A. NASIBOV: The radio station “Echo of Moscow” is working. Moscow time 22 hours 11 minutes. Ashot Nasibov at the microphone. Greetings dear listeners! This is the Back to the Future program. Today we are talking about disability, or more precisely, about the so-called fake disability. This topic is in last days“on hearing”, especially in connection with the problem of the emergence of various types fake certificates upon admission to a higher education institution. By at least, this is exactly how it was reported in our Russian press. We will touch on this topic and talk about disability in general, about what is being done to help people with disabilities. Guest expert in the studio: Sergey Kozlov, head of the medical department social expertise And social support Federal Medical and Biological Agency. Sergey Ivanovich, good evening!

S. KOZLOV: Good evening!

A. NASIBOV: Sergiy Ivanovich, before we start the program, I want to read to you an excerpt from the message that we received on the Internet before the start of the program.

Waldemar Green, a doctor from Sudan - as he introduced himself - expresses the following point of view: “The very concept of disability or group of disabilities does not indicate the degree of health or illness, but says that a person needs one or another degree social protection" – Do you agree with this statement?

S. KOZLOV: To some extent, we can agree, because today there is a regulatory document in force, and it provides for the establishment of disability in accordance with the limitations in life activity that have occurred as a result of a dysfunction of the body, and whether a person needs social protection measures. If you are aware, then in accordance with the instructions of the President, which was given when bringing the Council for Disabled Affairs, the Ministry of Health was instructed social development and the Federal Medical and Biological Agency to develop a new concept for improving the medical and social examination of people with disabilities in accordance with functional disorders. Currently, we are working in accordance with ICD-10 - this is a disorder of diseases. Therefore, the transition to a new concept, depending on the impairment and health status, will represent the state of disability in more detail than now.

A. NASIBOV: Approximately when can we expect the appearance of a new concept?

S. KOZLOV: In accordance with the president’s instructions, it should be presented before December 1, but I think that we will try to do this earlier in order to, in addition to the concept, prepare a number of regulatory documents, which must correspond to the accepted concept, so that work can already be carried out in some proper projects from January 2010.

A. NASIBOV: What new do you include in this concept?

S. KOZLOV: Most likely, we believe that a new concept of “rehabilitator” should appear. And from our point of view, it should come out through citizens who, in order to receive rehabilitation measures, they are first forced to establish a disability, then they receive a rehabilitation measure, which is paid for by the state.

S. KOZLOV: We take the disabled person beyond the scope. Therefore, according to the current government decree, persons must be sent to us after carrying out the entire range of rehabilitation measures. From our point of view, groups of people who need long-term or permanent replacement maintenance therapy should leave. Persons who, say, have the disease phenylketonuria, which is diagnosed practically in the maternity hospital, and so that the child does not become disabled - in addition to the fact that this is quite a serious mental trauma in the family, because he is severely disabled - if this child is given specific baby food, then he will not be disabled. Today, we determine indications for nutrition after we are forced to assign him the “disabled” category. – These are the main approaches.

A. NASIBOV: About a year ago, the medical and social examination was transferred to the Federal Medical and Biological Agency. What did you manage to do this year, what did you not manage to do? Where did you start?

S. KOZLOV: Yes, literally in June last year a presidential decree was adopted, then a government decree, and in accordance with the government decree of September 10, the departments of the Federal Medical and Biological agencies. So, it is impossible to say that the FMBA of Russia did not engage in medical and social examination, because in many medical institutions subordinate to the Federal Medical and Biological Agency there were medical and social examination institutions that were engaged in the examination of persons with particularly dangerous professions, and they were quite good results. And, apparently, it was considered that the results of the work of these institutions were quite decent, and thus the department was transferred to the FMBA. And first of all, we took part even before the transfer stage, this is in the preparation of the 240th government resolution, this is the provision of technical means of rehabilitation, as a result of which a number of positions have changed. New de jure rules appeared: disabled children were given the opportunity to receive technical aids, terms and conditions for the payment of compensation, and various other provisions were determined. And also the 247th government resolution, dated April 7, 2008, which determined the procedure and conditions for establishing a disability group in the category “disabled child” without a period for re-examination. – These are two main documents. The main talk of the town is the lengthy examination and difficulties in completing the document for a medical and social examination.

A. NASIBOV: There are a lot of questions related to this: “Why do you have to undergo a medical and social examination again every year, and, moreover, from general practitioners?”

