Why are children denied disability? How will ITU be reformed? Who should I complain about experts to? These questions were answered by Deputy Head of the Ministry of Labor Grigory Lekarev and Deputy Head of the ITU FB Sergey Kozlov

The Ministry of Labor continues to reform the system of medical and social examination. The Federal Register of Disabled Persons will soon be created, the requirements for medical experts will change, public councils will be created at the ITU bureau, and audio and video recording of the examination procedure will be introduced. Despite the changes ITU work still raises many questions: what kind of help can seriously ill people who have been denied disability receive from the state; what is being done to improve the accessibility of the premises where examinations are carried out; why the number of denials of disability to children has increased, how corruption schemes operate in the ITU, etc.

Reforms of medical and social examination

Grigory Lekarev, Deputy Minister of Labor and social protection RF

During the monitoring, the ministry identified for which diseases the number of refusals to establish disability for children has increased. What is the reason for the increase in refusals?

Medical and social examination is a very complex procedure, it concerns health and life large quantity of people. Each situation is unique, and the same diagnosis can have completely different effects on quality of life.

The reform of medical and social expertise began back in 2010, when the concept of its improvement and development was adopted. Until 2015, ITU Bureau experts were guided by such criteria as significantly expressed, pronounced and moderately expressed violations. At the same time, how exactly to determine the degree of severity was not prescribed, and almost always the expert made a decision on the disability group based on his professional knowledge and skills, that is, there was a certain amount of subjectivity.

It was to eliminate the subjective approach that the decision was made to develop new classifications and criteria. Their development was initially fraught with the risk that some health conditions would not be clearly defined. Therefore, we agreed with patient and public organizations that, while introducing them, we will jointly monitor their use.

This general monitoring was carried out throughout 2015. And this year we decided to conduct separate monitoring to determine the disability of children in 2015.

The monitoring results showed not only an increase, but also a decrease in the number of refusals to establish disability for certain nosologies.

For example, for celiac disease, bronchial asthma, neoplasms and autism spectrum disorders used to have more refusals. In 2010-2011, autism was rarely diagnosed at all.

And for diseases such as phenylketonuria, congenital cleft lip and palate, monitoring showed a certain increase in the number of refusals.

This is not due to the fact that the classifications and criteria are somehow incorrect. The fact is that for some diseases they were not spelled out clearly enough, and this allowed some experts to interpret them in a more stringent manner.

In some cases during the monitoring, we had to change the decision; in absolute numbers, this is several dozen people.

Also, when analyzing the situation, we made the necessary changes and clarified the classifications and criteria. Regarding phenylketonuria last changes came into force on August 9. Now experts have a clear guideline that when severe forms disability for this disease should be established.

We are now preparing an order to continue monitoring the decisions of the medical and social examination in order to analyze the practice of 2016.

The Ministry continues to reform the ITU system; a special roadmap has been developed for this purpose. What are the main points in it?

The beginning of the reform was associated with a change in approaches to establishing a disability group, with the development of a unified normative act. The continuation will concern the scientific and methodological support of ITU. After all, new methods and methods of treatment are emerging, more accurate and sensitive diagnostic tests are being used. And medical and social expertise must justify expert decisions, relying, among other things, on the achievements modern science. To keep up with the times, it is also necessary to improve the level of qualifications of personnel.

Another direction is organizational. We make certain efforts to eliminate the conditions for corruption as much as possible. For example, we plan to put into practice ITU electronic queue and independent distribution of cases between expert panels. This will, in our opinion, ensure an objective and impartial consideration of cases by experts.

Nowadays, many complaints are related to the rude, insufficiently sympathetic behavior of doctors, and our task is to make the examination more transparent for the population. For this purpose, we propose to create public councils at the main ITU bureaus. Councils will be able to quickly respond to people's complaints in case of unethical behavior of experts.

We also plan to create an institute of independent medical and social expertise in order to equip people with a professional independent opinion regarding the indications for establishing disability. They will be able to use this opinion when appealing decisions of federal ITU institutions, including in court. The Institute of Independent Expertise should help resolve many questions regarding the subjectivity of decisions of a particular ITU institution.

What public councils can do

Tell us more about the public councils at ITU. How can citizens use them to influence the situation?

We assume that the public councils at the main bureaus will include regional public figures, representatives of human rights organizations, ombudsmen for human rights, ombudsmen for children's rights. The council should consist of people who rely on public institutions and represent the interests of a large category of citizens.

I am far from thinking that we will be able to analyze the essence of the decision made (about the disability group) in a public council, because this is a highly professional area. But from the point of view of maintaining order public Council can do a lot.

We want to define the powers of the public council so that its decisions have serious weight. Most likely, this will require the development of special regulations.

- Who will be responsible for improving MTU methods?

Firstly, this is the Federal Bureau of Medical and Social Expertise. This is not only the highest authority, where particularly complex cases are considered or decisions of lower bureaus are appealed, but also a clinical base. Professionals in the field of cardiology, pulmonology, nephrology, etc. work there.

Secondly, the ministry is responsible for a number of educational and scientific institutions. For example, the St. Petersburg Institute for Advanced Training of Medical Experts (SPbIUVEK) is an educational organization that organizes advanced training of experts or retraining of doctors to work in medical and social expertise.

Another organization is the Albrecht Institute (St. Petersburg Scientific and Practical Center for Medical and Social Expertise, Prosthetics and Rehabilitation of Disabled People named after G.A. Albrecht).

Novokuznetsk Scientific and Practical Center for Medical and Social Expertise and Rehabilitation of Disabled People specializes in spinal injuries and issues related to vascular dysfunction. He also performs surgical operations.

These institutions have the largest concentration of candidates and doctors medical sciences who made their own scientific works specifically in the field of ITU.

- You mentioned the need to improve the qualifications of experts. What will they be taught first?

First of all, of course, this normative base, classifications and criteria. The second is the development of an individual rehabilitation program, including the appointment technical means rehabilitation. The third aspect is organizational issues, personnel and logistics.

- How can a disabled person prove that a medical expert behaved unethically?

When we talk about the examination procedure, we must not forget that the expert does not make decisions alone; he is not alone in the office. There are always witnesses who can confirm or refute the fact of unethical behavior. The draft “road map” includes video and audio recording of the examination procedure. If the patient wants the recording not to be kept, he can always declare this, but the expert will not have such a right.

We understand that to store these records we will have to increase server capacity. All data will be protected, and access to it by third parties will be limited as much as possible. Even an expert will not be able to modify, change or shorten the entry. When appealing or in cases of violation of the rights of a disabled person, the recording can be used as evidence. It is planned to provide access to it by the public council, judicial or investigative bodies.

