If you are refused hospitalization, where to complain?

Author of the article:

Muzyko Tatyana Andreevna - lawyer.

People in need of medical care can count on this.
There are various institutions in the country that can provide it quickly and efficiently. If the patient's rights are violated, inevitable punishment will follow from the authorities. Medical workers and entire institutions will bear responsibility.

Legislation

There are a number of legal acts that regulate the rights of citizens to receive medical care and protect them from unlawful refusals by medical workers. These acts include:

• “Law on the Protection of Citizens’ Health” No. 323 of 2011. This law lists all the responsibilities of paramedics and doctors when patients contact them.
• “Law on Compulsory Insurance” No. 326 of 2010. According to insurance legislation, all insurance holders must receive the medical care they need on the territory of the Russian Federation.
• The Criminal Code of the Russian Federation defines punishment for refusal to provide assistance or negligent attitude towards a patient.
• Government Decree No. 1492 of 2021, which guarantees the provision of medical care free of charge.
• Orders of the Ministry of Health No. 445/77 and No. 388n determine the operating procedures of medical institutions.

All emergency services, including ambulance, can now be called via a single number, 112.

In what cases is involuntary hospitalization possible?

There are exceptions to every rule; such prospects also include refusal of hospitalization.

The legislator provides for a number of cases when a person, without expressing his own will, can be placed in a hospital setting to receive the necessary treatment.

Such cases include:

1. If the patient is a carrier of the infection and there is a high probability of infecting the people around him.
2. If urgent surgical intervention is necessary, the absence of which can lead to death (for example, extensive pneumonia or peritonitis).
3. If the person in need of medical attention is unconscious (for example, after an accident or with a severe concussion).
4. If the person requiring medical assistance is incapacitated (immediate psychiatric treatment).
5. A woman in labor cannot refuse to go to the maternity hospital or leave the prenatal department if she is in a state of labor, since the domestic legislator prohibits childbirth (even with the voluntary consent of the pregnant woman) outside the conditions of specialized hospitals.

Pregnant women have the right to refuse treatment in a hospital if they disagree with the diagnosis or do not want to undergo treatment (maintain pregnancy) in a specific medical institution.
Thus, the expectant mother is responsible not only for her life, but also for the life and health of her baby.

Can they refuse hospitalization?

There are no absolute reasons for refusing hospitalization. But if the emergency doctor determines that there is no threat to life, then he has the right not to take the patient to hospital and not to give the appropriate direction. However, this does not mean that he cannot be hospitalized as planned.

Also, the patient himself decides, based on how he feels, to call an ambulance or go to a medical facility (clinic or hospital) on his own. At the appointment, the doctor prescribes the necessary treatment. If necessary, he will place the patient in a hospital. If this is not necessary and the patient can be treated at home, he will prescribe the necessary medications.

It is illegal to refuse assistance due to the lack of coupons or doctors of the appropriate profile. The clinic is required to assess the patient’s condition. If there is a threat to the patient's life, assistance must be provided within 2 hours. Otherwise - within ten days. Even if there is no doctor, the appointment must be conducted by the manager or another specialist

Contraindications for hospitalization

!!! If contraindications for planned surgical intervention are identified based on preoperative examination data, the patient will be denied hospitalization. If contraindications are identified during the preoperative examination, it is necessary to reschedule the date of hospitalization in advance (with a doctor’s certificate attached to the email of the hospitalization department) and prepare for surgical treatment: conduct additional examinations in order to clarify the diagnosis associated with deviations in examination data, if necessary, carry out treatment with in order to compensate for the somatic status.

