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Work of the program “Hippocrates” in the Rivne region

Larisa Simonovich, Rivne

In connection with active discussion of patients’ rights in the recent numbers of the bulletin “Prava ludyny”, we want to propose to our readers the brief information about the work of the program “Hippocrates” in the Rivne region. We also want to tell about our successes and failures and to present our propositions aimed at development of human rights protection movement in the Rivne region. Besides, we are inviting for cooperation and exchange of experience the organizations, which work for prevention of violations of the rights of patients and medical staff.

In March 2005 the Rivne regional department of the International charity foundation named after Saint Ksenia Peterburgska elaborated and realized the program ““Hippocrates” – school of rights and duties of patients and medical staff”.

The program was realized by efforts of the initiative group, without any help on the side of state and other organizations and agencies. Now many specialists are taking part in the program: experienced lawyers, medics and psychologists, as well as volunteers.

We are sure that the program “Hippocrates” will become a pilot project, which has started in the Rivne region and will extend over the whole country.

The main goals of the program ““Hippocrates” – school of rights and duties of patients and medical staff” are:

-  increase of activity of civil society;

-  change of attitude of people to their rights and duties, creation of the idea of personal responsibility for one’s health, responsibility of parents for health of their children, responsibility of bosses for health of their subordinates and responsibility of the state for health of the entire nation.

-  explanation to citizens of their rights and teaching them to protect these rights in state medical establishments, to demand from administration of medical establishments distinct determination of medical services, which must be rendered free of charge in state medical establishments according to the Constitution of Ukraine (taking into account the decisions of the Constitutional Court of Ukraine), and substantiation of paid services in state medical establishments with the detailed calculation of prices for these medical services;

-  change of the attitude of population and medics to the idea that the source of filling of doctor’s purse is not the almost empty purses of patients, but adequate remuneration, at the expense of the state, of the work of people, who are responsible for the greatest value – health of citizens;

-  promotion of activities of the movement of medical staff for defense of honor and dignity, social protection and respect to the people in the white smocks, who came into medicine by the dictate of their heart and live now in poverty;

-  rendering, in public reception office of the program “Hippocrates”, consultations on the instances, where one should turn for solution of certain problems, with the obligatory control of the process of consideration and taking decisions on the handed propositions, applications or complaints.

By now “Hippocrates” has given a great number of free oral and written consultations to medics and their patients; a number of letters (applications, complaints, informational requests) were prepared and sent to the organs of state power, prosecutor’s offices and state medical establishments.

Among the questions, which were brought up by “Hippocrates” in its appeals and letters, there were: violations of labor laws, ungrounded creation of temporary staffs of medics, violation of the conditions of coercive treatment of patients in psychiatric hospitals, awful conditions in some medical establishments, cases of persecution of medics that did not agree with the misuses of administration of the establishments, work of hospital cash desks, guaranteeing of citizens’ right for obtaining of free urgent medical aid, etc. Besides, a lawyer of “Hippocrates” took part in defense in court of the rights of a doctor, who was a subject of disciplinary punishment because of his active civil position and disagreement with the actions of hospital administration.

When “Hippocrates” sent a request on availability, list and grounds of paid services in the state medical establishments, ALL medical establishments answered: “… we do not render paid services…”

The only exceptions are the sanitary-epidemiological stations, which render the paid services on the basis of the tariffs approved by the Cabinet of Ministers, and the anonymous departments of dermatovenerologic dispensaries.

So, a logical question appears: why patients are forced to pay their money at every step in a hospital? If it is a charity contribution, then why its amount is fixed? The legislation clearly reads: charity is voluntary and does not imply obtaining of any services or compensation for the paid sum, the amount of charity contributions cannot be regulated. Why different hospitals demand different sums for the same type of examination? How these “charity contributions” are registered and spent?

The demands of the operating laws, which oblige state officials to respond to the appeals of citizens and organizations, are frequently violated too. “Hippocrates” has not received any answers from several medical establishments until now, although all terms have already expired. Now we are preparing the appeal to the organs of prosecution with the description of these violations and demand to bring the guilty to responsibility.

There are many interesting stories about the doctors, who work in medicine by their vocation and refuse to fulfill obviously criminal orders of administration concerning the coercive payment of “charity contributions” by patients. Such doctors are called “rara avis”, they are victimized, because, allegedly, they are guilty of absence of most necessary drugs and equipment in hospitals.

