Money should not stand between the patient and the doctor. The Minister of Health of the Sverdlovsk Region, Arkady Belyavsky, is firmly convinced of this.

Arkady Romanovich was prompted to speak out so categorically and talk about his vision of the problems of regional health care by the material “Diagnostic Shock”, published in Rossiyskaya Gazeta-Nedelya on December 30, 2009.

The story told in the material is quite typical for today: during paid treatment in a municipal hospital, the patient was incorrectly diagnosed with an incurable disease. He was forced to double-check the test results himself, but even after two laboratories confirmed that there was no disease, the mistaken doctor did not apologize.

Why is this possible and how to radically change the situation in healthcare - an RG correspondent talks about this with the minister.

Russian newspaper: Arkady Romanovich, in my opinion, this situation revealed two sore points in healthcare: inaccurate diagnosis and rude, unprofessional behavior of the doctor...

Arkady Belyavsky: I would put these problems in a different order. The first problem is lack of professionalism, and diagnosis is its consequence. The outstanding Russian doctor Sergei Botkin once said: if after talking with a doctor the patient does not feel better, then he is a bad doctor. Yes, of course, not every disease is curable, the doctor is not omnipotent, but the patient should feel care and attention in any situation. As for diagnostics, there are now conditions for accurate diagnosis in healthcare. But the ability to make a correct diagnosis is a doctor’s talent, a reflection of his professionalism. It's no secret that there are good and bad diagnosticians.

RG: Are talented diagnosticians somehow encouraged? I know that there is a similar program in the Chelyabinsk region...

Belyavsky: Yes, there is such a program on oncology... But, you see, I believe that there is a certain paradox in it. If you reward a doctor for correctly diagnosing an oncological disease, then why not reward him for correctly diagnosing a cardiac disease? Or anyone else. The doctor is obliged to make correct diagnoses, this is his job. Otherwise, tomorrow we will have to pay for every true “sneeze” of a doctor. This fundamentally undermines the essence of the noblest of professions.

RG: But, on the other hand, a doctor’s inability to make a correct diagnosis is not a reason for dismissal?

Belyavsky: Today we do not have any levers with which I could fire such a specialist. You can only tell him that he is out of place. He comes to work on time and leaves work on time, that is, he fulfills his duties, although not fully. To fire him, he must do something that God forbid. And this is a serious problem that requires a completely different approach to solve. In the USA, for example, powerful associations of doctors operate in the regions: surgeons, therapists, and so on. And if the community of professionals decides that, for example, this surgeon is so unprofessional that he should not practice in this state, he will never be licensed or accredited here. Reasonable. Who knows better than your colleagues whether you are a good doctor or a bad one? We will probably have something like this over time, but as long as there is a shortage of doctors in most hospitals, such a mechanism is useless.

Just as, unfortunately, another mechanism does not work - the patient’s right to choose a doctor, laid down in the law “On the Protection of Citizens’ Health,” adopted in 1993. In one of the districts where I recently visited for an inspection, instead of 20 local therapists, there is only one. So what should patients do? So the main task today is to staff hospitals.

RG: In my opinion, there is one more thing that is preventing the professional “cleaning”: the medical professional solidarity that has been rooted in the country since Soviet times. Until recently, few even decided to sue a doctor, not hoping to receive an alternative examination and an objective assessment...

Belyavsky: Now the situation has changed. This is evident from the number of trials and the number of appeals to control authorities.

I am extremely rarely on the side of doctors on many issues, but I am sure that sometimes patients are wrong. For many reasons, you cannot blame a doctor just because someone close to you has died. About seven years ago, I had a situation when the case came to court: a patient with the flu was admitted to the hospital, and within 24 hours he developed meningoencephalitis, which led to death. My relatives filed a lawsuit against the hospital where I was the chief physician. We won the case because we proved that the treatment method was chosen correctly, and that death was caused by hidden pathologies that the patient did not treat until the critical moment.

RG: Has the system of arbiters determining whether the patient is right or wrong been formed?

Belyavsky: I think not. Insurance companies usually take the patient's side. But, unfortunately, doctors working as experts are usually part-time workers. And ultimately it turns out that they must inspect themselves or their colleagues. And the expert must be independent, work only for the insurance company and at the same time be the most qualified, competent and respected in the medical community.

Nowadays, it’s not the experts who go to the insurance company. The best ones remain to work as doctors, because this is what they studied for, this is their calling. Training competent experts is a big problem. They do not train to become a medical expert; a system of evidence-based medicine has not been formed. If an expert believes that a doctor made a mistake, he must justify this with numbers and facts, and not with assumptions and emotions. Otherwise, it turns out that whoever says it more beautifully wins. There are no “pretty things” in medicine. Medicine is a very exact science.

RG: In such a situation, when many mechanisms for determining the quality of treatment have not been formed, what helps you personally set priorities?