• Deviations from the norm in laboratory test data (leukocytosis, leukocyturia, ESR more than 25 mm/h, increased levels of ALT, AST, bilirubin, urea, etc.).
• Recently suffered (1-2 weeks) acute respiratory infections, acute respiratory viral infections.
• Previous history of pneumonia less than 3 months before hospitalization.
• Hyperthermia at the time of hospitalization (more than 37.0C).
• Decompensated course of hypertension, the presence of life-threatening cardiac arrhythmias (polytopic ventricular extrasystole, complete blockade of the left branch of the His bundle, tachyform atrial fibrillation, etc.).
• CHF (reduced ejection fraction less than 50%), DN II (vital capacity less than 50%), CKD s3B.
• Acute myocardial infarction and stroke less than 6 months old.
• Lack of a positive opinion from a cardiologist on the possibility of elective surgery in patients with heart disease. When taking double disaggregation therapy, discontinuation or correction of therapy and recommendations for patient management in the pre- and postoperative periods are required. Surgical treatment while taking double disaggregation therapy is contraindicated due to the EXTREMELY high risk of bleeding during surgery and in the early postoperative period.
• Lack of authorization from a vascular surgeon in the presence of thrombosis according to ultrasound data of the veins of the lower extremities. In case of long-term use of vitamin K antagonists (VKA) (warfarin), warfarin should be discontinued at least 5 days before surgery. It is safe to perform surgery with INR values ​​<1.5. In patients with atrial fibrillation-flutter, artificial heart valves, or a history of pulmonary embolism, who have a high risk of thromboembolic complications, transitional therapy prescribed by a cardiologist before hospitalization is necessary.
• Moderate and severe anemia (Hb- less than 100 g/l).
• Obesity 4 degrees.
• Cirrhosis of the liver.
• The presence of ulcerative, erosive lesions of the gastrointestinal tract according to FGDS.
• Unspecified disorder of carbohydrate metabolism (increased blood sugar).
• Uncompensated diabetes mellitus (increased fasting blood sugar and glycated Hb level more than 8.0%), uncompensated thyroid function.
• Lack of adjusted basic therapy for systemic autoimmune connective tissue diseases (RA, ankylosing spondylitis, gouty arthritis, SLE, scleroderma, etc.; process activity on the “DAS – 28” scale – 5 or more).
• Exacerbations of chronic inflammatory processes (ENT organs, urogenital area, respiratory system, gastrointestinal tract, untreated caries, oral diseases, tooth extraction (removal) less than 4 weeks before hospitalization)
• The presence of purulent, fungal, viral (herpes), inflammatory diseases of the skin and mucous membranes, bedsores.
• Presence of unspecified neoplasms (as a concomitant pathology).
• Lack of conclusion from a dermatovenerologist with a positive Wasserman reaction.
• Absence of an infectious disease specialist's report if the test result is positive for hepatitis and HIV infection.
• Severe acute and chronic psychoneurological disorders, dementia.
• A contraindication for endoprosthesis replacement of the joints of the lower extremities is the presence of paresis, paralysis of the lower extremities, as well as the inability to stand and walk with supporting devices (crutches, walkers).
• Absence of an epileptologist's report no more than 1 month old in case of epilepsy.
• Taking oral contraceptives (must be stopped 1 month before the planned surgery.)
• Planned menstrual bleeding during the period of planned surgical treatment.
• Absence of a specialist’s opinion on tolerance to surgical treatment, if the patient has a concomitant chronic disease or newly identified pathological conditions listed above.

Is it legal for a doctor to refuse treatment in a hospital?

A person can be taken to the hospital by ambulance or he can go on his own with a referral from a doctor from the clinic. In the first case, there is a threat to a person’s life and urgent treatment is necessary. In this case, the patient must be hospitalized. Even if there are no places in the wards, they must mark him out in the corridor, but for no more than 24 hours. After this, the patient must be placed in the ward on an additional bed.

In case of emergency hospitalization, the patient does not have the right to demand an insurance policy and other documents. His relatives can bring all this later. Such rules are due to the fact that an emergency patient needs to be provided with medical assistance as quickly as possible.

In case of planned hospitalization on the direction of a doctor, the patient must come with all documents. He will be given an admission date according to the hospital schedule. But they have no right to refuse hospitalization on referral if the patient really needs treatment.

Consent or refusal to provide medical care

As a general rule, immediately before a medical intervention (for example, before an operation), it is necessary to obtain the informed voluntary consent of a citizen or his legal representative.
Before such consent is given, doctors are obliged to provide the patient with complete information about his state of health, methods of diagnosis and treatment, the procedure to be performed, as well as its possible consequences and risks. This information must be communicated to the person in an accessible and understandable form. Consent is given by the patient himself personally.

