“Legal risks of professional medical activity. Legal risks of professional medical activity

Send your good work in the knowledge base is simple. Use the form below

Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.

Posted on http://www.allbest.ru/

Ministry of Health care Russian Federation

state budgetary educational institution higher vocational education

"Far Eastern State Medical University"

Ministry of Health of the Russian Federation

(GBOU VPO FESMU of the Ministry of Health of Russia)

Faculty of Medicine and Humanities

Department of "Economics and Management at a Healthcare Enterprise"

Management - field of study 38.03.02, qualification (degree) - bachelor

TEST

discipline: "Jurisprudence"

on the topic: "Offenses in health care"

Completed by: R.I. Pankiv

Khabarovsk - 2015

Introduction

A responsibility medical workers, health care facilities and other organizations of the healthcare system is a rather acute medical and legal problem, for the solution of which it is necessary not only to carry out Scientific research but also to make certain efforts to implement their results in practice.

Historically, almost any mistake of a medical worker, which led to harm to a person, is condemned by society. At present, a high degree of responsibility placed on a medical worker is mainly associated with the opinion that he, as it were, receives into his own hands the most significant social value - the life and health of a person, and in most cases a person is already sick, i.e. being in danger. The latter is often associated with non-compliance by the individual healthy lifestyle life and irresponsible behavior in relation to their health. At the same time, by placing trust in medical workers, society seeks to establish strict control over their activities, including through the use of mechanisms legal responsibility. However, in view of the foregoing, it should be noted that in most cases the elements of risk inherent in medical activities in relationships with patients, especially those with severe and moderate physical and mental health disorders.

In the existing legal practice Responsibility refers to the negative consequences for a person in the form of certain deprivations of a physical, material or moral nature for actions or inaction condemned by society. In addition, considering the problem of responsibility, it must be remembered that along with legal responsibility, there is also moral responsibility, which is a more powerful regulator of social relations. If the history of legal responsibility has about 5 thousand years (since the emergence of the state), then the formation of responsibility to public morality began at the time of the birth primitive society, i.e. more than 50 thousand years ago. The essential difference between legal and moral responsibility lies in the nature of the rules of social behavior or the norms underlying them.

The first rules of conduct that arose in society were not distinguished by complexity and diversity. Later they were enriched by the norms of religion, family relations, military traditions, which had a significant impact on the development of peoples and states. In general, these norms are based on customs - rules of conduct that have been steadily formed in society through repeated application, therefore they are included in the concept of customary law, or unwritten law.

After the emergence of the state, a formal approach to the regulation of social relations was required, in connection with which a number of stable and widely used moral norms were enshrined in state legal acts. At the same time, the norms of morality did not cease to exist, becoming at the same time the norms of law. Since these norms were fixed on papyrus, clay tablets, and then on paper, they form the basis of the so-called written law.

Rules of social behavior, or norms, underlie all types of responsibility. Violation of some norms leads to liability, while other norms regulate its operation. Depending on the participation of the state, existing norms can be divided into moral (not regulated by the state), legal (regulated only by the state) and mixed (regulated by both the state and public opinion). Consequently, for the violation of moral norms there is only moral responsibility, for the violation of legal - legal, and for the violation of mixed norms - both legal and moral.

Moral or ethical responsibility is essential in the medical profession. Because state regulation cannot cover significant areas of medical activity, the role of codes of professional ethics becomes high.

Violation of the norms of medical ethics leads, as a rule, to the emergence of moral responsibility, which is expressed in the personal experiences of a medical worker associated with the commission of an inappropriate act by him, as well as in the condemnation of his colleagues and society. In some cases, moral wrongdoing is the basis for the emergence of legal liability, for example, disciplinary action.

Under the legal responsibility understand the obligation of a person to undergo adverse consequences, provided for by the rules of law, for the offense committed. Legal responsibility is expressed in the imposition of a specific measure of state coercion on a person.

Criminal liability

Criminal liability is the most serious type of legal liability. It is provided for the commission of offenses that pose the greatest threat to society - crimes. List of the most dangerous offenses, classified as crimes, with an indication of sanctions for their commission, is given in the Special Part of the Criminal Code of the Russian Federation (Criminal Code of the Russian Federation), each article of which (Art. 105-360) is devoted to a separate offense and its varieties.

To classify a particular offense as a crime, a formal criterion is used - its inclusion or non-inclusion in the Criminal Code of the Russian Federation. The same offense may receive the status of a crime after its inclusion in the Criminal Code of the Russian Federation and lose such status after exclusion. According to Part I, Art. 14 of the Criminal Code of the Russian Federation, a crime is understood as a guilty socially dangerous act prohibited by the Criminal Code of the Russian Federation under threat of punishment. This wording justifies the onset of the sanctions established by the Code by a ban on the commission of an unlawful act. However, in case of violation of the norms of the Criminal Code of the Russian Federation, liability does not occur in all cases. So, along with the fact of the illegality of behavior, it is necessary to have a number of signs that define a socially dangerous act as a crime and are called corpus delicti (Article 8 of the Criminal Code of the Russian Federation).

If there is a basis for criminal liability, which is an act that contains all the elements of a crime, the person (persons) who committed it is subject to criminal punishment. Punishment in criminal law is expressed in the form of sanctions established by the Criminal Code of the Russian Federation, which represent the practical implementation of criminal liability. Types of criminal penalties are established by Art. 44 of the Criminal Code of the Russian Federation and include:

Deprivation of the right to hold certain positions;

Deprivation of the right to practice certain activities;

correctional work;

restriction of freedom or arrest;

Deprivation of liberty for a certain period;

life imprisonment;

· the death penalty (currently in the Russian Federation a moratorium has been imposed on the use of the death penalty).

Sanctions may include one or more types of criminal punishment, imposed simultaneously or alternatively at the choice of the judge. For example, such an offense as failure to provide assistance to a patient (Article 124 of the Criminal Code of the Russian Federation) has two sets of crimes that differ objective side. The first composition, as socially dangerous consequences, implies the infliction of moderate harm to the health of the patient, the second - the death of the patient or the infliction of grievous harm to his health. Failure to provide assistance to the patient in the first case may be punished by a fine of up to 40,000 rubles. or withholding from wages, or other income of the convicted person for a period of up to 3 months, or by corrective labor for a term of up to 1 year, or by arrest for a term of 2 to 4 months. The same act in the second case is punishable by imprisonment for up to 3 years with deprivation of the right to hold certain positions or engage in certain activities for up to 3 years or indefinitely. Failure to provide assistance to the patient with causing slight harm his health does not constitute a crime.

As it was said, for the onset of criminal liability, it is necessary to have a set of signs established by law, called corpus delicti (Article 8 of the Criminal Code of the Russian Federation). The absence of at least one of the signs (elements) does not give grounds to speak of a crime. The elements of a crime are: the object and the objective side, the subject and subjective side. Consider specified elements in relation to crimes related to the activities of medical workers.

The object of crimes are public relations related to the implementation absolute rights citizens, first of all, to preserve their life and health. The Criminal Code of the Russian Federation does not specifically indicate either the objects of crimes or the rights of citizens in the field of health protection that are subject to criminal protection. To reveal the concept of "object of a crime", let's turn to the Constitution of the Russian Federation, according to which everyone has the right to life (Article 20), personal immunity (Article 22), personal and family secrets (Article 23), social Security(Art. 39), health protection and medical care (Art. 41), favorable environment (Art. 42). In the process of implementing these constitutional rights certain social relations are formed, which are the object of the crime infringing on them.

The objective side includes the interaction of persons in the process of providing medical care: illegal actions or inactions of medical workers, their socially dangerous consequences in the form of violation of rights and harm to patients, as well as a causal relationship that objectively determines the onset of negative consequences as a result of a specific illegal act.

The Criminal Code of the Russian Federation cites several cases of the absence of corpus delicti related to its objective side.

Committing an illegal act that does not provide for punishment in accordance with the Criminal Code of the Russian Federation (Article 3).

Committing an act that is not illegal due to:

necessary defense (art. 37);

extreme necessity (art. 39);

physical or mental coercion (art. 40);

reasonable risk (art. 41);

Execution of an order or instruction (Article 42).

The commission of an act, although formally containing signs of a crime, but due to its insignificance, does not have socially dangerous consequences (part 2 of article 14 of the Criminal Code of the Russian Federation).

If the onset of negative consequences, for example, the death of a patient, is not associated with the actions of medical workers, but was the cause of objective factors (the severity of the patient's condition, injuries incompatible with life), there is also no corpus delicti, since a causal relationship between the actions (inaction) of medical workers and the resulting negative consequences are not traced.