Deputy Head of the Federal State Budgetary Institution FB ITU Sergei Kozlov clarified in an interview with Miloserdiy.ru: “In many regions, audio recording is already underway. This disciplines both sides. For experts, this is a kind of guarantee that, if necessary, they will be able to prove their innocence. And if audio and video recording is not carried out by the institution, the applicant can come with a voice recorder himself. It is not prohibited. But the person must notify us about this in advance. Otherwise, the recording cannot be used as evidence of certain violations during the examination.”

- What to do if a person is seriously ill, but his disability is not determined?

Now experts from the Bureau of Medical and Social Expertise must not only explain decision, but also inform a person whose disability has not been established what support measures he is entitled to. Our main bureaus, together with regional authorities, have developed relevant leaflets.

For example, drug provision, according to government decree No. 890, applies not only to people with disabilities. There is a list of nosologies for which it is provided. Our task is to orient a person where to go, how to get help, what address, phone number, e-mail he should contact.

What to do about corruption

What work issues and gaps in legislation are usually used by employees prone to corruption?

- “Loopholes” for corrupt officials are found at almost every step, because during the examination there is always a certain amount of subjectivity. For example, this may be the recognition as disabled of a person who has no signs of disability. True, in this case, medical organizations are also involved, writing that there is a disease that in fact does not exist.

Establishing interdepartmental electronic interaction with medical organizations would help in the fight against corruption. We have such plans. In particular, we would like to receive form 088/у (referral for examination) in electronic form. Because during inspections, it sometimes turns out that such a form is missing in the file or the stamp on it is unclear.

Already now, a unified automated MTU system is a good tool. Since 2013, medical and social examination institutions have completely switched from paper examination to electronic examination.

The system records all changes made by the expert. Moreover, access to this information is available both in the main bureau and in the federal bureau of ITU. Why is it important? Sometimes during corruption schemes there is a desire to correct or change something, to make some clarifications. Sometimes experts are in such a hurry that they don’t fill out anything at all: there is a certificate of disability, but there is no file. The system records this.

I will say that the system disciplines ITU employees with regard to deadlines. As soon as a person submits an application for examination or for changing the IPRA, the deadlines established by the administrative regulations are included. They oblige us, in particular, not to delay sending information to the Pension Fund so that the disabled person immediately begins to receive payments.

This year we are completing the formation of secure communication channels for transmitting data about a person, since they are not only personal in nature, but also contain information about medical confidentiality. Now such channels have been formed between the Federal Bureau and all subjects, with the exception of Crimea and Sevastopol, which will also soon join the system.

- When is it planned to create a Federal Register of Disabled Persons, and why is this being done?

On January 1, 2017, the federal register of disabled people will begin to operate, which will consolidate a wide variety of information about disabled people.

I’ll immediately answer the question why it is needed. States that have signed the Convention on the Rights of Persons with Disabilities are obliged to establish end-to-end statistical records of people with disabilities in order to record their needs, demographic composition and develop balanced, correct management decisions. But we went a little further.

The federal register will be created Personal Area each disabled person, in which he can see at any time what support measures are provided for him, what has been done, who is responsible for their implementation. A person will be able to compare the information posted in the register with the activities actually completed and, if he is not satisfied with something, file a complaint.

Among other things, the register will reflect information related to vocational education. We want to see how many children with disabilities enter the labor market every year. This will allow both employment services and employers to know in advance what jobs can be offered to them.

Unfortunately, we have sad statistics: half of disabled children who enter professional educational organizations, for some reason they drop out of school. We have to figure out why they left the race early.

The register should be operational from January 1, but not all of it, but only part of it, since not all cases in ITU institutions have yet been transferred to electronic form. I have already said that in unified system all ITU institutions have been operating only for the last three years, and those paper files that are stored in the archives need to be digitized.

Cases regarding disabled children will be completely digitized by January. Next year, at the second stage, we will process and upload all the rest to the register.

The premises where ITU offices are located are not always accessible to people with disabilities. What is being done about this?

The ITU network is very extensive, with about 2,600 branches throughout the country. We try to keep the main offices in their own premises. For such institutions, funds are provided annually for repairs and additional equipment.

But ITU offices are often located in rented premises or buildings medical organizations, for example, clinics. Therefore, when they lack accessibility conditions, we, at the expense of federal budget We cannot retrofit them to meet the special needs of disabled people. In our opinion, the public council can provide significant assistance in resolving these issues through agreements with local authorities.

At the same time, it is important that local authorities understand: not only the premises must be accessible, but also the surrounding area, be it a bus stop public transport, sidewalks, parking areas.

Of course, on-site surveys are carried out, especially in hard-to-reach areas and in mountainous areas. Sometimes experts have to travel many hundreds of kilometers. For this purpose, ITU offices are provided with vehicles. No one can see this work, but it is being done.

- Previously, the issue of transferring MTU to the Ministry of Health was raised. How would you comment on this initiative?

It's not up to us to decide. The Russian Ministry of Labor is vested with its powers by an act of the government. But from my professional point of view, this would not be the right move. Issues of medical and social examination are mainly in the area of providing social support a person in difficult life situation. In addition, ITU institutions are federal institutions, and the hospitals are mostly regional. Are the regions ready to assume such powers? This will be an additional burden for them - both financial and organizational.

Why are people denied disability?

Sergey Kozlov, Deputy Head of the Federal Bureau of Medical and Social Expertise

- How will the responsibilities of ITU staff change in the near future?

On behalf of the Minister of Labor and Social Protection in job descriptions ITU specialists made changes regarding compliance with the rules of ethics and deontology, correct behavior in relation to persons being examined. The duty of ITU specialists has been established to explain the expert decisions taken and inform the person about the benefits that should be provided regardless of the “disabled” status.

The ITU Federal Bureau proposed to ensure “observation of children outside the expert setting” to improve the quality of examinations. What is it about? About the video camera?

A child’s presence in an expert setting (undergoing an examination) is always stressful situation for humans, and especially for small child. Therefore, his behavior during the examination may not be exactly the same as in a normal daily environment.

But game room with a mirror wall allows specialists to observe the actions of children in their usual environment and objectively assess how the child has mastered basic movements, that is, how he moves in the playroom, climbs, slides, and stands up.

At the same time, you can also note the presence or absence of shortness of breath, the level of development of fine motor skills.

Unfortunately, not all institutions have the opportunity to organize such game rooms. But in most bureaus that accept people under 18 years of age, there is either a hall with a gaming function, or a gaming room, where a specialist social work, a rehabilitation specialist or just a doctor can come in and see how the child behaves. The time of such observation depends on the workload of specialists.

