Andrei Yuryevich, five years ago, in 2016, we met personally on this topic — organizing assistance to terminally ill citizens of the Moscow Region. Then the Minister of Health was Nina Vladimirovna Suslonova. She was both the organizer of our meeting and the only person on your team who tried to solve this problem. You promised a lot then. But in fact, only a few machines were bought for the field services, which, however, still do not work.
None of the instructions of the President of Russia, as well as Deputy Prime Minister T.A. Golikova, who repeatedly emphasized the importance of palliative care in the country's health care system, were fulfilled in the Moscow Region.
I am a member The Central Headquarters of the All-Russia People's Front, responsible for the implementation of the president's instructions on monitoring the level of development of palliative care in the regions of the Russian Federation.
I would like you to share this responsibility with me, since my repeated attempts to change or at least somehow influence the situation in the Ministry of Defense have not led to anything.
I was directed now to the regularly changing indifferent ministers — one more indifferent than the other, then to your first deputy Ildar Gabdrakhmanov, who has his own favorite project — the SDG (Regional Management Center). But palliative care, apparently, is not included in the sphere of his interests. Meanwhile, thousands of people in your area continue to be left without help. They are forced to turn to the Palliative Care Center in Moscow, because they do not want to die in suffering in the 21st century, knowing that they have the right to help and pain relief.
And this is where our paths inevitably intersect. The fact is that palliative care is paid not through the compulsory medical insurance, but from the regional budget. And I am the director of that very state budgetary healthcare institution «Center for Palliative Care», subordinate to the Moscow Department of Health. It is to our Center that residents of the Moscow region in need of palliative care apply. In 2021 alone, we spent more than 15 million rubles to provide inpatient care to residents of the Moscow region. About the same for home help. All this money was spent from the Moscow budget. Although, from the point of view of the budget code, the Palliative Care Center had no right to spend them on helping residents of another region. But we did it in violation of the law, under my responsibility, because refusing to help, in my opinion, is an even more serious crime.
I think you understand better than me what the misuse of budget funds can turn out to be. And I do not want to carry the burden of this responsibility alone. I want and have the right to share it with you.
The people we help have permanent registration in the Moscow region. Some of them live in a rented apartment on the territory of Moscow, some have moved to their relatives during the illness, and some still live in the Moscow region, but still do not receive help at their place of residence. If your subordinates tell you that they are not, believe me, they are lying. Lying is very handy when it comes to dying people. The dying will no longer complain, they simply will not have time — they will die. And their relatives will not complain either. After the death of a loved one, they want to quickly forget about what happened, they do not have the strength to relive that humiliating hell to which your colleagues doom them.
I have been working in this area for a long time — more than 25 years — and I know for sure that the quality of organizing assistance to people at the end of their lives (as well as any other assistance) depends on the political will of the head of the region. Ask your fellow governors in Moscow, Tatarstan, Bashkortostan, Yekaterinburg, Samara, Pskov … The Moscow region is not a scarce region, it, like everyone else, receives a federal subsidy for the purchase of painkillers and equipment for providing palliative care and even reports bravely To the Ministry of Health of the Russian Federation on the fulfillment of the state assignment. However, having beds and completing a government assignment are not equal to providing assistance.
Patients of the First Moscow hospital Photo: Yuri Kozyrev/Novaya Gazeta
The palliative beds in the MO do not contain severe dying patients with pain, but grandparents in a stable condition who need many years of long-term care. Within the framework of the ONF project «Region of Care», we visited many regional healthcare and social protection institutions. And we saw grandparents, who “fulfill” the state assignment: the bed is occupied, budget funds have been spent, there are no complaints. Moreover, the chief doctors of the hospitals are satisfied, since they receive albeit small, but stable funding from the budget (and not the compulsory medical insurance funds, which are difficult to account for), and personnel are not particularly needed to care for stable old people. So the presence of such a department of «palliative care» at the hospital allows showing numbers, but there is no real palliative medicine there.
At the same time, the most severe category of patients is left without help. The exception is the only department in the Royal Hospital, which is headed by the wonderful Olga Berezikova. Unfortunately, Olga's attempts to do something in the Moscow Region (which we all very much hoped for) failed. No one needed her proposals or draft orders, which she repeatedly prepared and submitted to the Ministry of Health.
And, believe me, in 2021 things started to get worse than in 2020.
This is easy to prove, for example, using data on the use of potent opioid analgesics in the Moscow region. This figure, according to the Moscow Endocrine Plant, decreased by 45% compared to 2020. The estimated level of pain relief has dropped from 70% to 20% since 2020. There are drugs in warehouses, but they do not reach patients. Doctors do not prescribe them. In addition, despite all the changes in the legislation, in the Ministry of Defense, not a single field service issues prescriptions for drugs at home, at the patient's bedside. That is,
not a single patient received anesthesia as soon as the legislation allows.
In the Moscow region, prescriptions for painkillers can still only be obtained from general practitioners in the polyclinic after the recommendation of oncologists, which are not everywhere! Drugs, in turn, are not in every pharmacy, and relatives are forced to travel 100 or more kilometers for pain relief. (The availability of drugs in pharmacies could well be tracked through the SDGs, right? There would be a desire …)