The subject of crimes related to the peculiarities of medical activity is medical, middle, and in some cases junior medical and other support personnel. Persons who at the time of the commission of the crime reached the age established by the Criminal Code of the Russian Federation and were in a sane state (Article 19 of the Criminal Code of the Russian Federation) are brought to criminal responsibility. If a medical worker was in a state of insanity at the time of committing a socially dangerous act, criminal liability does not arise.

The subjective side of the crime is a reflection in the mind of the subject of the objective signs of the deed, expressed mainly in the form of his guilt (Article 5 of the Criminal Code of the Russian Federation). Guilt is understood as the internal attitude of a person to an offense that he committed either consciously or, with the due degree of attention and forethought, could have been prevented.

The Criminal Code of the Russian Federation provides for two forms of guilt in the commission of a crime: in the form of intent (Article 25 of the Criminal Code of the Russian Federation) and through negligence (Article 26 of the Criminal Code of the Russian Federation). An intentional crime can be committed with direct or indirect intent. If the guilty person was aware of the social danger of his actions (inaction), foresaw the possibility or inevitability of the onset of socially dangerous consequences, and also desired their onset, this is considered direct intent. A classic example a medical crime committed with direct intent (from the point of view of current legislation) is euthanasia (especially active).

If the guilty person was aware of the social danger of the consequences of his actions (inaction), foresaw the possibility of their occurrence, did not want, but consciously allowed their occurrence or treated them indifferently, we are talking about intentional crime committed with indirect intent.

The case (innocent infliction of harm, or incident) is not considered a crime. In accordance with Art. 28 of the Criminal Code of the Russian Federation, an act is recognized as committed innocently (accidentally) if the person who committed it did not realize the social danger of his act, did not foresee its socially dangerous consequences, should not or could not foresee them (the latter provision is established by specific circumstances affairs).

An example of an innocent act is the case when a doctor, after carefully collecting an anamnesis from a patient, prescribes the necessary drug therapy, but the patient suddenly has a severe allergic reaction and dies. In this situation, the doctor showed the due degree of attention and foresight and could not foresee the unexpected reaction of the body.

To establish whether a person was guilty or not, the criterion of prudence is used. The Court wonders what a prudent person would do if he were in the same circumstances as the accused. A person of average intelligence, knowledge and wisdom is recognized as prudent. To establish the doctor's guilt, a specialist is involved in evaluating comparable knowledge, skills and abilities. An act is also recognized as committed innocently if the person who committed it, although he foresaw the possibility of the onset of socially dangerous consequences of his actions (inaction), could not prevent these consequences due to the inconsistency of his psychophysiological indicators with extreme conditions or neuropsychic overload.

Punishment for criminal offense is appointed by a court verdict, is applied to a person found guilty of a crime, and consists in the deprivation or restriction of the rights and freedoms of this person provided for by the Criminal Code of the Russian Federation (Article 43 of the Criminal Code of the Russian Federation). The absence of a person's guilt means the absence of corpus delicti, and hence the basis for criminal liability.

Here is a list of the main crimes, the elements of which are related to the professional duties of medical workers or stem from the characteristics of medical activity.

1. Causing harm to human life and health through negligence as a result of improper performance of professional duties.

o Causing death by negligence (part 2 of article 109 of the Criminal Code of the Russian Federation).

o Infliction of grievous bodily harm through negligence (part 2 of article 118 of the Criminal Code of the Russian Federation, as amended by Federal Law No. 162-FZ of December 8, 2003).

o Careless infection with HIV infection (part 4 of article 122 of the Criminal Code of the Russian Federation).

o Causing harm to the health or death of a woman as a result of an illegal abortion (part 2 of article 123 of the Criminal Code of the Russian Federation (as amended by Federal Law No. 162-FZ of December 8, 2003).

o Causing harm to health or death of a patient as a result of failure to provide him with assistance without good reason (Article 124 of the Criminal Code of the Russian Federation).

o Causing death to the victim as a result of his illegal placement in a psychiatric hospital (part 2 of article 128 of the Criminal Code of the Russian Federation).

o Injury or death to a person as a result of unlawful private medical practice or private pharmaceutical activities (Article 235 of the Criminal Code of the Russian Federation).

o Mass disease or poisoning of people or death of a person as a result of violation of sanitary and epidemiological rules (Article 236 of the Criminal Code of the Russian Federation).

2. Violation of the rights of the patient.

o Coercion to remove human organs or tissues for transplantation (part 2 of article 120 of the Criminal Code of the Russian Federation).

o Illegal placement in a psychiatric hospital (parts 1 and 2 of article 128 of the Criminal Code of the Russian Federation).

o Disclosure of medical confidentiality (part 2 of article 137 of the Criminal Code of the Russian Federation).

o Disclosure of the secret of adoption (adoption) (Article 155 of the Criminal Code of the Russian Federation).

o Fraud (Article 159 of the Criminal Code of the Russian Federation).

3. Improper performance of professional duties.

1. Violation of the rules for storage, accounting, distribution, use or destruction of narcotic drugs or psychotropic substances (part 5 of article 228 of the Criminal Code of the Russian Federation).

2. Illegal issuance of prescriptions or other documents giving the right to receive narcotic drugs or psychotropic substances (Article 233 of the Criminal Code of the Russian Federation).

3. Concealment of information about circumstances endangering human life or health (Part I, Article 237 of the Criminal Code of the Russian Federation).

4. Knowingly false testimony or expert opinion (Article 307 of the Criminal Code of the Russian Federation).

Illegal actions of medical workers against citizens that are not related to their professional duties (for example, inflicting bodily harm on a patient by a doctor due to personal hostility) are not among the offenses under consideration. At the same time, it should be noted that in the event of a trial of such a case, the factors of the physical and mental state of the victim (weakness as a result of illness, condition after anesthesia), as well as the fact that the medical worker committed unlawful acts during the performance of his official duties, will be taken into account.

Crimes against patients committed in the territory medical institution persons who are not related to the treatment process are also not related to the specifics of the implementation of professional medical activities. An example of such crimes is a fight between patients that resulted in the death of one of them, or harm to a patient as a result of an explosion of a gas cylinder in the hospital yard.

Let us consider the main groups of crimes related to the professional duties of medical workers or arising from the characteristics of medical activity.

Causing harm to human life and health through negligence as a result of improper performance of professional duties. When starting to analyze this group of crimes, it should be pointed out that murder (Article 105 of the Criminal Code of the Russian Federation), intentional infliction serious (Article 111 of the Criminal Code of the Russian Federation), moderate (Article 112 of the Criminal Code of the Russian Federation) and light harm to health (Article 115 of the Criminal Code of the Russian Federation), committed with direct intent or out of hooligan motives, cannot be considered in the context of the responsibility of medical workers, since they are not related to the professional affiliation of the criminal, but are a consequence of his mental state. However, it must be remembered that when litigation of such crimes, the peculiarities of the relationship between a medical worker and a patient can be taken into account as an aggravating circumstance, for example, if the victim was in a helpless state, known to the perpetrator (clause "c", part 2 of article 105 of the Criminal Code of the Russian Federation).

An exception for this group of crimes is euthanasia - the satisfaction of the patient's request to hasten his death by any actions or means, including the termination of artificial life-sustaining measures. Euthanasia is directly prohibited by the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens, and this was done twice: in Art. 45, which is called "Prohibition of Euthanasia", and Art. 60, which limits euthanasia through the physician's oath. In accordance with the Criminal Code of the Russian Federation, euthanasia has a corpus delicti, interpreted as the intentional infliction of death on another person or murder. At the same time, it is indicated that the commission of a crime motivated by compassion is a circumstance mitigating punishment (Article 61 of the Criminal Code of the Russian Federation). A medical worker who did not carry out euthanasia himself, but did the necessary preparatory measures and explained how to carry out euthanasia to other persons (for example, relatives of the patient), may be held liable under Art. 105 of the Criminal Code of the Russian Federation as an accomplice in the commission of a crime (part 5 of article 33 of the Criminal Code of the Russian Federation).

Some cases of harm to patients by medical professionals are on the verge of indirect intent and negligence: for example, unauthorized medical experiments and the development of surgical techniques on hopeless patients that led to their death or other negative consequences.

Similar consequences can also arise from overly daring medical activities, called "surgical aggression", which include cases when a medical professional takes a conscious risk to save a patient's life, but overestimates its degree by using a disproportionate medical intervention, for example, an operation that is too dangerous. . Criminally punishable consequences may occur if it turns out that there was no real threat to the patient's life, and the only cause of his death was an "aggressive" surgical intervention. When such situations arise, it is necessary to carefully examine the validity of the risk, as well as take into account the initial state of the victim. According to Art. 41 of the Criminal Code of the Russian Federation, the risk is recognized as justified if the socially useful goal could not be achieved by unrelated actions (inaction) and the person who allowed the risk took sufficient measures to prevent harm to interests protected by criminal law. Causing harm to a patient in a situation of reasonable risk is not a crime.