Often parents complain that the child is treated, he gets better, and immediately after that his disability is removed, thereby depriving him of rehabilitation and medications, as a result of which his condition worsens again.

We know of cases where parents are incorrectly informed and are led to believe that if their child is recognized as disabled, they will receive high-tech medical care without waiting in line. This also applies to the provision of expensive medicine.

At the same time, in the government decree Russian Federation No. 890 clearly states what assistance should be provided by the region, including citizens who are not disabled. All regions, regardless of financial situation, must comply with this government regulation.

It must be remembered that health care appears on the territory of the Russian Federation in accordance with the compulsory medical insurance program (basic and territorial) and rehabilitation measures should be carried out for everyone who needs it, without reference to disability.

Moreover, high-tech methods medical rehabilitation are used to improve the quality of life of a patient with chronic disease and are aimed at preventing disability.

Most often, parents of children with certain diseases express concern about denials of disability. For some, decisions have already been made, for example, on phenylketonuria. What about others?

For cystic fibrosis, as well as congenital cleft lip, hard and soft palate decisions have also been made. After they came into force, the tension subsided.

On instructions from the ministry, we continue to work out general approaches when conducting a medical and social examination of children. The Federal Bureau has now prepared changes and additions to the rules for recognizing a person as disabled regarding the timing of the determination of disability. In our opinion, it would be correct appearance another list of diseases and irreversible nosological changes in which the category of a disabled child will be established for a period of five years, until the age of 14 or 18 years.

For example, with Down syndrome - immediately up to 18 years of age. For diseases such as cystic fibrosis, diabetes mellitus - up to 14 years. With such serious illnesses, there is no point in undergoing a medical and social examination every year.

Parents of children with diabetes believe that at the age of 14 it is still impossible to independently control the disease.

When conducting a medical and social examination of a child with diabetes, in each specific case the expert decision is made strictly individually. The examination is carried out on the basis of a comprehensive assessment of health status, analysis of social, psychological, and pedagogical data.

IN age group over 14 years of age, the influence of puberty with features hormonal regulation metabolism and psychological aspects of adolescent behavior that affect the ability to independently control the course of the disease and maintain optimal blood sugar levels.

During this period, children can behave completely differently. But we also rely on the records of observing doctors. If they indicate that the child calculates and makes injections independently, we take this into account.

Annual review activities of VOI

Our position

On April 15, 2009 at 12-00 o’clock an online interview was held with the head of the Department of Medical and Social Expertise and Social Support of the Population of the Federal Medical and Biological Agency, Sergei Ivanovich Kozlov. The topic of the interview: “Medical and social expertise: organization and procedure for passing. Experience and new solutions ".

Medical and social examination in the Russian Federation is one of the types of medical examination; it establishes the cause and group of disability, the degree of disability, determines the types, volume, timing of rehabilitation, social protection measures, and gives recommendations on the employment of citizens. These issues have been resolved in sufficient detail Federal law dated November 24, 1995 N 181-FZ “On the social protection of disabled people in the Russian Federation” (with subsequent amendments and additions).

In accordance with Decree of the President of the Russian Federation dated May 12, 2008 N 724 “Issues of the system and structure of federal bodies executive power", Decree of the Government of the Russian Federation dated June 2, 2008 N 423 "On some issues of the activities of the Ministry of Health and social development Russian Federation and the Federal Medical-Biological Agency" the powers to organize the activities of federal state institutions of medical and social expertise are assigned to the Federal Medical-Biological Agency.

Despite the fact that the implementation of functions on the territory of the Russian Federation for the provision of medical and medical-social assistance, the organization of forensic medical and forensic psychiatric examinations are regulated in sufficient detail by the current Russian legislation, its norms require further regulation and improvement.

Closely related to solving problems in the field of medical and social expertise are the problems of conducting rehabilitation activities disabled people in order to restore their social status. However, at present, the creation of only social institutions “medical and social examination services” is legally enshrined, which has slowed down the development of social and environmental rehabilitation infrastructure, which is the basis for restoring the body’s performance and skills for independent everyday activities, ensuring the prerequisites for the competitiveness of people with disabilities in the labor market, acquiring relative independence, restoration of the ability to adequately interact with society. The Department of Medical and Social Expertise and Social Support of the Population of the FMBA of Russia will have to change this situation.

During the online interview, it is planned to talk about new approaches to organizing medical and social examination in the Russian Federation, determine the procedure for its organization and implementation, analyze issues of improving legislation in this area, and determine the role of the Federal Medical and Biological Agency in reforming the MSA system.

These and other topical issues will be raised during an online interview with the head of the Department of Medical and Social Expertise and Social Support of the Population of the Federal Medical and Biological Agency, Sergei Ivanovich Kozlov.

By the time the interview began, several dozen different interesting and problematic questions had been received, which we would like to offer to our distinguished guest today.

The host of the online interview is Tsar Sergei Petrovich (Garant Company).

Good morning, dear ladies and gentlemen! Hello, dear Internet audience! We begin our online interview. Let me introduce our guest - Sergei Ivanovich Kozlov, head of the Department of Medical and Social Expertise and Social Support of the Population of the Federal Medical and Biological Agency.

Internet interview topic: " Medical and social examination: organization and procedure. Experience and new solutions".

Host: The first question came from Dmitry Malyshev from the city of Saratov. Sergey Ivanovich, please tell us about the procedure for organizing and passing a medical and social examination in Russia. What are the grounds for recognizing a citizen as disabled?

Kozlov S.I.:
I would like to briefly remind you in what cases disability is established. Recognition of a citizen as a disabled person is carried out by federal state institutions of medical and social examination when conducting a medical and social examination, based on a comprehensive assessment of the state of the citizen’s body based on an examination of the citizen, analysis of his clinical, functional, social, everyday, professional, labor and psychological data using classifications and criteria approved by the Ministry of Health and Social Development of the Russian Federation. In case of persistent disorder of body functions, which is caused by diseases, consequences of injuries or defects and leads to limitation of life activity, that is, complete or partial loss of the ability to self-care or, for example, orientation in space, learning. For each case of disability, a decision is made on an individual basis. The UN Convention on the Rights of Persons with Disabilities recognizes the concept of disability as an evolving one. This means that many functional disorders amenable to correction. For a certain period of time, specialists are engaged in the rehabilitation of a disabled person according to an individual program, which includes treatment, psychological help, development of recommendations for the best adaptation of the patient to life in new conditions. And if rehabilitation measures, compensation and elimination of impaired functions are effective, disability can be changed.

