuse to establish the degree of disability for military personnel, referring to incomprehensible instructions (which they refuse to present), simply motivating them with unwillingness to do this and their main motive - military personnel are already in a known worse situation than civilians, because monthly payments for military injuries can only be received by a court decision (and not in a declarative manner), and there is no established judicial practice on this issue . Problem monthly payment is that the RF Ministry of Defense does not insure military personnel to receive these payments, but insures them only to receive lump-sum insurance payments.
Kozlov S.I.:
Articles 1084-1094 of the Civil Code of the Russian Federation define the general procedure for compensation for harm caused to the life or health of a citizen. Specific mechanisms for the implementation of this procedure are established by the relevant federal laws and regulatory legal acts. Federal Law No. 125-FZ of July 24, 1998 "On Compulsory Social Insurance Against Occupational Accidents and Occupational Diseases" establishes the basis for compulsory social insurance against industrial accidents and occupational diseases and the procedure for compensation for harm caused to the life and health of an employee in the performance of them job responsibilities.
Guided by the Law, the Government of the Russian Federation, by Resolution No. 789 of October 16, 2000, approved the Rules for establishing the degree of loss of professional ability to work as a result of accidents at work and occupational diseases. Terms and conditions compensation payments Federal Law No. 52-FZ of March 28, 1998 "On Compulsory State Insurance of Life and Health of Military Personnel, Citizens Called for Military Training, Individuals and Commanders of Internal Affairs Bodies of the Russian Federation, Employees of Institutions and Tax Police Bodies".
According to Article 5 of the Federal Law, the amount of insurance amounts paid to military personnel and persons equated to them in compulsory state insurance depends on the severity of the disability group established by him and the severity of the disability received during the period of passage military service injuries (wounds, injuries, contusions). Determining the severity of injuries (wounds, injuries, contusions) of insured persons is carried out by the relevant medical bodies of the federal executive bodies, in which the legislation of the Russian Federation provides for military service, service, military training (paragraph 1 of Article 7 of the Federal Law). Thus, insurance payments to former military personnel and persons equated to them under mandatory state insurance, do not depend on the degree of loss of professional ability to work.
In this regard, at present, none of the current regulatory legal acts entrusts the institutions of medical and social expertise with the right to establish the degree of loss of professional ability to work as a percentage of former servicemen due to injuries (wounds, injuries, concussions) or diseases received during military service. . In turn, the criteria for determining the degree of loss of professional capacity for persons who served in the armed forces are absent in the legislation of the Russian Federation. Thus, the current regulatory legal acts do not define the procedure for establishing the degree of loss of professional ability for the above-mentioned category of citizens by the bureau of medical and social expertise.
Moderator: Thank you, and the next question. Dear Sergey Ivanovich, my daughter is sick diabetes. For more than 5 years we were on disability, a disabled child, we underwent VTEK every year, all these 5 years were observed at the Diabetology Children's Clinical Hospital, we have complications, but on September 30, 2008, our disability was lifted from us. Can we recover?
Kozlov S.I.:
Let me remind you that the legislation provides for the possibility of appealing the decisions of institutions of medical and social expertise. Considering that a significant amount of time has passed since the last examination of your daughter and changes in her state of health could occur, we recommend that you undergo an examination in the prescribed manner, i.e. with a referral for a medical and social examination of the organization providing it with medical and preventive care, after the necessary diagnostic, therapeutic and rehabilitation measures have been taken.
Moderator: Since October 1, 2008, Decree of the Government of the Russian Federation dated April 7, 2008 N 240 "On the procedure for providing disabled people with technical means of rehabilitation and certain categories of citizens from among veterans with prostheses (except dentures), prosthetic and orthopedic products" has been in force, which greatly simplifies the receipt of disabled people means of rehabilitation. Tell us about his most important novels. How will this document affect the life of a sick person? Question from Renata Alexandrovna from the Ivanovo region.
