It is important for a patient to know where to complain about unscrupulous doctors. Inspections by regulatory authorities in the healthcare sector: general provisions We write the appeal clearly and concisely

27.06.2020 -

In accordance with Article 9 Federal Law dated November 21, 2011 No. 323-FZ"On the basics of protecting the health of citizens in Russian Federation" (hereinafter referred to as the “Fundamentals”) state authorities and local government bodies, officials of organizations bear, within the limits of their powers, responsibility for ensuring guarantees in the field of health protection established by the legislation of the Russian Federation. One of the measures designed to ensure guarantees in the field of health protection, is state control.

can be, For example:

Monitoring the implementation of clinical trials medicines and clinical trials of drugs;
Monitoring compliance with licensing requirements when carrying out pharmaceutical activities;
Federal state supervision in the field;
Control for ; quality control of medicines in civil circulation;
Monitoring compliance by medical organizations and individual entrepreneurs carrying out medical activities; control over compliance by medical organizations and individual entrepreneurs carrying out medical activities, standards medical care ;
Monitoring compliance with the procedure for conducting examinations for the presence medical contraindications to driving a vehicle;
Monitoring compliance with the procedure for conducting military medical examinations, incl. independent military medical examination;
Monitoring compliance with the procedure;
Monitoring compliance with the procedure for conducting examination of temporary disability;
Monitoring compliance with the procedure for conducting forensic psychiatric examinations;
Monitoring compliance with licensing requirements when carrying out activities for the production and maintenance of medical equipment (except for the case if the maintenance is carried out to meet the own needs of a legal entity or individual entrepreneur).
Monitoring compliance by subjects of treatment medical products rules in the field of circulation of medical devices; carrying out, in accordance with the established procedure, inspections of the activities of organizations engaged in the production, circulation and use of medical products;
State control over the application of prices for medications included in the list of vital and essential drugs.
Compliance monitoring;
Monitoring the implementation of health care modernization programs in the constituent entities of the Russian Federation and federal modernization programs government agencies, providing;
Others.

Inspections must be carried out strictly in, established by law, and upon completion of the inspection an inspection report is drawn up.

When conducting an inspection, employees of the state control body, upon presentation of their service certificates and the decision of the head of the state control body, his deputy on conducting an audit of compliance with the legislation of the Russian Federation in the field of health protection, the legislation of the Russian Federation on the circulation of medicines they have a right(Article 86 of the Fundamentals):

Organize necessary research, tests, examinations, analyzes and assessments, including scientific research on issues of control in the established field of activity;
Request and receive information necessary for making decisions on issues within the competence of the state control body;
Giving legal entities and to individuals, explanations on issues within the competence of the state control body;
Involve, in the prescribed manner, scientific and other organizations, scientists and specialists to study issues in the field of health protection;
To freely gain access to the territory of the inspected bodies or organizations or to the buildings, structures, structures, premises used by these bodies or organizations in carrying out their activities, to the equipment used by them, similar objects, vehicles and transported goods;
Take samples of manufactured goods in established by law Russian Federation order;
Make copies of documents necessary for carrying out state control in the field of health protection in the manner established by the legislation of the Russian Federation;
Apply restrictive, precautionary and prophylactic measures provided for by the legislation of the Russian Federation, aimed at preventing and (or) eliminating the consequences of violating the legislation of the Russian Federation in the field of health protection, the legislation of the Russian Federation on the circulation of medicines.

At the same time, legislation certain restrictions have been introduced during inspections. For example, officials of the control (supervision) body do not have the right to inspect activities if this is beyond the scope of their powers (for more details, see the Law on Protection). An order to eliminate violations, and not an administrative measure. But during the inspection, officials, within the framework of their powers and in accordance with the provisions of the Code of the Russian Federation (hereinafter referred to as the Code of Administrative Offenses of the Russian Federation), may, under the relevant article of the Code of Administrative Offenses of the Russian Federation.

The rules of administrative proceedings are regulated by other legislation, namely: the Code of Administrative Offenses of the Russian Federation. But a medical or pharmaceutical organization may be punished for failure to comply with an order given by a supervisory authority during an inspection (Article 19.5 of the Code of Administrative Offenses of the Russian Federation) or, for example, for obstructing the legitimate activities of an official of a state control (supervision) body to conduct inspections or evading such inspections (Article 19.4.1 of the Code of Administrative Offenses of the Russian Federation).

