The case of Misyurina: Why judging for medical errors is dangerous
Olga Lukinskaya
In the late nineties, when I was studying dental Faculty of the Moscow "third honey", the medical field with the legal overlap is weak: private offices multiplied in high-rise apartments, and there were rumors about some clinics that at night gunshot wounds were sewn up to gangsters. About what was considered the norm to make two fillings, to spend on the checkout one, and the money for the second put in your pocket, probably, and do not say. Twenty years have passed, the scale of private clinics has changed, the insurance system has changed, and health care has undergone more than one reform - and another extreme has arisen: an article has appeared in the Criminal Code about the responsibility for medical errors.
In principle, the idea of suing doctors is not new: in the United States, most practitioners are insured against a lawsuit, and some call their careers successful simply because there were no such claims. At the same time, the issue that the compensation system needs to be reviewed is increasingly being raised, because not all problems can be prevented by the threat of a lawsuit. Adverse outcomes of medical interventions are only occasionally the results of negligence or medical errors. In most cases, they are associated with inherent risks to the procedure itself; No doctor in his right mind will carry out a treatment that is more dangerous than the disease itself - but a certain percentage of complications always exist, and patients are warned about this.
The problem, of course, is not in the law itself, but in its implementation - and unfortunately, we are witnessing its terrible results right now. Russian doctors are calling to sign a petition in defense of Elena Misyurina, a hematologist who was sentenced to two years in prison for "providing services that do not meet safety requirements and caused death." A flashmob of #YElena Misyurin began in social networks - in publications with this tag, doctors share opinions about what happened and what is waiting for medicine in the country. In short, nothing good: out of fear of lawsuits, more and more doctors will choose specialties with the minimum number of manipulations, the least risky ones, or leave the profession altogether.
In 2013, a patient died at the Medsi clinic, who got there with a preliminary diagnosis of appendicitis. It is known that he had serious diseases: prostate cancer, diabetes insipidus and cancer of the blood, which unhappyly happened to worsen at this very moment, transforming from a sluggish form to acute leukemia (that is, a condition that ordinary people call "blood cancer"). Coagulability was greatly impaired, and during the operation the patient lost a lot of blood - they could not save his life.
The following story looks confusing: it is known that if MEDSI had a license for hematological care, the clinic did not start treating leukemia - but then it was performed an autopsy without a license for it. Four days before his death, the patient visited the reception at Elena Misyurina, who conducted a routine and generally safe procedure - trepanobiopsy. During this procedure, a small fragment of bone marrow is taken from a person to examine it under a microscope and clarify the diagnosis; it sounds scary, but with experience and proper conditions, trephine biopsy is no more dangerous than tooth extraction. According to numerous comments by colleagues Mysyurina, after the procedure, the patient looked normal, left the hospital, smoked and left behind the wheel of the car.
It may seem that the fear of a lawsuit will make the doctor work better, but it is not. The constant fear of accusations will lead to the fact that there will be no more practicing doctors
And then Elena Misyurina was accused of a medical error that led to the death of a person - death that happened, we repeat, in another clinic, during a serious operation, several days after her trepanobiopsy. It was about the fact that during the procedure, the doctor allegedly damaged a large artery, the bleeding from which became lethal. It is clear to any sensible doctor that in this situation the puzzle does not stack up, and the case looks clearly fabricated with the goal of shifting responsibility onto someone - but in reality this is not the problem.
The problem is that if doctors are judged for mistakes, there will be no medicine left. If they are accused of carrying out high-risk manipulations, doctors will stop conducting them. All practical medicine by default is a risk area - this is a job where patients suffer and even die. Is it possible to prove that a person with cancer has died, for example, due to an error in taking blood from a vein? The example seems absurd, but do not underestimate the skillful prosecutors. Doctors again and again repeat that after the precedent with Misyurina, serious patients will simply stop practicing: the doctor’s own safety will outweigh the risk of being in prison in case of the slightest mistake.
Negligence and deliberate harming with errors should not be confused - the latter commit everything, and Hippocrates spoke about the doctor’s right to make a mistake. Many medical manipulations are performed blindly, and each of them has certain risks. It is impossible to refuse these procedures in such a way as to continue to diagnose, treat and save lives. It may seem that the fear of a lawsuit will make the doctor work better, but it is not. The constant fear of accusations will lead to the fact that there will be no more practicing doctors, and the consequences will be disastrous. And if, for example, we wait for a high-profile process due to the complication of vaccination, we will no longer be vaccinated and epidemics of measles or polio will break out.
Our regular expert, a gynecologist Natalia Artikova said that at one time a criminal case was opened against her father, an obstetrician-gynecologist with thirty-five years of experience. He was accused of injuring the intestinal wall during the operation - and in order to refute this accusation, it took three additional examinations. As a result, it turned out that the perforation of the intestine was not associated with medical intervention at all, the doctor was acquitted - but the year under house arrest and the unfair accusation severely undermined his health and will. For Artikova, this situation became the first swallow - she decided to leave obstetrics, and then completely abandoned any blind manipulations: “I don’t even put intrauterine contraceptives - I decided that I would work only with my head, minimizing the risks.”
Once I left practical medicine for a number of reasons: there was little pay, and I also wanted business trips and everyday use of English in my work. But one of the main concerns was the fear of responsibility: I didn’t know how I would live on if my patient died at the reception. Even if this happens without communication with the intervention, for example due to myocardial infarction, and I will do everything possible to save him. It was an irrational fear - at a dental appointment this happens very rarely - but he bothered me. Fifteen years later, I understand that everything can be even worse: a doctor can be blamed for death, to which he has no relation, and put in jail.
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