Silence kills

The possibility of doctors openly talk about problems is the only way to defeat the pandemic

On October 28, the Ministry of Health sent the decree to subordinate and federal institutions to coordinate any public comments on the doctors about the Covid-19 with the press service of the department. This is necessary in order to reduce the number of “inherent facts, assumptions and forecasts” in the information space and more “effectively” to inform people about the news, the department said. But to disturb doctors talk about problems is a bad way to combat Fake-Nachuz. The set, in order for Russia with the least losses to survive the second wave of coronavirus infection, it is necessary to quickly put into effect the system of protection of doctors who report violations of their rights.

During the pandemic of the coronavirus of Russian doctors, the lack of stimulating payments for work with Covid-19, a high risk of infection due to lack of personal protective equipment and insufficient testing of medical staff, showed the monitoring project “Unobvious victims of coronavirus in Russia”. The scale of these problems was very significant, but the regulatory authorities and the leadership of the medical institutions either ignored the messages of the medical applicants or imposed sanctions against them.

Such actions contradict Russian law. So, the law on the procedure for consideration of citizens' appeals prohibits the persecution of those who reported to the stateganese or official the information criticizing their activities.

Doctors suffered not only due to the lack of a clear algorithm for calculating the need for personal protective equipment. They were also afraid to openly declare their shortage. 43% of the doctors surveyed considered this topic "dangerous and risky for any commenting and discussion." Doctors are afraid to openly declare the lack of equipment and PPE because of the norms of the Code of Administrative Offenses of inaccurate information against them. This enhances the atmosphere of fear and forces doctors to transmit information to open sources anonymously and through third hands.

Not only Russian doctors are subjected to sanctions for problems about problems during coronavirus. So, in the United States, where the most in the world infected with coronavirus, the doctor of the emergency assistance department Min Lin was dismissed after the publication of a record of a lack of personal protective equipment in his hospital. Lin sued the hospital for illegal dismissal, and she accused him of violating the rules for the dissemination of information.

But the official bodies should not put pressure on employees for using other methods of disseminating information, but checking it and correcting their mistakes.

Similar conflicts were repeated at different levels. Thus, Rick Bright, an Immunology expert and ex-director of the Biomedical Research and Development Management and Development Expert, was subjected to pressure from the US presidential administration. He was fired after a report of a conflict of interests when concluding contracts for the supply of drugs for the treatment of Covid-19. Although the office of a special adviser to the US Ministry of Justice recommended restoring Bright in his position, he was reduced, transferred to another department, subordinate to the US Treasury, and soon left a new position: “The authorities made his work unbearable.”

The US Law on the protection of applicants directly prescribes the need to restore as an employee who reported offenses. But it turned out that in the field of healthcare, not only doctors and medical staff are poorly protected, but also experts and managers.

Cases of dismissal for messages about problems in medical institutions during the pandemic were observed in China, Poland, Nicaragua, Hungary and other countries. Heads of medical facilities, doctors and junior medical personnel are subject to sanctions. No one is safe from pressure or threat of dismissal for the distribution of information, which allegedly discloses the reputation of the medical institution or all health care. For this, some medical institutions include a clause on non -disclosure of information on how work in the hospital is organized.

Similar practice is common in Russia. The leadership of the Divnogorsk hospital (Krasnoyarsk Territory) invited employees to sign an agreement under which they cannot disclose the information that became known to them at work as a confidential one. Moreover, one of the clauses of the contract prescribes to doctors to inform the management about attempts to receive such information from them. The deputy of the Divnogorsk City Council Roman Ulsky then persuaded not to sign this document.

Profile trade unions or associations that provide legal support and providing confidentiality to medical applicants can become an effective tool for the protection of doctors and medical workers.

In the UK, the Association of Doctors announced the insecurity of doctors and medical staff from intimidation, disciplinary punishments and dismissal due to public statements.

But trade unions are not a universal way of protecting doctors. Firstly, not all medical facilities are included in trade unions. Secondly, participation in them in itself can be a danger to doctors.

In Russia, during the pandemic, health workers were subject to pressure for participation in trade unions. So, in Dagestan, the leadership of the Republican Center for Traumatology and Orthopedics named after Tsakhaev threatened the dismissal of doctors and their relatives for creating a trade union. “The persecution began in the fall of 2019,” says Evgenia Bogatyrev, an ambulance doctor in the queen near Moscow. “The reason is that we joined the“ Action ”medical workers' union. In September, Divnogorsk doctors also joined this trade union, said deputy Roman Ulsky.