Also, in accordance with Article 17 of the Law on Protection, supervisory authorities have the right to impose sanctions on organizations in the manner established by the Code of Administrative Offenses of the Russian Federation when establishing, during an inspection, facts indicating that the activities of a medical or pharmaceutical organization pose a direct threat of harm to the life and health of citizens, harm to animals , plants, environment, state security, the occurrence of natural and man-made emergencies, or such harm has been caused.

The topic of inspections by line control always causes trembling in the hearts of managers and employees of medical organizations, because line control is an indicator of the shortcomings that exist in our work.
What legal acts regulate inspections by line control of medical institutions?
1. Order of the Moscow Health Committee dated July 22, 1997. No. 416“On the control and administrative service of the Moscow Health Committee” (together with the provisions on the operational and administrative group of the control and distribution service of the Moscow Health Committee,” “On the line control group ...”)
2.Order of the Moscow Department of Health dated May 15, 1996. №292“On the implementation of categories of deficiencies identified in medical institutions by the line control group of the Department”
3. Letter from the Department of Health of the Moscow Government dated August 10, 1995. No. 25/09-95“Methodology for checking linear control of outpatient clinics”

History of creation with line control services of the Moscow Department of Health (formerly the Moscow Health Committee).
The line-control group of the control and administrative service of the Moscow Health Committee was created for the purpose of operational management and rational use of the forces and means of city healthcare, improving the quality of medical care for citizens, carrying out daily operational control over the activities of medical and preventive institutions subordinate to the Committee, adopting urgent measures to eliminate deficiencies in their work.
The linear control group includes a doctor (or 2 doctors) and the driver of the duty car.
Experienced doctors from among the employees of the Moscow Department of Health and its subordinate institutions, who are in the reserve for promotion to leadership positions, who have experience in medical and organizational work in healthcare, and who are capable of accepting independent decisions, aimed at organizing the actions of the city’s medical service in various situations.

Tasks of the line control service doctor:
1. operational control of the work of medical and preventive institutions subordinate to the Department of Health of the city of Moscow (except for substations of the SSiNMP, emergency departments and intensive care units of hospitals that are part of the emergency medical care service);
2. fulfillment of any operational tasks of the head of the Department of Health (deputy heads) and direct management for the organization of emergency or planned medical care in the field;
3. information to the head of the Department (at operational meetings) about identified shortcomings in the work of inspected medical organizations.

Rights and responsibilities of the line control group doctor:
1. upon presentation of an official ID - unhindered entry into treatment and preventive institutions subordinate to the Department of Health to check the work of any structural units in connection with an emergency or on a scheduled basis.
2.at emergency situations or disobeying the duty officer, medical personnel legal requirements of doctors of the control and administrative service of the Department of Health - calling the heads of institutions to their workplaces (including from home).
3. upon completion of the inspection - preparation of documentation.
3.1. in an inspected institution - the journal of the control and administrative service of the Moscow City Health Department (together with the doctor on duty - the head of the medical institution).
3.2. in the Department of Health - the inspection report of the doctor of the control and administrative service of the Moscow Department of Health.

How is line control checked?
Representatives of line control come to the medical institution at very different times:
1) before the institution starts operating,

2) at the end of the working day, sometimes just before the end,
3) late at night (usually in the interval from 23.00 to 4.00),
4) weekends and holidays.
IN Lately repeatedcases of inspection by line control for two consecutive days. Be carefull!

The line control service of the Moscow City Health Department inspects not only medical institutions located in Moscow, but also remote DZM objects located on the territory of the Moscow region(any time of the day!).

Objects of inspection may include all offices and structural units of the institution, information stands of the institution, and the territory adjacent to the medical institution.

Checked Availability of work schedules for structural units and duty schedules on weekends and holidays of the month, work schedule of the duty administrator.

In hospitals, very often the line control doctor asks to provide information on the number of patients in the department, then checks this data against availability individuals is currently recalculating medical histories. Moreover, recently, control of the number of patients in the department is carried out even at night, including medical institutions specialized type - drug treatment and psychiatric hospitals. An employee of the line control service quietly enters the room, turns on the light and counts all the patients head by head.