Belyavsky: Statistical indicators characterizing the activities of a doctor are approved by the Ministry of Health of the Russian Federation. In addition, an important component of the assessment is the opinion of management and patients. In fact, it’s very easy to find out what a doctor is like: walk through the wards, conduct a survey, and people will definitely say whether he’s good or bad. If you do this regularly, for example, introduce constant questioning of patients, you will see the level of patient trust in a particular doctor. And this gives the head of a medical institution management opportunities to make adequate decisions, including encouraging those specialists who are valued by patients.

RG: Will you propose this method as a uniform system for evaluating the work of doctors for the region?

Belyavsky: In my opinion, this should be practiced in every hospital. But issuing an order from the Ministry of Health to conduct a survey is incorrect. Each chief physician has the right to evaluate the work of his subordinates by any method. He must be interested in this. Some do this only based on the number of bed days required to treat the patient, while others take into account the opinions of patients.

I worked as a chief physician for many years and always took into account the opinions of patients. There were questionnaires with questions, for example, how were you greeted in the reception room, how long were you admitted? Were the nurses responsive? How do you evaluate the professionalism of doctors? What is the microclimate in the department staff?..

RG: Sometimes doctors encourage the patient to become a sponsor: yes, we would be happy to help, but there are not enough necessary drugs...

Belyavsky: I am against sponsorship in this form. Firstly, this violates Article 41 of the Constitution of the Russian Federation, which states: medical care should be provided free of charge. And secondly, if something is missing, this is the problem of the chief physician. When a clinic does not have money for expensive materials, technologies and drugs, then it must be honestly and openly said: there is no money for this! And post the rules for providing paid services so that everyone can understand. If there are no such rules in the hospital, then I consider it a kind of extortion.

Money should not stand between the patient and the doctor. The insurance company must stand between them. Why has the need to reform the compulsory health insurance system, which we have had for 17 years, been recently discussed? Yes, because it doesn't work. Not only are the patient's rights infringed - he does not have the opportunity to choose a doctor or a clinic he likes, good hospitals themselves are limited in development. Look at birth certificates. According to them, it is profitable for any maternity hospital to receive as many patients as possible, because money follows women in labor. And the more you accepted, the more you earned. This is how it should be in all medicine - the money should follow the patient.

Meanwhile

The hero of our publication received a response from the chief physician of the hospital where the conflict occurred. The document, in particular, reports that the situation was considered at a meeting to monitor the quality of medical care. The commission did not find “significant violations of the standards of conduct of personnel during the initial detection of hepatitis B and C virus carriage.” However, the hospital conducted additional professional training on how medical staff should act in similar cases. The head physician expressed deep regret to the patient that the data of the primary study differed from the final ones.

Help "RG"

Arkady Belyavsky was born in 1957. Graduated with honors from the Ivanovo State Medical Institute, specialty - obstetrics and gynecology. Since 1987 - in the Khanty-Mansiysk Autonomous Okrug: chief physician of the Central City Hospital of Nefteyugansk, chief physician of the district clinical hospital. Since December 2009 - Minister of Health of the Sverdlovsk Region. His wife is a general practitioner, his son is a cardiologist.

Arkady Romanovich Belyavsky was born in 1957. In 1980 he graduated from Ivanovo State Medical Institute. Received a diploma with honors in obstetrics and gynecology. According to the official himself, he decided on his choice of profession in his sixth year - before that time, medical students studied all specialties. In the direction he chose, he liked the combination of surgical and therapeutic profiles, as well as the positive emotional mood of the maternity hospital.

In 1987 Arkady Belyavsky began working in the Khanty-Mansi Autonomous Okrug. In March 1997 became the head physician of the Central City Hospital of Nefteyugansk, in March 1999– Chief Physician of the Khanty-Mansi Autonomous Okrug - Ugra “District Clinical Hospital”.

In 2004 became an organizer of healthcare of the highest category, adviser to the Russian Academy of Natural Sciences in the section “Russian encyclopedias”.

In December 2009 received the post of Minister of Health of the Sverdlovsk Region.

In 2012 during the formation of the new Government of the Sverdlovsk region after the change of Governor, he retained his post, despite numerous criticism of him from society and colleagues. Thus, the Minister of Health was blamed for the crisis with preferential medicines that flared up in 2011.

Arkady Belyavsky – Doctor of Medical Sciences. Honored Doctor of the Russian Federation. Honored Health Worker of Khanty-Mansi Autonomous Okrug. Corresponding member of the Russian Academy of Natural Sciences.

He has a number of awards, for example, the Order of the Russian Academy of Natural Sciences “For the Benefit of the Fatherland” named after V.N. Tatishchev, a badge of honor and a medal “For services to small nations,” as well as a silver medal of the Russian Academy of Natural Sciences “For the development of medicine and healthcare.”

Arkady Belyavsky is married. His wife is a general practitioner. Their son is also a doctor – candidate of medical sciences, cardiologist. The Minister has two granddaughters.

In 2011, he earned 1.8 million rubles. He did not indicate any real estate or vehicles he owned. There were two apartments in use. During the same year, his wife earned 222 thousand rubles. She owned an apartment.

Arkady Romanovich Belyavsky loves to relax in nature and read fiction. Favorite authors are Lyudmila Ulitskaya and Dina Rubina. He also prefers biographical books.