Host: Is it true that ITU has been instructed not to establish disability in order to save budget funds, and that doctors’ salaries depend on this?

Kozlov S.I.:
There are currently 13.2 million disabled people in Russia. This represents just over 9% of the country's population. In total, in 2008, 4.76 million people were examined, of which 1.20 million people were examined for the first time to establish disability, to determine the degree of loss of professional ability to work, and repeatedly, incl. to establish disability, to change the cause of disability, to formulate an individual rehabilitation program for a disabled person 3.56 million. The number of citizens examined by medical and social examination institutions in 2008, on average in the Russian Federation, was 390 thousand people per month, in January 2009 this the figure was 306 thousand people (subject to a 10-day holiday period), and in February - 450 thousand people, in March more than 418 thousand people, respectively. The number of citizens who were diagnosed with disability for the first time on average in the Russian Federation in 2008 was 80.5 thousand people per month, again 206 thousand people per month, in January 2009 these figures were 68 thousand people, and 180 thousand. people, and in February 2009 there were already 98 thousand people and 253 thousand people, in March 90.4 thousand people and 240 thousand people, respectively, which indicates an increase in the number of citizens recognized as disabled, and not a decrease in the level of disability.
Concerning wages and, in particular, incentive payments to ITU employees, first of all, attention is drawn to the absence of complaints about the work of the institution, the quality of decisions made, and there is no such criterion when determining salaries as the number of identified, confirmed or unconfirmed cases of disability.

Presenter: Last September, Russia joined the international Convention on the Rights of Persons with Disabilities, which provides for the creation of a full-fledged environment for people with disabilities, ensuring their rights to work, to medical service, education, full participation in public life. What is being done to ensure its speedy ratification? Asks Leonid Ivanovich Smolyakov from the Tambov region.

Kozlov S.I.:
Indeed, in 2008, the Russian Federation signed the UN Convention on the Rights of Persons with Disabilities. Its ratification presupposes a large amount of legislative, organizational and information work. First of all, it is necessary to develop and submit for approval to the Government of the Russian Federation an action plan to prepare for ratification of the Convention. And this work needs to begin with clarification and implementation for practical application a number of definitions, including definitions of such concepts as “disabled person”, “habilitation”, “rehabilitator”.
The Convention introduces the following concept of disability: “Disability is an evolving concept and is the result of the interactions that occur between disabled people and the attitudinal and environmental barriers that prevent them from participating fully and effectively in society on an equal basis with others.” That is why we must move from our existing system of social protection for people with disabilities to a policy of eliminating barriers and obstacles that prevent their full and effective participation in society on an equal basis with others.
State support for disabled people cannot be limited solely to pensions and social benefits. The most important objective is to enable persons with disabilities to lead independent lives and participate fully in all aspects of life, creating access on an equal basis with others to the physical environment, to transport, to information and communications, including information and communication technologies and systems, as well as to other facilities and services , open or made available to the public in both urban and rural areas.
We hope that the planned actions will allow Russia to accelerate the ratification of the UN Convention on the Rights of Persons with Disabilities.

Presenter: Which bodies control the organization of the activities of the Federal State Institution "Main Bureau of Medical and Social Expertise"?

Kozlov S.I.:
Control over the procedure for organizing and carrying out medical and social examinations, as well as the rehabilitation of disabled people and the procedure for establishing the degree of loss of professional ability to work as a result of accidents at work and occupational diseases in accordance with Decree of the Government of the Russian Federation dated June 30, 2004 N 323 “On approval of the Regulations on the Federal Service for Surveillance in the Sphere of Health Care and Social Development” is carried out by the Federal Service for Surveillance in the Sphere of Health Care and Social Development. In accordance with Decree of the Government of the Russian Federation dated April 11, 2005 N 206 “On the Federal Medical and Biological Agency,” the FMBA of Russia also exercises control over the activities of subordinate organizations.

Presenter: On April 7, 2008, Resolution of the Government of the Russian Federation No. 247 “On Amendments to the Rules for Recognizing a Person as Disabled” was adopted. From the Decree of the Government of the Russian Federation it follows that people with incurable diseases and persons with disabilities are not required to undergo annual examinations. Please tell me whether a person’s life has become disabilities better due to its adoption?

Kozlov S.I.:
I have already drawn attention to the fact that recently a number of normative legal acts with a social orientation have already been adopted, including Decree of the Government of the Russian Federation dated 04/07/2008 N 247 “On Amendments to the Rules for Recognizing a Person as a Disabled Person”, a list has been defined diseases, defects, and conditions according to which disability is established indefinitely, which eliminates the need for citizens to re-apply to treatment and preventive institutions to formalize a referral for a medical and social examination, as well as the re-examination of citizens in federal medical and social examination institutions.
The list of diseases, defects, conditions under which a disability group is established without specifying the period for re-examination has been adapted to ICD-10, taking into account the proposals of the All-Russian Public Organization of Disabled Persons. The period of observation by federal state institutions of medical and social examination has been determined, according to the list - for 2 years, after which the disability group is established without specifying the period for re-examination. In the case of the main forms of diseases, this period is necessary to carry out a set of therapeutic measures aimed at restoring impaired or lost health functions of sick and disabled people, or attenuating the consequences of an illness, injury or injury until full or partial restoration or compensation of disorders in the patient’s condition.
This legal norm is addressed, first of all, to federal state institutions of medical and social examination, and sets for them deadlines for monitoring disabled people when making a decision to establish disability indefinitely and prevents unreasonable, untimely decision-making to establish disability without specifying the period for re-examination, which will ensure the realization of citizens' rights, related to their recognition as disabled. In the Russian Federation in 2007 (May-December), the total number of all persons recognized as disabled (adult population) was 2,275,929 people, of which 21.84% were permanently recognized as disabled. total number. In 2008, after the release of this Resolution, the number of disabled people (for May-December) amounted to 2,222,359 people, of which 711,899 people or 32.03% were permanently recognized (i.e., almost 10% more than in 2007 ).

Host: Please tell us about judicial practice challenging decisions on medical and social examination? Can a citizen who does not agree with the decision of the ITU bureau immediately file a complaint with the court, or is he obliged to first appeal this decision to the main ITU bureau? What are the statistics of citizens appealing the conclusions of the ITU Bureau in the courts, whose side do the judicial authorities take in this controversial issue more often? What regulatory legal acts Are the issues of appealing decisions of medical and social examinations in the Russian Federation regulated?" Asks Vasily Lonovoy from Tyumen.