January 2017 in inpatient medical institutions began with monitoring the compliance of the number of beds according to the staffing table with the actual number of beds. During the inspection, the doctor of the line control service of the Health Care Department recalculates all the beds currently deployed in the medical institution, taking into account the “reserve” beds of the isolation ward.

Strictly checked according to schedule availability of medical personnel at the workplace medical institution. It is necessary to provide an identification document - this can be a passport or a pass to a medical organization, which mandatory every employee must have.

Are being checked rooms with aseptic operating conditions(procedure rooms, operating rooms, vaccination rooms, endoscopy rooms, dental offices, sanitary rooms).

Doctor-methodologist of the line control service of the Moscow Department of Health has access rights to any room medical organization any time of the day!
Are being checked storage rooms for narcotic drugs and their residues.
The test results are entered into control and administrative service journal in a medical institution and checking act according to Appendix 5 to Order of the Moscow Health Committee dated July 22, 1997. No. 416 “On the control and administrative service of the Moscow Health Committee” , with the obligatory indication of the assessment of the identified deficiencies using a four-point system. As a rule, in a medical organization this journal is called Line control log and is always kept in the reception department. The Line Control Log should always be kept copies of reports of all inspections performed. The methodologist of the line control service of the Department of Health Care must check the identified deficiencies of the previous inspection for elimination and record this fact in the report.

What practical experience do you have with line control inspections?

Let's look at one of the checks on compliance with the rules for handling narcotic drugs on weekends and holidays in the clinic (in a medical institution, the line control doctor is accompanied by an administrator on duty during the check).
Representatives of line control checked the premises where the safe was located for storing the remains of narcotic drugs handed over over the weekend.
We checked the presence and correct storage of the keys to this room and the safe.
We checked the correctness of the log of the transfer of keys to the safe of the doctor on duty.
We checked the presence in the safe of a copy of the license for the right to work with narcotic drugs, a list of patients receiving narcotic drugs in the current month, a certificate for the safe, a table of the highest single and daily doses of narcotic drugs, a table of antidotes to narcotic drugs.
Another situation, this time line control is carried out due diligence.
The line control doctor checks:
sanitary condition adjacent territory(lighting, including in front of the entrance emergency department; the line control doctor, passing through the checkpoint of the medical institution, assesses the availability of access control; available for all vehicles when parked in the checkpoint area in a visible place under the windshield)
availability of a copy of the license at the registry
Availability of a linear control log
Availability of a vehicle operation log and the procedure for maintaining it
availability of keys to all premises
Availability of security and the procedure for its operation
clinic schedule
schedule of doctors and support services
availability of information about the work of specialists in other medical institutions, including auxiliary services, in their absence in this medical organization
availability of information on the provision of traumatological, dental, ophthalmological, psychiatric, drug treatment, anti-tuberculosis, dermatovenerological and other care during the day and at night
operating hours of the medical and physical education clinic, rehabilitation treatment clinic
addresses and telephone numbers of nearby pharmacies
addresses and telephone numbers of medical and social expert commissions
addresses and telephone numbers of higher-level organizations (health administration, health department, prefecture)
information about the duty administrator (full name, location, telephone number, presence of an order or approved schedule of duty administrators)
Appointment times for the chief physician and his deputies by day of the week
on the procedure for organizing an extraordinary reception of preferential contingent
list of population groups entitled to free and preferential leave medicines
availability of information about insurance companies (time of issuance of compulsory policies health insurance, address and telephone number of the insurance company)
presence or absence paid services(if there are paid services - the procedure and organization of payment)
organizing appointments with doctors (preliminary and during the day), especially with specialists
organization of the work of the registry and card storage: the state of outpatient cards
availability of a book for recording proposals, administration work with critical comments and thanks
organization of receiving house calls on weekdays from 14:00 until the clinic closes
call execution time from the moment it is received
organization of provision emergency care: the presence of a doctor making house calls, in treatment room, or in the office intensive care
availability of instructions and a set of medications for providing emergency care for cardiogenic shock, anaphylactic reaction and others emergency conditions
shelf life and storage conditions of medicines
sanitary condition of offices and implementation of anti-epidemic measures by medical personnel, knowledge of the rules of the anti-epidemic regime by staff
availability and accessibility of instructional material, protective suit, actions of personnel in case of identification of a patient with special dangerous infection
Availability of emergency stowage in the rooms and ability to use it
availability and use of disposable syringes
quality and sufficiency of dental, otorhinolaryngological, ophthalmological, surgical instruments
fire safety conditions of the clinic premises