It is also not a crime to cause harm in a state of emergency. According to Art. 39 of the Criminal Code of the Russian Federation under urgent need understand the elimination of danger that directly threatens the person and rights this person, if this danger could not be eliminated by other means and at the same time it was not allowed to exceed its limits.

Exceeding the limits of extreme necessity is recognized as causing harm that is clearly inconsistent with the nature and degree of the threatened danger, i.e. when the harm done is equal to or greater than the harm prevented. Much more often in the process of providing medical care, there are cases of causing death by a medical worker (part 2 of article 109 of the Criminal Code of the Russian Federation) and serious harm to the patient's health through negligence (Article 118 of the Criminal Code of the Russian Federation). Infliction of harm of medium gravity and light harm to health through negligence does not provide for criminal liability.

Let us dwell on the main features that establish the severity of intentional harm to health.

A sign of serious harm to health is the infliction of harm, accompanied by a danger to human life, and in the absence of this sign, entailing the following consequences:

loss of vision, speech, hearing;

Loss of any organ or loss of its functions by the organ;

Indelible disfigurement of the face;

health disorder along with a permanent loss of general ability to work by at least a third;

Complete loss of professional ability to work;

· abortion;

· mental disorder;

A disease of drug addiction or substance abuse.

A sign of harm to health of moderate severity is the infliction of harm that is not dangerous to human life and did not entail the above consequences, but caused:

Long-term health disorder

· Significant permanent loss of total working capacity by less than one third.

Signs causing a lung health risks are:

short-term health disorder;

Minor permanent loss of general ability to work.

· A long-term health disorder should be understood as a temporary disability lasting more than 3 weeks (more than 21 days). A significant permanent disability of less than a third should be understood as a permanent disability from K) to 30% inclusive. A short-term health disorder should be understood as a temporary disability lasting no more than 3 weeks (up to 21 days). A slight permanent disability should be understood as a permanent loss of general ability to work, equal to 5%.

· A feature of the responsibility of a medical worker under the considered articles of the Criminal Code of the Russian Federation is the presence of a qualifying sign - improper performance by a person of his professional duties, which provides for a more severe punishment.

Negligent harm, as noted earlier, is the result of frivolity or negligence in the actions of a medical worker, which can be established based on the need for him to comply with the requirements job descriptions and rules for the provision of medical care. Such an act, committed as a result of the person's improper performance of his professional duties, may also be subject to criminal punishment. However, considering that all aspects of medical activity cannot be provided for by instructions and rules, each case of causing death or harm to a patient by a medical worker through negligence is carefully analyzed by specialists.

One of the particular cases of causing serious harm to health is the infection of patients with HIV infection. The danger of HIV infection is explained by two circumstances: 1) a person who has contracted this disease may not know about it for a long time and pose a danger to others if the precautionary rules are not observed; 2) in the case of the development of the disease, it is actually incurable, which leads to the development of fatal consequences for the patient.

If, as a result of improper performance of professional duties by a medical worker, a patient becomes infected with HIV, a criminal case is initiated under Part 4 of Art. 122 of the Criminal Code of the Russian Federation. By general rule the subjects of the crime in question are medical workers, employees of blood transfusion stations and pharmacies (pharmacists) who violated the this case their professional responsibilities.

This group of crimes also includes the illegal performance of an abortion, which negligently caused the death of the victim or the infliction of grievous harm to her health. According to Art. 123 of the Criminal Code of the Russian Federation, it is illegal to conduct an abortion by a person who does not have a higher medical education corresponding profile.

Some authors interpret the concept of "illegal abortion" more broadly than the Criminal Code of the Russian Federation, including in it the artificial termination of pregnancy outside a stationary medical institution by any person, regardless of the availability of an appropriate education. This approach seems unjustified because criminal law(Art. 3, 8 of the Criminal Code of the Russian Federation) excludes a broad interpretation of the grounds for criminal liability and requires the application of the norms of the Criminal Code of the Russian Federation in strict accordance with the text.

Thus, doctors can be held criminally liable for illegal abortion only if they do not have the necessary qualifications, confirmed by a specialist certificate, as well as a license. If such persons perform an abortion under conditions of extreme necessity, criminal liability is excluded.

Article 124 of the Criminal Code of the Russian Federation provides for liability for failure to provide assistance to a patient if this negligently entailed an average or grievous harm his health or death. In this case, we are talking about assistance that was not provided on the street, in transport, since the failure to provide assistance to the patient in a medical institution, which led to death or harm to his health, is regarded as inaction, subject to punishment under Art. 109 and 1 18 of the Criminal Code of the Russian Federation.

In some cases, courts erroneously apply Art. 124 of the Criminal Code of the Russian Federation. As an example, we will cite two cases from judicial practice, when for the same offense - improper performance of professional duties, which led to death by negligence, medical workers were held liable for various articles Criminal Code of the Russian Federation - 124 and 109.

Responsibility for failure to provide assistance to the patient is provided for persons who are obliged to provide it in accordance with the law or a special rule. Article 124 of the Criminal Code of the Russian Federation provides for the responsibility not only of doctors, but also of other medical workers, for example, secondary medical personnel.

The Criminal Code of the Russian Federation also provides for liability for the implementation of private medical activities without a license. If such activity has led to negligent harm to human health or death, criminal liability arises in accordance with Art. 235 of the Criminal Code of the Russian Federation. Criminal liability under the submitted article may also occur in the event that a doctor working in a medical facility or other healthcare organization renders medical services patients in private, because at that moment he was not fulfilling his official duties and cannot claim to be licensed by their employer.

In accordance with Art. 236 of the Criminal Code of the Russian Federation, violation of sanitary and epidemiological rules, which negligently caused a mass disease or poisoning of people, or death of a person, is subject to criminal liability. Similar norms and rules are established by federal legislation, N PA of the federal body executive power in the field of healthcare, bodies of the state sanitary and epidemiological supervision, other ministries and departments.

Sanitary rules govern various spheres of human activity. They determine the procedure for the behavior of citizens and officials to ensure a favorable state for the life and health of people. environment, prevention of the spread, as well as the elimination of infectious, mass non-communicable diseases and poisonings. Control over the observance of such generally binding rules is entrusted to federal and territorial bodies created in in due course for the implementation of state sanitary and epidemiological supervision. Violation of these rules can be committed both through unprofessional actions, for example, as a result of poor-quality sterilization of medical equipment or poor washing of dishes in the food blocks of medical organizations, and through various inactions. An example of the latter could be avoiding quarantine measures or planned disinfections, etc.

To be liable under Art. 236 of the Criminal Code of the Russian Federation in each case, it is necessary to establish which sanitary rules, norms and hygiene standards were violated.

Violation of the rights of patients. The implementation of professional medical activities is directly related to the observance of a number of citizens' rights in the field of health protection. In accordance with the Constitution of the Russian Federation and laws, such rights include:

protection from involuntary hospitalization in a psychiatric hospital (Article 22 of the Constitution of the Russian Federation, Article 11 of the Law of the Russian Federation of July 2, 1992 No. 3185-1 "On psychiatric care and guarantees of the rights of citizens in its provision");

Keeping secret information about the fact of applying for medical help, about the state of health, diagnosis and other information obtained during the examination and treatment of the patient (Article 23 of the Constitution of the Russian Federation, Article 30 of the Fundamentals);

Informed voluntary consent to medical intervention or refusal of it (Article 30 of the Fundamentals);

The right to free medical care in state and municipal institutions health care programs state guarantees(Article 41 of the Constitution of the Russian Federation, Article 20 of the Fundamentals), etc.

Consider possible cases criminal offenses related to non-observance of these rights by medical workers. The responsibility of medical workers for the forced placement in a psychiatric hospital of a person who obviously does not need hospitalization or without his consent is provided for by Art. 128 of the Criminal Code of the Russian Federation. In addition, the liability of the submitted article is also subject to the illegal extension of the period of stay in a psychiatric hospital of a person subject to discharge.

It seems that it is not just a violation of the procedure established by law for placing a person in a psychiatric hospital that is criminally punishable, but such a violation that led to the placement there of a person who does not need hospital treatment or who has the legal right to refuse it.

Violation of the procedure for placing a person who needs such treatment in a psychiatric hospital does not contain corpus delicti and can only be classified as a disciplinary offense.