S. KOZLOV: We have prepared a project for the Ministry of Health and Social Development, it is now being approved, which regulates the timing of examinations in medical institutions. We offer - we have Form 88 - a referral for a medical and social examination, one within a month. This means, from our point of view, from the moment of contacting medical institutions, out of turn, he must be examined, a referral for a medical and social examination must be filled out, if there are grounds for this, and he must be examined in the near future. The question that you mentioned is precisely what Resolution 247 has sent, which currently regulates the procedure for establishing the disability group of the “disabled child” category for persons under the age of 18 according to the period of observation. You see, the situation is such that when various diseases, well, basically, about two years is the minimum recovery period, which is necessary in order to restore or compensate for functions through rehabilitation measures, treatment.

A. NASIBOV: Well, this question concerns, for example, people with amputations. It is clear that an arm or a leg will not grow on its own, but then why do they need to undergo new examinations every year?

S. KOZLOV: Today, the first two years of life are practically spent by people with this pathology. Let's say, a serious injury: the first six months, a year, physiological and rehabilitation measures that are aimed, they allow you to somehow compensate and prepare a person to be fitted with prosthetics. Let's say, the first year - this could be the second group. And in accordance with the convention, which the Russian Federation signed, disability is an evolving condition. By carrying out rehabilitation measures, either compensation or restoration of functions can be achieved. In the case of the absence of limbs, say, restoration of functions is impossible, but by making a prosthesis, teaching a person to use this prosthesis, and having him in the field of rehabilitation specialists, a disability group is established for this period of rehabilitation measures. Then the person is assigned a disability group for an indefinite period.

A. NASIBOV: Sergei Kozlov, head of the department of medical and social examination and social support of the Federal Medical and Biological Agency, is a guest of the “Back to the Future” program on radio “Echo of Moscow”. Send your questions and comments via SMS to +7 985 970-45-45. We continue our conversation. Difference Russian system medical and social examination from foreign systems - what is the main difference?

S. KOZLOV: Let’s say, as part of preparing a concept for improving social expertise, we got acquainted with the work of a number of organizations that are involved in determining disability. And yet, it must be said that over time we became acquainted with the Canadian system. When we talked about the conditions in which our specialists work and what determines it, it was highly appreciated that we have a high social orientation. The main difference is that in other countries in Europe, America, Canada, the determination of disability is of a registration nature, and the person then decides for himself whether to apply for, say, rehabilitation, if he has insurance, or whether to apply for employment. Today we have interaction between medical institutions, because a large complex of institutions and organizations is engaged in the provision of rehabilitation services - these are healthcare, employment, cultural, educational institutions, prosthetic and orthopedic enterprises. There, a person is forced to walk with insurance himself. Here, based on the results of the examination, an individual rehabilitation program is developed for him. And we try to interact. Another change in the concept that we propose is to move away from Law 94 in providing disabled people with technical means of rehabilitation. Based on the results of the examination, there should be (inaudible) and the cost of expressions, that is, a certificate.

A. NASIBOV: And the person decides for himself?

S. KOZLOV: A person decides for himself which manufacturer to go to. There must be clearly defined amounts listed, for example, for a prosthesis. If a person has a desire, he can add funds and buy a new prosthesis.

A. NASIBOV: Or vice versa, cheaper.

S. KOZLOV: Or vice versa, yes. Here, as it were, if we have state or private prosthetic enterprises, then we supply them with information about the person’s consent, and it is no longer the person who goes to this enterprise, but the enterprise comes and says that I will install a prosthesis for you at home, I will bring it today. And the person will have a choice. When competition appears, quality will appear. Indeed, today, often those technical means that we recommend, which are supplied to a person, cannot be used by a person, because they quickly fail. This fact exists.

A. NASIBOV: Pensioner Alexander Bevzyukov writes: “When will the practice of annual confirmation of disability be eliminated?” And another question. Just a second... Grigory Mazurenko, a social worker, believes that in our country the main motive for receiving a disability group remains receiving a pension supplement.

S. KOZLOV: Well, it’s difficult to say here, because the disability pension does not always exceed the salary. And to say that people, as a rule, apply in order to compensate for some financial costs is difficult here. But, given that our medical and social examination is still socially oriented.

A. NASIBOV: You know, he is a social worker, he is “closer to the ground,” as they say. Here he writes: “In pursuit of material gain, our fellow citizens storm clinics and quarrel with doctors.”