How otse
detected during line inspectionm, lackki?
The deficiencies identified during the inspection of line control are assessed according to the table “Categories of deficiencies identified in health care facilities by doctors of the line control service of the Moscow Health Department.” These categories are reflected in

Illegal actions of employees of state medical institutions can be suppressed by citizens of the Russian Federation. Any mistake by a doctor in a clinic or hospital, or simply rude attitude towards patients, is punishable by law.

We will tell you who and where to complain about such careless specialists, and answer all important questions.

The rights of patients in Russian hospitals and clinics, which may be violated by unscrupulous doctors and health workers

Russian citizens should know their rights when coming to a hospital or clinic.

Everyone can count on:

Respectful and humane attitude towards yourself.
Appropriate conditions of stay in the institution.
Opportunity to consult.
First aid.
Keeping your personal life secret.
Choosing a doctor with whom you want to be treated.
Informing and obtaining any medical information.
Receiving VHI services.
Possibility of refusing medical intervention.
Familiarization with medical documentation that concerns the patient.
Compensation for damage that could have been caused to the health or property of a citizen.
Admission of a legal representative along with a sick patient.
Reimbursement of expenses that were unreasonably spent when receiving medical care under the compulsory medical insurance policy.
Support is not only medical, but also emotional and spiritual.
Appealing unlawful actions of doctors and employees of medical organizations.

If the above rights are violated, the patient can report the actions of an unscrupulous employee to government agencies and other organizations designed to monitor the work of medical institutions.

This is what it says federal law number 59 and the title “On the procedure for considering appeals from citizens of the Russian Federation”, adopted on May 2, 2006 under the editorship of the current year.

Where to complain about a doctor in a hospital or clinic - all options

There are several options for where to complain about a doctor at a hospital or clinic.

We list the authorities that can help solve the problem and understand the situation.

1. To the head of a medical organization - chief physician or manager

Of course, it is better to try to achieve justice on the spot. By determining the level of seriousness of the problem, you can decide for yourself who to contact and whether to file a complaint.

For example, for rudeness or lack of service, a patient can come to the manager and complain about the employees.

The manager, in turn, must resolve the situation, accept the complaint and find out who was right and wrong.

If you submit a complaint in writing, then require a written explanation from the head of the organization.

In the case when the head of the medical institution sided with the culprit and did not solve the problem, you can move on to other, more serious measures.

2. To the reception of the Ministry of Health of your district or region

1) You can always contact the ministry reception personally.

Better prepare your complaint in advance so as not to explain in words the problems that have arisen and your desires and requirements.

2) You can also submit an application online, by writing to the ministry's address, or using the online form on the website.

3) Another way to complain is write a letter to mailing address organizations.

Your complaint must be answered in writing within 1 month., and when applying in person, they must issue a notice confirming acceptance of the document.

3. To law enforcement agencies

If the violations are very serious and violate the rights and interests of citizens, then you can file a complaint with the prosecutor’s office.

This body can not only deal with the problem, but also identify the culprit in order to bring it to justice.

A prosecutor's inspection can be provided to a medical institution if a citizen's appeal indicates violations of current legislation.

Within 30 days you must be informed whether a criminal case will be initiated or not.

4. To court

A written statement to the prosecutor's office can also be sent to the court.

If you want to receive monetary compensation for harm caused, or for unreasonably spent funds on the purchase of medicines, although they should have been provided by a hospital or clinic, then the court will help you with this.

Also, through the courts, it is possible to punish the perpetrators of illegal actions that were committed against patients of medical institutions.

When writing statement of claim It should be noted that everything written must be supported by documents.For example - certificates, extracts, contracts or video and photographic materials.

You can even find witnesses to the crime that occurred.

5. To the local police station

If a crime has been committed against a citizen that has caused harm to health or life, then you should contact the police.

It is the staff's responsibility to understand the situation, review the complaint, and advocate for you by taking action against the health care provider.

But there are times when there is no point in contacting the police.. For example, when the crime was not committed through the doctor’s fault and not intentionally.

