Alexander (Valentinovich) Kartsevsky (born 14 April 1959) — Health Minister of the Nizhny Novgorod regional Government, the longest-serving member of Valery Shantsev's team. Length of service as a physician : 1 year [1].

Graduated from the Institute of Business and Politics with a degree in "economics".

People's Deputy of the Russian Federation (1990-1993), was a member of the Committee of the Supreme Soviet of the Russian Federation for health protection, social security and physical culture, and belonged to the deputies' groups "Medical Workers" and the Federation of Independent Trade Unions of Russia.

The essence of the phenomenon

One of the strangest ministers of the Shantsev government from the point of view of effectiveness. Qualified medical staff resign and write open letters to the media, while the network of medical institutions that existed earlier is being steadily wound down.

He became truly famous for the collapse of the work of the ambulance stations of the regional capital. Staff claim that a qualified doctor earns no more than 14 thousand roubles a month. Kartsevsky, however, stated that their salary was 26 thousand roubles. [2]

Brief biography

Born in the town of Balakhna, Nizhny Novgorod Region.

  • 1982-1983 – intern doctor at the Semashko Clinical Hospital.
  • 1983-1991 – chief physician of the Balakhna Central City Hospital
  • 1991-1998 – director of the health department of the administration of Nizhny Novgorod Region
  • 1998 – 2005 – general director of ZAO «Sberbank Mortgage Company».

The ambulance service

On 1 January 2012 the emergency medical service of Nizhny Novgorod was taken out of municipal subordination and transferred to the authority of the Government of Nizhny Novgorod Region. Less than six months had passed before the staff of the state budgetary health institution «Nizhny Novgorod Emergency Medical Service Station» voiced their dissatisfaction with the new management.

According to Mikhail Rozhdaikin, leader of the ambulance workers' trade union of the regional capital, in today's situation it is simply impossible for his colleagues to work. The blame for it all lies with the wholesale underfunding of the service. It has led to a catastrophic shortage of staff. Whereas earlier every crew was staffed with two paramedics, now they work alone. Turnover is high. People work for a salary that is very modest for specialists of this level and for such extreme conditions. The responsibility is enormous, and working conditions have become simply appalling. There is not enough money for the most essential medicines. And with what, one may ask, are the medics supposed to save people? A kind word?

The service's vehicle fleet is in a horrifying state. «By the norms we ought to field 128 crews, 108 go out on the line, and 10 crews we regularly cannot send out because of technical faults in the vehicles: there are no spare parts, no wheels... The vehicles stand idle regularly because of unscheduled repairs! Because the transport is not serviced the way it should be. It is shameful: in the capital of the Volga Federal District there is not a single purpose-built substation - all the premises are adapted ones, and even that only nominally. While in other municipalities ambulance substations are being built, in Nizhny Novgorod the question of the Nizhegorodskaya substation, whose premises were closed because of their dilapidated condition, has been dragging on for years. We were forced to move some of the crews to the Priokskaya substation, but now even that is held against us», laments Mikhail Rozhdaikin.

What is more, to save money on drivers, ministry officials suggest that the doctors themselves take the wheel. «We have women working here! Not every one of them will agree to get behind the wheel of an ambulance. And who is going to pay 40 thousand each for their training? And what is it we want to achieve? That a woman should first bring a patient out of shock, then haul him into the vehicle on her own back and sit down there and then to turn the wheel?! Does anyone anywhere take into account the specifics of emergency situations?»

- the trade union leader fumes at the state of affairs in the medical sector.

All in all, the ambulance staff were driven to the point where the medics had to write an open appeal to Governor Shantsev. He instructed Alexander Kartsevsky to look into the situation. And what came of it? The minister, instead of getting to the heart of the problem, beginning to look for ways of solving it and at least somehow calming the staff down, only went on inflaming the situation. He delivered a thundering rebuke to the medics in the mass media, blaming all the troubles on the medics themselves and on their former supervisors - the administration of the city of Nizhny Novgorod, which, owing to the transfer of subordination to the Ministry of Health of the Russian Federation, has long had nothing to do with the service.

