|
English Language Page Public associations, both professional, and non-professional, have the right to “realize control over the observance of the rights and legal interests of citizens… in providing psychiatric care to them” (Article 46). Yet this right is limited by numerous conditions. Thus, for example, the right of public associations to visit psychiatric and neuro-psychiatric institutions must be not only reflected in their regulations, but also “agreed with the bodies which are responsible for the psychiatric and neuro-psychiatric institutions,” i.e. with the bodies of health care. Besides that, the representatives of public associations must “agree the conditions of the visit with the administration of the psychiatric institution” beforehand and sign a recognizance not to reveal medical secrets. It seems that the last requirement is to protect the interests of the patient, but, in this case, it usually opposes the very aim of the intervention on the part of public associations which try to check the information they received about the violations of norms and legal interests of the citizen in the psychiatric clinic, and, in case they are confirmed, to send them to the prosecutor’s office, to the court, and, sometimes (when asked by the citizen or his or her legal representative) to mass media. The basics of the legislation of the Russian Federation concerning the protection of the citizens’ health (Part 3, Article 61) allow for such actions. Unlike the state control bodies, a public association can visit the psychiatric institution only on the asking (or consent) of a concrete citizen staying at this institution. The law does not provide for the examination of the activity of psychiatric institution as a whole by a public association. Information received from head doctors of major republican, regional and territorial hospitals often provides the basis for checks performed by the prosecution bodies, the Health Care Committee, the Labor Committee, local financial bodies, bodies against economic crimes, bodies against illegal drugs turnover, pharmaceutics departments, Ombudsmen representatives. Besides that, sanitary-and-epidemiological/ service comes at least once in two months, and Fire Inspection comes once in three months to inspect hospitals, Energy Surveillance Department, Traffic Police come once in a year. The hospitals, which have departments for children, are sometimes examined by the Inspection on the Underage Affairs, Patronage bodies. Small hospitals are not checked that often, especially when they are located in out of the way areas. These checks are usually associated with serious complaints. One head doctor gave the following answer to the question about checks: “Nobody has remembered us for several years,” which meant that there was no regular external control over that hospital. The Law, besides external control, provides for an internal one which is to be realized by the Service for the Protection of the Rights of Patients Staying at Psychiatric clinics (article 38 of the Law on Psychiatric Care). But this service has not been created yet, so at present the only mechanism of internal control is the investigation of complaints coming from patients or their relatives by the administration of the institution. Some hospitals have a book where they register all complaints and appeals. When a written complaint is lodged, a written response is prepared, the response to an oral complaint is also oral. At many hospitals head doctors said that practically all complaints they received were unfounded: “We don’t have complaints which should be investigated. We can create a commission if we need it.” Such an a priori renunciation of any basis for complaints testifies to insufficiently considerate attitude to patients and infringement on their rights. At the places where an administrative investigation is conducted on such complaints (at the Novgorod regional clinical psychiatric hospital, for instance), it is revealed that patients complain on a wide range of issues (“complaints basically concern everyday life, but sometimes there are complaints of involuntary hospitalization” ), and their complaints are often founded, and they display sufficient knowledge of their rights. At some hospitals they believe that patients’ complaints are associated with certain faults inside the hospital and try to eliminate them, “the response must be positive to avoid the reiteration of the complaint.” In many regions commissions were created under the auspices of the local health care bodies to examine complaints and appeals of citizens concerning psychiatric care (Voronezh region, Perm region, Mordovia Republic, Udmurtia and so on), but citizens have little information on the existence and work of such commissions, and sometimes even the doctors of psychiatric clinics do not know about them. As a result their work is limited to the examination of two or three complaints a year which, according to the opinion of the commission members, are unfounded. Nevertheless, in some regions these commissions are efficient enough receiving 100—350 appeals a year (Penza, Tver, Smolensk regions, Buryatia Republic, Khabarovsky territory, Jewish autonomous area and some others) and satisfying sometimes up to 60% complaints. Thus, “unfounded” character of complaints looks rather like a biased attitude of the commission members, not the real fact. Where there is a desire to improve the operation of the psychiatric service, the work with complaints is regarded as a necessary feedback which is used for real improvement in the conditions of patients. The staff of the psychiatric institutions does not even think of civil control of the observance of patients’ rights although the Law contains a corresponding article (article 16, Control of Public Associations over the Observance of the Rights and Legal Interests of Citizens in the Providing of Psychiatric care). Thus, for instance, when asked about the checks of public organizations, the head doctor of the Republican psychiatric clinic of Alania (North Osetia) responded, “we created a relatives’ society…” Cooperation with public organization eventually has not been developed. Many head doctors said that “nobody is interested in psychiatric clinics,” “nobody called us,” “our doors are open,” but some of them remarked that it was necessary to reach “agreement with the administration.” During several recent years many non-government organizations took up the issue of the rights of patients of the psychiatric service, but the stand of some of them is anti-psychiatric, they do not take into account the specificity of psychiatric institutions, their actions breaking up the organization of work at psychiatric clinics, and sometimes even harming those whom they “protect.” In this situation the workers of the psychiatric service usually take up the position of “bans,” “stopping,” and do not try to find a way to interact with civilian organizations. They only agree to receive charity aid from them. Only several hospitals (Moscow psychiatric clinic #4, Perm regional and city psychiatric clinics, etc.) spoke of permanent cooperation with non-government organizations. The idea of public checks, civilian control is alien to the heads of psychiatric clinics and to almost all the staff of the psychiatric service. Psychiatry still remains a very closed sphere. |
Íàøà êíîïêà  |
|