S. KOZLOV: I can’t say this about everyone. There are certain episodes when you want something more than you should. But the majority, nevertheless, apply for examination when it is absolutely unbearable! If we compare before the crisis broke out - this year we had an increase in the number of examinations - this suggests that people somehow held on to work and coped with their illness with all their capabilities. As soon as they have lost their jobs, in order to receive some kind of compensation or means of subsistence, they apply for examinations. Although, I say that there are cases when the desires of citizens do not always coincide with what they are entitled to.

A. NASIBOV: Valery Valeev, a pensioner, is interested: “Why do they keep increasing the service life of wheelchairs for disabled people?” – In my opinion, you partially answered the question about technical means.

S. KOZLOV: As of today, the deadlines have not been changed, they remain the same. Another question is that the wheelchairs that disabled people receive do not always meet these deadlines. And the question should be raised not about whether or not to increase the shelf life of wheelchairs, but the question should be raised about the fact that attention should be paid to the quality of technical means of rehabilitation so that they can withstand the periods for which they are designed.

A. NASIBOV: That is, if, according to your concept, a person himself will determine where to buy the same wheelchair and where to give this certificate. Am I right?

S. KOZLOV: Yes. He will choose himself, and of the best quality. And the company will be interested. When there are two companies, and one goes bankrupt because its quality is worse, this will pose a question to manufacturers: either the company goes bankrupt, or they have to do something. If the quality does not match, either reduce the price or increase the quality level so that this stroller is competitive.

A. NASIBOV: How will you relate the cost of this certificate to the average cost of these technical means on the market?

S. KOZLOV: We believe that we have now prepared, with the participation of the Ministry of Health, medical contraindications to provide technical means for rehabilitation. We believe that there should also be medical and social indications: for example, people of retirement age in rural areas who need the same prosthesis to restore mobility. There should be funds for the purchase of this prosthesis, or a technical means of rehabilitation in somewhat smaller quantities, say, if a person is of working age, goes in for sports, has an active life position, then the wear rate of this technical means of rehabilitation will, as a rule, be greater for him, and he will need to change it more often. – The intersection of these two indicators - medical-technical and medical-social - should determine the average cost. Plus, there must also be a pricing policy that must take into account the delivery of this technical equipment, because we have a large country, this must also be taken into account.

A. NASIBOV: Alexander from Volgograd believes that the degree of disability is, in fact, a ban on the right of a Russian citizen to work. He proposes to abolish the concept of degree of disability.

S. KOZLOV: I think the question here is not about the degree of disability, but the degree of limitation labor activity. Currently, disability is established depending on seven categories of disability, the component of which is the limitation of the ability to work. Pensions are currently paid depending on the degree of restriction on work activity. And therefore, people with visual impairments of the first group, who have limitations in communication, movement, and self-care, have the first group of disabilities. But, given that they can work in specially created conditions, they have restrictions on work activity of the second degree and they receive a pension in the second group. At the suggestion of the Ministry of Health and Social Development, a justification has been prepared. And if you read in the press, a bill is being prepared, which, starting from the new year, if everything goes well, will be amended, and the disability pension will be paid depending on the disability group, and not on the degree of limitation to work. – This is also a proposal that came from us.

A. NASIBOV: Sergei Kozlov, head of the department of medical and social examination and social support of the Federal Medical and Biological Agency, is a guest of the “Back to the Future” program on the waves of radio “Echo of Moscow”. Please ask your comments and questions via SMS by sending them to the number +7 985 970-45-45. In the second half of the hour we will begin, perhaps, with the question of medicines for the disabled. Let's try to start with this question and then continue the topic of those very certificates that are now used for admission to a higher educational institution. There is a lot of interesting things here.

(News).

A. NASIBOV: The radio station “Echo of Moscow” is working. Ashot Nasibov at the microphone. This is the Back to the Future program. Today we are discussing assistance to the disabled and the so-called fake disability. Sergei Kozlov, head of the department of medical and social examination and social support of the Federal Medical and Biological Agency, is a guest in the studio. Send questions and comments to +7 985 970-45-45. There are already several questions about medications for the disabled. Could you say a few words about this?

S. KOZLOV: Well, this group of issues indirectly relates to our management, because we are organizing a medical and social examination. But, depending on the disability group, a number of categories have certain preferential conditions for receiving medications. The main group is those with disabilities who have not refused the social package - they have the right to be provided with medicines in the prescribed manner when applying to medical institutions.

