How to properly file a claim for improper provision of medical services?

To determine who to complain to about medical care, it is important to understand that medical care is a service. In our country, you can receive free treatment under the state program of compulsory health insurance (CHI), using the appropriate policy. Paid treatment is provided in private clinics at the expense of the clients themselves. In both cases, the patient has the right to rely on the Law of the Russian Federation N 2300-1 of 02/07/1992 “On the Protection of Consumer Rights” (ZOPPP).

Quality of medical care

According to Law No. 323-FZ of November 21, 2011 “On the Fundamentals of Health Protection...”, the quality of medical care is:

1. Timely medical care provided.
2. Correctly chosen method of providing the service.

Quality characterizes the degree of achievement of the set goal. In judicial practice, there are frequent disputes between patients and medical institutions due to the fact that the law does not focus on the correct implementation of the chosen method of treatment. In other words, if the prescription is correct, then this already indicates the correctness of the provision of medical services. There is no need to talk about guarantees of results (achieving the goal) due to the specifics of the healthcare industry.

When do patients usually complain? The most common cases:

1. Help was not provided in a timely manner or assistance was refused.
2. Misdiagnosis.
3. Negligence.
4. Too expensive appointments.
5. Rudeness and rudeness.
6. Damage to health as a result of treatment.
7. Wrongly chosen treatment method.

Forms of protecting patient rights

There are 2 forms of protecting patient rights:

1. Pre-trial (peaceful, claim).
2. Judicial.

The claim procedure within the framework is not mandatory. However, the court will certainly inquire whether the plaintiff tried to resolve the conflict peacefully. If this was done, it will be counted in his favor.

Not only the patient himself can defend the rights, but also on his behalf:

1. Representative (legal, by power of attorney).
2. Insurer representative (under policy or).
3. Prosecutor.
4. Ministry of Health
5. Public organization.
6. Rospotrebnadzor.

How to complain about poor quality medical services in 2021

If there are grounds for a complaint, then the patient first of all needs to contact the management of the medical organization where he was provided with poor-quality service. This can be done in person, in writing, or by mail. At the same time, refusal to fulfill the claim requirements is a good reason for contacting the Prosecutor’s Office, the Ministry of Health, Rospotrebnadzor, public organizations, and, if necessary, the court.

A compelling argument in a dispute with medical institutions is the expert opinion on the quality of the service provided. This will allow the trial to be based on the established fact of guilt, rather than personal biased opinion.

The perpetrators may be held accountable by regulatory agencies, up to and including deprivation of their license. A victim of poor-quality treatment has the right to demand compensation for physical and moral damage, and in disputes with private clinics, seek a refund of payment.

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Where to complain about poor quality medical services

The criteria for the quality of medical care are set out in Order of the Ministry of Health No. 520n dated July 15, 2016. It is the Ministry of Health that approves the procedure for providing services for each group of diseases, as well as the corresponding standards.
They are guided by all medical institutions operating within the framework without exception. Having identified a violation of the approved standard, you can send a claim:

1. The head of the doctor who provided poor quality service, the head physician of the hospital. He is obliged to accept the complaint and notify in writing of the result of its consideration.
2. The refusal of the clinic management to take action within 30 days gives the patient the right to contact Roszdravnadzor.
3. In order to protect your rights, you can contact the Prosecutor's Office with a request to conduct an inspection at the medical institution. The processing time for the application is the same - 30 days.
4. Leaving the complaint by Roszdravnadzor and the Prosecutor's Office without satisfaction implies only one option for further proceedings - in court.

If there are signs of a criminal act in the actions of medical workers, then you must contact the police, setting out in a statement all the circumstances of the incident. In this case, the proceedings will take place within the Russian Federation.

Patient instructions

Step one - you need to write a claim to the management of the medical institution and demand compensation for the harm caused.

Here you can do without the help of a lawyer.

It is best to draw up the paper in the form of an application. That is: “hat” is the name of the chief physician or manager to whom the message is addressed. Then information about yourself: full name, home address and telephone number. The content is the essence of the problem. Brief, but specific and understandable. In conclusion, you need to indicate your requirements for the head of the medical institution. Here you can cite articles of federal law that, in your opinion, were violated by the attending physician. At the end - signature, date and description of the attachment, if you are attaching any documents confirming your case.