The subject of the crime under consideration may be persons who make a decision on the illegal placement of a person in a psychiatric hospital or on the illegal extension of the period of stay in it of a person subject to discharge. These include such persons as a psychiatrist who is a member of the commission that makes a medical decision, an attending physician or another psychiatrist who has prepared medical report, clearly untrue, or falsified for this purpose a medical history.

The subject of the crime under Part 2 of Art. 128, which refers to the use of official position, may be, for example, the head of the department or one of the heads of this hospital, a superior person in the health authorities, or any other person who, by virtue of his official position, can influence the decision to illegally isolate the victim .

The right of citizens to keep secret information about the fact of applying for medical care, their state of health and diagnosis is constitutional. In accordance with Art. 23 and 24 of the Constitution of the Russian Federation established common law every citizen to inviolability privacy, which is guaranteed by criminal law protection, which is provided for by Art. 137 of the Criminal Code of the Russian Federation.

According to this article, the illegal collection or dissemination of information about the private life of a linden, constituting his personal or family secret, without his consent, is subject to criminal liability. Thus, violation of privacy can be punished by a fine of up to 200,000 rubles. or in the amount of wages or other income of the convicted person for the period up to IX months, or a number of other measures. If the same act is committed by a person using his official position, then the punishment is more severe, including a fine of up to 30,000 rubles. The law also includes information constituting a medical secret to such information.

According to Art. 61 Fundamentals of medical secrecy is information about the fact of applying for medical care, the state of health of a citizen, the diagnosis of his disease, as well as other information obtained during his examination and treatment. Damage to the rights and legitimate interests of the patient as a result of the dissemination of information about him constituting a medical secret may be moral or property and expressed in distrust of him by other persons, refusal to hire or dismissal from it, in the disruption of a profitable deal, discord in family, etc.

The actions of a medical worker to disseminate information constituting a medical secret can be regarded as crimes only if they were committed with direct or indirect intent, subject to his mercenary or other personal interest.

Criminal liability for divulging the secret of adoption (adoption) against the will of the adopter, committed by a person who is obliged to keep the fact of adoption (adoption) as an official or professional secret, out of mercenary or base motives, is provided for by Art. 155 of the Criminal Code of the Russian Federation.

The rights of citizens to consent to and refuse any medical interventions are especially protected in the Russian Federation. In accordance with Art. 32 of the Fundamentals, medical intervention can be carried out only after obtaining the informed voluntary consent of the citizen. The Criminal Code of the Russian Federation provides for a special offense that takes place in the event of coercion of a person to obtain consent to the removal of organs or tissues for transplantation (Article 120). One form of such coercion is deceit under the pretext of the need for a medical operation.

Coercive actions can be carried out by any person. However, only a specialist with the appropriate qualifications can carry out the necessary surgical intervention. If the doctor did not participate in coercion, but removed an organ or tissue, knowing that coercion took place (for example, by the recipient's relatives), his actions can be qualified as complicity under Art. 120 of the Criminal Code of the Russian Federation.

In accordance with the Law of the Russian Federation of February 7, 1992 No. 2300-1 "On Protection of Consumer Rights" (as amended on January 9, 1996 No. 2-F "Z"), a medical worker is obliged to inform the patient about the main consumer and other properties of medical services In case of misleading the patient, i.e. transferring deliberately distorted information to him in order to obtain money or any material assets for a free medical service, a medical worker may be held criminally liable under Art. 159 of the Criminal Code of the Russian Federation "Fraud" (new edition of December 8, 2003 No. 162-FZ). Criminal liability in case of violation by medical workers of other rights of citizens in the field of health protection is not provided. offense liability medical punishment

Improper performance of professional duties. Medical personnel using narcotic drugs and psychotropic substances in their work are obliged to comply with special rules for their storage, accounting or use, the violation of which may lead to criminal liability under Art. 2282, which, as amended on December 8, 2003, No. 162-FZ, was introduced into the Criminal Code of the Russian Federation as an addition called "Violation of the rules for the circulation of narcotic drugs or psychotropic substances."

The Criminal Code of the Russian Federation lists persons who have access to narcotic substances due to the use of their official position and / or duties (clause "b" part 3 of article 228; parts I and 2 of article 2282), which with good reason should be include medical and pharmaceutical workers, including nursing staff. Illegal activities with narcotic substances, committed out of mercenary motives or through negligence, pose a high degree of public danger, as they can cause harm to human health or other serious consequences, often with irreparable damage to him. Consequently, the establishment of criminal liability for almost any violations related to the circulation of narcotic drugs is due to the need to protect society from the public danger of such acts.

According to the Federal Law of January 8, 1998 No. 3-FZ "On Narcotic Drugs and Psychotropic Substances", narcotic drugs in the Russian Federation include substances of synthetic or natural origin, including drugs, as well as plants classified as such by the Single Convention on Narcotic Substances of 1961 and included in the List of Narcotic Drugs published by the Standing Committee on Drug Control under the federal executive authority in the field of health. Psychotropic substances include substances of synthetic or natural origin, classified as such by the Convention on Psychotropic Substances of 1971 and included in either the Schedule of Narcotic Substances or Schedule No. 1 of Violent Substances, also issued by the Standing Committee on Narcotics Control.

It should be noted that the legal and pharmacological concepts of narcotic drugs and psychotropic substances do not always correspond to each other.

Criminal liability for the illegal issuance or forgery of prescriptions or other documents giving the right to receive narcotic drugs or psychotropic substances is provided for in Art. 233 of the Criminal Code of the Russian Federation. The subject of the crime under this article are prescriptions that give the right to receive narcotic drugs or psychotropic substances and are the only document of such content for citizens.

Illegal issuance of a prescription should be understood as the issuance of a prescription in violation of established rules registration containing the prescription of narcotic drugs or psychotropic substances without appropriate medical indications or with a clear excess of the required amount of the substance (Resolution of the Plenum Supreme Court RF dated May 27, 1998 No. 9 "O judicial practice on cases of crimes related to narcotic drugs, psychotropic, potent and poisonous substances"). To establish the illegality of issuing prescriptions, one should refer to the current legal acts.

Prescriptions have the right to write out only doctors and only if there are relevant medical indications. The prescription must be written in the hand of the doctor who signed it, and provided with his personal seal, as well as have a stamp and a round seal of the medical institution. The number of narcotic drugs prescribed in one prescription is strictly limited.

Currently, not all medical institutions and medical organizations, as well as doctors, are granted the right to issue prescriptions for narcotic drugs or psychotropic substances.

Article 237 of the Criminal Code of the Russian Federation provides for liability for concealing or distorting information about events, facts or phenomena that endanger human life or health or the environment, committed by a person, obliged to provide the population and the authorities authorized to take measures to eliminate such a danger, with the specified information. Based on this article, a medical worker may be held criminally liable, for example, for not providing colleagues with information about the presence of a dangerous disease in a patient. infectious disease especially HIV infection. At the same time, penalties of up to 300,000 rubles are provided. (part 1 of article 237) and from 100,000 to 500,000 rubles. (part 2 of article 237). The group of crimes under consideration also includes a knowingly false conclusion of a medical or forensic expert, the responsibility for which is provided for in Art. 307 of the Criminal Code of the Russian Federation.

Criminal liability can arise not only because of the actions of medical workers who violate professional duties, but also in connection with crimes against state power, interests public service and service in the organs local government. However, the crimes of this group, contrary to the prevailing opinion, are in many cases rather indirectly related to medical activity. In particular, to criminal liability for exceeding official powers(Article 286 of the Criminal Code of the Russian Federation), accepting a bribe (Article 290 of the Criminal Code of the Russian Federation), official forgery (Article 292 of the Criminal Code of the Russian Federation) and negligence (Article 293 of the Criminal Code of the Russian Federation) can only be brought against officials who, from the point of view of criminal law include persons exercising the functions of a representative of power or performing organizational, administrative, administrative and economic functions in state representative and executive bodies, local governments, state and municipal institutions, as well as in the Armed Forces of Russia (Notes to Chapter 30 of the Criminal Code of the Russian Federation).

Based on Art. 293, it should be specified that negligence means:

according to part 1, failure to perform or improper performance by an official of his duties due to dishonest or negligent attitude to the service, if this caused major damage (punished by a fine of up to 120,000 rubles, in the amount of income for a period of up to 1 year, or other measures) ;

Part 2 - an act that negligently caused serious harm to health or death of a person (is punishable by imprisonment for up to 5 years with deprivation of the right to hold certain positions or engage in certain activities for up to 3 years or without it);

part 3 - an act under part 1 of this article: negligently causing the death of two or more persons (is punishable by imprisonment for up to 7 years with or without deprivation of the right to hold certain positions or engage in certain activities for up to 3 years) .

Major damage in Art. 293 recognizes damage, the amount of which exceeds 100,000 rubles.