A.NASIBOV: Sergey Ivanovich, in recent days the topic of so-called “fake” disabled people has been on our lips, thanks to my fellow journalists. Just today I saw one report on one of the federal TV channels, where a person said that on budget, when entering higher education educational establishments, I almost exclusively apply to two categories of applicants: the category of winners of summer school Olympiads and people who provided certificates of disability. Regarding the second half of this question, we are familiar with this situation.

S. KOZLOV: Yes, we are familiar with this situation, this is a rather painful issue for us. I believe that representatives of higher educational institutions and the press formulated the question rather incorrectly. If we put our heads together, this situation was predictable. If in past years, people with disabilities, including, like all beneficiaries, took exams on a general basis, and if they received an unsatisfactory grade, they were not accepted for enrollment, but now, as you all know, we have a Unified State Examination, new system assessments of students' knowledge, which formed the basis of the old information base. According to the head of Rosobrnadzor, there are one hundred and fifty-three preferential categories for enrollment upon admission to a university.

A. NASIBOV: One hundred and fifty-three categories of beneficiaries for enrollment in a university?

S. KOZLOV: Yes, including disabled beneficiaries. Those statements about what managers don’t see include the fact that these are beneficiaries. And we analyzed this situation: there were multiple accusations that the number of disabled people who received disability in May and June increased, that the group of the “disabled child” category was established for several months, only for a period - this is not true. To date, we have received information from sixty-nine of our main bureaus for the constituent entities of the Russian Federation.

A. NASIBOV: Sixty-nine regions, in fact, right?

S. KOZLOV: Yes. Sixty-nine regions received data. And we have virtually no increase in the number of people on disability compared to last year. We commissioned a check to compare the number of disabled children who were assigned the category “disabled child” from 16 to 18 years old, and the groups of people 18 years old and older - these are the categories by which disability groups are established. And we have a clear ratio, we have no increase compared to last year for this period. This is the first situation where there is no increase. We also analyzed qualitatively the numerical composition. The majority of people represented in this contingent are disabled people whose disability was established at the beginning of the “disabled child” category - this was in 2004–2005. And their next examination coincided: May-June, or January. Rosobrnadzor presented us with lists of students at two higher educational institutions in Moscow: the Higher School of Economics and the Financial Academy - 80 and 42 people. We asked our institutions, the main bureaus for the constituent entities of the Russian Federation provided us with information: the main body - the disability group was established with reason. The fact that purely physically they do not see that this is a disabled person, this suggests that more than 80 percent are persons who have been diagnosed with a disability with somatic diseases. These are mainly bronchial asthma and diabetes mellitus. That is, it is not purely visually visible on a person; a few percent are people with paralysis, with cerebral palsy, something that we, ordinary people, see as a manifestation of disability. To say that the certificates are fake: we checked, we do not have confirmation for only three persons.

A. NASIBOV: From what quantity?

S. KOZLOV: Out of 122.

A. NASIBOV: Of 122.

S. KOZLOV: Yes.

A. NASIBOV: There is no confirmation of three persons?

S. KOZLOV: There is no confirmation of three persons, but we were presented with very brief information, that is, last name, first name and patronymic, and certificate series number, and subject. So, these three people - one in Moscow, one in the Moscow region, the other from the Chelyabinsk region - did not undergo examination. We will now make a request for the rest of our institutions in the Russian Federation, because inaccurate information may have been provided; these persons could have gone to another of the regions. The abundance of disabled people, as well as in general, the number of people who have applied to higher educational institutions, is due to the fact that it is allowed to apply to several educational institutions this year. So, therefore, the list of, say, representatives of Kalmykia with disabilities, out of 16 people who applied to the Higher School of Economics, they also submitted applications to the Financial Academy. Thus, one gets the impression that a large number of people are disabled. Therefore, I would ask you to be very correct in this regard, because disabled children who have now acquired the opportunity to receive an education - we, after all, signed the convention, including, there are clauses on education without discrimination, and create equal opportunities. If today normative base allows them to go to college, then, as a rule, I want to answer that such children are more diligent, more demanding both in work and in school, therefore, the situation that is now playing out, from my point of view, is very incorrect.

A. NASIBOV: Tell me, please. But did representatives of Rosobrnauka, representatives of those same universities, the same developers of new rules for admission to higher education institutions contact you before this whole situation began to develop? Did anyone consult you? Perhaps you offered your advice to the Graduate School to prevent such misunderstandings?