He calls himself a real workaholic and admits that, as a leader, he demands the same attitude towards work from his team members. Therefore, he tries to be a strict and demanding boss.

Using his own example, he tries to show the need for annual medical examinations. In one of the conversations with journalists, the Minister said that every year he gets a flu shot, undergoes an ECG, a fluorographic examination, and takes an AOC, OAM and a biochemical blood test.

Walking in the fresh air and table tennis also help him improve his health.

Publications with mentions on fedpress.ru

EKATERINBURG, March 5, RIA FederalPress. The government of the Sverdlovsk region reviewed the implementation of the order of Prime Minister Denis Pasler to monitor drug prices. By...

EKATERINBURG, March 6, RIA FederalPress. Reshuffles took place in two ministries of the Sverdlovsk region: Deputy Head of the Ministry of Health Dilyara Medvedskaya and her colleague from the ministry...

Sverdlovsk region At 10:00 at the TASS information center (Ekaterinburg, Lenin Avenue, 50 "b") a press conference will be held on preparations for floods in Sverdlovsk region...

EKATERINBURG, April 1, RIA FederalPress. From the beginning of the year to the end of March, prices for medicines in the Sverdlovsk region included in the list of vitally important drugs increased by 6%, ...

Sverdlovsk region

EKATERINBURG, May 6, RIA FederalPress. Co-chairman of the Sverdlovsk headquarters of the ONF Larisa Fechina said that the presidential movement will side with the residents of the village...

VERKHNYA PYSHMA, May 25, RIA FederalPress. One of the daughters of the family of priest Vitaly Agoshkov, who was poisoned by gas on May 19, was discharged from the hospital. Behind the situation in constant...

Sverdlovsk Region At 10:00 at PJSC “Kamenskoye” (Kamenskoye urban district, Belovodye village) the grand opening of the traditional summer event “Field Day” will take place. ...

SVERDLOVSK REGION, July 24, RIA FederalPress. In the village of Neivo-Alapaikha, Alapaevsky district, Sverdlovsk region, a first-aid post was opened, which was liquidated in January. ...

Karamzin Kantemir Feliksovich Artur Kokoev

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At this point there was an article entitled “The Golden Sum dissuaded, or Why the forecast of the editors of Kompromat-Ural regarding Ziya(v)udin Magomedov is coming true.” The text of the article dated April 4, 2018 consisted of five paragraphs. Only one of them mentioned Mikhail Kiyko. Mikhail Yuryevich is now the former general director of United Grain Company JSC (UGC). Kiiko stayed in this position for barely a year and a half and was fired in November 2018. JSC "OZK" is half owned by a businessman Ziyavudin Magomedov.

The mention in the above-mentioned article about the “relationship of financial dependence” between Magomedov and Kiiko caused the latter’s displeasure. Mr. Kiyko’s application demanding the removal of the disputed article (all five paragraphs, and not just about Kiyko) was considered by a judge of the Arbitration Court of the Sverdlovsk Region Elena Seliverstova. She fully satisfied the claim, which was far-fetched, in our opinion.

On 01/09/2019 the decision came into force. Following the letter of the law, the editors of Kompromat-Ural deleted the text within the established period. Nevertheless, we will continue to appeal the illegal and absurd, in our opinion, judicial act and thank all readers who assist in this.

We remind you of the feedback address:compromising- ural@ protonmail. com

The May holidays turned out to be hot for the correspondents of the Kompromat-Ural portal. We have new information at our disposal to continue the anti-corruption investigation against the deputy of the State Duma of the Russian Federation Nikolai Brykin. This is a former general of the tax police and the Ministry of Internal Affairs, and now a representative of the lower house of parliament in the Supreme Court (Brykin was delegated to the State Duma in 2016 on the list of United Russia from the Khanty-Mansi Autonomous Okrug, the Yamal-Nenets Autonomous Okrug and the Tyumen Region).

The scandals surrounding Brykin are caused by the fact that the Ugra entrepreneur is from the “list Titova» Konstantin Dyulgerov, forced to flee Russia due to pressure from the security forces, openly accused the retired general of organizing a custom-made criminal prosecution. Dyulgerov revealed the details of his misadventures in detail in an actual interview with Novaya Gazeta. The victim in the dubious case of Dyulgerov is Brykin’s son-in-law Sergey Kiryanov, and the hero of the scandal himself, as the editors of Kompromat-Ural found out, before being nominated to the State Duma, transferred multimillion-dollar development assets on the Black Sea coast to his daughter Valentin Kiryanov(in 2016, Breeze LLC, which was transferred to her, had assets worth almost half a billion rubles on its balance sheet!). Brykin ran for deputy as a modest representative of the “patriotic fund” (legally this was a fiction).