In conclusion, it should be noted that despite the principle of the inevitability of punishment for committed crime, in some cases exemption from criminal liability is possible. Such cases are established by Art. 75 and 76 of the Criminal Code of the Russian Federation.

Article 75 of the Criminal Code of the Russian Federation, in particular, provides for exemption from criminal liability in connection with active repentance. A person who has committed a crime of small or medium gravity for the first time may be released from criminal liability if, after the commission of the crime, he voluntarily turned himself in, contributed to the disclosure of the crime, compensated for the damage or otherwise made amends for the damage caused as a result of the crime, and as a result of active repentance ceased to be socially dangerous.

According to Art. 76 of the Criminal Code of the Russian Federation, exemption from criminal liability may occur in connection with the reconciliation of the guilty person with the victim. For example, in the case when a person who has committed a crime of small or medium gravity for the first time.

Administrative responsibility

As well as criminal, administrative responsibility is associated with the commission of unlawful acts by a person, however, they are assessed with a lower degree of public danger compared to crimes.

The types of responsibility under consideration have much in common, which makes it possible to combine them into a single group of administrative responsibilities. At the same time, the types of liability under consideration have three significant differences.

The first of these is that administrative law unlike the criminal one, it is the subject of joint jurisdiction of the Russian Federation and its subjects (Article 72 of the Constitution of the Russian Federation). This means that it is possible to establish administrative responsibility not only in accordance with the Code of Administrative Offenses of the Russian Federation (CAO RF), but also on the basis of the laws of the constituent entities of the Russian Federation on administrative offenses adopted and in accordance with it (Article 1.1 of the CAO RF).

The second fundamental difference is that the Code of Administrative Offenses of the Russian Federation provides for the responsibility of not only individuals, but also legal entities (Articles 2.10).

The third difference is due to the fact that establishing guilt in the commission of a crime and criminal liability is the exclusive prerogative of the court, and bringing a person to administrative responsibility, including the imposition of administrative sanctions on him, can be carried out not only by the court, but also by authorities or officials. (Section III of the Code of Administrative Offenses of the Russian Federation).

As mentioned earlier, administrative responsibility is established both by the Code of Administrative Offenses of the Russian Federation and by laws on administrative offenses of the constituent entities of the Russian Federation. At the same time, types administrative penalties and the rules for their application, as well as the scope of administrative responsibility (except for the warning and administrative fine) can only be set by one legislative act- Code of Administrative Offenses of the Russian Federation. Like a criminal punishment, liability for an administrative offense occurs in the presence of guilt (intent or negligence). The concepts of "intentional guilt" and "careless guilt" coincide with similar concepts in criminal law.

Administrative responsibility is less important for medical activity than criminal responsibility. In list administrative offenses, which are associated with the professional duties of medical workers or arise from the peculiarities of medical activity, according to the Code of Administrative Offenses of the Russian Federation, the following can be indicated:

· unlawful refusal to provide a citizen with the information he needs, including about his health (Article 5.39);

· illegal private medical practice (art. 6.2);

Violation of sanitary and hygienic and sanitary and anti-epidemic norms and rules (Article 6.3);

implementation entrepreneurial activity in violation of the conditions stipulated by the license (part 3 of article 14.1);

Provision of services to the population of inadequate quality or in violation of sanitary regulations(art. 14.4);

Deception of consumers (Article 14.7);

Violation of other consumer rights (art. 14.8);

knowingly false expert opinion (Art. 17.9);

Knowingly false call for an ambulance (Article 19.13).

The most common type of administrative punishment is an administrative fine. If, as a result of an administrative offense, property damage patient, then when deciding on the imposition of an administrative penalty, a decision can be made simultaneously on compensation for damage (Article 4.7 of the Code of Administrative Offenses of the Russian Federation).

Along with criminal and administrative liability, there are special types of administrative liability.

Disciplinary responsibility

Along with criminal and administrative responsibility, disciplinary responsibility for many years also belonged to public legal responsibility. This was due to the fact that in the Soviet period the only employer - the owner of all institutions and enterprises - was the state, which gave labor activity population national importance. Currently, there has been a transition of disciplinary liability to the category of private legal.

This trend is confirmed by the fact that Labor Code of the Russian Federation (Labor Code of the Russian Federation) (as amended on December 30, 2001 No. 197-FZ) considers labor relations as legal relations based on collective agreement, as well as a personal agreement between the employer and the employee (Article 15), which implies the responsibility of the employee not to the state, but to the interests of a private person - the employer. In addition, the employer's counter-responsibility to the workforce is also provided. At the same time, for those types of labor activity where the employer is the state, for example, for public service or service in law enforcement agencies, disciplinary liability has retained its public character.

The legal regulation of disciplinary liability is insignificant, which makes it possible for teams to independently determine the list of disciplinary violations, as well as to establish disciplinary punishments for them through the rules of internal work schedule organizations (Article 189 of the Labor Code of the Russian Federation). Naturally, in this case, the rights of the individual established by the Constitution of the Russian Federation and the current legislation cannot be violated, the only type of disciplinary liability that has found serious legal regulation is liability for violation job duties or disciplinary offenses subject to disciplinary action.

The list of general labor duties is established by the Labor Code of the Russian Federation, special - by charters and regulations on discipline approved by the Government of the Russian Federation, private - by internal labor regulations, as well as individual labor contracts (contracts). According to Art. 21 of the Labor Code of the Russian Federation, the employee is obliged:

...

What is an administrative offense?

By virtue of h. 1 Article. 2.1 of the Code of Administrative Offenses of the Russian Federation, an administrative offense is an unlawful, guilty action (inaction) of an individual or legal entity, for which this code establishes administrative responsibility. Legal entities are subject to such liability for the commission of these violations in cases where provided for in Articles sec. II of the Code of Administrative Offenses of the Russian Federation or the laws of the constituent entities of the Russian Federation on administrative offenses. A legal entity is found guilty of committing such an offense if it is established that it had the opportunity to comply with the rules and norms, for the violation of which this Code or the laws of the subject of the Russian Federation introduced administrative responsibility, but it did not take all measures depending on them to comply with them.

Based on Art. 2.4 of the Code of Administrative Offenses of the Russian Federation, an official is subject to administrative liability if he commits a violation due to non-fulfillment or improper performance their official duties. Officials are understood as a person who permanently, temporarily or in accordance with special powers, performing the functions of a representative of the authorities, that is, endowed in the manner prescribed by law with administrative powers in relation to persons who are not in official dependence on him, as well as a person performing organizational and administrative or administrative and economic functions in state bodies, local governments, state and municipal organizations, Armed Forces of the Russian Federation, other troops and military formations of the Russian Federation.

What is responsible for?

Violation of the procedure for the provision of medical care.

In accordance with Part 1 of Art. 37 of the Federal Law of November 21, 2011 No. 323-FZ “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” (hereinafter referred to as Federal Law No. 323-FZ), from January 1, 2013, medical care is organized and provided in accordance with the procedures for the provision of medical care, mandatory for execution on the territory of the Russian Federation by all medical organizations, as well as on the basis of standards of medical care, with the exception of medical care provided as part of clinical testing.

According to part 2 of Art. 37 of Federal Law No. 323-FZ, the procedures for the provision of medical care and standards of medical care are approved by the authorized federal body executive power.

Draft federal law No. 1093620-6 provides for the introduction of Art. 6.34, by virtue of which the violation of the procedures for the provision of medical care, approved by the authorized federal executive body, in terms of non-compliance with the established by them mandatory requirements will entail a warning or the imposition of an administrative fine on officials in the amount of 10,000 to 20,000 rubles, and on the institution itself in the amount of 100,000 to 300,000 rubles.

Moreover, if such an act leads to harm to the life or health of citizens or creates a threat of harm, an administrative fine in the amount of 20,000 to 30,000 rubles will be imposed on officials, and on the institution itself - in the amount of 200,000 to 400,000 rub. (or an administrative suspension of activities for up to 90 days will be applied).

Violation of the procedure for conducting a medical examination.

Draft federal law No. 1093620-6 provides for administrative liability for violation by a medical worker, medical organization of the established procedures for conducting a medical examination, with the exception of an examination of the quality of medical care, clinical examination, medical examinations and medical examinations.

According to Art. 6.35 violation by a medical worker, a medical organization of the procedures for conducting a medical examination established in accordance with the legislation of the Russian Federation, except for the examination of the quality of medical care, clinical examination, medical examinations and medical examinations, except as provided for in Art. 11.32 of the Code of Administrative Offenses of the Russian Federation, will entail the imposition of an administrative fine on officials of a healthcare institution in the amount of 2,000 to 3,000 rubles, and on the institution itself in the amount of 30,000 to 50,000 rubles.