Kozlov S.I.:
Issues of appealing decisions of the medical and social examination bureau are also regulated by Decree of the Government of the Russian Federation of February 20, 2006 N 95 “On the procedure and conditions for recognizing a person as disabled.”
The legislation provides: if a citizen or his legal representative does not agree with the decision of the branch of the medical and social examination bureau, then he can appeal this decision to the main ITU bureau in his region, and if he disagrees with the decision of the main bureau, to the Federal Bureau. Decisions of the bureau, the main bureau, the Federal Bureau can be appealed to the court by a citizen (his legal representative) in the manner established by the legislation of the Russian Federation. According to monitoring data from the Federal Medical and Biological Agency, in 2008, 2,764 cases were appealed in court, or 0.06% of total number examinations of 4.76 million people. 210 lawsuits were satisfied, which is 0.004% of the total number of examinations, or 7.6% of the number of appealed decisions of medical and social examination institutions. At the same time, I note that not a single claim was satisfied due to abuse of official position.

Presenter: There is a Letter of the Ministry of Health and Social Development of the Russian Federation dated May 5, 2006 N 2317-BC, which directs Guidelines to provide disabled people with technical means of rehabilitation. Then Letter N 3092-ВС dated April 18, 2007 was sent, which, in turn, recalled the previous letter from execution, but did not provide new recommendations. Question: what is the status of Letter No. 2317-BC of May 5, 2006 and the Methodological Recommendations, “valid” or “lost force”. If “active”, what does the “withdrawn” status mean?

Kozlov S.I.:
Letter of the Ministry of Health and Social Development of Russia dated May 5, 2006 N 2317-ВС was withdrawn from implementation by medical and social examination institutions, therefore, the Methodological recommendations for providing disabled people with technical means of rehabilitation are no longer valid legal force act.

Presenter: In the course of the FMBA of Russia carrying out its functions in terms of ITU, are representatives of the public involved in the discussion of various projects and initiatives? To what extent is the opinion of public associations of people with disabilities and human rights organizations taken into account when making a decision? On what issues has this cooperation already been established, is there any positive impact?

Kozlov S.I.:
Recently, a number of normative legal acts with a social orientation have been adopted. Thus, in the preparation of Decree of the Government of the Russian Federation dated 04/07/2008 N 247 “On amendments to the Rules for recognizing a person as disabled” and Decree of the Government of the Russian Federation dated 04/07/2008 N 240 “On the procedure for providing disabled people with technical means of rehabilitation and individual categories citizens from among veterans with prostheses (except dentures), prosthetic and orthopedic products" public organizations of disabled people took an active part. Active participation is also expected public organizations disabled people when preparing the Concept for reforming the state system of medical and social examination and rehabilitation of disabled people, widely discuss it with all interested institutions of civil society.

Host: The supplementary drug program suffers from gaps and shortcomings in the legislation. The needs of beneficiaries for medicines are determined unqualifiedly, almost by eye, inventory management is poorly organized, the issuance of prescriptions for medicines is often unsystematic, and funding from the federal budget is insufficient. When will they finally take appropriate measures to regulate DLO?

Kozlov S.I.:
This issue does not fall within the competence of the Federal Medical and Biological Agency of Russia, but I can say that in 2008, the drug provision scheme for preferential categories of citizens completely changed. The powers to provide them with the necessary medicines transferred to the constituent entities of the Russian Federation. And patients with diseases of seven nosologies (hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher disease, myeloid leukemia, multiple sclerosis, as well as after organ and (or) tissue transplantation) in need of expensive therapy, began to be provided with the necessary medicines at the expense of the federal budget.

Presenter: The degree of restriction is now being determined labor activity. Tell me, please, what is the difference between the disability group and this very degree? What is taken into account first of all when determining it?

Kozlov S.I.:
A medical and social examination is carried out to establish the structure and degree of limitation of a citizen’s life activity (including the degree of limitation of the ability to work). Depending on the degree of disability caused by a persistent disorder of body functions resulting from diseases, consequences of injuries or defects, a citizen recognized as disabled is assigned disability group I, II or III. When a disability group is established for a citizen, the degree of limitation of his ability to work is simultaneously determined (III, II or I degree of limitation) or the disability group is established without restriction of his ability to work. Thus, limiting the ability to work is one

Meeting on improving the state system of medical and social examination
Meeting program and materials

On May 18, 2018, a meeting was held on the basis of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia on improving the state system of medical and social examination.

PROGRAM
MEETINGS TO DISCUSS ISSUES
QUALITY OF MEDICAL AND SOCIAL EXAMINATION

Presidium: Afonina K.P., Kozlov S.I.

09.00 - 10.30 Registration of participants

10.30-10.40 - Opening of the meeting and introduction Deputy Director of the Department for Disabled People of the Ministry of Labor and Social Protection of the Russian Federation Kira Pavlovna Afonina

10.40-11.00 - Clinical manifestations and features of manifestation diabetes mellitus in children" Deputy Director of the Federal State Budgetary Institution "National Medical Research Center endocrinology" of the Russian Ministry of Health for scientific work - director of the Institute of Pediatric Endocrinology. Academician of the Russian Academy of Sciences, Professor, Doctor of Medical Sciences, Chief freelance pediatric specialist endocrinologist of the Ministry of Health of Russia Valentina Aleksandrovna Peterkova

Deputy Head for Improving Medical and Social Expertise and Rehabilitation of Disabled Persons, Federal State Budgetary Institution FB ITU Ministry of Labor of Russia, Ph.D. Kozlov Sergey Ivanovich

11.20-11.40 “New approaches when conducting medical and social examination according to. Head of the Scientific and Methodological Center of the Federal State Budgetary Institution FB ITU Ministry of Labor of Russia, Doctor of Medical Sciences, Lyudmila Leonidovna Naumenko

11.40-12.00 - “Features of application in determining medical indications and contraindications. Deputy Head of the Organizational and Methodological Department of the Federal State Budgetary Institution FB ITU Ministry of Labor of Russia, Ph.D. Mirzayan Eleonora Israilovna

12.00-12.40 - “Ensuring uniformity of application when conducting medical and social examination of persons under the age of 18.” Head of the expert staff of the pediatric profile of the Federal State Budgetary Institution Federal Budgetary Institution ITU Ministry of Labor of Russia Ph.D. Malova Natalya Evgenievna, Head of the expert staff of the pediatric profile of the Federal State Budgetary Institution FB ITU Ministry of Labor of Russia Elena Vitalievna Miroshnichenko

12.40-13.00 - “Reliability, completeness and timeliness of providing information from the EVIIAS ITU to the FSIS FRI, Head of the Center for Documentary Support of the Activities of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia Elena Viktorovna Lesina.