The other day, the editorial office of Kompromat-Ural received a response from the Assistant Prosecutor General of the Russian Federation Valeria Volkova(Valery Georgievich came from the leadership of the Prosecutor General’s Office for supervision over the implementation of anti-corruption legislation). We contacted Yuri Chaika on the issue of verifying the accuracy of the declaration information about the personal welfare of Mr. Brykin. Is the people's servant living within his means, who in the shortest possible time after leaving the Ministry of Internal Affairs turned into a dollar millionaire, and then just as quickly got rid of his “deserved” wealth before the elections to the State Duma?

In a recent publication by our colleagues from the Tyumen publication 72.ru, it was noted that according to formal declarations, Nikolai Brykin hangs out at the bottom of the deputy rating: “for 2017, his income amounted to “only” 4.8 million rubles. Less than others, but don’t rush to conclusions. He owns two huge plots of land, a couple of spacious country houses and a modest apartment of 76 square meters. His wife has a larger apartment: 116 square meters. Also registered on it are four residential country houses and two plots of land. And all their family vehicles are registered to Brykin’s wife - a Toyota Land Cruiser, a Shore Land SRV31B trailer and a Sea Ray 185S boat. How the lady managed to buy all this “herself”, earning 2.9 million a year, one can only guess.”

An assistant to Yuri Chaika reported to the editors of Kompromat-Ural that “the powers to conduct appropriate checks in relation to deputies of the State Duma” are vested in the Duma commission for monitoring the reliability of income information, headed by Natalia Poklonskaya(she is also deputy chairman of the Committee on Security and Anti-Corruption). Therefore, according to Valery Volkov’s response, the appeal about Brykin was sent to the lower house. The editors of Kompromat-Ural will monitor the responses of the State Duma Speaker’s office Vyacheslav Volodin and the profile commission. In mid-April, Mrs. Poklonskaya confirmed to reporters that Brykin is indeed one of the five persons involved in anti-corruption checks carried out by the commission she heads. By the way, in this list Brykin is adjacent to the “pubic” deputy from the LDPR, the hero of immoral sex scandals Leonid Slutsky.

Current publications

11 thousand defrauded shareholders of the bankrupt investment fund "Yamal" can join the company of depositors of the bank "Ugra", whose claims are directed to the banker arrested the other day Alexey Khotin. As follows from published documents studied by the editors of Kompromat-Ural, more than a billion rubles from Yamal’s assets were used to purchase obviously illiquid bills of the Krasny Bogatyr company, controlled by Khotin. It is obvious that the banker could have pulled off such a large-scale scam only in collusion with the former managers of Yamal and the fund’s property management company.

Last November, the arbitration court’s ruling on the liquidation of the enterprise ended the inglorious history of the Yamal Fund OJSC, which was dubbed the “Yamal MMM” in the press. Almost 11 thousand residents of the Autonomous Okrug were defrauded by the fund's investors, including representatives of the small peoples of the North, whose small incomes were skillfully taken advantage of by swindlers.

In a letter to the governor of the Yamal-Nenets Autonomous Okrug Dmitry Kobylkin from 2010, minority shareholders told how in the early 90s the former general director of the Fund Eugene Sklyarov actively traveled around the cities and towns of the district, not ignoring even the temporary camps of reindeer herders, met with people and persistently invited them to exchange recently received privatization checks for shares of the Fund.

At first, investors who responded to this offer felt confident: the fund converted the collected vouchers into shares of OAO Gazprom, which until 2008 made up 90% of its investment portfolio. And then events began that can only be explained by the selfish interests of the people authorized to make decisions...

Perm security forces hope to detain sooner or later the former chairman of the board of Ekoprombank JSCB Andrey Tueva(TIN 590301312244), who has been in Cyprus for several years, dodging in every possible way from extradition to Russia. According to investigators, Tuev’s machinations to withdraw assets brought the bank to financial collapse, sources of the Kompromat-Ural editorial office note. Today this is perceived satirically, but the accused New Cypriot himself was a member of the organization “Public Commission to Combat Corruption in the Perm Region” several years ago.

By August 1, 2012, Ecoprombank’s obligations to creditors exceeded the financial capabilities of the institution by 847 million rubles! And by the time the license was revoked on August 18, 2014, this amount had increased to 3.1 billion rubles. Ecoprombank was created in 1992 and took 252nd place in the TOP 300 banks ranking. It is believed that 53% of the bank’s shares belonged to the structures of the ex-CEO of Silvinit Petra Kondrasheva, the rest - to the deputy Vladimir Nelyubin(also in the dock, his criminal case is being considered in the Leninsky District Court of Perm) and his companions.

Former chairman of the board of OJSC JSCB Ekoprombank Andrei Tuev fled Russia shortly after the bankruptcy of the bank - on December 8, 2015. According to Interpol, Tuev, his wife Tatiana Mazuka, their son has been registered in Germany since 2011. The German identification cards issued to them, which were valid until the end of 2016, gave the defendants the right to permanent residence in Germany and to free movement in 26 member countries of the Schengen agreement, as well as in the Republic of Cyprus and more than ten other states not included in this agreement.

On June 2, 2016, Tuev’s wife flew from Moscow Sheremetyevo to Munich airport and never returned to Russia. In the bankrupt Ecoprombank, she worked as a member of the board, head of the treasury, and deputy chief accountant - and became suspected of complicity in committing fraud imputed to Tuev.