We recall that, by virtue of Art. 58 of Federal Law No. 323-FZ, a medical examination is a study conducted in the prescribed manner, aimed at establishing the state of health of a citizen, in order to determine his ability to carry out labor or other activities, as well as to establish a causal relationship between the impact of any events, factors and the state of health of the citizen.

The following types of medical examination are carried out in the Russian Federation:

examination of temporary disability;
medical and social expertise;
military medical expertise;
forensic medical and forensic psychiatric examinations;
examination of professional suitability and examination of the connection of the disease with the profession;
examination of the quality of medical care.

The procedure for conducting these types of expertise is established by the authorized federal executive body.

Medical examination of a person is a combination of methods of medical examination and medical research aimed at confirming such a state of human health, which entails the onset of legally significant consequences (Article 65 of Federal Law No. 323-FZ).

species medical examination are:

examination for the state of intoxication (alcoholic, narcotic or other toxic);
psychiatric examination;
examination for the presence of medical contraindications to driving;
examination for the presence of medical contraindications to the possession of weapons;
other types of medical examination established by the legislation of the Russian Federation.

It should be noted that administrative liability for violation of the prescribed procedure for conducting a mandatory medical examination of drivers Vehicle(candidates for drivers of vehicles) or mandatory preliminary, periodic, pre-trip or post-trip medical examinations is defined by Art. 11.32 Administrative Code of the Russian Federation.

Non-compliance with restrictions in the implementation of activities in the areas of health protection and circulation of medicines.

The restrictions imposed on medical and pharmaceutical workers in the exercise of their professional activities are listed in Art. 74 of Federal Law No. 323-FZ.

By virtue of part 3 of this article, for violation of these restrictions, medical and pharmaceutical workers, heads of medical organizations and heads of pharmacy organizations, as well as companies, representatives of companies are liable under the legislation of the Russian Federation. Note that at present the Code of Administrative Offenses of the Russian Federation does not contain rules establishing responsibility for these violations. This gap is intended to eliminate the draft federal law No. 1093620-6, which introduces Art. 6.36. According to the said article, non-compliance with the restrictions imposed in accordance with the legislation of the Russian Federation on medical workers, heads of medical organizations, pharmaceutical workers and heads of pharmacy organizations in the exercise of their professional activities will result in a warning or the imposition of an administrative fine on officials in the amount of 5,000 to 7,000 rubles. ., and for an institution - in the amount of 20,000 to 30,000 rubles.

In addition, non-compliance with the restrictions imposed under the circulation legislation medicines to organizations engaged in the development, production and (or) sale of medicinal products for medical use, organizations that have the rights to use the trade name of a medicinal product for medical use, wholesale trade organizations for medicinal products, pharmacy organizations(their representatives, other individuals and legal entities carrying out their activities on behalf of these organizations) will entail the imposition of an administrative fine on legal entities in the amount of 300,000 to 500,000 rubles. Recall that the restrictions applied in the implementation of activities in the field of circulation of medicines are contained in Art. 67.1 of the Federal Law of April 12, 2010 No. 61-FZ "On the Circulation of Medicines".

Violation of the rights of citizens in the field of health protection.

Draft federal law No. 1093620-6 provides for the introduction of administrative liability for the following violations of the rights of citizens in the field of health care (Article 6.37 of the Code of Administrative Offenses of the Russian Federation).

1. Refusal to provide medical care in accordance with the territorial program of state guarantees free provision citizens of medical care by a medical organization participating in the implementation of this program, if such actions do not contain signs of a criminally punishable act. The commission of this violation will entail the imposition of an administrative fine on officials in the amount of 20,000 to 30,000 rubles, and on the institution itself in the amount of 30,000 to 40,000 rubles.

2. Collection of fees for the provision of medical care under the territorial program of state guarantees of free provision of medical care to citizens by a medical organization participating in the implementation of this program, and by medical workers of such an organization. This action will lead to the imposition of an administrative fine on officials in the amount of 20,000 to 30,000 rubles, and on the institution itself in the amount of 30,000 to 40,000 rubles.

3. Violation of the right of a citizen to informed voluntary consent to medical intervention or refusal of medical intervention, with the exception of cases provided for in Part 1 of Art. 6.32 of the Code of Administrative Offenses of the Russian Federation. This act will entail a warning or the imposition of an administrative fine on officials in the amount of 2,000 to 3,000 rubles, and on an institution in the amount of 20,000 to 30,000 rubles.

4. Violation of the right of a citizen to choose a doctor in accordance with the procedure established by the legislation of the Russian Federation and medical organization receiving information about the state of his health. The specified violation will entail a warning or the imposition of an administrative fine on officials in the amount of 2,000 to 3,000 rubles, and on an institution in the amount of 20,000 to 30,000 rubles.

Recall that the rights and obligations of citizens in the field of health protection are defined in Ch. 4 of Federal Law No. 323-FZ.

Violation of the procedure for prescribing and prescribing drugs.

Prescribing and prescribing drugs in the provision of medical care in medical organizations, other organizations providing medical care, and individual entrepreneurs licensed to conduct medical activities are carried out in accordance with the Procedure for prescribing and prescribing medicines, approved by Order of the Ministry of Health of the Russian Federation of December 20, 2012 No. 1175n (hereinafter - Procedure No. 1175n).

In accordance with paragraphs 30 and 34 of this procedure, the appointment and prescribing of drugs in the provision of primary health care and palliative care in outpatient settings, including preferential categories citizens, are carried out based on the severity and nature of the patient's disease or by the sole attending physician in the case of a typical course of the disease or in agreement with medical commission with an atypical course of the disease, in the presence of complications of the underlying disease and (or) concomitant diseases, as well as in other cases.

At the same time, by virtue of clause 6.1 of Order No. 1175n, medical workers are prohibited from issuing prescriptions:

on medicines in the absence of medical indications;
for medicinal products not registered in the territory of the Russian Federation;
for medicinal products that, in accordance with the instructions for medical use, are used only in medical organizations;
for narcotic drugs and psychotropic substances included in List II of the List of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation, approved by the Decree Government of the Russian Federation dated June 30, 1998 No. 681, registered as drugs for the treatment of drug addiction.

According to Art. 6.37 Violation by a medical worker of the procedure for prescribing and prescribing medicines in the provision of medical care, if these actions do not contain signs of a criminally punishable act, will lead to the imposition of an administrative fine in the amount of 5,000 to 20,000 rubles.

Violation of the procedure for conducting clinical trials of medicinal products for medical use and preclinical studies of medicinal products for medical use.

New Art. 6.38 of the Code of Administrative Offenses of the Russian Federation provides that a violation of the rules of good clinical practice approved by the authorized federal executive body when conducting clinical trials of medicinal products for medical use will result in a warning or the imposition of an administrative fine on officials in the amount of 5,000 to 10,000 rubles, and on institution - in the amount of 20,000 to 30,000 rubles.

In addition, liability is introduced for violating the rules of good laboratory practice, approved by the authorized federal executive body, when conducting preclinical studies of medicinal products for medical use. Sanctions for this act are similar to sanctions for violating the rules of good clinical practice when conducting clinical trials of medicinal products for medical use.

Carrying out medical and pharmaceutical activities in violation of license requirements.

According to Part 1 of Art. 6.40 of the Code of Administrative Offenses of the Russian Federation, the implementation of medical and pharmaceutical activities in violation of the requirements provided for by the relevant licenses will entail a warning or the imposition of an administrative fine on officials in the amount of 20,000 to 30,000 rubles, and on an institution in the amount of 150,000 to 200,000 rubles.

In addition, in the case of carrying out medical and pharmaceutical activities with a gross violation of the requirements established by licenses, a fine in the amount of 25,000 to 35,000 rubles will be imposed on the official of the institution, and on the institution - in the amount of 200,000 to 300,000 rubles. (or an administrative suspension of activities for up to 90 days will be applied).

note

The concept of a gross violation will be established by the Government of the Russian Federation in relation to a specific licensed type of activity.

Violation of the legislation on the circulation of medicines.

AT new edition Art. 14.4.2 of the Code of Administrative Offenses of the Russian Federation. According to part 1 of this article, violation of the established rules for the wholesale trade in medicines and the procedure retail drugs will entail the imposition of an administrative fine on officials in the amount of 20,000 to 30,000 rubles, and on an institution in the amount of 100,000 to 150,000 rubles. (or administrative suspension of activities for up to 90 days).

For reference:

The current version of this article provides for the application of an administrative fine: for officials - in the amount of 5,000 to 10,000 rubles, for legal entities - in the amount of 20,000 to 30,000 rubles.

