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, and public councils will be created for ITU Bureau, audio and video recording of the examination procedure is 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 RF

– 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, the 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 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 examination.

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 of medical sciences who did their scientific works specifically in the field of ITU.

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

- 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 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.

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 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 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

- 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.

An aid in the fight against corruption would be the establishment of interdepartmental electronic interaction with medical organizations. 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 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.

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 regarding 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 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 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 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 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

- Howwill changeresponsibilities employees ITU 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.

– 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 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.

IN age group over 14 years of age, the influence of puberty with features hormonal regulation metabolism and psychological aspects behavior of adolescents that influence 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.

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Head - chief federal expert on medical and social examination of the federal state budgetary institution"Federal Bureau of Medical and Social Expertise" of the Ministry of Labor and Social Protection 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 area of responsibility included the creation of the structure and subsequent functioning of the expert bureaus of the Federal State Institution "FBMSE", interaction with the main ITU bureaus for 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 civil service(Smolensk branch), majoring 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 organization’s quality control department social assistance population, the Federal Service for Surveillance in Healthcare and social development 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 Railways, Moscow, qualification Engineer-economist, specialty “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).

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

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.

Supervisor Federal Center scientific, methodological and methodological support for the development of a system of comprehensive rehabilitation and habilitation for people with disabilities and disabled children - 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 Department of Medical Labor Expertise of the Ministry social security 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 Reference 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 FB ITU Sergei 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

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, experts from the ITU Bureau were guided by such criteria as significantly expressed, pronounced and moderately expressed pronounced 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 also 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 the patients and public organizations that, while introducing them, we will jointly monitor their application.

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 work 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, 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 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.

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

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 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

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.

- 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.

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.

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 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 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 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, 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 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

- How will the responsibilities of ITU staff change 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.

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 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.

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. This also applies to the provision of expensive medicine.

At the same time, Decree of the Government of the 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 mellitus They 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 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.

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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

Reforms of medical and social examination

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Annual review of VOI activities

Our position