If we are talking about medical intervention in relation to a minor or incapacitated person, consent from one of the legal representatives (parents and guardians) will be required in the following cases:

• the patient is a person under 15 years of age;
• drug addicted patient under 16 years of age;
• patients under the age of majority who are indicated for organ and tissue transplantation;
• incompetent persons in respect of whom there is a court decision that has entered into legal force;
• minors suffering from drug addiction directly at the time of providing drug treatment medical care or conducting an examination (consent from a legal representative is not required if, in accordance with the procedure established by law, the minor acquired full legal capacity before reaching 18 years of age - for example, got married).

If the patient or the child’s legal representatives do not agree to the medical service, a refusal is issued. In this case, those who refuse medical care should be explained the consequences that are most likely to occur.

It is also possible to declare the termination of certain medical procedures : for example, if consent was initially obtained, but for some reason the patient decided to stop the procedure.

If the refusal is issued by the legal representative of an incompetent person whose life is in danger, then the guardian is obliged to inform the guardianship and trusteeship authority about this within 24 hours.

It must be taken into account that if the patient’s parent or guardian refuses treatment in the event of a direct threat to the patient’s life, the medical organization in accordance with Part 5 of Art. 20 of the Law has the right to go to court to protect the interests of the patient. If a refusal in conditions of danger to life is accepted from the patient himself, the law does not provide for the possibility of doctors going to court.

Is it legal to require the refusal to be in writing?

Based on the above, it follows that hospitalization can be refused only if the patient’s life is not in danger and he does not need treatment in a hospital. But such a decision must be based on diagnostic results, including tests and the use of special medical equipment. The diagnostic results are described in the conclusion of the doctor who examined the patient. A copy of the report must be given to the patient.

Accordingly, if hospitalization was refused based on referral, then the reasons for the refusal should also be indicated in the conclusion and supported by research data.

If the hospital simply refuses to work with the patient, you need to demand from them a written explanation of the reasons.

Refusal of a tuberculosis patient

We do not have a law in the country that could force patients who could pose a threat of infection to other civilians to undergo treatment in closed hospitals.

This includes HIV carriers, AIDS patients and tuberculosis patients.

Doctors have only one way out of a difficult situation - to convince the patient himself that he needs to regularly carry out preventive medical procedures in the hospital.

Tell him about possible risks and consequences for other members of society. In other words, focus on his morality.

Important! By signing a document refusing hospitalization, a tuberculosis patient transfers all responsibility for the occurrence of serious consequences and the formation of possible dangerous situations to himself.

Consequences for the doctor and the hospital

An assessment of the actions of medical personnel who refused to help a patient will be given taking into account the consequences of their refusal and the positions held by these employees:

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• If a doctor refuses to see you, a disciplinary sanction will be imposed on him. But if his refusal resulted in the death of the patient, then the prosecutor’s office will open a criminal case for negligence leading to the death of a person. The punishment may be imprisonment.
• Receptionists who refuse to admit a patient will incur penalties on the hospital.

As for the ambulance dispatcher, they cannot refuse to call a brigade. There are criminal penalties for this.

Where to contact if rights are violated

In an effort to defend their rights, patients often write angry reviews or go to see deputies, but do not contact the competent authorities directly. The first authority that should resolve a controversial issue is the administration of the medical institution. The manager is obliged to accept the complaint and provide the patient with a written response about the measures taken. In practice, this happens quite rarely, so citizens have to contact other authorities:

• insurance companies and territorial insurance funds;
• Rospotrebnadzor department;
• official societies for the protection of patients' rights;
• Prosecutor's Office of St. Petersburg;
• district or city court.

The patient’s demands may relate to both the suppression of unlawful actions and the payment of material compensation or penalties, or compensation for losses. In addition to administrative and judicial, there is a third form of protecting the rights of patients - self-defense (Article 14 of the Civil Code of the Russian Federation). It refers to the physical actions of a citizen aimed at eliminating the violation. For example, a patient can take down a list of patients posted in the corridor of an inpatient department. This action will restore the violated right to medical confidentiality.

Where to go if a patient is denied admission to a hospital?

In a situation of refusal of hospitalization, it is necessary to refute the arguments of doctors, and also point out to them the responsibility for such a refusal, including criminal liability, if the patient’s condition worsens.