It is worth noting that a hospital and a clinic are almost one medical institution, so there should be no division into where to complain about one of the organizations - of course, to the same authorities.

The most common situations in which it is necessary to complain about doctors - lawyers comment

We will answer the most common questions asked by patients who have encountered chaos in Russian hospitals and clinics.

- I'm pregnant, and the doctor yelled at me. Where can I complain about the rudeness and rudeness of a doctor?

The first person who should help you is manager or chief physician hospitals , which you contacted. Talk to him, explain which doctor was rude or yelled at you, and then ask him to sort it out and transfer you to another specialist.

If the head doctor is not on your side, then file a complaint to the Ministry of Health of your area . They will definitely not ignore your request.

- The doctor refused to see the patient or come to the call - where to complain about the refusal of medical care?

Medical care that should be provided to citizens of the Russian Federation is strictly controlled.

If you received assistance when going to a hospital or clinic, you can complain to the following authorities: Administration of the medical institution, Ministry of Health, Social Insurance Fund.

If refusal to help leads to serious consequences, for example, the death of the patient, then you can contact to the prosecutor's office, police, court.

- The doctor demands a bribe, makes hints, or drags out time in providing assistance to the patient.

In the event that a medical professional demands or hints at a bribe from you, you should prepare evidence of this.

You can record the conversation on a voice recorder, agree on the amount, and then contact the authorities so that it is no longer you who understands the problems.

It is worth contacting law enforcement, police, calving federal security, Public Chamber of the Russian Federation, Tax Service.

- The doctor refused to issue a sick leave certificate.

If there are no compelling reasons for this, then solve the problem first with the head of the medical institution - chief physician or manager . Ask to find out why the doctor does not want to give out sick leave, although it should.

If the medical organization was unable to solve the problem, then contact to the Ministry of Health. They must consider your complaint within 1 month.

- The doctor made the wrong diagnosis and prescribed the wrong treatment.

First, write a complaint to chief physician of a medical institution .

If the clinic administration does not resolve the issue, then contact the following authorities: Ministry of Health, prosecutor's office, court, police .

Often incorrect treatment and an incorrect diagnosis leads to serious problems with health, so you should not ignore irresponsible, inattentive health workers.

- Doctors refused to issue documents for disability. Where to complain?

Registration of disability is a rather long process. However, if you are immediately denied registration for disability, you should contact to the administration of the hospital or clinic, and try to resolve the issue with the head physician. Usually you have to write an application, after which a commission is convened, which decides whether or not to issue documents for disability.

You can also contact with a complaint that you are being denied paperwork.

- The doctor does not provide assistance to the patient. Where and how to complain about a doctor’s inaction?

Unfortunately, ignoring requests for help or inaction on the part of employees of medical institutions can occur in medical institutions in Russia.

You can complain about an irresponsible doctor, firstly, to the administration of the medical organization .
Secondly, you can contact to the Ministry of Health .
If inaction goes beyond all limits, and this poses a direct danger to the life and health of a citizen who goes to the hospital, then you can attract law enforcement and police .

- The doctor treats his duties in bad faith. How to complain about doctor negligence?

In the event that the patient was harmed intentionally, on purpose, then you should contact to the prosecutor's office or police .

According to current legislation, there is an article for negligence or dishonesty of a doctor - 293 of the Criminal Code of the Russian Federation.

After considering your application, law enforcement officials must conduct an investigation and either initiate a criminal case or refuse to initiate one.

In other cases, you can complain about negligence to the administration of the medical institution, and then to the Ministry of Health .

- The doctor does not write out the required prescription.

Doctors are not always to blame for this problem.

However, if you are sure that the pharmacy has necessary medicine, but the doctor simply voluntarily refuses to issue a prescription, then you should write a complaint and send to the administration of the medical institution, Ministry of Health .

If after this the problem is not resolved, write a complaint to the prosecutor's office .

- They were rude at the clinic reception desk.

Ordinary rudeness can be stopped with a complaint written to chief physician, head of a hospital or clinic.

If you understand that this will not solve anything, and the doctor will be on the side of the nurses working at the reception, then write a complaint to the Ministry of Health .

- Inappropriate behavior of doctors and medical staff in a hospital or clinic - where to complain?

There can be many examples of inappropriate behavior of medical personnel.

