How to receive compensation for poor-quality treatment under compulsory medical insurance

In what cases is a complaint filed?

The work of public and private medical institutions, as well as pharmacies, is controlled by the Federal Service for Surveillance in Healthcare. The features and procedure for conducting this activity and the rights of citizens are prescribed in the Federal Law of November 21, 2011 No. 323-FZ. The department is obliged to consider the appeal if it concerns treatment, provision of free medications, or rehabilitation of patients.

A citizen can complain to Roszdravnadzor, for example, in the following cases:

• The rights of citizens to receive free medical care, medicines, and rehabilitation products have been violated.
• The doctor who refused treatment misdiagnosed me.
• The medical institution refused to issue a referral for surgery.
• The private clinic violated the terms of the paid agreement with the patient.

The list of situations is incomplete.

For your information! In addition to Roszdravnadzor, a citizen can contact the prosecutor’s office, court, Rospotrebnadzor, insurance company, FFOMS.

Responsibility of a doctor for committing unlawful acts

After identifying violations on the part of doctors, patients do not understand what will happen if they complain about the actions of a doctor in the clinic.

The legislator provides several types of liability for doctors, taking into account the nature of the violations:

• disciplinary;
• civil law;
• administrative;
• criminal

Moreover, each type of liability may provide for both restrictions on the doctor and his activities, as well as specific encumbrances, up to and including termination of work.

For example, if a doctor makes an incorrect diagnosis, the patient can sue for moral and material damage under Art. 1064 of the Civil Code of the Russian Federation, since such a violation can lead to both mental suffering of a person and serious, unnecessary costs for medications.

Another example is the measure of criminal liability for causing harm to a patient through negligence, which involves several types of sanctions: forced labor, imprisonment for up to four years, as well as deprivation of medical practice for a period of up to three years.

How to file a complaint to Roszdravnadzor

The complaint form is not established by law, so it can be written in free form. The main thing is to follow the standard structure for a complaint: header, descriptive part, request. The text should not contain colloquial or colloquial expressions or emotionality. It is recommended to write a complaint using a formal business style of speech.

The document must contain the following information:

1. Addressee's name. You must indicate the name of the territorial body of the department for which the complaint is intended.
2. Who is this appeal coming from? Information about the applying citizen or organization. An individual must indicate his full name, passport details, registration address, and telephone number for contact. If, instead of an individual, the complaint is filed by his representative by proxy, then its details must also be indicated. A legal entity indicates the name, legal address, telephone number, full name and position of the person acting on behalf of the organization.
3. The essence of the violation that occurred. Describe the circumstances of the dispute, indicate information about the medical or pharmacy institution, full names of doctors, date and other important information.
4. The results of contacting other departments, if any (for example, contacting the chief physician of a medical institution).
5. A request to conduct an inspection and take the necessary measures.
6. Links to legislative acts.
7. Attachments to the complaint. This is documentary evidence of a violation of the rights of patients, if such papers are available (sick leave certificates, correspondence with a medical institution, prescription forms, copies of pages of a medical record, checks for payment for medical services, etc.). You can also attach audio and video materials.

The complaint ends with the signature of the person applying. They also indicate the date of submission of the document to Roszdravnadzor.

Where can you complain about a doctor?

When determining how to complain about the actions of a doctor in a clinic, you need to know exactly to which higher authority such a complaint is being filed.

Note! When filing complaints against the actions of doctors, one should not distinguish between doctors in clinics and hospitals. Regardless of this factor, the appeal is submitted to the appropriate and uniform authority for all.

The management of a medical institution is the first authority where you can complain. Depending on which of the health workers committed the violations, the complaint can be submitted to the head of the department, or directly to the hospital management - the chief physician. The complaint must receive a written response.

How and where to file a complaint

A complaint must be filed with the territorial body of Roszdravnadzor. You can do this in three ways:

1. Personal visit to the department. The citizen himself or his authorized representative comes to the department for an appointment; you need to have an identification document with you, as well as 2 copies of the complaint. On one of them, the employee receiving the documents will mark the receipt of the second copy and leave it to the citizen.
2. By post. Documents must be sent by registered mail with a description of the contents and receipt of receipt. This notification will confirm the department's receipt of the letter.
3. Electronically. In this case, the complaint is submitted through the public services portal or the Roszdravnadzor website. To do this, you need to provide all the necessary data, write your request in a special field, attach supporting files and submit the form.

For your information! Complaints and other requests received by the department are considered within 30 days from the date of their registration.

Roszdravnadzor is obliged to give a written response to the applicant. It indicates what measures were taken, whether orders to eliminate violations were issued, etc.