This paper is best sent by registered mail. Or fill out two copies and take it to the reception of the head physician of the medical institution. Leave one for the proceedings, and on the second ask the secretary to sign and date the document. This is your proof of going to a medical facility.

It is important to show your opponent the seriousness of your intentions and the prospect of litigation.
Often such disputes end with the conclusion of a settlement agreement on the payment of compensation even before the trial. If you have not received proposals to resolve the conflict within the period specified in the pre-trial claim, you must go to court. Typically, organizations prefer not to refuse complaints, but simply ignore them. The absence of a written response or compliance with the requirement is regarded as a refusal to fulfill it, and therefore the patient can safely go to court. — comments Elena Panikarskaya.

Step two is to involve your insurance company.

She comes to the defense of the insured client if he receives poor-quality medical care under the compulsory medical insurance policy. After all, it is only the patient who does not pay for treatment. The insurance company does this for him. Therefore, it is she who is interested in proceedings in case of conflict and misunderstanding with a medical institution. AlfaStrakhovanie-OMS official representative Yuri Nekhaychuk spoke about how insurers work with citizens’ appeals:

Our company has launched a project - we install a telephone in every clinic where patients can call and report their problem. For example, they didn’t serve you at the reception desk, they gave you the wrong diagnosis, and so on. That is, any dissatisfaction in the compulsory medical insurance system serves as a reason for appeal. A person gets to the so-called first wave of insurance representatives, who must fundamentally figure out whether the claim is justified. If violations are “obvious,” the question of examination arises. The complaint is forwarded to a higher-level specialist who understands the serious issues.

That is, in fact, the patient simply needs to inform his insurance company that he suffered from the unprofessionalism of a health care worker by calling the phone number indicated on the compulsory medical insurance policy. And then the insurers investigate this case and, if necessary, conduct an examination of the quality of medical care.

That is, all the hassle and expense of carrying it out no longer concerns the patient. He'll just have to wait for the result.

#IMPORTANT

By the way, the insurance company sends the expert’s opinion not only to the patient, but also to the management of the medical institution.
If it turns out that there were indeed violations in the provision of medical care, this is fraught with serious problems for the medical institution. Firstly, he will face considerable fines, and secondly, if the case goes to court, then the expert opinion is a strong argument in defense of the patient. Over the first 9 months of 2021, we received just under two million requests. Almost 700 thousand of them turned out to be justified. Therefore, insurers advise not to be shy and not to neglect contacting the insurance company.

How to write a complaint against a doctor at a private medical institution

The patient must understand that in the eyes of the law there is almost no difference between a public and private clinic. In the first case, the services are free, in the second, they are paid. But both private and public doctors are obliged to comply with legal requirements.

There are slight differences in the form of complaints that can be sent to different authorities.

To the Ministry of Health

You can submit a complaint in person at an appointment at a territorial unit, by visiting the institution’s website rosminzdrav.ru, or by mail to the address: 127994, GSP-4, Moscow, Rakhmanovsky lane, 3.
When drawing up a document, follow the rules:

1. In the upper right corner they list the exact name of the institution where the document is addressed, as well as their data: full name, address, contacts (e-mail, telephone).
2. B, indicating the details of the doctor (clinic, hospital, etc.) for whom the appeal is being made.
3. The following briefly lists the circumstances of the conflict. All facts must be indicated: dates, amounts, times, names of drugs, references to violated legal norms.
4. All previous appeals to the management of the medical institution, Rospotrebnadzor, etc. must be listed. The results are indicated. Copies of requests and responses to them must be attached.
5. List the requirements. This could be compensation for harm, a refund, receiving a quality service, etc.

At the end they put a signature and date. The attachments include all previous requests, as well as documentary evidence (checks, invoices, payment receipts, agreement for the provision of paid services, etc.). A list of applications is listed in the text in the final part.

To the prosecutor's office

There is no point in complaining to the Prosecutor's Office about poor quality service. Here they deal with disputes related to violation of civil rights. Therefore, when drawing up a complaint, it is necessary to be guided by the same principles as when applying to the Ministry of Health, however, it is imperative to cite those norms of civil law that were violated by a private doctor. Without this, the complaint will be left without consideration.