For example, doctors “celebrate” a holiday at the workplace (such cases are especially common on New Year’s or May long weekends) and drink, or simply do not pay attention to patients who need to provide first aid. The doctor can be held accountable for such inappropriate behavior.

This control system is equally relevant for all medical organizations, including those working in the field of cosmetology and plastic surgery. Private practitioners are also included in the scheme.

About the new controls medical activities the portal site already wrote at the state level at the end of last year.

You can fully familiarize yourself with the Decree of the Government of the Russian Federation of November 12, 2012 “On approval of the Regulations on state control of the quality and safety of medical activities” in the Legislation section.

What was missing, in fact, was the third link connecting state and internal control. And this link is now defined as departmental control, which is carried out by the Russian Ministry of Health.

The Ministry of Health, by order of December 21, 2012, approved the Procedure for organizing and conducting departmental control of the quality and safety of medical activities.

What will be the tasks of departmental control?

prevention, detection and suppression of violations in the work of medical organizations;
responding to violations discovered during security measures state control;
ensuring the quality of medical care;
determination of quality indicators of medical activities;
compliance with the volumes, terms and conditions of medical care;
creation of a system for assessing the performance of medical workers involved in the provision of medical services.

Naturally, the verification algorithm begins with whether the organization and its doctors comply with the operating procedures for providing medical care in the relevant profile.

In aesthetic medicine, this is the Order of the Ministry of Health and Social Development of Russia dated April 18, 2012 “On approval of the Procedure for providing medical care to the population in the field of cosmetology” and the Order of the Ministry of Health of Russia dated October 30, 2012 “On approval of the Procedure for providing medical care in the field of plastic surgery.”

The inspections will evaluate:

1) compliance with the stages, conditions and terms of medical care;

Naturally, this type of check is directly related to how the doctor keeps records medical documentation. An analysis of the patient’s outpatient card will immediately put everything in its place.

It is timely to say here that the portal site will organize a special project of the Russian Medical Academy on October 12, 2013, within the framework of which a workshop will be held for chief doctors and cosmetologists on filling out a patient’s medical record, as the main type of accounting documentation in medical institution. The organizers of the business laboratory will provide participants with a new electronic service that allows them to bring the diagnosis of a patient at a cosmetology clinic in accordance with ICD-10.

2) the doctor’s compliance with the requirements of the provisions regulated by the procedures for providing medical care;

The doctor’s personal file should contain copies of documents confirming his qualifications - diplomas, specialist certificates (valid certificates, not expired!). The list of documents and qualification requirements can be found in the Order dated 07.07. 2009 "On approval of qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare."

3) compliance with the requirements of equipment standards of a medical organization and its structural divisions;

This is the area of competence of the head of the clinic, but, in any case, the doctor can familiarize his head with the standard of equipment for the office, which for cosmetologists and plastic surgeons is contained in orders of the Ministry of Health No. 381n and No. 555n.

An important point: a doctor is hired for a position that is approved by the staffing table, and it is this position that is recorded in his work book. If the staffing table says one thing, but work book other, in the certificate - third, then this will not allow confirming work experience in the specialty in the future. Meanwhile, the Order of the Ministry of Health of the Russian Federation dated August 3, 2012 "On approval of the procedure and timing for improvement medical workers and pharmaceutical workers professional knowledge and skills through training in additional professional educational programs in educational and scientific organizations" states that one of the mandatory conditions enrollment in additional training programs vocational education- this is the presence of documents confirming continuous experience practical work in the relevant medical specialty.

This happens quite often. In the staffing list there is a cosmetologist, in the work book - a dermatologist, in the certificate - a dermatocosmetologist. So understand who is currently in front of the commission checking the doctor’s activities!

So, the control system has been built.

Where should doctors themselves begin to work within it?

From putting things in order in your workplace. Let's go through this briefly:

We make a list of equipment that should be in the office and give it to the head of the clinic.
We put magazines in order and outpatient cards patient, we store the latter in a locked cabinet, since only the doctor is responsible for maintaining medical confidentiality.
We analyze the list of services provided, assess their legality on the market aesthetic medicine and we are aware of the danger if they are not included in medical services.
Check the services and quality of the ones used cosmetics Can
We check the legality of the medical products we use during work. How to do this, read