It is worth contacting the chief doctor or the duty officer if the hospital visit occurs at night. You can also call the ambulance service (by phone 03 and 112) and tell about the refusal to hospitalize. The dispatcher needs to call:

• Your data.
• Describe the symptoms of illness.
• Tell us in detail about all the nuances of refusal.
• Name the health care institution that refused hospitalization.

An ambulance can transport the patient to another hospital where he will be admitted.

You can also contact the insurance company based on the policy.

Another option to influence the situation is to call the 24-hour Roszdravnadzor number - 88005001835.

General concepts of refusal of hospitalization

Citizens of the Russian Federation who have a compulsory health insurance policy are guaranteed to receive the necessary qualified assistance from medical staff if the need arises:

The right to adequate medical care is realized in two ways:

• the person personally goes to the hospital (at his place of residence or to a clinic of a certain profile of his choice);
• a person calls an ambulance, whose crew provides assistance at home (at the place of call) and/or offers hospitalization.

So, is it possible to write a refusal to be hospitalized in a hospital?

The mentality of the “Russian person”, as a rule, does not allow one to go to the hospital unless there is an extreme need, which leads to numerous refusals of hospitalization.

As stated above, doctors do not have the right to force a patient to begin treatment, much less force him into a hospital bed.

Refusal of hospitalization by the Law “On the Rights of Patients”, each citizen is given the right to choose the method of treatment:

• in a hospital setting;
• Outpatient (with an in-person or in-person physician visit).

The legislator provides for the possibility of outpatient treatment (without medical examination), even for tuberculosis and cancer patients.
However, treating tuberculosis at home does not exempt you from registering with a tuberculosis dispensary. If doctors prefer treatment of a certain disease within the walls of a hospital, they can only offer, but not insist on hospitalization, and the patient can agree or write a written refusal, which is written to the head physician and registered in a special journal in which the citizen who made the application about refusal to undergo inpatient treatment, puts a personal signature.

Patient's actions in case of refusal

In case of any refusal of doctors to fulfill their direct duties, a complaint must be filed.

For a doctor

If a doctor refuses examination, hospitalization or other medical care, you need to make a written complaint addressed to his boss (the head physician of the medical institution). The complaint is written in two copies. In addition to the information of the recipient and the applicant, the text describes in detail and as correctly as possible the essence of what happened, what rights of the patient were violated and the requirements for punishing the doctor, as well as for providing medical care to the patient.

The applicant signs the complaint and submits it to the secretary of the chief physician. The secretary must make a note of receipt on the copy, which remains with the applicant.

To the hospital

Such a complaint is drawn up according to the same rules as a complaint against a doctor. But it is submitted to the supervisory authorities - Roszdravnadzor, the Ministry of Health, health insurance funds, the police and the prosecutor's office.

Complaint to the Ministry of Health

This department is usually contacted when the refusal to provide it has led to subsequent treatment or rehabilitation and costs for them. When drawing up an appeal following the example of any other complaint, it must indicate the demands for compensation from the perpetrators, their punishment, or an explanation of the reasons for the violation of the patient’s rights.

To the prosecutor's office

A complaint must be filed with the prosecutor's office in three cases:

• The patient's health condition worsened.
• He needed emergency surgery.
• Due to the refusal to provide assistance, he subsequently had to have his limbs amputated.

You need to file a complaint with the prosecutor at the location of the hospital. He initiates an investigation and if the violations described in the complaint are confirmed, he will contact the police to initiate a criminal case.

The prosecutor's office is also considering allegations of extortion of bribes by medical workers.

Lawsuit

When asking the question: where to complain if hospitalization is denied, people also want to take into account their material interests. If the actions (or rather, inaction) of doctors led to material costs, then you need to file a claim in court.

The statement of claim must indicate the details of the court and the applicant, as well as describe in detail all the facts of violations of the law by doctors, as well as how their actions led to additional expenses.

All medical certificates confirming the doctors’ violations must be attached to the statement of claim. Also, the application itself must be drawn up in several copies. Often the hospital administration takes the side of their doctor. In this case, both the doctor and the administration will be defendants in court, and each of them must receive a copy of the claim.

Complaints can be submitted to several authorities at once; the law does not require you to choose only one of them.