«Until 2012 the emergency medical service of Nizhny Novgorod was under the authority of the city government. That is why such problems as the lack of premises of its own for the Nizhegorodskaya emergency substation and its being housed at the central substation in the Sovetsky district, which has a negative effect on how promptly its crews work — problems that went unsolved for many years — cannot be solved in the short time since the change of subordination», minister Kartsevsky declared, and went on: «As for fuel and lubricants, we did indeed allocate less money for fuel than last year. But there are objective reasons for that: if 67 vehicles out of 108 are in working order, why allocate money for petrol for those units that are standing idle? Besides, I can say with full responsibility that the use of fuel and lubricants in the ambulance service requires tighter control».

Succinctly put! And yet it did not occur to Mr Kartsevsky that it would be more sensible to repair or renew the vehicle fleet and supply it with fuel in full?

It is unclear what the minister ultimately wants to achieve. It is clear that medical workers will not go on strike. But what if most of the staff simply resign? Who will then save the lives of Nizhny Novgorod residents? Including those of high-ranking officials themselves?..

Trauma Centre No. 4, which brings in no profit

Another scandal could well have flared up over the closure of the trauma centre at Hospital No. 4 (Sovetskaya St.) in the Kanavinsky district. How could the health minister of the Nizhny Novgorod region come up with the idea of leaving the most socially troubled district, the city's global trading hub, the crossing point of transport arteries, without the only facility where the injured can urgently receive emergency care for trauma?

Such an ill-considered decision by Mr Kartsevsky immediately stirred up the trauma centre's staff (the trauma specialists did not want to be left without work) and the residents of Kanavino themselves. They were not at all pleased at the prospect of having to seek help for injuries and broken limbs in neighbouring districts.

It got to the point where the head of the Kanavinsky district, Sataev, had to intervene in the situation. Although formally the district head has nothing to do with the trauma centre's work. Nikolai Sataev is convinced that a trauma centre is vitally necessary for a district as difficult as Kanavino. He managed to get through to the regional officials and was heard. The decision to close the trauma centre has for now been suspended. And in future it will operate in different premises - on the basis of Hospital No. 6. At the same time all the trauma specialists will keep their jobs.

Corruption scandal at the Semashko Hospital

Some time ago «Leninskaya Smena (newspaper)» wrote about a corruption scandal at the Semashko hospital. The distinguished surgeon Pugin approached the editorial office with an open letter, claiming that corruption schemes flourish at the most respected medical institution in the Nizhny Novgorod region. The letter dealt not only with money extorted from patients. It was claimed that for a surgeon to be granted access to high-technology operations, what is required is not medical professionalism but knowledge of a different kind. In particular, one has to know how much you will bring "in your beak" to the head of the department who distributes the quotas for operations of that kind.

Extortion at Nizhny Novgorod's Maternity Hospital No. 1

Nina Ryazhkina, the chief physician of Nizhny Novgorod maternity hospital No. 1, came under investigation on suspicion of extorting money from patients. She was charged with organising paid wards run by the "Persona" clinic, which women in labour could get into for 30,000-40,000 roubles. But they received excellent care. All this differed radically from the services provided to non-paying patients. From the latter, according to the investigation, money was nevertheless also requested. Only through "grey schemes". Patients were offered the chance to conclude a personal contract with a doctor. These funds were presented as charitable aid from people voluntarily donating cash for the good of the national healthcare system. Naturally, no particular rights or obligations of the parties were spelled out in the document.

Thus, complaining about disgusting care was pointless. Meanwhile, here is what one of the hospital's patients says about the practices that reign there: "The first time, I was put in a ward for 6 people. There was one toilet for the whole department, with two lavatory bowls, a partition between them, but no doors. (Forgive the details, but there was almost the same kind of toilet in the delivery department too, and you must admit, that is not very convenient…). The shower was there as well, in a separate little room, true, but to get into it you had to walk… through the toilet. Unfortunately, it was almost always hard to get into the shower.