S. KOZLOV: I understand the question. No, there were no such requests to us. We had an appeal after this situation took place. Here is the direction of the lists of two universities through Rosobrnadzor High school economy. Well, in our letter that we prepared to Rosobrnadzor, we communicated these instructions to the heads of the main constituent entities of the Russian Federation: in the case of requests from representatives of universities, justified requests, confirm the validity of issuing a certificate. - Whether this certificate appears to have been validly issued, whether such a person has passed through, and whether it is false - provide all possible assistance. I can say that at the same time, social security authorities contacted the main bureau for Krasnodar region: The Kuban Academy also presented a list of 36 people. It’s as if all decisions are also correctly justified. That is, such work is also already underway in the regions. And, if doubts arise, then, let’s say, there was a very large appeal to MSTU. Bauman, a large number, but, as a university representative said: “Not a single false certificate was identified.” And before making such statements about the dominance of false certificates, you could still contact the Federal Medical and Biological Agency.

A. NASIBOV: Do you have a database of all issued certificates?

S. KOZLOV: We can give instructions on the subjects, our subjects have this database, and we can give instructions to check in the shortest possible time. And if there is such a need to indicate passport data, place of residence, because the Russian Federation is large, and, naturally, some of the applicants and disabled people want to study at universities in the capital.

A. NASIBOV: As far as I understand, the situation boils down to the fact that this year the Unified State Exam was introduced, and all the flaws, “fleas”, shortcomings came to light - this is not only due to the large number of disabled people entering universities, but also with the emergence of one hundred percent results on the Unified State Exam in a number of cases. This is probably a trial year.

S. KOZLOV: Yes.

A. NASIBOV: Have you drawn any conclusions for yourself?

S. KOZLOV: We have drawn conclusions for ourselves, and we are preparing appeals to Rosobrnadzor to meet together and discuss the proposals being made - after all, there was a proposal to reduce the number of beneficiaries - that is, so that this does not happen to the detriment of those people we called upon to protect. There must be reasonable cuts, some reasonable approach, so that this procedure will be simplified for the next entrance exams at universities, and there will not be such a rush.

A. NASIBOV: Waldemar Green asks another question: “What areas in medical and social expertise need to be developed to eliminate the possibility of false disability?” – One thing you mentioned is the development of this very database, and checking against the databases, if you are approached. What else could it be?

S. KOZLOV: What else? This means, again, the concept provides for a change in the very procedure for referral for examination in the use of computer electronic equipment. We are now preparing a situation based on the fact that our medical institutions should have electronic medical records, electronic outpatient cards. And in the case of a referral for an examination, neither the doctors of the medical institutions nor our specialists had the opportunity to, well, to put it mildly, play pranks. Because electronic documents have an access level, and if someone came in and changed some results in one direction or another, you can always track who did it. From our point of view, the procedure for referral for examination will change again. Apparently, we are proposing to simplify the procedure - in some cases this will be done in absentia, without inviting the person, and the examination procedure itself will change, it will be simplified. – Therefore, all this will allow us to make a transparent procedure for sending an examination and obtaining results, thereby eliminating the possibility of any falsification. Literally on the tenth, as part of the delegation of the Ministry of Health and Social Development, together with Minister Tatyana Alekseeva Gulikova, we were in Krasnoyarsk, where, as a pilot project, a premises for a branch of the main bureau of health care was opened Krasnoyarsk region, based at the Siberian Clinical Center. This institution is a prototype of what we want to see - large, spacious halls, large game room, light. To be honest, our institutions do not always meet the standards that they should have. There are no ramps, sometimes they are replaced on the upper floors without elevators, so this is now receiving a lot of attention from both the Ministry of Health of the Russian Federation and the Federal Medical and Biological Agency.

A. NASIBOV: But I also know from the municipalities that in Moscow there is also a corresponding program.

S. KOZLOV: Well, currently we have a problem with placement, and basically most of the subjects in the Russian Federation. Providing premises for our institutions is a very big issue, a very painful issue. So, in Krasnoyarsk, in addition to everything that there is premises, we are switching to quite new level: help terminals have been installed, a unified help service with a telephone number has now been launched in Krasnoyarsk, it is announced, a person can call work time by phone. We proposed that the operators of this help desk should be people with disabilities, including those with limited mobility, who have remote access, - a computer, a telephone line, - specially trained people who have, say, a legal education, - there are such persons too. And regarding medical and social examination of pension provision, you can contact revolutionary services, and if the operator cannot answer any questions, then you will be switched to specialists of the appropriate level. Further implies an electronic account, and based on the results of the examination, the person will receive a login and password, and can log into his or her account via the Internet. Personal Area, look at the results, can instruct this service to remind him in the form of either an email or an SMS message that, say, he needs to undergo re-examination in advance - different situations can be. If, in the event of a written appeal regarding disagreement with the decision of the institution, a person will be able to trace the movements of the complaint: when the complaint was received, who is considering it, when he received the answer. – This is what we are working on. Several subjects have now been selected to participate in the pilot project. And I think that by the time we prepare the concept, which we will have to report to the president, we will already be able to show some concrete results in implementing individual elements of this concept.