COVID is no offense: how to defend your right to medical care

As early as next week, Russia may reach a plateau in terms of daily incidence, says professor at the Research Center for Epidemiology and Microbiology named after N.F. Gamaleya Anatoly Alshtein. But in the near future, he clarified, the growth in indicators will continue. On Monday, October 19, the operational headquarters for the prevention and control of the spread of coronavirus in the Russian Federation reported 15,982 new cases of COVID-19 infection - and this is another anti-record. The capital still ranks first in terms of daily incidence (+5376), followed by St. Petersburg (+686) and the Moscow region (+466). In anticipation of stabilization of the epidemiological situation, Izvestia answers important questions related to coronavirus. Today we are talking about how to defend your rights during a pandemic.

I called an ambulance. How long should she arrive?

According to current regulations, to provide emergency assistance (if there is a threat to the patient’s life), the team must arrive within 20 minutes; in case of emergency assistance (when there is no threat to the patient’s life), the waiting time increases to two hours.

“It should be especially noted that in some cases the ambulance has the right not to arrive,” said Maria Spiridonova, a member of the Russian Lawyers Association (RLA). — For example, if a call is used to subsequently obtain a forensic or expert opinion, establish alcohol or drug intoxication, issue a sick leave certificate and other medical certificates.

The team is not obliged to service non-core calls related to acute toothache, bandaging or injections, the lawyer added.

What to do if the ambulance is not coming?

If the wait exceeds the standards, first of all, you should contact the dispatcher again and report what is happening. Perhaps he can quickly resolve the issue.

— The right of citizens to receive free medical care in state and municipal institutions is directly enshrined in paragraph 1 of Art. 41 of the Constitution of the Russian Federation,” emphasized Maria Spiridonova.

The work of the ambulance, the lawyer added, is regulated by a whole list of regulatory documents, which includes the law “On the fundamentals of protecting the health of citizens in the Russian Federation” (Article 35), Russian Government Decree No. 1492 dated December 8, 2017, and orders of the Russian Ministry of Health dated March 26, 1999 No. 100 and dated June 20, 2013 No. 388n.

“If an ambulance refuses to arrive when called, or if the call was accepted, but the ambulance never arrived, there are several authorities to which a complaint can be sent: the management of the ambulance station, the Ministry of Health, the police and the prosecutor’s office,” the lawyer clarified. — Criminal legal consequences are also possible. Unlawful refusal to provide medical care is a criminal offense.

In particular, she explained, violators can be prosecuted under Art. 124 of the Criminal Code of the Russian Federation “Failure to provide assistance to a patient. If the unlawful actions (inaction) of ambulance workers cause moderate harm to the patient’s health, or it worsens significantly, then a complaint should be filed with the police.

— The general recommendation is to contact all authorities in writing in the form of a pre-prepared application in two copies, one of which is handed over at the destination, and the second is marked with acceptance. It will then be proof that the official appeal was accepted,” Maria Spiridonova emphasized.

The doctor did not take a coronavirus test, although I have signs of acute respiratory viral infection. Where to contact?

On the hotline for questions related to coronavirus (8-800-200-01-12), the Izvestia correspondent was asked to contact the local ministry or health department, and also report the violation to Rospotrebnadzor.

“If there are appropriate symptoms, a doctor should in any case take samples to test for coronavirus,” the hotline emphasized.

Lawyer Maria Spiridonova explained that, according to the explanations of the territorial divisions of the Ministry of Health, the test is not a prerequisite for ARVI. It is prescribed in case of arrival from other countries, contact with patients with COVID-19 or potentially infected within the last two weeks. In addition, tests will be taken for moderate or severe forms of ARVI and community-acquired pneumonia. People over 65 years old will be tested for coronavirus if they have symptoms of a respiratory infection.

— Separately, the Ministry of Health notes that the indications for taking samples for analysis are determined primarily by the attending physician. Such recommendations are already practically a standard,” the lawyer emphasized.

I have coronavirus, but I feel fine and don’t want to isolate. Will I be punished for violating it?

Yes. For violation of sanitary and epidemiological rules under Art. 236 of the Criminal Code of the Russian Federation, punishment can be a fine of up to 700 thousand rubles, restriction or imprisonment for up to two years, as well as forced labor for the same period.