It was easiest after 10 p.m., and there were problems with the hot water too. Quite often the shower was used not for its intended purpose but as a telephone booth, since it is the only place whose window looks out not onto traffic-choked Varvarka but onto the quiet side lane of Volodarsky St., where you can talk more or less in peace. There is no canteen as such; there are tables in the lobby where people eat, and read newspapers, and play cards and dominoes. True, the lighting there is very poor. As it is in the ward, for that matter. Besides the 6 beds, the ward had 5 bedside cabinets, a table and a couple of chairs. There were 2 refrigerators in the lobby, both usually packed, so we kept some of our food supplies between the window frames (it was the month of March). The food, naturally, as in all state hospital institutions, was meagre, just enough not to die of hunger".

When the scandal received public exposure in the media, Kartsevsky immediately dismissed the chief physician of maternity hospital No. 1. The staff came out in defence of their former boss. To this day no agreement has been reached. Meanwhile it is surprising: how could Kartsevsky not have known earlier about the activities of the "Persona" company in an institution under his authority? After all, as the Nizhny Novgorod resident Alena Grebeshkova noted on one of the internet forums, "the deputy director of the 'Persona' clinic is his own wife". No doubt all of this is down to a strange concurrence of circumstances and a most rare coincidence…

Making money on tomographs, 70 million on each one

The regional police headquarters is investigating a criminal case over the purchase of high-technology computed tomography scanners, "Siemens" and "Tohsiba", at inflated prices.

Certain officials of the regional ministry are suspected of having acquired the machines for the region's needs at a price of 162 million roubles per unit. It also emerged that this is 70 million roubles above their market value.

According to the investigation, the case involved "kickbacks" and "carve-ups" into the pockets of high-ranking officials of the department. The damage caused to the regional budget is obvious. Despite the fact that the case is stalling because of delays in carrying out a price assessment of the tomographs with the manufacturing firms, the police are firmly determined to bring the corruption situation in Kartsevsky's department to court.

source: Leninskaya Smena No. 040, 27 September 2012, p. 7

Healthcare reform. The income gap between chief physicians and "ordinary doctors" in Nizhny Novgorod

The average salary of an ordinary doctor is 7,000-11,000 roubles, whereas a chief physician's salary starts at 100,000 roubles.

The way bonuses and supplements are distributed also leaves much to be desired. It is known that since January all medical institutions have moved to single-channel financing from the Compulsory Medical Insurance Fund.

The money that arrives in a polyclinic's account is distributed by the chief physician at his own discretion. His own salary is regulated partly from above – by the healthcare administration bodies – and partly by himself. The base salary itself is 40,000 and upwards. But the monthly supplements and bonuses for administrative work, which he awards to himself, sometimes reach 200% of a senior official's base salary. In addition, a chief physician often holds several posts at once – for example, his own and that of a surgeon (with the duties of the latter hardly being performed at all). That is how a tidy sum adds up.

Many doctors support the protest sentiment in the medical community, but are afraid to speak out openly.

Medical officials, for their part, urge medics to "work harder". But how much harder… By law, district doctors work 8 hours. But the reality is different.

An ordinary paediatrician's day looks like this.

8.00–12.00 – filling in medical records, reports, sick-leave certificates and so on. 12.00–14.00 – home visits. The norm is 6, but it can reach 15. 14.00–15.00 – lunch. 15.00–16.00 – more home visits. 16.00–17.00 – paperwork again (the hardest are the records of disabled patients, patients under dispensary observation and newborns). 17.00–20.00 – seeing patients. The norm is 12 people, in reality 25–30, and if the doctor is covering for two, 50. 20.00 – the remaining paperwork is often taken home.

[3]

Open letter from the Ambulance Service trade union

« Despite the growth in the number of people calling for help and the increased workload on the mobile crews, the station's budget in 2012 was for unclear reasons cut by almost 70 million roubles compared with 2011, which had the most negative effect on the effectiveness of the staff's work, the medics write.

In one of the most sought-after services in the healthcare system, one that also works in emergency-situation mode, the staffing question has reached a critical level. The existing supplements have ceased to play any motivating role. The average monthly salary of doctors, including the federal payments under the "Health" Priority National Project, night-shift and incentive supplements, amounts to 14,195 roubles. At the same time it is precisely in the "Ambulance Service", compared with other healthcare structures, that staff have the highest rates of illness and occupational injury.