As the “action” trade union emphasizes, in Russia, health workers are very dependent on the chief physicians who can always find a reason for dismissal. Most of the statements transmitted by the “action” to the regulatory and supervisory authorities sign the health workers anonymously, fearing sanctions from the leadership. In the Astrakhan region, medical workers are pressed not only after reports of a lack of PPE, but also for information about the absence of stimulating allowances for the intensity of work during the pandemic, the “action” indicates. In Russia, there are no legislative mechanisms for the protection of applicants-medical applicants and available channels for messages about violations of their rights. The role of trade unions can be more important.

In order for the trade unions to successfully cope with the protection of law enforcement doctors, it is necessary that health workers know about this role. It is necessary to make effective measures to protect the applicants and extend them not only to a permanent state of doctors, but also to their assistants (students, interns) who are not part of medical institutions.

The trade unions should have the opportunity to provide legal and financial support to health workers in litigation due to illegal dismissal or unreasonable sanctions. Not all trade unions can provide such assistance. In Russia, in some cases, regional trade union organizations are headed by medical institutions. It is clear that such trade unions will not protect the rights of health workers. It is useless to contact them, they work in conjunction with the administration of the medical institution.

It is necessary to create in Russia the legislative framework for the protection of launcher doctors. Such steps were taken in some countries with the participation of civil society and experts already during the pandemic. So, in Iceland in May 2020, a law was adopted on the protection of applicants, which applies to any employees who conscientiously report on violations in the workplace.

International and Russian practice show the presence of structural problems in healthcare systems that have taken over high risks during the pandemic of coronavirus. The shortage of health protection and legal protection of health workers negatively affects the protection of the whole society.

The restriction of the freedom of statements and the pressure on the medical staff from the leadership of the medical institutions and the state authority is not a solution to problems, but only drives them deep into them and increases their scale.

A transparent and open reporting culture that allows people to talk about security problems, saves life, notes Jenny Voan, head of the British Doctors Law and Politics Department. Now the covid-19 incidence has grown around the world again, and to minimize risks in the medical field, the governments need to quickly respond: make a transparent system for the supply of personal protective equipment and testing of health workers to coronavirus, check all cases of negative impact for messages about violations and introduce a system of protection of applicants in Russia from negative impacts-dismissal, lowering, decreasing, lower deprivation of allowances and additional payments.

Alexey Kuznetsov

Assistant Minister of Health of the Russian Federation

- During the period of pandemia, it became obvious that in the context of the spread of a new infection, the information field began to be filled with various speculations, forecasts, and recommendations - sometimes diametrically opposite. One of the experts recommends wearing gloves, someone says that drugs do not exist, others recommend that in order to prevent antibiotics, which, incidentally, can only be effective for bacterial complications of Covid-19. Various organizations and associations began to publish their guidelines for the treatment of coronavirus infection that are not related to the official recommendations of the Ministry of Health. As a result, practicing doctors were confused: what recommendations should I follow?

Citizens must have access to reliable information, and not to pretend to speculate. The structure of subordinate organizations and the main freelance specialists of the Ministry of Health is such that the names of institutions, as in the very status of the main freelance specialist, indicate belonging to the Ministry of Health of Russia. Thus, almost any statement of managers or employees subordinate to the Ministry of Health of institutions or main freelance specialists is interpreted by the media and is perceived by the audience as the position of the ministry.

The Ministry of Health of Russia always seeks to convey to citizens and healthcare professionals the most reliable and updated information, and our colleagues are full participants in the information process. That is why we turned to the heads of our organizations and respected chief freelance specialists with a request to coordinate our activity to inform citizens about measures to prevent and treat a new coronaviral infection. After all, we all together, ultimately, are responsible to society.

As an illustration of the ministry responsible for information on Friday on the basis of the Sechenov University of Sechenov, one of the flagships of the struggle with Covid-19, a large federal webinar dedicated to new approaches to the treatment of coronavirus, set forth in the 9th version of the official methodological recommendations of the Ministry of Health, will be held.

After all, a uniform approach to the treatment of patients and the use of the best practices by doctors throughout the country is that, I am sure, it will help us stop the spread of the virus and preserve the lives and health of our citizens.

I want to emphasize that the recommendations sent to institutions and specialists, in no case do not affect the possibility of doctors to give comments regarding various aspects of their work, including problematic ones. Moreover, the Ministry of Health welcomes the openness and publicity of the entire healthcare system. Indeed, in the person of the “fourth power” we have a reliable ally, helping us to open the painful problems of the industry. And together we are working to improve all Russian healthcare.

Alena Vandysheva -expert of the regional anti-corruption center "Transpenser Internet-P" in St. Petersburg; Anastasia Lapunova - Analyst Transpenseri International - P; Svetlana Petrova is a journalist.

The material was prepared with the participation of the interns “Transpenser Internet-P”, students of the Higher School of Economics-St. Petersburg Maria Bespalova and Anna Filchakova.