“All patients with confirmed COVID-19 undergoing treatment at home personally sign Rospotrebnadzor’s orders to comply with the isolation regime and connect the monitoring system for patients with COVID-19,” the Moscow Department of Health told Izvestia.

Even if there were indications, I was not sent for a CT scan and was not connected to a ventilator. How to deal with medical negligence?

A patient who believes that his rights are being violated has the right to write appropriate complaints and statements addressed to the head of the medical institution where the doctor works. It may also be advisable to contact the Ministry of Health.

“But it is worth understanding that it is the attending physician who, taking into account the results of studies, tests, and the dynamics of the disease, must decide whether to refer the patient to a particular procedure,” noted lawyer Maria Spiridonova.

The capital’s Department of Health added that when visiting a patient with a confirmed diagnosis of COVID-19, a doctor examines him. He decides on the need for hospitalization, referral for a CT scan, or the possibility of treatment at home.

“Patients undergoing treatment at home are sent for a CT scan as prescribed by a doctor if they have symptoms of deterioration,” the department clarified. — Artificial ventilation is not a means of treating or restoring damaged lungs. The decision to connect to a ventilator can only be made by a doctor. Typically, this measure is used only for the most critically ill patients in the intensive care unit.

For patients with difficulty breathing or shortness of breath, if necessary, the doctor can prescribe oxygen support - it comes in different types and depends on the degree of respiratory failure and lung damage, the department noted.

Medicines for coronavirus are very expensive. I'm afraid that I won't be able to pay for treatment if I get sick.

According to the website stopcoronavirus.rf, if you are sick with coronavirus, all necessary medications are provided free of charge under compulsory medical insurance.

“Patients diagnosed with COVID-19 who are being treated at home receive antiviral drugs as prescribed by doctors,” the Moscow Department of Health reported. — Medicines are given to patients with coronavirus infection free of charge when a doctor visits them at home or when the patient visits an outpatient CT Center.

The decision to prescribe certain drugs can only be made by a doctor and only after examining the patient, the department emphasized. The course of treatment and dosage depend on the severity and course of the disease.

They refused to serve me at the checkout without a mask and forced me to buy one on the spot. Is this legal?

Yes, but you are not required to purchase the mask from this store.

— The store may require you to wear a mask or offer to purchase one. Store sellers can legally refuse to serve a customer without a mask, explained Maria Spiridonova.

The seller who served me did not have a mask covering his nose. So it is possible?

No. According to the virologist, professor at the National Research Center for Epidemiology and Microbiology named after N.F. Gamaleya by Anatoly Alshtein, a mask that does not cover the nose is useless and does not prevent the spread of the virus.

“They don’t wear a mask like that, you might as well wear it around your neck,” he said.

What is more effective - a mask or a respirator?

A respirator is more effective, says virologist Anatoly Alshtein. But “it’s actually harder to breathe in it,” he added.

“A medical mask needs to be changed every three to four hours, a fabric mask at least once a day,” the expert added.

When will the epidemic end?

It's difficult to predict. However, according to Professor Anatoly Alshtein, although the indicators are growing and this trend will continue for now, we may reach a plateau as early as next week.

“It is impossible to guess how long we will stay on it and whether there will be a decline after it,” he added.

Arbitrage practice

The majority of civil cases are claims for compensation for harm to the health or life of patients. In this case, the court takes into account the degree of guilt of the medical institution or a specific doctor, the level of physical and moral suffering of the patient, and the amount of damage caused. In all cases, an independent forensic medical examination is ordered, the results of which seriously influence the court's decision.

Litigation related to the protection of patients' rights is one of the most complex cases of legal practice. This is explained by the abundance of regulatory documents, gaps in legislation, and the subjectivity of the prescribed treatment. Such cases should be handled by a medical lawyer with systemic knowledge and extensive experience in this area of ​​law.

If you are faced with the incompetence or negligence of doctors, suffered from an incorrect diagnosis or disclosure of medical confidentiality, call us! Our experts will represent your interests in pre-trial and judicial proceedings, forward claims to medical institutions and regulatory authorities, and help you obtain financial compensation.