Medical services are a rather specific type of service. It seems that a person without special knowledge cannot understand that the service was provided poorly. However, everything is not as complicated as it seems at first glance.

ATTENTION : our lawyer for protecting the rights of patients in Yekaterinburg will help when low-quality medical services are provided: professionally, on terms of legal services favorable to you and on time. Call today!

How to determine the quality of medical services?

The quality of a medical service is its compliance with regulatory requirements. The fact is that healthcare legislation establishes standards and procedures for the provision of medical services. All medical organizations must comply with these standards and procedures.

The quality of medical services can be established by a medical insurance organization, Roszdravnadzor. In addition, in case of disputes about the quality of medical services and the consequences of poor-quality medical care, the final decision can be made by the court.

It is quite difficult to independently determine the quality of a medical service. However, there are some guidelines:

• if medical care was provided under the policy, the waiting time for medical care must be observed from the moment of contacting the organization (depending on the type of medical care)
• the program of state guarantees for the provision of free medical care to the population must be observed
• if the result of a medical intervention differs from the usual (complications have occurred), this may indicate poor quality medical care. help. The same quality criteria, with the exception of compliance with guarantees of free medical care, apply to paid medical services.

NOTE: Medical care is also of poor quality if it is provided by a doctor without the appropriate certificate, or by a medical organization without the appropriate license to provide medical services of a certain type.

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Where to write a complaint about poor quality medical services?

The quality of medical care in the field of compulsory medical insurance (according to the policy) is controlled and assessed by medical insurance organizations. Contacts of such an organization are located directly on each citizen’s compulsory health insurance policy.

In addition, the Compulsory Health Insurance Fund (MHIF) and its territorial branches (TFIF) have the same powers to control the assistance provided by medical organizations.

Roszdravnadzor is a special service created within the Ministry of Health, which has special powers to supervise the healthcare sector (for more information on filing a complaint with Roszdravnadzor, follow the link). In addition, Roszdravnadzor is the licensing authority for the activities of a medical organization.

Thus, you can send a complaint:

• To the insurance company that issued the policy
• To the compulsory medical insurance fund
• To Roszdravnadzor
• To the Ministry of Health of the Russian Federation
• Other organizations that you think are somehow capable of helping with the current problem (prosecutor’s office, Governor of a constituent entity of the Russian Federation, President of the Russian Federation, etc.)

How to file a complaint about poor-quality medical services provided?

1. Start of appeal . The complaint must contain a “header” indicating the addressee (name and address, full name of the official), the sender (own full name and location address).
2. In the middle part of the complaint text, you must briefly and clearly describe what happened: the time, place of receipt of the medical service and the reasons why you consider the medical service received to be of poor quality (non-compliance with standards, non-compliance with the program guaranteeing free medical care to citizens, long waiting times or the occurrence of unusual consequences and etc). The text of the complaint is drawn up in free form. Your own arguments can be supported by reference to regulations.
3. In the final pleading part of the complaint, it is necessary to indicate the requirements corresponding to the authority of the addressee. For example, TFOMS and medical insurance organizations have the right to check the volume, timing, quality and conditions of medical care, draw certain conclusions, formalize them in a protocol and send them to the applicant.

The powers of Roszdravnador are to control the circulation of medical drugs and products, control the quality and safety of medical activities.

USEFUL : watch a video with additional advice from a lawyer on filing a complaint

Claim for medical services

A claim for poor quality medical services is filed directly with the medical organization. A claim can be made both in the case of receiving medical care for free, and in the case of receiving paid medical services.

A claim by a consumer of a medical service or a patient who received assistance under the policy can be drawn up both for the purpose of resolving a conflict and for the purpose of attempting to resolve a dispute out of court.

In practice, claims are made by consumers of paid medical services in order to return money and compensate for harm caused by poor-quality medical care.

A claim is prepared in the same way as a complaint. This type of appeal is distinguished by the fact that the addressee is the organization itself that provided the service, and among the requirements of the claims most often appear requirements of a civil law nature, presented in accordance with the Law of the Russian Federation “On the Protection of Consumer Rights”

USEFUL : For complete material on filing a claim for poor-quality medical services, read the link

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Claim for poor quality medical services

A claim for poor quality medical services initiates a civil process. The jurisdiction of such cases is at the location of the plaintiff. There is no need to pay state duty.

The requirements of the statement of claim for poor-quality provision of medical services are reduced to the recovery of:

• amount paid under the contract for paid medical services
• compensation for moral damage caused by poor-quality medical care
• compensation for material damage (for example, in the case when the patient has incurred or must incur expenses to eliminate the consequences of poor-quality medical care, undergo surgery, buy medications)
• collection of a consumer fine for refusal to satisfy the consumer’s legal demands in pre-trial proceedings

The content of the claim must indicate not only the events that gave rise to the claim, but also the regulatory justification for the claims that arose. For example, standards and procedures for the provision of medical care in conjunction with consumer legislation.

In addition, the consideration of such cases does not involve taking into account the conclusions of medical insurance organizations and independent experts, and forensic medical examinations.