Well, is it a duty of medics to procure money for the needs of hospitals? Why the situation is common, when, by the oral order of head physician or administration of the hospital, medics realize current, and sometimes even capital, repair of hospital rooms at their own expense? I do not believe that medics, with their misery salary, can afford to have one more item of expenditures, such as “repair of workplace and hospital building”.

Minister of health protection M. Polishchuk states that it is normal, when a patient gratifies his doctor, but we believe that the best gratitude for a medic, who helps and treats, but not only earns money, must be good health of his patients and adequate payment of his work by the state. Why a doctor must count patient’s money in order to assess his ability to pay for “free” medical aid?

We also may not ignore the problem, which is not regulated either on legislative level or on the level of branch norms. Accurate differentiation is absent in Ukraine of the concepts “medical aid”, “medical service”, “obligatory medical examination” and “additional medical examination”. It is also incomprehensible what is included into the sphere of urgent aid.

Absence of such differentiation and legal definitions was pointed out by the Constitutional Court of Ukraine in its decisions No. 15-рп/98 of 25 November 1998 and No. 10-рп/2002 of 29 May 2002. Yet, in spite of obligation of these decisions, no competent organ (the Supreme Council of Ukraine, Cabinet of Ministers, State committee of statistics, State committee of standards, etc.) regulated this question in proper way.

Medics of the Rivne region introduced their own interpretation of the term “medical service”: application of phonendoscope or sensor of the ultrasound apparatus, insertion of probe, incision of skin during surgery operation, stirring of blood in test-tube and so on. So, there is a service, and it is rendered “free of charge”, but one must pay for all components of this procedure, or, what is even more frequent, the components must be provided by the patient. At the same time, the medics do not give any grounds of quantity of materials and drugs, which must be brought for examination (operation, delivery), their practical necessity and expediency of such quantity. We know a vivid example, when it was proposed to a patient to bring 60 (sixty!) meters of gauze for insignificant operation.

However, “Hippocrates” SUPPORTS the existence of insurance medicine, hospital cash desks, paid medicine and, especially, private medical establishments (where it is clear to whom and for what you pay), but with plain and transparent system of tariffs and well-grounded calculation of cost of services.

We do not understand the position of the state, which, on the one hand, creates the extremely thorny path to legal private medical practice (complications with registration and obtaining of licenses, noticeable taxes, large quantity of inspecting and controlling organs, etc.), ignoring the untaxed incomes of medical staff from the pockets of patients and their relatives, and, on the other hand, regularly says about budget deficit and absence of funds for proper financing of state medical branch.

“Hippocrates” supports the establishment of the distinct amount of aid and examinations, which should be guaranteed to every citizen, especially in critical situations, and rendering of all additional services or examinations by patient’s wish and for separate pay.

Unfortunately, today the number of questions essentially exceeds the number of answers. And the problem is not in the honest medics, who try to survive for scanty salaries, which are even lower than the cost of living. The problem is in consciousness of all citizens, in attitude to this question of everybody, independently of his role in this situation.

“Hippocrates” turns to everybody, who is not indifferent and wants to change the existing state in medicine, with the appeal: “Let us change our attitude to medicine and provide with adequate salaries the people in white smocks!” Then nobody would demand to pay for medical services under the pretext of low salaries and absence of proper financing.

“Hippocrates” plans to realize the following tasks:

-  informing of wide circles of citizens about their patients’ rights;

-  explanation of everybody’s duty to care about own health, to fulfill thoroughly the instructions of doctors;

-  persuasion of medics that it is necessary to demand from the state proper financing and adequate salaries on the European level, instead of obtaining the minimal wages, balancing on the verge of criminally punishable actions (bribe-taking, untaxed income, not-rendering of medical aid because of insolvency of patient, etc.) and looking for alternative between the welfare of their families and fulfillment of professional duty in accordance with laws.

We will be happy to receive letters from the like-minded persons and those, who want to change our medicine. We also are grateful in advance to those, who do not agree with us and have other opinion, since the constructive (objective and well-founded) criticism will help us and will promote better and more optimal solution of the existing problems.

We will consider the propositions on cooperation and united overcoming of difficulties in medicine, we are ready to join the existing projects aimed at solution of similar problems.

“Hippocrates”, in its turn, will readily share its ideas concerning the necessary changes and ways of meeting the crisis in the medical sphere of Ukraine, as well as the planned projects and actions.

“Hippocrates” will appreciate and will be thankful for any financial or material aid directed to its address by associates or philanthropists for the fulfillment of out tasks, since the program, started in the Rivne region, is aimed at rendering of free medical aid to the poor layers of population.

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