In addition, liability is introduced for the following offenses:

for the sale and dispensing of medicines included in the list of vital and essential medicines in violation of the requirements of the legislation on the circulation of medicines in terms of setting maximum retail markups on the actual selling prices determined by manufacturers of medicines for these medicines. This act will entail the imposition of an administrative fine on officials in the amount of 100,000 to 150,000 rubles, and on legal entities in the amount of 250,000 to 500,000 rubles. (or administrative suspension of activities for up to 90 days);
for the sale and dispensing of medicines included in the list of vital and essential medicines, in violation of the requirements of the legislation on the circulation of medicines in terms of setting the maximum size of wholesale mark-ups on the actual selling prices provided by manufacturers of medicines for these medicines. These violations will lead to the imposition of an administrative fine on officials in the amount of 150,000 to 200,000 rubles, and on legal entities in the amount of 500,000 to 1,000,000 rubles. (or administrative suspension of activities for up to 90 days).

Who will be held accountable?

In accordance with Part 1 of Art. 28.1 of the Code of Administrative Offenses of the Russian Federation, the reasons for initiating a case on an administrative offense, in particular, are:

a) direct detection by officials authorized to draw up protocols on administrative offenses of sufficient data indicating the presence of an event of an administrative offense;

b) received from law enforcement, as well as from other government agencies, local self-government bodies, from public associations materials containing information indicating the presence of an event of an administrative offense;

c) messages and statements of individuals and legal entities, messages in the media mass media, containing data indicating the presence of an event of an administrative offense.

Based on Part 1 of Art. 28.3 of the Code of Administrative Offenses of the Russian Federation, protocols on administrative offenses are drawn up by officials of bodies authorized to consider cases of administrative offenses in accordance with Ch. 23 of the Code of Administrative Offenses of the Russian Federation, within the competence of the relevant authority.

Draft federal law No. 1093620-6 proposes to grant powers to consider cases of administrative offenses under a number of articles on establishing administrative responsibility introduced by the bill, Federal Service for health care supervision.

So, according to the new edition of Part 1 of Art. 23.81 of the Code of Administrative Offenses of the Russian Federation, Roszdravnadzor, its territorial bodies consider cases of administrative offenses under Art. 6.24 (regarding tobacco smoking in the territories and premises intended for the provision of medical, rehabilitation and sanatorium services), 6.25 (regarding non-compliance with the requirements for a smoking ban sign, allocation and equipping of special places for tobacco smoking, or failure to fulfill control obligations for compliance with the norms of legislation in the field of protecting the health of citizens from the effects of second hand tobacco smoke and the consequences of tobacco consumption, in territories and in premises intended for the provision of medical, rehabilitation and spa services), 6.28, parts 1, 2 and 3 of Art. 6.29, art. 6.30, 6.32, part 1 of Art. 6.34, Art. 6.35 - 6.39, part 1 of Art. 14.4.2, parts 1 and 2 of Art. 14.43, Art. 14.44, 14.46, part 5 of Art. 19.4, part 21 of Art. 19.5, art. 19.7.8 of the Code of Administrative Offenses of the Russian Federation.

To consider cases of administrative offenses on behalf of Roszdravnadzor have the right:

head of Roszdravnadzor, his deputies;
leaders territorial bodies Roszdravnadzor, their deputies.

As a general rule, a decision in a case on an administrative offense cannot be issued after two months from the date of the commission of an administrative offense, except for the cases expressly specified in Art. 4.5 of the Code of Administrative Offenses of the Russian Federation. Note that the expiration of the statute of limitations for bringing to responsibility is a circumstance that excludes proceedings in a case of an administrative offense (clause 6, part 1, article 24.5 of the Code of Administrative Offenses of the Russian Federation).

The lack of administrative responsibility currently proposed by the draft federal law No. 1093620-6 does not allow the full application of enforcement measures when violations of the quality and safety of medical activities are detected during inspections by officials of Roszdravnadzor.

At the same time, the issuance of prescriptions is not an effective enough measure to eliminate violations in the healthcare sector, administrative responsibility for which is provided for by the named bill.

In conclusion, we list once again the violations for which administrative liability is introduced:

violation of the procedure for providing medical care;
violation of the procedure for conducting a medical examination;
non-compliance with restrictions in the implementation of activities in the areas of health protection and circulation of medicines;
violation of the rights of citizens in the field of health protection;
violation of the procedure for prescribing and prescribing drugs;
violation of the procedure for conducting clinical trials of medicinal products for medical use and preclinical studies of medicinal products for medical use;
implementation of medical and pharmaceutical activities in violation of license requirements;
violation of the legislation on the circulation of medicines.

Draft Federal Law No. 1093620-6 "On Amendments to the Code of the Russian Federation on Administrative Offenses in Part of Improving Administrative Responsibility in the Health Sector".

The conference will be held within the framework of the Cooperation Agreement between the All-Russian state university of Justice (RPA of the Ministry of Justice of Russia) and the Union of the Medical Community "National Medical Chamber".

Russian legislation in the field of health care has undergone numerous changes since the early 1990s. His novelization is still ongoing. . However, constant adjustments, the main purpose of which is to increase the efficiency of work, often achieve the opposite result - they develop legal nihilism and ignorance of laws. There are quite good reasons for this: legislative innovations are not always consistent and correct. Many legal provisions are very difficult to apply in practice. As a result, voluntary or involuntary violations occur in the process of providing medical care, which leads to negative consequences that entail legal liability: more often criminal, often civil law. Chamber experts believe that it is necessary to change approaches to legal regulation in healthcare. The purpose of the conference is to develop a unified approach to solving the most significant legal problems and develop a unified algorithm for the legal assessment of violations of legislation in the field of healthcare.

The event will discuss and develop solutions on a number of topical issues. Among them:

a combination of relevant and irrelevant errors with extreme necessity, justified by risk, the possibility of unconditional exclusion of liability in the event of an irrelevant error;
compensation for harm caused to the patient and determination of its size;
problems of liability insurance of medical workers;
issues of deontology and ethics;
the impact of economic factors on the quality of medical care;
issues of liability for non-execution of an illegal order or instruction;
contradictions between federal and regional legislation;
new medical technologies and their legal support;
problems of legal assessment and responsibility for violations of legislation in the field of healthcare;
competition of the provisions of the criminal law with the provisions of other regulations.

In addition, the conference participants will raise the issue of the long overdue need to prepare and discuss the decision of the Plenum of the Supreme Court of the Russian Federation on judicial practice in cases of offenses in the field of medical care and medical services.

Obviously, the issues raised cannot be resolved only by lawyers without discussing them jointly with representatives of the medical community.

The conference will be attended by representatives of the medical community, lawyers, deputies of the State Duma of the Russian Federation, employees of the Ministry of Health and the Ministry of Justice of the Russian Federation, representatives of the Constitutional and Supreme Court of the Russian Federation, the Investigative Committee of Russia, Prosecutor General's Office Russian Federation, Ministry of Internal Affairs of Russia.

To organize further effective work, the issue of holding regular symposiums of representatives of the medical and legal communities to develop common approaches to solving the most significant problems will be considered.

21.04.2018

The purpose of the workshop:

Formation of the concept of legal protection of the interests of a medical organization.
Establishing the basis for the adoption of effective management decisions to improve the quality and safety of medical activities.
Minimization of legal and financial risks.

The target audience:

managers and employees of the administration of medical organizations;
practicing physicians of various specialties;
heads of legal departments and legal advisers of medical organizations;
other interested professionals.

As a result of the training, you will be able to learn how to:

Optimize the document management system in a medical organization.
Comply with the requirements of the legislation in the field of medical services.
Avoid systemic legal errors in the provision of medical and non-medical services by medical organizations different forms property.
Build effective system internal control quality of medical care in a medical organization.
Create a system for predicting and preventing systemic defects in the provision of medical care.
apply ways pre-trial settlement conflicts with patients.
Improve the efficiency of work with appeals and complaints of patients.

Seminar program

Review of regulatory legal acts that determine the conditions and procedure for the provision of medical care in the Russian Federation.
Legal meaning medical documentation when considering court cases: systemic legal errors in the preparation of medical and legal documents, recommendations for optimizing workflow.
Systematization of defects in the provision of medical care as a risk factor for the onset of legal liability. World statistics of medical errors.
The structure of the conducted forensic medical examinations for the period 2015 - 2016. Analysis of forensic medical examinations in medical cases for 2015-2016.
Features of bringing to criminal and administrative responsibility in the provision of medical services: analysis of law enforcement practice, analysis of the most common offenses.
The system of professional and malfeasance in the field of healthcare: novelties of criminal law
Determining the grounds and limits of criminal liability as a guarantee against unfounded accusations of medical workers
Features of the application of norms establishing criminal liability and the imposition of criminal penalties on medical workers. Classification of articles of the criminal code
"Improper provision of medical care" and "Failure to provide assistance to the sick." Classification problems
Investigation of crimes committed by medical workers (iatrogenic crimes). The concept and classification of iatrogenic crimes.