Since 2011, ambulance service employees have begun to resign, the appeal states. In 2011, 20 doctors resigned, while only 6 were hired; in 2012 another 17 doctors left the service, and just 1 person joined. Paramedics have started to leave too: since the beginning of the year 40 people have resigned.

Many of those who remain have begun to refuse additional shifts taken on as secondary employment, because, unlike in other regions, the additional payments under the "Health" national project (subsidies) are not distributed in proportion to hours worked above 1.0 of a full-time post. The restriction on payments from the federal budget introduced by Decree No. 68 of the Government of the Nizhny Novgorod Region of 10.02.2012 contradicts Articles 2 and 21 of the Labour Code of the Russian Federation, since subsidies from the federal budget are an integral part of an employee's wages, and the restriction introduced violates the employee's right to receive fair wages paid in full. The trade union committee stands with the employees and asks the regional authorities to lift this restriction.

In the situation that has arisen, as the trade union states, with an acute shortage of staff at the substations the level and quality of care provided is falling, and meeting the standards for the provision of emergency medical care is becoming impossible in a number of respects. "What standards can we talk about if the station needs 67 million roubles for medicines alone for 2012, while in fact only 23 million roubles have been allocated. There are no funds needed for the purchase, repair and calibration of equipment. There is no stock of electrocardiographs or defibrillators in the pharmacy store. There is nothing to replace faulty equipment on the crews with", the letter states.

And this is despite healthcare being a priority national project. "Or does the emergency service on the front line of healthcare not require particular attention and proper funding?" the medics ask the governor. And ahead lies the transition to financing from compulsory medical insurance funds, which, according to the union's forecasts, will worsen the staffing and financial situation at the institution still further.

In view of the facts listed, the workers of the "Ambulance Service" are addressing the authorities with several urgent questions.

1. Is it planned to establish monthly regional supplements to the wages of doctors and mid-level medical staff and to increase the amount of the monthly payments to ambulance service drivers and orderlies?

2. Will the restrictions be lifted on supplements to the wages (subsidies) of ambulance service medical staff from the federal budget for work above 1.0 of a full-time post, in proportion to hours worked, following the example of other regions of the Russian Federation (for instance, the Rostov Region)?

3. Will the institution's funding be increased in the current year and in 2013, taking into account the requirements of the legislation on providing citizens with emergency medical care in accordance with the procedures and standards?

4. Is it planned to purchase reserve ambulance vehicles for the substations and to replace those whose service life expires in January-February 2013?

»


Medics have been driven to the brink. The Nizhny Novgorod Region's ambulance service is sending an "SOS" signal

Svobodnaya Pressa, 25 September 2012, 18:12 | Svetlana Gomzikova

In Nizhny Novgorod the passions stirred up by the publication of an open letter from the regional ambulance service trade union addressed to Governor Valery Shantsev show no sign of dying down. Voicing in their appeal the problems that it had always been customary to keep quiet about, the medics ask the head of the region to look into the matter and help. Otherwise it may turn out that there will soon be no one left to provide emergency medical care in a city of a million and a half people.

"Some sort of planned collapse of our service is under way," the author of the collective appeal, deputy chief physician for medical affairs and chairman of the Nizhny Novgorod ambulance service trade union Mikhail Rozhdaykin, told "SP". "I have been working in the ambulance service for thirty-odd years, but there has never been such an outrageous situation. Global underfunding across all budget lines has made it utterly impossible to work. Every call is a trial. That is exactly what we said publicly to the head of the region, since we are not allowed to strike."

The problems, as they say, are on every "front". Specialists are in short supply, wages are low. At the same time there are more and more calls from patients, and one has to do the work of two people, sometimes three, ambulance workers say.

People cannot stand the "sweatshop" schedule and leave. At present the "personnel question has reached a critical level". In 2011 twenty doctors resigned and only six were hired; in 2012 another seventeen doctors left the service, and just one arrived. Paramedics have started leaving too: forty people have resigned since the beginning of the year.

For such hard work the medics could count on supplementary payments. However, in 2012 the station's budget was cut, for reasons that remain unclear, by almost 70 million roubles.

Today the average salary of an emergency doctor in the Nizhny Novgorod region, including federal payments, night-shift and incentive supplements, amounts to 14,195 roubles." A paramedic gets even less: 11,496 roubles.