Are you aware of financial abuse? Write to the editors of Kompromat-Ural:compromising- ural@ protonmail. com

After sending numerous appeals to the Presidential Administration, the Prosecutor General's Office, the FSB, the Investigative Committee and the Ministry of Internal Affairs, the editorial office of Kompromat-Ural became aware of the arrest of a scandalous lawyer involved in numerous frauds with large property assets. Prisoner - 48 year old Karamzin Kantemir Feliksovich(TIN 773373042820, before changing my passport it was Artur Kokoev). In the registers of the Federal Tax Service he is listed as the director of Nobel Technologies LLC, co-owner of Lie Detector CJSC and Kamchatsky Bear LLC (a legal entity of one employee) and the former co-founder of International Lottery Company LLC (liquidated by tax authorities as inactive). Judging by the abundance of the same type of sugary and laudatory links given by Internet search engines in the first positions, Karamzin tried to hide from the public unpleasant, with a criminal odor, facts of his biography.

Readers and correspondents of the Kompromat-Ural publication are interested in Mr. Karamzin (Kokaev) due to information about his corrupt relationships with government officials and involvement in raider attacks. Now Karamzin is in a pre-trial detention center on suspicion of particularly large-scale fraud. He was detained upon returning to Moscow from the United States, where he ignored requests from Russian law enforcement officers for a long time. As Pravo.Ru reports, the arrest took place at the entrance to the Moscow Arbitration Court. At the same time, Karamzin “became ill,” but the emergency doctors who arrived found no reason for his hospitalization. Did your artistic abilities not help this time?

The circumstances of the arrest indirectly confirm the rumored version about the suspect’s close acquaintances with “werewolves in robes.” According to media reports, Karamzin’s preventive measure was specifically chosen not in the capital, but in the Moscow region - in the Balashikha city court, “due to his connections in the Moscow judicial system.”

In the comments of readers of the Rosbalt news agency it is reported (literally): “the corrupt judges with whom he dealt have long since been reassigned and promoted...” Sources from the Kompromat-Ural editorial team believe that FSB operatives will be interested in the arrestee’s revelations about his connections in the justice system and the actions of the “judicial mafia” (if, of course, there is one in our impeccable rule of law state). In the future, the recorded testimony may be useful for the Investigative Committee of Russia and the High Qualification Board of Judges. Our correspondents, in turn, are also ready to accept interesting information and make it available to the competent authorities. Write:compromising- ural@ protonmail. com

The editors of Kompromat-Ural keep under control information about schemes and scandals surrounding the Naftagaz company. Recent reports from corporate and law enforcement sources suggest that Tokay Kerimov, the beneficiary of Naftagaz, which includes Naftagaz-Burenie, plans to introduce enterprises into the so-called “controlled bankruptcy.” “The scheme may be as follows,” says a law enforcement officer, “not without the knowledge of Tokay Kerimov and the general director of Naftagaz-Burenia.” Islam Nazaralieva LLCs are registered in the name of third parties, where machinery and equipment are purchased with creditors’ money. Then all this is leased to NG-Burenie at prices with all the signs that they are obviously higher than market prices. Thus, Kerimov has two birds with one stone killed at once. Firstly, cash flows in, and secondly, the creditor’s debt to these same friendly companies is increasing.”

The editors of Kompromat-Ural are collecting new information from knowledgeable specialists to evaluate the presented version. According to the economist Andrey Weber, “such a scheme is used, as a rule, when deliberate bankruptcy is planned. In the situation with Naftagaz-Burenie, the owner Tokay Kerimov and the company’s management are acting according to a well-known scenario - they are doing everything to ensure that debts to friendly companies are higher than to other creditors. Then friendly firms will file for bankruptcy at NG-Burenia, Kerimov will appoint his own person as bankruptcy manager and bankrupt the company as he pleases, most likely transferring all the property to newly created legal entities with dummy owners. In this way, Tokai Kerimov will be able to introduce NG-Burenie into controlled bankruptcy,” the expert sums up his opinion.

It is worth noting that today Naftagaz-Burenie owes over 3 billion rubles to real creditors, and the debt to “front” creditors is likely to be approximately the same size.

The largest operator of waste reform, Municipal Unitary Enterprise of Yekaterinburg "Spetsavtobaza", for whose work the mayor is responsible Alexander Vysokinsky, under the pressure of public protest and the actions of inspection bodies, was forced to admit the exorbitance of his financial appetites. The day before, correspondents of the Kompromat-Ural project learned that Spetsavtobaza had changed its mind about seeking an increase in its tariffs through the courts. Let us recall that the consideration of the claim in the Sverdlovsk Regional Court ended in failure for the scandalous enterprise: Themis sided with the prosecutor’s office.

