A sober look: in Russia, it was proposed to refuse routine care to drunk patients

Russian doctors were asked to refuse routine care to patients in a state of intoxication. This initiative was initiated by the National Association of Healthcare Managers (NAUZ), contacting the Ministry of Health. According to the association, the new measure will protect doctors from aggressive patients and help them "focus on those who really need help." Izvestia reviewed the document and found out how the proposal could be implemented in practice.

What is known about the new NAUZ initiative

Doctors were offered permission to refuse routine care to patients in a state of intoxication. This initiative was initiated by the National Association of Healthcare Managers (NAUZ), having sent a letter to the Ministry of Health.

As stated in the NAUZ letter (available to Izvestia), cases of aggressive behavior, insults and attacks on medical workers by patients in a state of obvious alcohol or drug intoxication, as well as their aggressive relatives, have become noticeably more frequent in Russia.

—Working with such patients is not only ineffective, but also associated with increased risks due to their unpredictable behavior <...> and disrupts the normal operation of the institution," the document says.

Photo: RIA Novosti/Taisiya Vorontsova

The way out of the situation, according to the authors, could be the introduction of amendments to the regulatory framework regarding the regulation of the procedure for providing care, which would give the doctor the right to refuse outpatient admission to such patients. Exceptions may include accidents, injuries of any severity, acute life-threatening conditions, exacerbations of chronic diseases, assistance to minors, and the provision of emergency and emergency medical care.

"The introduction of the measure will improve the safety of staff and other patients, optimize the use of the doctor's working time by directing it to other patients, reduce the psycho—emotional burden on medical workers and will contribute to a more rational allocation of resources in conditions of acute shortage," the NAUZ concluded.

Izvestia sent a request to the Ministry of Health, but no response had been received at the time of publication.

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How the new measure will protect doctors

As Muslim Muslimov, the author of the initiative, chairman of the National Association of Healthcare Managers, member of the Civic Chamber of the Russian Federation, explained to Izvestia, the proposal is primarily aimed at protecting medical workers who often face "aggression and inappropriate behavior" and other patients suffering from such situations.

— The consolidation of this right in legislation will allow doctors to legally refuse scheduled appointments without fear of disciplinary consequences, and focus on those who really need help. Because of the inappropriate behavior of some patients, others who really need treatment should not suffer," Muslimov believes.

Photo: IZVESTIA/Dmitry Korotaev

According to the expert, today many medical clinics are trying to combat this phenomenon on their own: they indicate in their internal rules for the provision of paid medical services that services are not provided to patients in a state of intoxication. But this is regulated by internal documents, not legislation.

According to the current law "On the protection of Citizens' Health," explains lawyer Sean Betrozov, a doctor has no right to refuse medical care to any patient, even if he came drunk or under the influence of drugs.

— An exception is if a person behaves aggressively, threatens doctors or other patients, or violates the order in the clinic. In such situations, the staff can call security or the police," the source told Izvestia. — If the patient behaved calmly, the doctor is obliged to accept him — the decision to refuse admission is possible only in exceptional cases and with the completion of all documents.

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Is it legal to refuse admission to patients now

According to lawyer Sean Betrozov, today at the federal level there are no clear rules on what a doctor should do if a patient comes in a state of intoxication. The procedure for providing medical care is described in various documents, for example, in the order of the Ministry of Health No. 804n. It states that appointments are made by appointment or on a first-come, first-served basis, and emergencies are handled first.

— Therefore, every controversial situation (for example, with drunk patients) is resolved by the doctor and the administration according to the situation, and this creates legal uncertainty. Refusal of admission may be considered illegal if it is not proven that the patient threatened someone or posed a danger. This puts doctors in a vulnerable position," says Sean Betrozov.

Photo: IZVESTIA/Anna Selina

According to the lawyer, in general, various measures have been taken in Russia in recent years to protect doctors. For example, now, if a patient attacks a doctor while performing his official duties, this is considered a criminal offense. Alarm buttons, surveillance cameras, and security guards have been installed in some clinics.

— The Ministry of Health has issued recommendations on how to act if a patient behaves aggressively. But all these are rather temporary solutions," the lawyer believes. — In fact, today the doctor decides for himself what to do in a conflict situation, and acts at his own risk. If he refuses admission, there may be complaints and proceedings. If he accepts a drunk patient, and he, in turn, shows aggression, then the doctor risks his health.

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Can the measure be extended to emergency care?

Andrey Konoval, co-chairman of the Action Healthcare workers' union, calls the initiative relevant, but at the same time "quite moderate." In his opinion, it will not reverse the situation with attacks on medical workers, but it may improve it somewhat.

— According to official statistics from the Ministry of Health, in 2023, in just six months, health workers were attacked 820 times (over 1,700 times in a year. — Izvestia). But most often it concerned an ambulance, which is not mentioned in the document. However, there are situations when a person will come to the doctor himself, in the company of drunk relatives and friends, and this may already fall under this initiative," says Konoval.

If the amendments are adopted, he believes, over time, it would be possible to carefully extend the practice to some cases related to emergency care. But in this case, it is important to clearly define specific situations and preserve the right of patients to receive care when it is really necessary.

Photo: RIA Novosti/Alexey Sukhorukov

Lawyer Sean Betrozov shares the same opinion: the law should specify in which cases a doctor can make a decision. When it comes to routine care, these may be situations where the patient is inadequate, aggressive, or simply unable to have a conversation.

— A doctor should not make a decision alone. It is better if this is recorded in the presence of an administrator or other employee. The patient's condition can be described in a special report to avoid disputes. At the same time, the person himself must understand that he was not rejected, but simply offered to come another day when he could fully undergo an examination. He should have the right to file a complaint if he believes that the refusal was unfair," the lawyer concludes.