"There is a saying: on one salary rate a doctor has nothing to eat, and on two he has no time to eat," the medics joke sadly.

In the situation that has developed, the trade union states, meeting the standards of emergency medical care is becoming impossible on a number of counts:

"What standards can we be talking about if the station requires 67 million roubles for medicines alone in 2012, while in fact only 23 million have been allocated. There are no funds needed for the purchase, repair and calibration of equipment. The pharmacy warehouse has no stock of electrocardiographs or defibrillators. There is nothing to replace faulty equipment on the crews with. Repair of medical equipment requires 650 thousand, and 161 thousand roubles have been allocated. There is no money left for calibration in the fourth quarter. In total, under budget line 225 (property maintenance services) only 1.5 million of the required 3.9 million roubles has been funded. For capital repairs the allocation is 0 roubles."

"The authorities must finally make up their minds: does the capital of the Volga Federal District need an ambulance service or not? If not, say so and we will all leave. But do not mock common sense and the people who carry this burden. Who work round the clock every other day on one and a half or two salary rates and receive a beggarly wage," Rozhdaykin says.

"SP": - Mikhail Nikolayevich, have you received any official reply to your appeal?

- Apart from intensified pressure from the Ministry of Health, we have received nothing. Now they are trying to find something to accuse us of. Supposedly we are manipulating public opinion. Supposedly the open letter is a defence against the consequences of the audit of the station by a commission of the control and audit department. So it turns out that it is we ourselves - the administration and the trade union committee - who are wrecking everything? But it is not in my interest to wreck anything: I am already of pensionable age. Besides, the ambulance service is my brainchild, I have grown attached to it with all my heart over the decades I have worked here.

"SP": - What audit is this, by the way?

- Of administrative and economic activity. It was supposed to end on 7 September. But after our appeal these commissions have been working at our place permanently, replacing one another. The chief physician has already taken to a hospital bed... They are looking for the money that was given to us. But for what was not given, that for some reason they are not looking. Our problems do not reach them.

"SP": - There is no interest?

- Where would it come from? Do you know what the first reaction of the regional health minister Alexander Kartsevsky to our appeal was? "I have read the appeal of the trade union committee - it is complete nonsense," he said at a meeting attended by heads of the region's medical institutions. How does that sound? It turns out that a public organisation is nonsense. This is simply open disrespect not only towards our organisation, but towards the entire professional community. How can an official of such rank allow himself such things?!

"SP": - And is Valery Shantsev's reaction already known?

- The governor listens first of all to his minister. We write that the emergency medical service is suffocating, that it must be helped. And Shantsev says that the chief physician there gets 70 thousand and that there is a heap of management there, that it is necessary to look into it and dismiss the whole administrative and economic section. Is that a way out? The service would not last two days, because we are 13 million roubles short for petrol. That is what should be the priority. Previously every crew was staffed with two paramedics, and today it is practically impossible to find even one. Doctors are leaving too. We spin around as best we can to staff the crews, but because of the difficult position the ambulance service is in today, the problem is becoming unsolvable.

The Ministry of Health of the Nizhny Novgorod region is so far refraining from official comment.

"We know about the trade union's appeal. But an answer to it will be given after the internal review of the institution is completed, in the first ten days of October," the ministry's press service assured "SP".

Meanwhile, colleagues and ordinary townspeople for the most part share the concerns of the letter's author and fully support him.

Here are just a few of the responses published by the Nizhny Novgorod agency NewsRoom24:

"I am very proud that M.N. Rozhdaykin was able to write an open letter. Everything is correct. There is no pay, no medicines, no second assistant, no equipment, no vehicles, but it does not say that there is also no legal protection for staff," writes an author under the nickname sotrudnik smp. "Everywhere staff are insured against medical error. People have watched too much of 'The Hour of Judgement' and rush off to court to knock money out of the ambulance service. But we do not work in a hospital, where all the inpatient equipment is available, and we do not have X-ray machines and ECGs in our eyes. Yes, we are professionals in our field, but everything has its limit. Every year we develop more and more 'emotional burnout', and it needs to be treated. We have no psychologist at work and no rehabilitation!!! Paramedics do not get to rest at sanatoriums."