Sample complaint to Roszdravnadzor from a legal entity

To the Territorial body of Roszdravnadzor for the UR address: 426039, Izhevsk, st. Dzerzhinsky, 3 from the general director of Perpetual Motion LLC, address: 426009, Izhevsk, st. Partizanskaya, 156, office. 14 tel.

Complaint

I, General Director of Eternal Engine LLC, Nikolaev Sergey Sergeevich (TIN 1834561231, KPP 234123123, OGRN 3451236784563, legal address: 426009, Izhevsk, Partizanskaya st., 156, office 14, tel.: 8 ( 3412) 76-43-21), entered into an agreement with the private clinic “Doctor Profi” (Doctor Profi LLC, INN 5612341231, legal address: 426005, Izhevsk, Elochnaya St., 123) to conduct a medical examination of my workers.

On November 12, 2021, employees of Perpetual Motion LLC underwent a medical examination. The examination of the surgeon and dentist took place in inappropriate conditions, the office was dirty, doctors Voronov A.V. and Sokolov E.K. were without gowns and medical masks. Also on November 13, 2021, the blood test results of three of my employees were lost, one result was false.

Based on the above, I ask that state control be carried out on the quality and safety of medical activities in terms of compliance with the procedures for providing medical care and the standards of Doctor Profi LLC in relation to employees of Perpetual Motion LLC.

Please inform me of the results of the inspection of the quality and procedure for providing medical care by mail to the address indicated above.

Application:

1. Contract for medical examination dated November 10, 2020 No. 234 for 2 pages.
2. Blood test results from November 13, 2021 (with incorrect values) for 1 liter.
3. Results of blood tests dated November 15, 2021 (in correct indicators) per 1 liter.
4. Photos of medical offices where patients are received for 5 years.

Nikolaev / S.S. Nikolaev

"19" November 2021

If you were diagnosed or treated incorrectly

Did the doctor make the wrong diagnosis or provide treatment?

Today, a fairly pressing problem is medical errors by state medical institutions and private clinics. Patients who have suffered from improper treatment are in most cases inert, therefore, over the past decades, a strong opinion has formed about the impunity of those to whom we trust our health and life.

The lack of initiative of citizens is also due to the fact that law enforcement agencies are not interested in investigating cases related to medical error, are reluctant to take up their consideration, and are not always aimed at opening a criminal case. The uncertainty of the injured person makes the internal affairs bodies even more negligent in this matter, for which the topic of medical errors, in principle, is not interesting, since it is often hopeless.

A doctor’s liability for improper treatment occurs in rare cases, with the exception of situations where a qualified lawyer who already has experience working with a similar category of cases takes part in the case.

Call by phone and your rights will be protected at the highest professional level and in the shortest possible time

Preliminary FREE consultation!

Memo for patients: how to sue a doctor and not lose!

A medical malpractice lawyer, Igor Vitalievich Goloveshkin, will help you here.

If you forgive the doctor’s negligence, his ignorance, unlawful actions/inactions, you do not intend and want to hold the doctor accountable for improper treatment and poor-quality medical services, then you will definitely take into account our recommendations and advice.

• When contacting a medical institution, no matter what the consequences will be in the end, it is imperative to save all available cash receipts, receipt orders, prescriptions written by a doctor, and concluded contracts for the provision of medical services.
• It is important to save X-rays taken and other data recorded on paper or electronic media, for example, cardiogram, MRI or CT results, for at least six months. It is the above documents that will serve as the evidence base in the framework of the civil or criminal proceedings under consideration.
• It is advisable to keep your medical records and your family members at home. If this is not possible, we recommend that you at least have a copy of the medical record with all the tests, data and conclusions. It is not uncommon for situations where, when controversial situations arise, existing data and records in some strange way disappear from the outpatient card. Already remembering these two rules, you can not doubt that you are right and have an idea, hire a medical malpractice lawyer and definitely not lose.

Cost of a lawyer

Incorrect provision of medical services: how should the injured party act?

Let’s make a reservation right away - poor quality medical services should be punished! First of all, a letter of complaint should be sent to the medical institution where the examination was carried out and treatment was provided.

The letter should be issued as a registered letter - this is the only way to be sure that it will reach the addressee and will be registered with a medical institution.

The complaint should indicate your arguments, as well as existing requirements in relation to the medical institution or a specific doctor. A claim, as our practice shows, is rarely satisfied in full; almost always a medical institution ignores a claim submitted by a dissatisfied patient. But this step (drawing up and sending a claim by registered mail) should be completed from a formal point of view if you plan to file a claim in court in the future.

The judge, by the way, will first of all ask whether a complaint was written to the medical institution, and what was the organization’s response to it.

Assistance in preparing a statement of claim to court in connection with improper treatment.