A. NASIBOV: Telephone number for the live broadcast of the Ekho Moskvy radio studio: 363-36-59, Moscow year 495. We are starting to receive your calls. Ask questions to Sergei Kozlov, head of the department of medical and social examination and social support of the Federal Medical and Biological Agency. We are discussing the so-called fake disability. – 363-36-59. The first phone calls came. Put on your headphones, Sergei Ivanovich. First call, we are listening to you. Hello!

LISTENER-1: Hello, good afternoon!

A. NASIBOV: What is your name? Where are you calling from?

LISTENER-1: I’m from Moscow, my name is Oleg.

A. NASIBOV: Listen, Oleg

OLEG: I would like to ask the guest a question. Can you tell us about the practice of teaching people with disabilities in higher education institutions?

A. NASIBOV: More specifically. What does practice mean?

OLEG: Well, how do you actually work with them in practice, how comfortable are they to learn? Because, as far as I know, in fact everything rests on individuals, who, on their own initiative, somehow pull these people, often despite the administration of higher educational institutions, and so on.

A. NASIBOV: Thank you!

OLEG: You're welcome!

S. KOZLOV: I have to agree somewhere that in some cases it is quite difficult for people with disabilities to study in our universities, simply physically: in some places there are no ramps, in others there are no elevators. Persons with disabilities simply cannot come and go to this university. Currently there are groups at MSTU. Bauman, who work quite widely with people with disabilities, are developing new distance learning systems. So, I have already said that the Russian Federation has signed the convention, including clauses in education. And therefore, now all steps must be taken, and the situation in a similar case must be corrected, and conditions for normal study must be created. If a person cannot attend, say, higher educational institutions, medical and social examination institutions may be offered, various shapes. For people with disabilities, full-time or part-time forms can be offered, for example, home schooling, distance learning. And now there is every opportunity to introduce these proposals into the concept, which will be aimed at improvements.

A. NASIBOV: Is this the one you are developing?

S. KOZLOV: Yes.

A. NASIBOV: Are you planning to put these provisions into the concept? Am I right?

S. KOZLOV: Yes.

A. NASIBOV: 363-36-59. Next call. Hello.

LISTENER-2: Hello!

A. NASIBOV: Hello! Turn down your radio, please.

LISTENER-2: Hello!

A. NASIBOV: Hello! Turn down your radio please!

LISTENER-2: I see. Hello.

A. NASIBOV: What is your name and where are you calling from?

LISTENER-2: Leningrad region, Kashinsky district.

A. NASIBOV: What is your name?

LISTENER-2: Georgy Alexandrovich.

A. NASIBOV: Listen, Georgy Alexandrovich.

G. ALEXANDROVICH: So, I am a disabled person of the third group, injured at work. I had it back in '62. Since 1962, I have been ordering something similar to a prosthesis from the Leningrad prosthetic enterprise. In general, in short, the function of the leg is completely impaired. I have been ordering this device since 1962. It was always without any problems, I came to the plant... Yes, I have permanent disability group 3.

A. NASIBOV: Georgy Alexandrovich, what is the question?

G. ALEXANDROVICH: I recently went to a rehabilitation program, it only consisted of me going through all the rooms. Four times I went from my village to the regional center to see all the doctors. I have to go through all the doctors so that they can write me a certificate stating that I benefit from the rehabilitation program, so that I can harden this prosthesis. Do you understand what's going on?

A. NASIBOV: Do we understand?

G. ALEXANDROVICH: I asked the doctor: “What, we’ll meet in two years?” - By the way, it lasts me two years, I can still fix it myself, and so on. In two years, do I have to go through the same system again?

A. NASIBOV: Thank you, Georgy Alexandrovich. Now let's try to find out the answer. Thank you! This is where we started our conversation.