13.00-14.00 - Lunch (canteen of the Federal State Budgetary Institution FB ITU Ministry of Labor of Russia, 1st floor)

14.00-14.20 - « Current issues provision information security in federal government institutions medical and social examination" Head of the Information Security Department of the Center for Information Technology Support and Interdepartmental Electronic Interaction of the Federal State Budgetary Institution Federal Budgetary Institution ITU Ministry of Labor of the Russian Federation Nuriakhmetov Dmitry Saitgaleevich

14.20-14.40 - “Features of conducting inspections of medical and social examination institutions by the Accounts Chamber of the Russian Federation”, Head of the State Budgetary Institution MSE for the Oryol Region, Ministry of Labor of Russia Oksana Nikolaevna Petrova

14.40-15.00 - “Review of court decisions in the field of medical and social expertise for 2017”, head of the Center for organizing the activities of expert panels and especially complex methods of expert rehabilitation diagnostics, improving technologies and the quality of implementation of MSE, Ph.D. Valentina Subkhanovna Kurbanova, Natalya Viktorovna Shatrova, leading legal adviser, Galina Petrovna Karaseva, head of the ITU technology and quality improvement department.

15.00-15.40 - “Organizational aspects of the work of medical and social examination institutions in the EAVIIAS ITU.” Project Director of LLC " Software» Burylin Sergey Anatolyevich, leading software engineer of Software Product LLC Popov Sergey Viktorovich

15.40-16.40 - “Questions and answers.” Deputy Head for Improving Medical and Social Expertise and Rehabilitation of Disabled Persons, Federal State Budgetary Institution FB ITU Ministry of Labor of Russia, Ph.D. Kozlov Sergey Ivanovich.

Listen

Head - Chief Federal Expert on Medical and Social Expertise of the Federal State Budgetary Institution "Federal Bureau of Medical and Social Expertise" of the Ministry of Labor and Social Protection of the Russian Federation

In 1993 he graduated from Moscow medical academy them. THEM. Sechenov, Faculty of Medicine.

Since 2002 - Deputy Chief Physician of the Clinic of the Federal Scientific and Practical Center for Medical and Social Expertise and Rehabilitation of the Disabled. Coordinated the work of all departments that took part in the medical and social examination and rehabilitation of citizens of the Russian Federation.

From 2005 to 2010 - Deputy Head of the Federal Bureau of Medical and Social Expertise. His responsibilities included the creation of the structure and subsequent functioning expert bureaus FGU "FBMSE", interaction with the main ITU bureaus in the constituent entities of the Russian Federation, as well as the development of a unified policy...

when carrying out medical and social examination of citizens of the Russian Federation, analysis of the level and causes of disability in the Russian Federation and its individual constituent entities, coordination of work on expert rehabilitation diagnostics.

In 2003, 2004 he took an active part in international programs Russian-European Foundation, dedicated to the rehabilitation aspects of socially vulnerable categories of the population and disability, independent life persons with disabilities; has higher internship certificates educational institutions Austria and Great Britain in relevant areas.

In 2005, 2006, he worked as part of the Russian delegation at the 6th, 7th and final 8th sessions of the UN Special Committee on the Development of International Convention on the rights of persons with disabilities.

In 2007 and 2008, he twice took part in sessions of the UN Economic and Social Commission for Asia and Pacific Ocean on food security, demographic development, health financing, and gender and disability issues.

By Order of the Ministry of Labor of Russia No. 84-KR dated September 4, 2013, he was appointed to the position of Head - Chief Federal Expert for Medical and Social Expertise of the Federal State Budgetary Institution "Federal Bureau of Medical and Social Expertise" of the Ministry of Labor and Social Protection of the Russian Federation.

Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia on issues of improving medical and social examination and rehabilitation of disabled people - a doctor for medical and social examination.

In 1984 he graduated from Smolensk State medical school, specialty: “General Medicine.”

In 2004 he graduated from the Oryol Regional Academy of Public Service (Smolensk branch), with a degree in State and Municipal Administration.

1985 - 2001 - expert doctor, chairman of the VTEK, head of the main bureau of the Smolensk region.

2001 - 2004 - head of the state service for medical and social examination - chief expert of the Smolensk region.

2004 - 2007 - Head of the quality control department of the organization of social assistance to the population, Federal Service for Supervision in the Sphere of Healthcare and Social Development of the Russian Federation.

2007 - 2010 - Head of the Department of Medical and Social Expertise and Social Support of the Population of the Federal Medical and Biological Agency.

2010 - 2012 - Deputy Head of general issues activities of the Federal State Institution “Main Bureau of Medical and Social Expertise in the Moscow Region”.

Since 2012, he has been Deputy Head - Chief Federal Expert on Medical and Social Expertise on Improving Medical and Social Expertise and Rehabilitation of People with Disabilities.

Carries out:

Coordination and control of the activities of the divisions of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia participating in the provision of public services on conducting medical and social examination and rehabilitation of disabled people;

Organization of interaction between federal institutions of medical and social expertise in the constituent entities of the Russian Federation and the Federal State Budgetary Institution FB MSE of the Ministry of Labor of Russia, including on issues of information support for the activities of institutions of medical and social expertise.

He is a candidate of medical sciences.

Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia for organizational issues

In 1991 she graduated from ShTIBO, Faculty of Technology.

Since 2003 - Scientific Secretary of the Federal Scientific and Practical Center for Medical and Social Expertise and Rehabilitation of the Disabled.

From 2010 to 2011 – head of the educational and organizational department of the educational and methodological center of the Federal State Institution “FBMSE”.

Since 2012 – Deputy Head of the Federal State Budgetary Institution FB ITU of the Russian Ministry of Labor for organizational issues.

Is a candidate technical sciences, associate professor, author of more than 40 published scientific works, including 5 methodological instructions, 1 patent invention.

Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia for Economics and Forecast economic development

In 1997, she graduated from the Russian State Open Technical University of Transport, Moscow, with the qualification of Engineer-Economist with a degree in Economic Informatics and Automated Control Systems.

In 2010, she graduated from the Financial University under the Government of the Russian Federation with a degree in Accounting, Analysis and Audit.

1999-2003 – Chief Accountant Federal State Institution Blood Center of the Federal Medical and Biological Agency of Russia.

2006-2011 – Deputy Head of the Department for Expenditure Planning of Healthcare and Educational Institutions of the Planning and Financial Directorate of the Federal Medical and Biological Agency of Russia. The scope of her activities included planning and distribution of federal budget funds between subordinate institutions, implementation of current financing for wages of institutions, the priority national project “Health” in terms of payments to district services, emergency medical services and first-aid posts.