The resonance from the antics of the new leadership of “Spetsatobaza”, which appeared in the municipal unitary enterprise after Vysokinsky’s “reign” at the mayor’s office, has already reached Moscow. For now, it’s up to the federal government, but soon Vysokinsky may “arrive” from the Presidential Administration, which, as any official knows, is not to be trifled with. Head of the Federal Antimonopoly Service Igor Artemiev took personal control of the financial “wishlist” of the EMUP “Spetsavtobaza”. The head of the Regional Energy Commission (REC) of the Sverdlovsk region may get it from Artemyev Andrey Grishanov. This governor's appointee Evgenia Kuyvasheva together with his subordinates, he agreed on tariffs for the garbage operator.

The chief Russian antimonopoly official officially confirmed the fact of an inspection in relation to the regional regional energy commission “in order to determine the reliability and economic justification of tariffs” EMUP “Spetsavtobaza”. According to the editorial office of Kompromat-Ural, the FAS Russia inspection has already pointed out signs of violations of the law committed by the REK members. Now Andrei Grishanov’s department has the right to submit objections to the central office of the FAS, but has not yet done so, Artemyev clarified. In any case, he promises to hold a special meeting of the commission in Moscow on the problem of inflated tariffs of the Yekaterinburg “Spetsavtobaza”. Our correspondents will monitor developments.

Meanwhile, the forecast made by analysts of the Kompromat-Ural portal in one of the previous publications is confirmed. We reported that this is a real Klondike for law enforcement (not only the prosecutor’s office, but, for example, the FSB and the Investigative Committee) and control and supervisory authorities (primarily the regional OFAS under the leadership Dmitry Shalabodova) may become the procurement activity of EMUP "Spetsavtobaza". In other words, where are the billions collected from citizens and businesses under the enslaving “garbage reform” flowing from the municipal enterprise? Particularly interesting are the facts of ignoring transparency requirements and manipulating procurement procedures...

Observers of the Kompromat-Ural publication are working to develop a public investigation into the activities of the EMUP Spetsavtobaza. We are grateful to readers for interesting messages on a topical topic:compromising- ural@ protonmail. com

The Minister of Health of the Sverdlovsk Region Arkady Belyavsky resigned of his own free will. The corresponding decree was signed by Governor Yevgeny Kuyvashev on Monday, the information policy department of the head of the region reported. “The minister wrote a statement of his own free will and I signed it,” said the governor. “I am grateful to Arkady Romanovich for his work for seven years in the difficult post of head of the regional health care. As a result, we were able to make serious progress in the development of high-tech medical care for patients. According to this indicator "The Sverdlovsk region has become a leader in Russia. But life does not stand still, and we need to constantly move forward, solving new problems."

“The minister [...] resigned due to retirement. This is his decision,” said the chairman of the regional government, Denis Pasler. “By decree of the governor, Nonna Nikolaevna Kiveleva, who served as Deputy Minister of Health, was appointed acting minister,” the prime minister said.

Arkady Belyavsky was appointed Minister of Health under Governor Alexander Misharin in 2009. Belyavsky turns 60 years old - the official retirement threshold for civil servants - only next year, but taking into account his 15 years of “northern” experience, he received the right to retire at the age of 50. Graduate of the Ivanovo Medical Institute (1980), since 1987 years Belyavsky worked in the Khanty-Mansiysk Autonomous Okrug. In 1997 he became the head physician of the Central City Hospital of Nefteyugansk, in 1999 - the chief physician of the Khanty-Mansiysk Autonomous Okrug - Ugra "District Clinical Hospital". His wife is a general practitioner. Their son is also a physician - Candidate of Medical Sciences , cardiologist. Belyavsky’s family has two granddaughters. The media called Belyavsky the personal physician of the then governor of the Tyumen region Sergei Sobyanin.

There was a Minister of Health. Even under Misharin, in 2011 a crisis broke out with preferential medicines. Under Kuyvashev, the head of the regional Ministry of Health was criticized for buying an apartment with budget money. In 2014, a scandal broke out involving a reduction in doctors’ salaries. The main reason for Belyavsky’s criticism was the ongoing optimization of the healthcare system. Demands for the minister's resignation were heard at dozens of protests throughout the region. Sverdlovsk healthcare was repeatedly mentioned in a negative context by the federal media.

According to data over the 7 years of his tenure as minister, Arkady Belyavsky was mentioned in off-line media 1678 times, of which 83 were neutral-negative mentions in the last year alone. At the same time, the number of mentions in the negative context of the Ministry of Health itself grew year by year (with 8 in 2012 to 51 in 2015, since the beginning of 2016 - already 28).

“Today, the main task facing the Ministry of Health is the development of municipal medicine, ensuring accessibility of medical services,” Governor Kuyvashev noted in his commentary on the resignation of the minister. “So that not a single resident of the region has the feeling that they have been forgotten about, or that "It is difficult for him to take advantage of the achievements of modern medicine. The essence of the May presidential decrees is to put the achievements of medicine at the service of people, regardless of the distance from urban centers and the size of the wallet."

Prime Minister Pasler called the main tasks of Belyavsky’s successor as minister “ensuring the availability of medical care, strengthening the material base of medical institutions and resolving issues of staffing health care institutions.”

“In the near future I will announce the name of the new head of the Ministry of Health. The candidacy will necessarily be agreed upon with the medical professional community,” the governor said.