Valentin believes that "with health care developing like this, our society will soon be left without doctors and nurses".

And Irina, who works for the ambulance service, shares her own experience: "Everything set out in the letter does not fully convey the whole wretchedness of the situation. The pay is pennies, no uniform is issued, the vehicle assigned to our crew is utterly worn out, there are holes in the floor. We freeze unbearably ourselves, the heater barely works, and there is no question of the van being heated. And yet we transport small children, and in general this is contraindicated for any patient. This shift, for example, three vehicles were idle. Last shift I worked alone. Naturally, I received no extra pay for it. I lugged three cases around on my own, and at night walked through dark stairwells in some slums, looking for yet another drug user who had overdosed.

Believe me, it is frightening. During the shift I handled 21 calls. It looks like practically one call an hour. But add the journey, the traffic jams, the time on the call, and hospitalisation if it is required, which means I practically never got out of the vehicle. I was at the station for two hours at most, at night. And do not forget, during those two hours we do not sleep but write a mountain of paperwork that must be handed in the next morning. In short - come and work with us, you will like it."

Kommersant: the prosecutor's office was called in for the ambulance service

Kommersant (N. Novgorod), No. 189 (4971), 09.10.2012

The Ministry of Health of the Nizhny Novgorod region has forwarded the audit report on the city ambulance station (GSSP) to the regional prosecutor's office. The former management of the ambulance service is suspected of providing poor-quality services and of questionable spending on expensive medicines. In the middle of the audit, the ambulance medics wrote a much-discussed open letter to the governor, complaining of high staff turnover and low wages. The station's problems will now be dealt with by a new chief physician: yesterday Vladimir Klimenko, who came from the territorial Compulsory Medical Insurance Fund, was appointed to the post. It will also fall to him to resolve the main issue - remuneration, on which the ambulance staff and the minister have so far found no common ground.

Yesterday at a press conference the Minister of Health of the Nizhny Novgorod region Alexander Kartsevsky announced the results of the audit of the GSSP, whose staff at the beginning of September wrote an open letter to Governor Valery Shantsev about low wages, as a consequence of which, in the opinion of the authors of the appeal, the last professionals are leaving the ambulance service. According to the version voiced yesterday by Mr Kartsevsky, the open letter, which caused a great stir in the city, was a "planned campaign" in response to the audit of the GSSP, which brought unseemly facts to light. In particular, the minister mentioned that in the first half of the year the ministry recorded a sharp drop in the ambulance service's use of expensive thrombolytics (130 cases against 230 in the first half of last year).

The audit found that in the summer, instead of being distributed to the substations, the medicines were accumulating in the pharmacy. "In addition, more than 400 medical records were checked selectively - in 66% of cases the standards of medical care were not met, and in 30% there were violations of patients' rights," Alexander Kartsevsky reported. The minister sent the report of the ministry's commission to the prosecutor's office for an assessment of the actions of the GSSP management. Also, in the official's view, the complaints about low wages are groundless: official salary rates at the ambulance station are on the whole higher than the average figures in the region's medical institutions, while the previous management distributed the payroll fund unevenly, setting maximum salaries for seven deputy chief physicians.

Furthermore, Mr Kartsevsky cited a number of indicators showing that some ambulance doctors have no specialisation, have not completed their internship, or received their medical education in a field other than the core speciality of "general medicine". All this, according to the minister, may in future lead to insurance companies refusing to pay for the medical care provided by ambulance doctors: from 1 January 2013 this emergency service is being transferred from direct budget funding to payment through the territorial Compulsory Medical Insurance Fund on the basis of services actually rendered. To carry out the transfer to the new funding system, Vladimir Klimenko has been appointed chief physician of the GSSP; he worked for eleven years at the territorial Compulsory Medical Insurance Fund and most recently headed the ministry's centre of medical inspection (the previous chief physician Oleg Kirzon resigned of his own accord - "Ъ"). Mr Klimenko himself promised to get to know the staff personally and to "climb into every hole", advising journalists to write more about positive news.