S. KOZLOV: Yes. Problems exist. And, say, with government decree 240, from April 7, 2008, it is stipulated that an individual rehabilitation program for a disabled person, a disabled child, can be developed for a year, for two, or for an indefinite period, or for children until they turn 18 years old. The rehabilitation program for the victim is currently being developed for the recovery period.

A. NASIBOV: For a period?...

S. KOZLOV: For the recovery period, the degree of loss of professional ability to work as a percentage. So, in in this case either a year or two is set for a person. We are now preparing documents stating that the PRP (Victim Rehabilitation Program) can and should be issued indefinitely in such cases. And upon contacting the same prosthetic company, we should simply change this tuter purely automatically, and eliminate this “hellish” circle of going to medical institutions to fill out Form 88, then visiting a medical and social examination institution. A PRP will be issued, say, for an indefinite period. If, in the event of a deterioration of the condition, there is a need for some additional measures, he can contact the institutions himself.

A. NASIBOV: It is you who put into this the very concept that begins to operate from the 10th year.

S. KOZLOV: Well, as the government decides.

A. NASIBOV: How the government will accept it. Thank you! 363-36-59 – live telephone number. We are listening to you. Hello.

LISTENER-3: Hello!

A. NASIBOV: Hello!

LISTENER-3: My name is Natalya.

A. NASIBOV: Where are you calling from, Natalya?

NATALIA: From Moscow.

A. NASIBOV: Let's listen.

NATALIA: So I have the following problem: three years ago I completely lost my sight. Since I was 16 years old, I have been disabled in the first group of the second degree in vision. Sorry, I'm worried.

A. NASIBOV: Don’t worry, Natalya. Don't worry. We are here to answer your questions.

NATALIA: On this moment I have a second degree disability. The fact is that one eye I have is a prosthesis, the other completely does not even see light. The group is given a second degree rating. Naturally, I can’t work, I can’t get to work. I can hardly walk with a stick either.

A. NASIBOV: What kind of work did you have?

NATALIA: I am an opera singer, soloist and vocalist, I worked in the theater.

A. NASIBOV: I see.

S. KOZLOV: At the moment I am trying to find opportunities to do my professional activity, but it’s impossible to get a job in the Philharmonic Society now. These can only be private concerts. Unfortunately, this is very bad now.

A. NASIBOV: I understand correctly, your question still concerns work for those who have disabilities?

NATALIA: Yes. This concerns not only work: I am now receiving a pension under the second group - that is, I have completely lost my vision, but nothing has changed for me. I receive the same pension as I received when I saw and when I had the opportunity to work. At the moment I am at home, I receive the same pension, I am dependent on my mother, a pensioner, who receives a minimum pension, she has a 2700 pension in Moscow. And, unfortunately, I have another question: I was given the opportunity for rehabilitation, in everyday conditions I sort of rehabilitated myself, I believe that I can adapt myself at home. Walking with a cane is very difficult, I can’t get a guide dog either, because I live in a hostel, the conditions don’t help. They give me the opportunity to travel on a voucher, but, again, the first group of the second degree does not have the right to get the opportunity to have an accompanying person. That is, I can go by myself, but I cannot have an accompanying person.

A. NASIBOV: I see. A whole range of questions.

NATALIA: The complex is very large. Unfortunately, I am now in such conditions that I cannot help but go anywhere, turn anywhere.

A. NASIBOV: Natalya, let's try to hear at least the answers to some of the questions you asked.

NATALIA: Thank you!

A. NASIBOV: First, regarding employment.

S. KOZLOV: The question here is about non-employment, here we are talking about what we talked about. That being a visually disabled person of the first group, Natalia has a second degree limitation in her ability to work, which means she receives a pension, as in the second group before. That is, there is no difference here. – This is the most vulnerable contingent, which, due to the limited ability to work, turns out that even if a person is employed and works, it turns out that we are punishing him. He can work with the first group of disability. But the rest, even if there is a second group, if they have the ability to limit labor degree third degree - they receive a pension as disabled people of the first group.

A. NASIBOV: Do I understand correctly? For me, as a person a little from the outside, I still want to understand for myself. Do I understand correctly that if a disabled person with a second disability group gets a job, or tries to get a job, he loses part of his income?

S. KOZLOV: No.

A. NASIBOV: Incorrect?

S. KOZLOV: Wrong. According to restrictions on the ability to work, Natalya is in the first group.

A. NASIBOV: Yes.

S. KOZLOV: But our pension is now paid according to the limitation of the ability to work; it can work in specially created conditions.