It is likely that Nonna Kiveleva will act as minister temporarily - she is a candidate of economic sciences, has worked in the Ministry of Health since 1999 and is in charge of issues of financial planning and long-term economic development; accounting, reporting and control.

Nonna Kiveleva

According to UPImonitor, the head of the regional government is lobbying another of Belyavsky’s deputy, Dilyara Medvedskaya, for the post of Minister of Health. However, in the off-line media (only since the beginning of the year - 12 neutral-negative mentions in the off-line).

Dilyara Medvedskaya

One of them - then Medvedskaya stated that the unification of various medical services would lead to positive results. A negative story about the closure of an ambulance station in this municipality as a result of “optimization” was broadcast on Channel One literally today.

Immediately after the holidays, it became known about the resignation of the Minister of Health of the Sverdlovsk Region, Arkady Belyavsky. Shortly before this, he gave an interview to the editor-in-chief of NDNews.ru Polina Rumyantseva, talking about what was achieved in 7 years of work, the true goals of optimizing Sverdlovsk hospitals and what awaits the future of Sverdlovsk medicine.

– Arkady Romanovich, one of the main topics in healthcare today is optimization. What is it in a nutshell?

Arkady Belyavsky: In short, this is the joining of low-power ones to stronger ones. Life forces us to optimize. A hospital that employs four thousand people, has a chief physician, a chief accountant and a lot of service personnel cannot survive.

– Are there any successful examples?

Arkady Belyavsky: We had hospitals with overdue accounts payable, which remained until optimization. Once they were affiliated with large hospitals, this problem was eliminated. In Reftinsky, for example, where there are similar problems now, the clinic was historically part of the Asbest hospital. So in areas with a small population, where hospitals have debts, issues will be resolved by joining larger medical institutions. For example, in Makhnevo, Verkh-Neyvinsky, Malysheva, ZATO Svobodny. In Verkhnyaya Tura, there is also an urgent question about joining the hospital to the Kushva one. I met with residents. And he asked - why do you want to have a hospital? You have a population of 9,200 people, and you have opened a maternity hospital. How many children were born last year? 128. On average, one birth takes three days. What qualifications of the staff can we talk about if there is one obstetrician-gynecologist and one neonatologist? In addition, they cannot work around the clock; midwives attend births at night. What if something happens? Thanks to the fact that we closed eight maternity wards in the Sverdlovsk region and centralized childbirth in intermunicipal centers, last year our maternal mortality rate was 9.6 compared to the norm of 10, and infant mortality in general was 5.5 ppm - the lowest figure in the entire history of observations in the Sverdlovsk region. Here is the result of the optimization.

– Patients and relatives have questions about the need to go somewhere to give birth and be treated in other cities...

Arkady Belyavsky: Look, according to statistics, every woman goes through childbirth once or twice in her life. That is, during one birth she must be somewhere in another city for about three days, but at the same time we guarantee her that she will be discharged healthy with a healthy baby. Isn't it worth three days spent somewhere away from home? Yes, you yourself will go for surgery (and childbirth is a planned operation) to a doctor who practices every day, and not to one who operates once a week. The same goes for many other things.

With the continued availability of medical care, the quality of its provision should improve. And quality can only improve when patients are routed to places where they can provide more qualified care.

What did our routing lead to? 80% of premature births take place in intermunicipal centers. 95% of strokes are treated in intermunicipal centers. 74% of road accident victims are treated in intermunicipal centers. That is, we immediately take them not to the nearest hospital, but to where they need to go. Yes, it's further away, but it's more efficient. Only with regard to heart attacks, the statistics are not very good yet - 51% receive treatment in intermunicipal centers. Even in Yekaterinburg, if a heart attack occurs, the patient is hospitalized in the nearest hospital, and after 2-3 days they are still transferred to either the 33rd or the Institute of Cardiology.

Or here are the highway points - they don’t exist anywhere in Russia, but we have already created 20 sorting and evacuation sites where you can pick up a seriously ill patient and transport him by helicopter to Yekaterinburg. This year we will build 6 more helipads.

- So in demand?

Arkady Belyavsky: Certainly. Imagine a burn patient with 50% damage. It is impossible to carry it by car. A serious accident, multiple fractures - we can transport you by helicopter. This is a more gentle way than driving on our roads.

Last year we had 196 flights. Due to the fact that Mi-2 helicopters are on duty - the car is nimble and mobile - they can land right on the road and pick you up from the highway. The traffic cops just block traffic for 20 minutes.

“But people are afraid that the patient may not be transported.”

Arkady Belyavsky: Well, they’ll take him to the nearest hospital - and what will they do with him there? There, for example, there are less qualified doctors, there is no such equipment as in intermunicipal centers. In addition, by the way, about “they won’t take you” - if the patient is seriously ill, we always have another car leaving to meet the ambulance, so that the first one, if it is alone in the area, for example, does not leave the territory for a long time, returns to duty. And in the one that came out to meet us, there is equipment, and specialized specialists can go along with the emergency medical service team.