To court

A statement of claim can be drawn up in different ways. The exact form depends on what exactly the plaintiff wants to receive in the end. You can appeal to the norms of the Russian Federation, the Russian Federation, and others. However, any claim must contain complete information about the case:

1. Name of the court, personal information of the plaintiff and defendant (institution, doctor, clinic, etc.).
2. The essence of the violation. Evidence is provided, as well as references to violated rules of law.
3. Claim.

RF.[/useful]

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Legislation

The Criminal Code protects the rights of patients. Criminal liability is provided for:

1. Failure to provide medical care to a sick or injured person (Article 124). For this, not only the doctor, but also the nurse, the head of the institution, etc. can be punished.
2. Death of the patient (Article 109).
3. Damage to health due to unqualified treatment (Article 118).
4. An abortion performed by a person who does not have the appropriate specialization (Article 123).
5. Known danger of HIV infection (Article 122).
6. Illegal engagement in medical activities (Article 235).

This is not a complete list of situations falling under criminal law. In a specific case, you should seek advice from a criminal lawyer.

Sample complaint

Sample complaint about poor quality medical services

Filing a claim in court

Jurisdiction of claims is the district court at the location of the medical institution or at the patient’s place of residence.
The form of the document is strictly regulated, so it is forbidden to use colloquial expressions, insult the defendant, etc. It is important to provide not only references to legal norms, but also to attach a sufficient amount of evidence for each fact presented:

1. Agreement with a medical institution.
2. Receipts for payment.
3. Extract from the medical history.
4. Copies of prescriptions, prescriptions, diagnoses, diagnostic examinations, tests, etc.

Legal medical disputes

In a legal dispute, an important point is the competent drafting of the claim, since on its basis a case is initiated and subsequently, taking into account the evidence in the case, a decision is made.

A claim for a medical dispute is drawn up in compliance with the requirements of procedural legislation and must contain the following information:

• name of the court to which the plaintiff applies
• Full name of the plaintiff and his place of residence, or the name of the organization and its location
• name of the defendant and his location, and/or full name of the defendant and his place of residence

ATTENTION : from March 30, 2020, changes will come into effect regarding the content of information about the defendant in the claim, according to which it will also be necessary to indicate other information about the defendant, for example, his place of work, one of the identifiers, if they are known to the plaintiff.

• the price of the claim, i.e. amount of claimed claims
• circumstances of the case. When presenting this information, it is necessary to reflect what the violation of the plaintiff’s rights is, what evidence confirms this
• information that the plaintiff filed a claim with the defendant, as well as information about the response to the defendant’s claim, i.e. whether or not there was a response to the complaint
• the pleading part of the claim must formulate the specific demands of the plaintiff;
• after the requirements, the documents that are attached to the claim are listed
• At the end of the claim, the signature of the plaintiff and a transcript are placed, and the date of signing the claim may also be indicated.

In addition to the specified information, the plaintiff can indicate telephone numbers, faxes, e-mails, and make some petitions, for example, for the court to request a medical record from the defendant.

USEFUL : You can always order the preparation of a statement of claim from us (more details at the link), in addition, watch the video with additional tips on writing this procedural document

In order to win a lawsuit with a medical organization, you must prove the following facts and circumstances:

1. that the plaintiff was harmed by a medical organization or a doctor;
2. that the harm was caused as a result of unlawful actions of a doctor or medical organization;
3. that there is a cause-and-effect relationship between the unlawful actions of the medical organization and the resulting harm to health;
4. that there is guilt of the medical organization’s employees in causing harm. Guilt can be either in the form of intentional infliction of harm to health or in the form of careless infliction of harm. Moreover, if the plaintiff files a claim in court on the basis of the Consumer Rights Protection Law, then in this case there is no need to prove guilt.

To prove his case, the plaintiff must provide all medical documents available to him if, for example, the defendant’s errors were identified in another medical organization, which subsequently treated the plaintiff. As part of a civil case, a medical examination may be appointed and carried out.

In support of the specific expenses that the plaintiff incurred to restore his health after the harm caused by the defendant, the plaintiff must attach payment documents, contracts, etc.

ATTENTION : It is better to attach copies of documents to the claim and provide to the court, and provide the originals to the court for review. Certain documents may subsequently be added by the court to the case file in the originals, for example, cash receipts.