Stage of initiation of a criminal case investigating authorities:
Checking the crime report;
Analysis of information obtained during the verification of a crime report;
Refusal to open a criminal case.
Features of the investigation of iatrogenic crimes:
seizure and search;
Inspection of documents, premises, computer technology;
Investigative experiment;
Control and recording of telephone and other conversations. Obtaining information about connections between subscribers and (or) subscriber devices;
Interrogation. Tactics of interrogation in the investigation of crimes committed by medical workers. Interrogation of the victim, witnesses, the accused.
Usage special knowledge in the investigation of iatrogenic crimes. Commission forensic examinations of the quality of medical care.

Features and procedure for conducting commission forensic medical examinations.
Establishment of causal relationships on the fact of non-provision or improper provision of medical care. Problems of establishing a causal relationship on the fact of non-provision and improper provision of medical care. Who establishes cause and effect relationships
The procedure for determining the severity of harm to health.
Innocent infliction of harm and circumstances excluding the criminality of the act in the implementation of medical activities.
Features of civil liability of medical workers and medical organizations. Problematic issues compensation for non-pecuniary damage in cases of inadequate medical care. The problem of filing a recourse claim against a medical worker in case of harm to the life or health of a patient. Presumption of guilt of the provider of medical services. Application of the rules establishing civil liability of the tortfeasor without fault.
Application of legislation on the protection of consumer rights in the provision of medical services by medical organizations with any form of ownership (imposition of fines when the court satisfies the requirements of the consumer in connection with the violation of his rights; payment of a penalty for violation of the deadlines for satisfying the consumer's requirements.
Administrative responsibility (review of the articles of the Code of Administrative Offenses of the Russian Federation applicable to medical organizations (employees).
Organization of activities to consider applications (complaints) of patients and (or) their legal representatives: algorithm of actions. Tactics for resolving and preventing conflicts with patients, organizing ways of pre-trial conflict resolution.

Location:

"Institute of Biotechnology and Interdisciplinary Dentistry", Moscow, Frunzenskaya metro station, Komsomolsky pr-t, 32, building 2

Cost of participation: 10 000 rub

Institute for the Development of Additional Professional Education (IRDPO)

in cooperation with the National Institute of Medical Law (NIMP)

conducts training in electronic form

using distance learning technologies under the advanced training program:

(120 hours)

For whom?

Advanced training program " Legal risks in the implementation of professional medical activities” was developed for managers and employees of medical organizations and health authorities; managers and employees of compulsory medical insurance funds and insurance organizations; heads and faculty of medical universities, faculties, medical colleges and research institutes; heads and legal advisers of medical organizations and health authorities, representatives of pharmaceutical companies, the medical industry and industry who need to acquire the skills of legal analysis and develop legal thinking, free orientation in regulations for independent decision-making in specific situations that arise in the course of their professional activities.

About what?

The advanced training course gives an idea of the main provisions and norms of leading industries Russian law as guarantors of the rights and legitimate interests citizens of the Russian Federation in the field of healthcare, and also includes practical matters legal support medical activities: features of the legal status of medical workers, principles and provisions of their social legal protection; legal problems ensuring the quality of medical services, the algorithm of responsibility of medical organizations and medical personnel for professional and malfeasance, providing legal protection against unfounded claims of patients, etc.

Academic plan educational program advanced training

"Legal risks of professional medical activity"

120 ac. hours

Module 1 "Rights and obligations of medical workers and medical organizations"

Module 2 "Modern requirements for the execution of medical and legal documents to ensure medical activities"

Module 3 "The procedure for the provision of paid medical services in medical organizations"

Module 4 " Legal Criteria assessment of the quality and safety of medical services"

Module 5 "Responsibility of medical workers for professional and official offenses"

Module 6 Features labor relations medical workers"

For what?

To achieve this goal, the following tasks were set:

Formation of skills in working with normative and methodological literature, codes and comments to them, by-laws regulations governing legal relations in the field of health protection;
Formation of skills for making lawful decisions in specific situations that arise in the course of professional activities;
Formation of the opportunity to independently give a legal assessment of cases of improper provision of medical care and determine possible legal consequences such acts, ways of their prevention;
Formation of skills in the preparation of local regulatory and management acts used in the activities of medical organizations;
Formation of skills in the use of legal mechanisms for the protection of the rights and legitimate interests of both medical workers and patients.

What's in the program?

Apart from more 800 pages of material aimed at satisfying cognitive interest in the field medical law and ongoing activities in the health sector, 28 situational tasks, which will have to be solved in order to successfully master the training program, as well as 6 tests and a tutor leading you all the way through the training, the program includes relevant topics, divided into modules for the logical and semantic organization of the learning process:

MODULE 1. RIGHTS AND OBLIGATIONS OF MEDICAL WORKERS AND MEDICAL ORGANIZATIONS: NOVELS IN LEGAL REGULATION

1.1.1. Modern legal framework in the field of healthcare: practice of application.

1.1.2. Legal status participants in legal relations in the field of health protection.

1.1.3. Rights and obligations of citizens in the provision of medical care.

1.2.1. The rights of medical and pharmaceutical workers and their incentives.

1.2.2. Responsibilities of medical and pharmaceutical workers.

1.2.3. Restrictions imposed on medical workers and pharmaceutical workers in the exercise of their professional activities.

1.3.1. Rights and obligations of medical organizations.

MODULE 2. MODERN REQUIREMENTS FOR FORMULATION OF MEDICAL AND LEGAL DOCUMENTS FOR MEDICAL ACTIVITIES.

2.1.1. Informed voluntary consent (refusal) for medical intervention.

2.1.2. Form of refusal of medical intervention.

2.2.1. Protection of information constituting a medical secret.

2.3.1. Defects in the design of primary medical documentation: analysis of systemic legal errors.

MODULE 3. PROCEDURE FOR PROVIDING PAID MEDICAL SERVICES IN MEDICAL ORGANIZATIONS.

3.1.1. Legislative regulation of the procedure for the provision of paid medical services.

3.2.1. Application of consumer protection legislation in the provision of medical services.

3.3.1. Pre-trial procedures for resolving conflicts with patients. Minimizing the risk of litigation.

MODULE 4. LEGAL CRITERIA FOR ASSESSING THE QUALITY AND SAFETY OF MEDICAL SERVICES.

4.1.1. The concept of quality of medical care in current legislation. The value of orders and standards in ensuring the quality of medical care.

4.2.1. Clinical and legal classification of defects in the provision of medical care. Legal analysis of the most common defects in medical care.

4.3.1. Quality control and safety of medical activities. Examination of the quality of medical care. Organization of control over the volumes, terms, quality and conditions for the provision of medical care under compulsory medical insurance.

MODULE 5. RESPONSIBILITY OF MEDICAL WORKERS AND MEDICAL ORGANIZATIONS FOR OFFENSES DURING THE IMPLEMENTATION OF MEDICAL ACTIVITIES.

5.1.1. Features of civil liability of medical organizations.

5.2.1. Criminal liability for professional and malfeasance medical workers.

5.3.1. Improper provision of medical care. Responsibility of medical workers and medical organizations.

MODULE 6. FEATURES OF LABOR RELATIONS OF MEDICAL WORKERS.

6.1.1. Employment contract: procedure and conditions for concluding, amending and terminating employment contract.

6.2.1. Features of termination of the employment contract at the initiative of the employer.

6.2.2. The procedure for bringing medical workers and heads of medical organizations to disciplinary responsibility.

6.3.1. Features of the labor relations of medical workers: reduced working hours, provision additional leave, pensions for medical workers.

And what is the result?

knowledge for practical application in their professional activities,
the opportunity to continue studying (at a discount) further, since this course is included in the advanced training program "SETTLEMENT OF DISPUTES WITH THE PARTICIPATION OF THE INTERMEDIARY (MEDIATOR) IN THE SPHERE OF HEALTH CARE (TRAINING OF MEDIATORS IN THE SPHERE OF HEALTH CARE)", 576 ac. hours,
if you wish, you can join the practice (or internship),
of course standardized certificate of advanced training(in accordance with federal law dated December 29, 2012 No. 273-FZ "On Education in the Russian Federation"), in case of successful completion of the advanced training course, if you are not in Moscow, the certificate will be sent along with the original documents by registered mail by Russian Post.

In the process of studying the material, it is necessary to pass all tests and practical tasks (cases) for each topic.