2011 – Head of the Planning and Economic Department of the Federal State Institution “FB MSE”.

2012 – Deputy Head of the Federal State Budgetary Institution “FB MSE” of the Russian Ministry of Labor.

2012 – present Deputy Head of the Federal State Budgetary Institution “FB ITU” of the Russian Ministry of Labor for Economics and Economic Development Forecast.

Deputy Head of information technology

In 1979 Completed full-time graduate school at the Moscow Institute of Radio Engineering, Electronics and Automation.

In 2009, preparation for the training program for senior managers DBA “Doctor of Business Administration” (Higher School of Management, State University Higher School of Economics).

From 1979 - 1993 Research Institute of Automatic Equipment named after. Academician V.S. Semenikhin. Deputy Chief Designer for Software and Information Support, Head of Department.

From 1993 - 1997 Commercial companies. Director of Information Technology.

From 1997 - 2000 Pharmaceutical trading company "Vremya". Deputy Financial Director for Information Support.

From 2000 to 2003, RUSAL - Management Company (Russian Aluminum Management) was the management company of the holding vertically integrated corporation Russian Aluminum. Director of the Information Technology Department.

From 2003-2004 State University Graduate School Economics. Director of Information Technology.

From 2004 - 2007 SSU "Russian Federal Property Fund". Deputy Head of the Information Technology Department.

From 2007 - 2008 ANO GRP Inform-expertise. Director, Chief Designer of the State Automated System (GAS) “Management”, Chairman of the Board of Designers of the State Automated System “Management”, Deputy Head of the Interdepartmental Working Group (IWG).

From 2008 - 2010 Ministry of Health and Social Development of the Russian Federation. Director of the Department of Informatization.

From 2010 - 2014 Medical Information and Analytical Center of the Russian Academy of Medical Sciences (MIAC RAMS). Director of Information Technology.

From 2013 - 2014 Portal of the Russian Academy of Medical Sciences. CEO.

From 2014 - 2014 Intourist Hotel Group (since July 2014 Cosmos Hotel Management Company). Member of the Board, IT Director.

From 2015 to 2016 Deputy General Director of SMO Medstrakh. Director of the Information Technology Department.

From 2012 - 2016 Health modeling technologies. General Director, member of the Expert Council of the Russian Ministry of Health on the use of ICT in healthcare.

From 2016 to present Deputy Head of the Federal State Budgetary Institution FB ITU of the Russian Ministry of Labor for IT.

He is a candidate of technical sciences, associate professor, and author of 65 published scientific works.

Head of the Federal Center for Scientific, Methodological and Methodological Support for the Development of a System of Comprehensive Rehabilitation and Habilitation for People with Disabilities and Children with Disabilities - Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia

1988 - Kuibyshev Pedagogical Institute named after. V.V. Kuibysheva.

1994 - St. Petersburg State University by specialty: " Practical psychology in the health care system."

2000 - Institute of Psychology and Pedagogy, Moscow, specialty
"Psychological counseling."

From 1998 to 2004 - medical psychologist at the State Budgetary Institution MSE for the Samara Region.

From 2004 to 2018 - Director of the State Budgetary Institution of the Samara Region "Social and Health Center "Overcoming".

Since 2019 - Head of the Federal Center for Scientific, Methodological and Methodological Support for the Development of a System of Comprehensive Rehabilitation and Habilitation for People with Disabilities and Children with Disabilities - Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia.

Is a candidate psychological sciences, (2004), author of more than 30 published works.

Deputy Head of the Federal State Budgetary Institution FB ITU Ministry of Labor of Russia | Honored Worker of Social Protection of the Russian Federation

In 1975 she graduated from the Ryazan Medical Institute named after Academician I.P. Pavlova with a degree in general medicine.

From 1975 to 1979 - Inspector-doctor of the Department of Medical and Labor Expertise of the Ministry of Social Security of the RSFSR.

From 1979-1981 - clinical residency in the specialty: “ internal illnesses» Central Research Institute for Examination of Working Capacity and Labor Organization of Disabled People.

From 1981 to 1992 - Head of the territorial department of the Office of Medical and Labor Expertise of the Ministry of Social Security of the RSFSR.

From 1992 to 2000 - Head of the ITU Department of the Department for Rehabilitation and social integration disabled people of the Ministry of Labor and Social Protection of the Russian Federation.

From 2000 to 2004 - Deputy Head of the Department of the Ministry of Labor and Social Protection of the Russian Federation.

From 2004 to 2008 - Head of the Department for Disability Issues of the Department for the Development of Social Protection of the Ministry of Health and Social Development of the Russian Federation.

Since 2009 - head of the center for documentary support of the activities of expert bureaus of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia.

Since 07/14/2014 - head of expert teams of the Federal Bureau, deputy head of the Federal State Budgetary Institution Federal Budgetary Institution ITU of the Ministry of Labor of Russia (Order No. 6 35-l dated 07/14/2014)

Head of the information and reference center for citizen support - deputy head

In 1984 she graduated with honors from the Moscow Aviation Institute. Sergo Ordzhonikidze with a degree in Spacecraft Dynamics and Flight Control with qualification as a systems engineer.

In 1994, she graduated from the International Academy of Marketing and Management with a degree in Finance and Credit with a Master of Science in Economics qualification.

Graduated with honors in 2007 Russian Academy civil service under the President of the Russian Federation in the specialty “Human Resources Management” with the qualification “manager”.

From 1996 to 2012 - Director of the state budgetary cultural institution of the city of Moscow "GBUK DK "Astrum".

From 2012 to 2014 - Vice-Governor of the Primorsky Territory for health, education, culture, social protection, physical education and sports.

Since 2015 - Head of the Information and Referral Center for Citizen Support - Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia.

Why are children denied disability? How will ITU be reformed? Who should I complain about experts to? These questions were answered by Deputy Head of the Ministry of Labor Grigory Lekarev and Deputy Head of the ITU FB Sergey Kozlov

The Ministry of Labor continues to reform the system of medical and social examination. The Federal Register of Disabled Persons will soon be created, the requirements for medical experts will change, public councils will be created at the ITU bureau, and audio and video recording of the examination procedure will be introduced. Despite the changes, the work of ITU still raises many questions: what kind of help can seriously ill people who have been denied disability receive from the state; what is being done to improve the accessibility of the premises where examinations are carried out; why the number of denials of disability to children has increased, how corruption schemes operate in the ITU, etc.

Reforms of medical and social examination

Grigory Lekarev, Deputy Minister of Labor and Social Protection of the Russian Federation

– Tell us more about the public councils at ITU. How can citizens use them to influence the situation?