Probably one of the main questions the new chief physician will have to resolve is that of the ambulance staff's wages. Yesterday the GSSP doctors and paramedics who came to the press conference tried to find out from the head of the regional ministry of health whether their wages would be increased. However, they and the minister failed to understand one another: Mr Kartsevsky stressed that the average salary of an ambulance doctor is 26 thousand roubles a month and that of a paramedic 17 thousand, and that the medics "take up the entire payroll fund". The staff cited different figures: 14-16 thousand and 9-11 thousand roubles respectively (for a single salary rate), and wondered whether they were apparently working "in some other Nizhny Novgorod" than the minister. "Because of low wages the number of cardiologists has fallen compared with last year.

For some reason nobody mentions that most of the cardiographs are out of order. Unfortunately, the equipment purchased last year is of poor quality, and that is certainly not the fault of the ambulance service, but of those who won the tenders," said Tatyana Rozhdaykina, a cardiologist at the GSSP's Northern substation. In her opinion, the commission found nothing criminal in the ambulance service's work, and the thrombolytics accumulated in the warehouse because deliveries of medicines began late, since the ministry itself approved the estimates with a delay. "We are told that the management ate up the entire payroll fund, but we have calculated that if the salaries of the chief physician and all his deputies were divided among the whole staff, the increase would come to 200 roubles a month," the cardiologist told "Ъ".

Paramedic Maxim Alexandrov reminded those present that about a thousand ambulance service employees had signed the letter about the GSSP's problems, and that this is the opinion of the collective, which cannot be ignored. The minister declined to answer his questions about regional incentive payments and about cutting the ministry's officials and redistributing their salaries to the medics. He explained to journalists in detail what an ambulance doctor's wage consists of and what schedule they work, and advised that questions about pay be addressed to the management of the institution, promising to tour all the substations together with the new chief physician and talk with people on the spot. The few ambulance staff dispersed dissatisfied, taking the view that the regional ministry of health would now "shift the blame - whoever raised the problem will answer for it", while the regional official evaded discussion of the sore points.

Roman Kryazhev

Kartsevsky's ban on inspections "without prior approval" led to a formal notice from the prosecutor's office

22 August 2013, 10:12 (Moscow time) | Politics | NIA-Nizhny Novgorod

The prosecutor's office has issued a formal notice to the regional minister of health In connection with the violations of legislation that were committed, the regional prosecutor's office has issued a formal notice to the minister of health.

The prosecutor's office has uncovered instances in which the Ministry of Health of the Nizhny Novgorod region improperly exercised its powers in implementing the regional health care modernisation programme. This was reported by the prosecutor's office of the Nizhny Novgorod region.

As stated in the announcement, in the course of supervising the enforcement of laws in the sphere of protection of citizens' health, facts were revealed of the ministry improperly exercising its powers in implementing the regional healthcare modernisation programme for 2011-2013, approved by decree of the Government of Nizhny Novgorod Region No. 174 of 15 March 2011, which consisted in the absence of control over the recording and efficient use of the medical equipment supplied to healthcare institutions.

In addition, in the course of an inspection carried out by the Directorate for Supervision of Compliance with Federal Legislation of the Regional Prosecutor's Office, it was established that in July 2013 the Ministry of Health of Nizhny Novgorod Region sent, by electronic means of communication, a letter to the heads of all medical and preventive treatment institutions subordinate to the ministry, from the content of which it follows that inspections of such institutions by supervisory bodies of any level are impermissible without prior agreement of the inspection with the ministry.

At the same time, under current legislation, when supervisory bodies inspect the activities of business entities, no additional authorisations or approvals are required.

Thus, the Ministry of Health of Nizhny Novgorod Region exceeded the powers granted to it by law and violated the requirements of federal legislation governing the grounds for and the procedure of inspections by state control (supervisory) bodies.

In connection with the violations of legislation committed, the regional prosecutor's office has submitted a formal recommendation to the Minister of Health of Nizhny Novgorod Region, which is currently under consideration.

"Those who write in Governor Shantsev's blog will be temporarily suspended from their main job"

mirielle 30 March 2012 at 16:17:59, City Forum NN.RU

Today several employees of Children's City Clinical Hospital No. 1, those taking the most active civic stance, were summoned to the Ministry of Health of Nizhny Novgorod Region for a "serious" talk. The conversation proceeded, let us say, in anything but a warm atmosphere. And what took place cannot even be called a conversation. It was mostly the ministry staff who spoke, interrupting their opponents and not letting them have their say.