The submitted statement of claim is accepted by the judge within five days. Subsequently, the court issues an order to prepare the case for consideration, during which a preliminary hearing may be held.

A mandatory appendix to the statement of claim must be a calculation of the cost of the claim - the amount of money to be recovered.

USEFUL : order a lawsuit from our lawyer, and also watch additional tips on writing a statement in our video from the YouTube channel

What is considered “poor quality treatment”

When you come to a hospital, you formally become a consumer of its services. Therefore, theoretically, you can receive compensation for any poorly provided medical service.

Here is a list of reasons for which you can claim compensation:

✅ If you have doubts about the diagnosis

There is a good way to check whether the doctor diagnosed you correctly: take a medical card extract from the clinic and go to two more doctors. If their diagnoses are the same, but different from the diagnosis you were originally given, you can seek compensation.

To receive an extract, fill out an application addressed to the head physician. The hospital is obliged to issue it. If it doesn’t, you can write a complaint to the head physician - and the hospital will be fined.

Application addressed to the head physician, required to obtain an extract from the medical card

The best tactic: go to public and private clinics so that doctors are not suspected of bias. To go to a doctor from another state clinic that does not have a registration, you need to be attached to it by writing a corresponding application. But then you will detach yourself from your old clinic. The easiest way is to ask a doctor whose diagnosis you doubt for a referral to a specialized medical center. For example, to the regional one.

The doctor may refuse and not give a referral. Then you should write complaints to the head physician: “I doubt the diagnosis, I want to be rechecked at the regional hospital, they won’t allow me.” As a last resort, if complaints and conversations with a doctor do not help, you can visit two private clinics with qualified specialists.

Compensation for misdiagnosis is most often obtained when the cost of the doctor's error is truly high. This applies to diseases that can be fatal or lead to disability: neoplasms, cirrhosis, serious damage to the musculoskeletal system, chronic diseases of the central nervous, cardiovascular and immune systems, etc.

For example, a resident of the Kamchatka Territory sued the hospital for 60 thousand rubles as compensation for moral damages for an incorrect diagnosis. The doctor did not schedule an examination on time and incorrectly suggested treatment for a fracture of the knee joint. The patient had to undergo treatment herself in private clinics. After that, she sued the hospital. Important note: the patient spent 120 thousand rubles on treatment in a private clinic, and the court did not return it.

✅ If treatment only made things worse

Let’s say a patient had surgery, but it didn’t help or made it even worse. This is a serious reason for investigation. In this case, you can claim compensation.

Compensation can be recovered when, due to improper treatment, the patient became disabled or died. In other cases - when everything did not end so badly - you should not count on serious compensation: you are unlikely to sue for anything. And even if you sue, it may not cover your expenses.

For example, due to poor-quality surgery on his leg, a resident of Bashkortostan became disabled. For this, the court collected 800 thousand rubles from the hospital for compensation for moral damage and another 400 thousand rubles as a consumer fine.

✅ If complications begin

The treatment may be correct, but violation by medical staff, for example, of sanitary standards can lead to complications. Let's say you might get an infection. Then you can also sue the hospital.

You can count on a significant amount here only if complications lead to disability or death. But even if the consequences are serious enough, the money won may not even cover the costs of paid treatment and subsequent trials.

For example, the brother of a deceased resident of Orenburg was able to sue the hospital for 350 thousand rubles. Doctors made a large number of errors during the treatment process, and this, as a consequence, led to the death of the patient.

✅ If medical confidentiality was disclosed

By law, a doctor cannot talk about a patient’s health or treatment at all without his permission. But there are a number of exceptions:

• If the patient is under 15 years of age, his legal representative, parent or guardian can obtain full treatment details from the doctor.
• If the patient has been harmed as a result of illegal actions. For example, a street shootout started and someone was hit by a bullet - then the doctors can tell the police the details so that the police can quickly begin to understand the situation.
• If the patient undergoes a military medical examination. For example, he registers with the military registration and enlistment office - then the doctors at the military registration and enlistment office can disclose information about his state of health.
• If information about the patient’s health is requested by the bodies of inquiry and investigation, the prosecutor or the judge. During an investigation or trial, participants in the process may ask doctors to provide details in order to understand in more detail.

If none of these conditions are met and someone still shares information about your health and treatment, you can seek compensation.

For example, a resident of St. Petersburg sued CORIS, a private emergency medicine clinic, for 30 thousand rubles for disclosing medical confidentiality. Before the flight to Kaliningrad, he felt ill and called doctors from CORIS. They gave the go-ahead for the flight, but on the plane the man had a heart attack. At first, the patient wanted to sue the company for poor quality treatment. But then the head of the clinic sent documents describing what happened to the doctors of the Association of Private Clinics of St. Petersburg, and this was already a disclosure of medical confidentiality.

Material and moral damage for poor-quality medical services

Poor quality medical service, depending on its consequences, can cause harm - moral or material.

Moral harm refers to physical and moral suffering – physical pain and anxiety caused by poor-quality medical services or its consequences.

Material damage is additional expenses that a citizen has incurred or must incur to eliminate the consequences of poor-quality medical services.

The harm must be directly related to poor quality medical care.