A. NASIBOV: Oh, that’s it.

S. KOZLOV: Yes. And she receives a pension, as disabled people of the second group previously received. And in accordance with the current legislation... Yes, she clearly said that these people, they are well socialized at home, in their region, but when they go for treatment to another region, they are completely independent. They can't navigate. But, according to current legislation, an accompanying person is provided not to disabled people of the first group, but to persons with restrictions on work activity of the third degree, and she has a second degree. That is, she is deprived of this right. This is what I said at the beginning: if everything works out and the draft law passes, then from the new year the disability pension will be paid not depending on the degree of restriction on work activity, but as before, according to the disability group. That is, whether she works or not, she will receive disability depending on those functional impairments in the first disability group. That is, her pension will increase and she will receive the right to have an accompanying person to go to the same health center for treatment, with the same mother, or with another person who will accompany her. – This is what we talked about.

A. NASIBOV: Sergey Ivanovich, quickly prepare your concept! Prepare a draft on new laws quickly! Judging by the number of calls and SMS messages we have received, people really need what you are doing now.

S. KOZLOV: These are very painful questions, always when it comes to health. And we are now inspecting our institutions a lot and meeting with representatives of the disabled community, meeting with citizens, and how we discuss and verify these concepts. Therefore, we will try, well, as quickly as possible, taking into account all the comments and proposals that exist, to implement them. And the point is that for people who are in trouble, in this misfortune, it would still be at least a little easier to live.

A. NASIBOV: Sergei Kozlov, head of the department of medical and social examination and social support of the Federal Medical and Biological Agency, is a guest of the “Back to the Future” program on the waves of “Echo of Moscow”. Leave your comments and suggestions on the Ekho Moskvy radio website and on Tatyana Fengelgauer’s blog. The “Back to the Future” program is aired thanks to cooperation with the public council of the state corporation Rosatom. I say goodbye to Ashot Nasibov! See you in a week! Thank you, Sergey Ivanovich, for your participation!

S. KOZLOV: Thank you! Goodbye!

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 examination: 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", By Decree of the Government of the Russian Federation of June 2, 2008 N 423 "On some issues of the activities of the Ministry of Health and Social Development of the Russian Federation and the Federal Medical and Biological Agency" the powers to organize the activities of federal state institutions of medical and social examination are assigned to the Federal Medical and 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 carrying out rehabilitation measures for disabled people in order to restore their social status. However, at present, the creation of only social institutions“medical and social examination services”, which 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 disabled people in the labor market, acquiring relative independence, and restoring 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 others current issues will be touched upon 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 can be corrected. 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 form individual program rehabilitation of disabled people 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 figure was 306 thousand people (subject to a 10-day holiday decade), 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.

Host: Last September, Russia joined international convention on the rights of people with disabilities, providing 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 requires 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 of a number of definitions, including the definition 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 people with disabilities 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 implementing 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. It follows from the Decree of the Government of the Russian Federation that people with incurable diseases and injuries are not required to undergo examinations annually. Please tell me, has the life of a person with disabilities become better due to his acceptance?

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. For the main forms of diseases, this period is necessary to carry out the complex therapeutic measures influences aimed at restoring impaired or lost health functions of sick and disabled people, or mitigating the consequences of illness, injury or injury until full or partial restoration or compensation of disorders in the patient’s condition.
This legal norm addressed primarily to federal government agencies medical and social examination, and establishes for them deadlines for monitoring disabled people when making a decision to establish disability indefinitely and prevents unreasonable, untimely decision-making on establishing disability without specifying the period for re-examination, which will ensure that citizens realize the rights associated with recognizing them as disabled. In the Russian Federation in 2007 (May-December), the total number of all people 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 certain categories of citizens from number of veterans with prostheses (except dentures), prosthetic and orthopedic products" public organizations of disabled people took an active part. It is also expected that public organizations of disabled people will actively participate in the preparation of the Concept for reforming the state system of medical and social examination and rehabilitation of disabled people, and discuss it widely 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, issuing prescriptions for medicines is often unsystematic, financing from federal budget not enough. 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 of work activity is now being determined. 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

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, 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 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 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 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.

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 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.

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.

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 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 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.

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 to a person in difficult situations. 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 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 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 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 the age group over 14 years old, the influence of puberty with features of hormonal regulation of 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.

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 the health and life of a large number 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 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 of 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.

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 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 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.

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 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.

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 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.

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.

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.

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 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 a 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 develop common approaches when conducting medical and social examinations 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.

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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