Kozlov S.I.:
Decree of the Government of the Russian Federation of April 7, 2008 N 240 "On the procedure for providing disabled people with technical means of rehabilitation and certain categories of citizens from among veterans with prostheses (except for dentures), prosthetic and orthopedic products" adopted a new conceptual direction for providing disabled people, veterans, technical funds and services at the expense of the federal budget, thereby simplifying the procedure for providing disabled people with technical means of rehabilitation, and certain categories of citizens from among veterans with prostheses and prosthetic and orthopedic products. The rules for providing disabled people with technical means of rehabilitation are extended to persons under the age of 18 who are assigned the category of "child with a disability". The procedure for providing prostheses and prosthetic and orthopedic products to citizens from among veterans who are not disabled has been determined. The procedure for working with the application of a disabled person, a veteran is regulated: simultaneously with the consideration of an application for providing disabled people with technical means of rehabilitation, and for veterans of prostheses and prosthetic and orthopedic products, the executive body of the Social Insurance Fund of the Russian Federation forms a case, and at the same time sends (issues) a referral for obtaining (manufacturing ) a disabled person of the specified technical means of rehabilitation (product), and a veteran of a prosthesis, prosthetic and orthopedic product, and if it is necessary to travel to the location of the organization to which the referral was issued, a special coupon is simultaneously issued or sent for the right to receive travel documents free of charge.
I especially want to draw attention to the fact that if provided for by an individual rehabilitation program for a disabled person, a conclusion on the provision of prostheses, prosthetic and orthopedic products for a veteran issued by medical commissions medical organizations providing medical and preventive care to veterans, a disabled person (veteran) purchased a technical means of rehabilitation, a prosthesis and a prosthetic and orthopedic product at their own expense, compensation is paid in the amount of the cost of a technical means of rehabilitation, a prosthesis and a prosthetic and orthopedic product. The procedure for paying compensation has been determined if disabled people and veterans have independently provided themselves with the appropriate technical means of rehabilitation (product), prosthesis, prosthetic and orthopedic product by purchasing at their own expense, payment is made within a month from the date of the relevant decision. The procedure for the repair of technical means of rehabilitation, prostheses, prosthetic and orthopedic products has been determined, compensation is provided if a disabled person, a veteran independently repaired, respectively, a technical means of rehabilitation, a prosthesis, a prosthetic and orthopedic product, previously this norm was absent. The procedure and conditions for the replacement of technical means of rehabilitation, prostheses, prosthetic and orthopedic products have been determined. Eliminated the need for citizens to apply, both to medical institutions and to federal institutions of medical and social expertise, if individual program rehabilitation of a disabled person is developed before the citizen reaches the age of 18, or indefinitely, and the period of rehabilitation measures is determined by the period of use of the technical means of rehabilitation, prosthesis and prosthetic and orthopedic product.
The replacement of technical means of rehabilitation after the expiration of the established period of use is carried out by the executive body of the Social Insurance Fund of the Russian Federation at the place of residence of the disabled person, if there is a conclusion on the absence of contraindications to providing the disabled person with a technical means of rehabilitation. It has been established that technical means of rehabilitation transferred to the disabled, and prostheses, prosthetic and orthopedic products - to veterans free of charge for gratuitous use after the expiration of the period of use are not subject to delivery. Compensation is provided for when a disabled person or a veteran independently decides on the issue of travel to the location of the organization that provides prostheses and prosthetic and orthopedic products, previously this norm was absent.
Moderator: The Ministry of Health and Social Development of the FMBA of Russia was instructed to develop a concept for modernizing the work of medical and social expertise, which will subsequently be discussed at the Public Council under the Ministry. How is work progressing in this direction? Does the Federal Biomedical Agency already have any ideas and proposals, because you have accumulated a lot of experience on this issue? Asks Novikov Kirill Vyacheslavovich from the Bryansk region.
Kozlov S.I.:
Social policy towards disabled people should be preventive, socially efficient and economically feasible. The main tools for solving the problem of disability are: development and improvement of the regulatory legal framework, effective state regulation in the social sphere, application of the program-target method (meaning federal and regional target programs), introduction of innovative technologies (social, technical, economic, managerial, etc.), targeting and economic feasibility of decision-making, taking into account international experience in decision-making this problem.
Undoubtedly, the ITU service is currently in need of a serious reorganization, however, the reform of its activities should go along with a change in the country as a whole of the concept of disability, rehabilitation and social (including labor) integration of people with disabilities into ordinary living conditions. In itself, the reorganization of the ITU service may not have an effect if the system of rehabilitation of the disabled in the country is not debugged, affecting the reform and activities of healthcare institutions, the social sphere and other services engaged in this area of work. In our opinion, modern concept disability should move away from the usual pattern of a disabled patient. That is, when a patient without sufficient treatment, and the terms of this treatment due to temporary disability (up to 10-12 months), with the proper approach, allow you to get more favorable results, they are immediately sent to the ITU institutions, where they are established in accordance with the current criteria disability group and is being developed by the IPR for rehabilitation measures. Disability is often established only in order to receive free of charge (otherwise it will not be provided to a sick citizen) technical means of rehabilitation or dietary nutrition, sanatorium treatment; in other cases, to undergo retraining in another profession, in case of impossibility to work in their previous profession. Those. first we make a person disabled, and then we try to rehabilitate him. While in the entire civilized world, rehabilitation is carried out before the determination of disability.