Those invited were asked blunt questions, namely: "does communicating with the governor on the subjects of the hospital's construction and the level of salaries fall within the employees' official duties" (despite the fact that all the appeals to the governor took place outside working hours), "what are you going to show the governor during his visit to the hospital?", "what questions do you intend to put to the governor?" and so on, and immediate answers were demanded on the spot. It seemed to me that all that was missing were bars on the windows and a lamp shone in one's face.

Those invited were informed in a peremptory manner that the ministry is very displeased with the communication between employees of Children's City Clinical Hospital No. 1 and Governor Shantsev in his personal blog. After each appeal to the governor, ministry staff are forced (quotation follows) "to spend 80% of their working time on written replies to the regional administration", which, in the opinion of the health minister's assistant Mr Toguzov, greatly distracts ministry employees from their immediate duties. Therefore, if the words of the head of the department for childhood and obstetric care, Ms Borovkova, are to be believed, Minister Kartsevsky has issued an order under which the "rebels" who write in Governor Shantsev's blog will be temporarily suspended from their main job and transferred to work on drafting written replies to the regional administration.

Possibly the "last straw" that enraged the health minister of Nizhny Novgorod Region was the appeal by the anaesthesiology and neonatology nurses of Children's City Clinical Hospital No. 1 to the official site of the Governor of Nizhny Novgorod Region with an innocent question: why, having raised the salaries of anaesthesiologists-intensivists and neonatologists, did no one think of the mid-level nursing staff working in those departments?

But one gets the impression that what really infuriates the ministry is the activity of the employees of Children's City Clinical Hospital No. 1, who are trying, going over people's heads and possibly against the wishes of Minister Kartsevsky, to pull the hospital out of the pit into which it has been steadily pushed over all the recent years.

After visiting the Ministry of Health of Nizhny Novgorod Region, I wondered whether Minister Kartsevsky and those like him are not afraid for their own posts ?

Incidentally, Governor Shantsev promised to visit Children's City Clinical Hospital No. 1 on Monday, 2 April.

Mikhail Iosilevich : what hope there is for Children's City Clinical Hospital No. 1

« Shantsev and his porn blog are the only hope of Children's City Clinical Hospital No. 1. no one else has the power to help the doctors !
Iosilevich Mikhail 2 April 2012 at 08:08:46
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Notable statements

  • "The pharmaceutical business in principle cannot run at a loss" [4] (archive) (on the fact that some municipal pharmacies operate at a loss and that transferring them to regional jurisdiction would make them profitable.)
  • "In 66% of cases the staff of the Nizhny Novgorod ambulance service failed to comply with the standards of medical care. In 30% of cases there was a violation of patients' rights. Some of the doctors admitted to work do not have the required medical education, and some have no certificates and have not completed an internship. All this could have served as grounds for not paying for the ambulance service's work" [5] (justification of the low earnings and mass dismissals of Nizhny Novgorod medical staff)
  • "One has to fight for the patient, and money will be received only by those who provide medical services of high quality. As part of the reorganisation of medical institutions, all of them will be converted either into budget-funded, or state-run, or autonomous ones. In essence they will become medical enterprises, where revenue will shape the life of their collectives. Those who do not want to work will not survive. Doctors will have a material interest in working well." [6] (archive) (on the aim of reforming Nizhny Novgorod medicine)

Interesting facts

  • Closed down the trauma centre in Kanavino as unprofitable [7].
  • Issued an official licence to the sorcerers from the scandalously closed "Modus" centre.
  • Without explanation dismissed one of the deputies of the Duma of Dzerzhinsk, in everyday life the chief physician of the city tuberculosis dispensary, who had not supported the amendments to the city charter [8].
  • Maternity Hospital No. 1 in Nizhny Novgorod has paid wards run by the Persona Clinic. Its deputy general director is Elena Kartsevskaya, the wife of Mr Kartsevsky.

Journalism

  • Socio-political articles (based on telephone interviews) signed by A. Kartsevsky on APN-NN.

See also