The next step should be filing a statement of claim in court, in parallel filing a complaint with the prosecutor's office and Roszdravnadzor of the Russian Federation (on a territorial basis). Assistance in drawing up a claim for compensation for personal injury must be provided by a qualified lawyer who has participated in such cases in his practice. It is the specialist who will tell you how to sue a doctor and what to do if the doctor prescribed the wrong treatment. The doctor prescribed the wrong treatment.

Current legislation requires filing a claim both at the plaintiff’s place of residence and at the place of legal registration of the medical institution. All types of medical services fall under the law on the protection of consumer rights, and therefore the statement of claim, regardless of the requirements specified in them, is not subject to state duty.

Qualified consulting assistance from an experienced lawyer is required!

Consult with a medical lawyer about the amount of the claim, determine the amount of compensation for moral damages, as well as other circumstances that will be indicated in the statement of claim.

For obvious reasons, the court can satisfy the stated claims in full or in part. As practice shows, most often the amounts of compensation for moral damage specified in the claim are not recovered in full.

The claim should be accompanied by evidence that is not prohibited as such by law. The evidence base can be documents, things, videos, audio recordings, and so on.

For reference, you can see the cost of legal services

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Sample complaint against a doctor

As mentioned above, there is no single example of a complaint against a doctor. In each individual case, the citizen independently formulates an appeal. The only requirement is compliance with the structure of the document presented in federal legislation. Samples of writing a complaint can be found in this article if difficulties arise in formulating the situation and justifying the position.

Thus, it is possible to challenge the actions of doctors by contacting several authorities at once. A complaint will help not only to obtain compensation for material losses and moral damage, but to deprive the doctor of practice.

A sample complaint can be downloaded below:
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Pre-trial settlement

Before using extreme measures of influence on employees of a medical institution, you should try to resolve the conflict situation pre-trial. To do this, you need to contact the management of the clinic with a statement, which should indicate all the circumstances of the current situation, as well as your requirements. Consideration of such an appeal should not take more than 10 days. The likelihood of compliance with the requirements may be increased if a similar application is submitted to the health department. The application should be made in two copies. One is handed over to the management of the clinic, and the second is marked with acceptance of the application and this copy remains with the applicant. This measure is necessary so that if the application is ignored, its originator has evidence of the measures taken to resolve the issue.

You should also contact the insurance company that issued the compulsory health insurance policy. This company is directly related to the quality of the services provided and, if there are violations against its client, it must stand up for the protection of his rights.

If the issue cannot be resolved out of court, then you need to sue the medical institution. To do this, a statement of claim is drawn up demanding compensation for the damage caused.

When to serve

Before you start thinking about filing a lawsuit against a doctor, you need to find out what the grounds are for this. In most cases, patient complaints arise for the following reasons:

• Incompetence or negligence of a medical institution employee;
• Making an erroneous diagnosis;
• Medical error resulting in a serious deterioration in health or death;
• Insufficient qualifications and prescription of medications that are not suitable for treatment;
• Refusal to perform one's official duties.

Info

It is worth noting that the complaint will not be addressed to the doctor, but to his superiors, and his supervisor will be responsible for the employee’s actions. In this regard, it is necessary to make sure that the doctor was really at fault.

How to complain about a doctor at a private clinic

Private medicine, in fact, is no different from city clinics, since the principle of its work is also to provide assistance to sick people. The violations that may be committed by doctors at such medical institutions are no different. A person is prescribed the wrong medicine, makes a mistake in diagnosis, extorts money beyond the stipulated cost of services - all this serves as a reason to complain.

You can file a complaint against the actions of a doctor, regardless of whether it is a private clinic or a public one.

To file a complaint against a doctor at a specific private clinic, you can select one of the considered authorities. It is also additionally possible to contact Rospotrebnadzor, since private medicine involves the provision of paid services to individual entrepreneurs or other individuals. This department is vested with the authority to supervise the activities of entrepreneurs, in particular the medical field. Which, if violations are detected, will entail contacting the authorities for the application of penalties.

Filing a complaint with the chief physician

You can complain to the head doctor of the hospital about the actions of employees either orally or in writing. It is necessary to remember about the correctness of handling. You cannot swear, use obscene language, or insult the staff who committed the violation. In this case, the head physician is obliged to accept a person with a complaint and consider the appeal, giving a reasoned answer, regardless of whether the application is refused or not.

Note! If the chief doctor refused to take action and decided that the circumstances presented by the patient did not contain any violations, then you can also complain directly to the hospital management in the same manner.

Also, when contacting the head physician, you need to remember that the nature of the violations on the part of the doctor or hospital management may affect the outcome of the dispute. When it comes to bribes, extortion, threats, you should immediately write a statement to the police or prosecutor’s office.