"Major overhaul of the ITU system and rehabilitation" is the only option, in our opinion, to eliminate the current shortcomings. To this end, it is necessary to finalize the concept of improving the reform of the system of comprehensive medical and social rehabilitation of the disabled as soon as possible. At the same time, it is planned to regulate and simplify the procedure for sending citizens for medical and social examination, simplify the examination procedure, shorten the route of movement of a disabled person, expand the volume and improve the quality of medical, social and rehabilitation services provided to disabled people.
Host: Of the large number of disabled people who have indications for work, only a small part works. Judging by the polls, many are held back by the fear that when they get a job, they will remove their disability, and with it, benefits. But the majority still strives to undergo rehabilitation and get a feasible profession. However, to compete in the labor market with healthy people disabled people cannot. What measures have been taken in our country to encourage employers who employ people with disabilities, and what positive can be taken from the experience of foreign countries in this area?
Kozlov S.I.:
Today, the number of working disabled people is about 460 thousand people. According to expert estimates, employment among people with disabilities of working age in the Russian Federation does not exceed 15%. It is especially low among disabled people of I and II disability groups (8%). Low level employment of disabled people is due to a number of factors. Among them is the aggravation of the situation on the labor market as a whole, the existing “linking” of the amount of monthly cash payments to the degree of limitation of the ability to work, as well as the imperfection of the legal regulation of the employment of people with disabilities. To solve the problems of employment of disabled people, it also seems appropriate to combine the measures of quoting jobs for disabled people, as one of the guarantees of their employment, with measures to support employers, including subsidizing enterprises that use the labor of disabled people.
Moderator: Nowadays, the rule rather than the exception is the presence of huge queues waiting for the ITU. People lose nerves and money. What measures are being taken to remedy this situation? What is being done to improve the work of ITU institutions, to reduce queues? Asks Oleg Menshikov from the Moscow region.
Kozlov S.I.:
At present, in accordance with the Order of the FMBA of Russia, the structure of the ITU institutions has been determined, aimed at optimizing the activities of the bureau and bringing the medical and social expertise closer to the population, which, in turn, should have a positive impact on the quality of the expertise and eliminate the queue. To date, an insignificant priority remains in a number of constituent entities of the Russian Federation (St. Petersburg, Moscow, Moscow, Vologda, Oryol regions).
Moderator: Thank you very much, Sergey Ivanovich, for interesting and comprehensive answers, for taking the time to answer the questions of our Internet audience.
Internet interview organized by the company
Listen
Head - Chief Federal Expert on Medical and Social Expertise of the Federal State Budgetary Institution "Federal Bureau of Medical and Social Expertise" of the Ministry of Labor and Social Protection of the Russian Federation
In 1993 he graduated from the Moscow medical academy them. THEM. Sechenov, Faculty of Medicine.
Since 2002 - Deputy Chief Physician of the Clinic of the Federal Scientific and Practical Center for Medical and Social Expertise and Rehabilitation of the Disabled. He coordinated the work of all departments that took part in the medical and social examination and rehabilitation of citizens of the Russian Federation.
From 2005 to 2010 - Deputy Head of the Federal Bureau of Medical and Social Expertise. His area of responsibility included the creation of a structure and the subsequent functioning of the expert bureaus of the Federal State Institution "FBMSE", interaction with the main ITU bureaus in the constituent entities of the Russian Federation, as well as the development of a unified policy ...
in the implementation of medical and social examination of citizens of the Russian Federation, analysis of the level and causes of disability in the Russian Federation and its individual subjects, coordination of work on expert rehabilitation diagnostics.
In 2003, 2004 he took an active part in the international programs of the Russian-European Fund, dedicated to the rehabilitation aspects of socially vulnerable categories of the population and disability, independent life of persons with disabilities; has certificates of internships of higher educational institutions in Austria and the UK in the relevant areas.