By the way, last year we also united seven emergency medical care stations. But the vehicles were on duty in the area and continue to be on duty. And local therapists - just as they were sitting, will continue to sit still. Our optimization task is to retain doctors and nurses, and not related personnel. When we began to study staffing levels in hospitals, it turned out that they were inflated, and the staffing level of doctors was only 35%.

– Is this 3-4 bets per person?

Arkady Belyavsky: That's it. As a result, they are revising the staffing table - for example, the Demidov Hospital in Nizhny Tagil alone reduced 502 staffing positions in a year. And the regional hospital, the Collective Clinical Hospital, and the oncology clinic have also shrunk, but it hasn’t gotten any worse. In general, in the region the staffing level with medical personnel is somewhere around 62%, but 100% is needed. And specialists are reluctant to go to clinics - the work is harder. The hospital doctor came to work at nine o'clock, and may go on rounds at nine, or maybe ten. And I came to the clinic - and you have such a queue that you can’t drink tea, and even the patients are on edge, because they stood at the reception for half an hour, and at the hospital a patient was admitted to you yesterday, you already know him, yesterday he prescribed treatment, I checked it today. Therefore, young doctors do not want to go to work in a clinic. Last year, when we cut beds, we also cut doctors from the hospital - but they did not go to the clinic.

-Where did they go?

Arkady Belyavsky: They were retiring. Our main problem is the age composition of doctors. And we are waiting for 2017. Then, due to the peculiarities of the legislation, there will be double graduation in universities. In 2016, roughly speaking, 750 people will graduate, and in 2017 – 1,500. Because internships are cancelled. And they will immediately enter practical healthcare.

– Won’t this affect the quality?

Arkady Belyavsky: No. In my opinion, they don’t do anything in internship either, but here they will see a more experienced doctor and learn quickly. Even more - since last year, in many clinics we have three paramedics and one doctor working at receptions. The first accept lighter patients, the second – more severe. Differentiation is underway. And this immediately made it possible to increase the number of patients admitted, and the doctor is not busy with routine work. But this is only for the transition period. Our task, of course, is to ensure that doctors still work at the clinics. New criteria for assessing the effectiveness of the work of chief doctors are now being prepared, and one of the indicators is doctors’ appointments.

– How are things going with the technology?

Arkady Belyavsky: We have monthly monitoring of the operation of equipment - MRI and CT machines, angiographs, each of which has its own workload. For example, 23 computed tomograms should be done on this device, and 20 magnetic resonance imaging on that one. The devices should be used for differential diagnosis of stroke and heart attack, and they should operate around the clock. And we also included this criterion in the criteria for assessing the effectiveness of the head physician.

– Can everyone decrypt data from these devices?

Arkady Belyavsky: You can pass the picture on to those who can advise if there is a difficult case. We have a central archive of medical images where images are uploaded via the Internet. So if you have access, you can get advice. In general, telemedicine is an area that we are actively developing. We have telemedicine installations in almost all hospitals, and the number of such consultations has increased by almost 30%. Why send a patient somewhere if you can consult him online? Both those who receive consultations and those who consult via telemedicine receive payment under the compulsory medical insurance system, so that it does not happen that one benefits, but the other does not. Payment goes to two. And in this regard there are no problems either.

– I often hear that in Russia diagnostics are traditionally at a low level, but we cut well and know how to care...

Arkady Belyavsky: This is no longer the case. In the past, diagnostics were really lagging behind. After all, what did the first private medical centers cost? They had CT and MRI machines. We have them now too. We now have another problem - we don’t always have enough qualifications to carry out complex operations. Especially in oncology, when different systems and organs are affected. For example, a patient has esophageal cancer and lung cancer. But the surgeon is either thoracic or abdominal, but cannot do a general one. This should be the training of special doctors.

– How will this be resolved?

Arkady Belyavsky: We send you for an internship. Either to Moscow or abroad. For example, last year two doctors in France trained with a urologist using the da Vinci apparatus.

- Do we have it?

Arkady Belyavsky: Eat. But it's not loaded. There were doctors who worked well but left. They were supposed to train new ones in 2015, but they don’t have the same qualifications yet.

– Is it possible to outbid specialists in other regions?

Arkady Belyavsky: Eat. Our wage fund allows it.

– Who should do the recruiting?

Arkady Belyavsky: Chief doctors. We installed an angiography unit in Krasnoturinsk, and the task there was to find doctors - and the head physician found them. The doctor travels from Yekaterinburg to operate; there is no longer a need for the patient himself to travel to Yekaterinburg. You need to understand that for a young doctor, interesting work comes first. For the last two or three years, many doctors from Yekaterinburg have been leaving as chief doctors to Artemovsk, Polevskoy, Verkhnyaya Salda, Novaya Lyalya. This didn't happen before.

– Where to find personnel?

Arkady Belyavsky: Our salaries are good, significantly higher than in other regions, even in the Tyumen region. Imagine, two doctors, a married couple, they came to us from the Kurgan region. There their salary between them was 50 thousand, but here it was 110.