– We assume that the public councils at the main bureaus will include regional public figures, representatives of human rights organizations, human rights ombudsmen, and children’s rights ombudsmen. The council should consist of people who rely on public institutions and represent the interests of a large category of citizens.

We want to define the powers of the public council so that its decisions have serious weight. Most likely, this will require the development of special regulations.

- Who will do improvement techniques ITU?

– Firstly, this is the Federal Bureau of Medical and Social Expertise. This is not only the highest authority, where particularly complex cases are considered or decisions of lower bureaus are appealed, but also a clinical base. Professionals in the field of cardiology, pulmonology, nephrology, etc. work there.

Secondly, the ministry has jurisdiction over a number of educational and scientific institutions. For example, the St. Petersburg Institute for Advanced Training of Medical Experts (SPbIUVEK) is an educational organization that organizes advanced training of experts or retraining of doctors to work in medical and social expertise.

These institutions have the largest concentration of candidates and doctors of medical sciences who did their scientific work specifically in the field of MSE.

- YouI'll mentionwhether O necessity promotion qualifications experts. Why their will learn V first queue?

– First of all, of course, this is the regulatory framework, classifications and criteria. The second is the development of an individual rehabilitation program, including the appointment of technical means of rehabilitation. The third aspect is organizational issues, personnel and logistics.

- How disabled person Maybe prove, What medical expert led myself unethical?

– When we talk about the examination procedure, we must not forget that the expert does not make decisions alone, he is not alone in the office. There are always witnesses who can confirm or refute the fact of unethical behavior. The draft “road map” includes video and audio recording of the examination procedure. If the patient wants the recording not to be kept, he can always declare this, but the expert will not have such a right.

Deputy Head of the Federal State Budgetary Institution FB ITU Sergey Kozlov clarified in an interview with Miloserdiyu.ru: “In many regions, audio recording is already underway. This disciplines both sides. For experts, this is a kind of guarantee that, if necessary, they will be able to prove their innocence. And if audio and video recording is not carried out by the institution, the applicant can come with a voice recorder himself. It is not prohibited. But the person must notify us about this in advance. Otherwise, the recording cannot be used as evidence of certain violations during the examination.”

- How be, If Human hard is ill, But disability to him Not install?

– Now experts from the Bureau of Medical and Social Expertise must not only explain the decision made, but also inform a person for whom a disability has not been established what support measures he is entitled to. Our main bureaus, together with regional authorities, have developed relevant leaflets.

What to do about corruption

- Which workers moments And spaces V legislation usually are used employees, inclined To corruption?

– “Loopholes” for corrupt officials are found at almost every step, because during the examination there is always a certain amount of subjectivity. For example, this may be the recognition as disabled of a person who has no signs of disability. True, in this case, medical organizations are also involved, writing that there is a disease that in fact does not exist.

Already now, a unified automated MTU system is a good tool. Since 2013, medical and social examination institutions have completely switched from paper examination to electronic examination.

- When planned Creation Federal registry disabled people And For what This is it being done?

– From January 1, 2017, the federal register of disabled people will begin to operate, which will consolidate a wide variety of information about disabled people.

A personal account of each disabled person will be created in the federal register, in which he will be able to see at any time what support measures are provided for him, what has been done, and who is responsible for their implementation. A person will be able to compare the information posted in the register with the activities actually completed and, if he is not satisfied with something, file a complaint.

Unfortunately, we have sad statistics: half of disabled children who enroll in professional educational organizations drop out for some reason. We have to figure out why they left the race early.

The register should be operational from January 1, but not all of it, but only part of it, since not all cases in ITU institutions have yet been transferred to electronic form. I have already said that all ITU institutions have been working in a single system only for the last three years, and those paper files that are stored in archives need to be digitized.

Cases regarding disabled children will be completely digitized by January. Next year, at the second stage, we will process and upload all the rest to the register.

– The premises in which ITU offices are located are not always accessible to people with disabilities. What is being done about this?

– The ITU network is very extensive, with about 2,600 branches throughout the country. We try to keep the main offices in their own premises. For such institutions, funds are provided annually for repairs and additional equipment.

But ITU offices are often located in rented premises or in the buildings of medical organizations, for example, clinics. Therefore, when they do not have accessibility conditions, we cannot, at the expense of the federal budget, equip them to meet the special needs of people with disabilities. In our opinion, the public council can provide significant assistance in resolving these issues through agreements with local authorities.

At the same time, it is important that local authorities understand: not only the premises must be accessible, but also the surrounding area, be it a public transport stop, sidewalks, or parking areas.

- Previously rose question O transmission ITU Ministry of Health. How You please comment this initiative?

– It’s not for us to decide. The Russian Ministry of Labor is vested with its powers by an act of the government. But from my professional point of view, this would not be the right move. Issues of medical and social examination are mainly in the area of providing social support to a person in a difficult life situation. In addition, ITU institutions are federal institutions, and hospitals are mainly regional. Are the regions ready to assume such powers? This will be an additional burden for them – both financial and organizational.

Why are people denied disability?

Sergey Kozlov, Deputy Head of the Federal Bureau of Medical and Social Expertise

- Howwill changeresponsibilities employees ITU in the near future?

– On behalf of the Minister of Labor and Social Protection, changes were made to the job descriptions of ITU specialists regarding compliance with the rules of ethics and deontology, correct behavior in relation to persons being examined. The duty of ITU specialists has been established to explain the expert decisions taken and inform the person about the benefits that should be provided regardless of the “disabled” status.

– Federal Bureau ITU suggested For promotion quality examination provide "observation behind children outside expert situation." ABOUT how coming speech? ABOUT video camera?

– A child’s presence in an expert environment (undergoing an examination) is always a stressful situation for a person, and especially for a small child. Therefore, his behavior during the examination may not be exactly the same as in a normal daily environment.

But a playroom with a mirrored wall allows specialists to observe children’s actions in their usual environment and objectively assess how the child has mastered basic movements, that is, how he moves in the playroom, climbs, slides, and stands up.

At the same time, you can also note the presence or absence of shortness of breath, the level of development of fine motor skills.

Unfortunately, not all institutions have the opportunity to organize such game rooms. But most offices that accept people under 18 years of age have either a lounge with a play function or a playroom where a social work specialist, rehabilitation specialist, or just a doctor can come in and see how the child behaves. The time of such observation depends on the workload of specialists.

In the age group over 14 years old, the influence of the puberty period with the peculiarities of hormonal regulation of metabolism and psychological aspects of adolescent behavior, affecting the ability to independently control the course of the disease and maintain optimal blood sugar levels, is taken into account.