In 2005, 2006 he worked as part of the Russian delegation at the 6th, 7th and final 8th sessions of the UN Special Committee on the development of the International Convention on the Rights of Persons with Disabilities.
In 2007, 2008, he twice took part in the sessions of the Committee of the UN Economic and Social Commission for Asia and the Pacific on food security, demographic development, health financing, as well as gender and disability issues.
By order of the Ministry of Labor of Russia No. 84-KR dated September 04, 2013, he was appointed to the position of Head - Chief Federal Expert on Medical and Social Expertise of the Federal State Budgetary Institution "Federal Bureau of Medical and Social Expertise" of the Ministry of Labor and Social Protection of the Russian Federation.
Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia for the improvement of medical and social expertise and rehabilitation of the disabled - doctor for medical and social expertise.
In 1984 he graduated from the Smolensk State Medical Institute with a degree in General Medicine.
In 2004, he graduated from the Oryol Regional Academy of Public Administration (Smolensk branch), with a degree in State and Municipal Administration.
1985 - 2001 - doctor-expert, chairman of the VTEC, head of the main bureau of the Smolensk region.
2001 - 2004 - head of the state service of medical and social expertise - chief expert of the Smolensk region.
2004 - 2007 - Head of the Department for Quality Control of the Organization of Social Assistance to the Population, the Federal Service for Supervision of Health and Social Development of the Russian Federation.
2007 - 2010 - Head of the Department of Medical and Social Expertise and Social Support for the Population of the Federal Medical and Biological Agency.
2010 - 2012 - Deputy Head of general issues activities of the institution of the Federal State Institution "Main Bureau of Medical and Social Expertise in the Moscow Region".
Since 2012, he has been Deputy Head - Chief Federal Expert in Medical and Social Expertise on improving the medical and social expertise and rehabilitation of people with disabilities.
Carries out:
Coordination and control of the activities of the departments of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia, participating in the provision public service on conducting medical and social expertise and rehabilitation of disabled people;
Organization of interaction between federal institutions of medical and social expertise in the constituent entities of the Russian Federation and the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia, including on issues of information support for the activities of institutions of medical and social expertise.
He is a candidate of medical sciences.
Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia for organizational issues
In 1991 she graduated from ShTIBO, Faculty of Technology.
Since 2003 - Scientific Secretary of the Federal Scientific and Practical Center for Medical and Social Expertise and Rehabilitation of the Disabled.
From 2010 to 2011 - head of the educational and organizational department of the educational and methodological center of the Federal State Institution "FBMSE".
Since 2012 - Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia for organizational issues.
He is a candidate of technical sciences, associate professor, author of more than 40 printed scientific papers, including 5 guidelines, 1 patent invention.
Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia for Economics and Economic Development Forecast
In 1997 she graduated from the Russian State Open Technical University of Railways, Moscow, qualification Engineer-Economist with a degree in Economic Informatics and Automated Control Systems.
In 2010, she graduated from the Financial University under the Government of the Russian Federation with a degree in Accounting, Analysis and Audit.
1999-2003 - Chief Accountant of the Federal State Institution Blood Center of the FMBA of Russia.
2006-2011 - Deputy Head of the Department for Planning the Costs of Healthcare and Educational Institutions of the Planning and Financial Department of the FMBA of Russia. Her scope of work included the planning and distribution of federal budget funds between subordinate institutions, the implementation of current financing for the remuneration of institutions, the priority national project "Health" in terms of payments to the District Service, SMPs and FAPs.
2011 - Head of the Planning and Economic Department of the Federal State Institution FB ITU.
2012 - Deputy Head of FGBI "FB ITU" of the Ministry of Labor of Russia.
2012 – to date, Deputy Head of the Federal State Budgetary Institution “FB ITU” of the Ministry of Labor of Russia for Economics and Economic Development Forecast.
Deputy Head for information technology
In 1979 completed full-time postgraduate study at the Moscow Institute of Radio Engineering, Electronics and Automation.
In 2009, preparation under the program of training for top managers DBA "Doctor of Business Administration" (Graduate School of Management of the State University Higher School of Economics).
From 1979 - 1993 Research Institute of Automatic Equipment. Academician V.S. Semenikhin. Deputy chief designer for software and information support, head of department.
From 1993 — 1997 Commercial companies. Information Technology Director.
From 1997 - 2000 Pharmaceutical trading company "Vremya". Deputy Financial Director for Information Support.
From 2000 - 2003 RUSAL - Managing Company (Russian Aluminum Management) is the managing company of the vertically integrated holding corporation Russian Aluminum. Director of the Information Technology Department.
Since 2003-2004 State University Graduate School Economics. Information Technology Director.
From 2004 - 2007 SSU "Russian Federal Property Fund". Deputy Head of Information Technology Department.
From 2007 - 2008 ANO GRP Inform-expertise. Director, Chief Designer of the State automated system(GAS) "Upravlenie", Chairman of the Council of Designers of the GAS "Upravlenie", Deputy Head of the Interdepartmental working group(MRG).
From 2008 - 2010 Ministry of Health and Social Development of the Russian Federation. Director of the Department of Informatization.
From 2010 - 2014 Medical Information and Analytical Center of the Russian Academy of Medical Sciences (MIAC RAMS). Information Technology Director.
From 2013 - 2014 RAMS Portal. CEO.
From 2014 - 2014 Intourist Hotel Group (since July 2014 Cosmos Hotel Management Company). Member of the Board, IT Director.
From 2015 - 2016 Deputy General Director of CMO "Medstrakh". Director of Information Technology Department.
From 2012 - 2016 Health modeling technologies. General Director, member of the Expert Council of the Russian Ministry of Health on the use of ICT in healthcare.
From 2016 to present Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia for IT.
He is a candidate of technical sciences, associate professor, author of 65 printed scientific papers.
Head of the Federal Center for Scientific, Methodological and Methodological Support of System Development complex rehabilitation and habilitation of disabled people and children with disabilities - Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia
1988 - Kuibyshevsky pedagogical institute them. V.V. Kuibyshev.
1994 - St. Petersburg State University, specialty: "Practical psychology in the health care system."
2000 - Institute of Psychology and Pedagogy, Moscow, specialty
"Psychological Counseling".
From 1998 to 2004 - medical psychologist in the State Institution "GB ITU for the Samara Region".
From 2004 to 2018 - Director of the State Budgetary Institution of the Samara Region "Social and Health Center" Overcoming ".
Since 2019 - Head of the Federal Center for Scientific, Methodological and Methodological Support for the Development of a System for Comprehensive Rehabilitation and Habilitation of the Disabled and Disabled Children - Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia.
Is a candidate psychological sciences, (2004), author of more than 30 publications.
Deputy Head of FGBU FB ITU Ministry of Labor of Russia | Honored Worker of Social Protection of the Russian Federation
In 1975 she graduated from the Ryazan Medical Institute named after Academician I.P. Pavlova with a degree in General Medicine.
From 1975 to 1979 - Inspector-doctor of the Department of Medical and Labor Expertise of the Ministry of Social Security of the RSFSR.
From 1979-1981 - clinical residency in the specialty: " internal illnesses» Central Research Institute for the Expertise of the Ability to Work and the Organization of Labor of the Disabled.
From 1981 to 1992 - Head of the territorial department of the Office of Medical and Labor Expertise of the Ministry of Social Security of the RSFSR.
From 1992 to 2000 - Head of the ITU Department of the Department for the Rehabilitation and Social Integration of Disabled Persons of the Ministry of Labor and Social Protection of the Russian Federation.
From 2000 to 2004 - Deputy Head of the Department of the Ministry of Labor and Social Protection of the Russian Federation.
From 2004 to 2008 - head of the department on disability issues of the department for the development of social protection of the Ministry of Health and Social Development of the Russian Federation.
Since 2009 - head of the center for documentary support of the activities of the expert bureaus of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia.
From July 14, 2014 - Head of the expert teams of the Federal Bureau, Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia (Order No. 6 35-l dated July 14, 2014)
Head of the information and reference center for the support of citizens - deputy head
In 1984 she graduated with honors from the Moscow aviation institute them. Sergo Ordzhonikidze with a degree in Spacecraft Flight Dynamics and Control with a qualification of systems engineer.
In 1994 she graduated from the International Academy of Marketing and Management with a degree in Finance and Credit with a Master's degree in Economics.
Graduated with honors in 2007 Russian academy public service under the President of the Russian Federation with a degree in Human Resources Management with the qualification of a manager.
From 1996 to 2012 - Director of the state budgetary cultural institution of the city of Moscow "GBUK DK" Astrum ".
From 2012 to 2014 - Vice-Governor of the Primorsky Territory for health, education, culture, social protection, physical education and sports.
Since 2015 - Head of the Information and Reference Center for Citizen Support - Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia.