A. NASIBOV: The radio station “Echo of Moscow” is working. Moscow time 22 hours 11 minutes. Ashot Nasibov at the microphone. Greetings dear listeners! This is the Back to the Future program. Today we are talking about disability, or more precisely, about the so-called fake disability. This topic has been in the news in recent days, especially in connection with the problem of the appearance of various kinds of fake certificates when entering a higher educational institution. At least, this is exactly what was reported in our Russian press. We will touch on this topic and talk about disability in general, about what is being done to help people with disabilities. Guest expert in the studio: Sergey Kozlov, head of the department of medical and social examination and social support of the Federal Medical and Biological Agency. Sergey Ivanovich, good evening!

S. KOZLOV: Good evening!

A. NASIBOV: Sergiy Ivanovich, before we start the program, I want to read to you an excerpt from the message that we received on the Internet before the start of the program.

Waldemar Green, a doctor from Sudan - as he introduced himself - expresses the following point of view: “The very concept of disability or disability group does not indicate the degree of health or illness, but says that a person needs one degree or another of social protection.” – Do you agree with this statement?

S. KOZLOV: To some extent, we can agree, because today there is a regulatory document in force, and it provides for the establishment of disability in accordance with the limitations in life activity that have occurred as a result of a dysfunction of the body, and whether a person needs social protection measures. If you are aware, then in accordance with the instructions of the President, which was given when establishing the Council for Disabled People, the Ministry of Health and Social Development and the Federal Medical and Biological Agency were instructed to develop a new concept for improving the medical and social examination of people with disabilities in accordance with functional disorders. Currently, we are working in accordance with ICD-10 - this is a disorder of diseases. Therefore, the transition to a new concept, depending on the impairment and health status, will represent the state of disability in more detail than now.

A. NASIBOV: Approximately when can we expect the appearance of a new concept?

S. KOZLOV: In accordance with the president’s instructions, it should be presented before December 1, but I think that we will try to do this earlier in order to, in addition to the concept, prepare a number of regulatory documents that must correspond to the adopted concept so that it is possible in some then the necessary projects have already been carried out since January 2010.

A. NASIBOV: What new do you include in this concept?

S. KOZLOV: Most likely, we believe that a new concept of “rehabilitator” should appear. And from our point of view, it should come out through citizens who, in order to receive rehabilitation measures, they are first forced to establish a disability, then they receive a rehabilitation measure, which is paid for by the state.

S. KOZLOV: We take the disabled person beyond the scope. Therefore, according to the current government decree, persons must be sent to us after carrying out the entire range of rehabilitation measures. From our point of view, groups of people who need long-term or permanent replacement maintenance therapy should leave. Persons who, say, have the disease phenylketonuria, which is diagnosed practically in the maternity hospital, and so that the child does not become disabled - in addition to the fact that this is quite a serious mental trauma in the family, because he is severely disabled - if this child is given specific baby food, then he will not be disabled. Today, we determine indications for nutrition after we are forced to assign him the “disabled” category. – These are the main approaches.

A. NASIBOV: About a year ago, the medical and social examination was transferred to the Federal Medical and Biological Agency. What did you manage to do this year, what did you not manage to do? Where did you start?

S. KOZLOV: Yes, literally in June last year a presidential decree was adopted, then a government decree, and in accordance with the government decree of September 10, the departments of the Federal Medical and Biological agencies. So, it is impossible to say that the FMBA of Russia did not engage in medical and social examination, because in many medical institutions subordinate to the Federal Medical and Biological Agency there were medical and social examination institutions that were engaged in the examination of persons with particularly dangerous professions, and they were quite good results. And, apparently, it was considered that the results of the work of these institutions were quite decent, and thus the department was transferred to the FMBA. And first of all, we took part even before the transfer stage, this is in the preparation of the 240th government resolution, this is the provision of technical means of rehabilitation, as a result of which a number of positions have changed. New de jure rules appeared: disabled children were given the opportunity to receive technical aids, the terms and conditions for the payment of compensation, and various other provisions were determined. And also the 247th government resolution, dated April 7, 2008, which determined the procedure and conditions for establishing the disability group of the “disabled child” category without a period for re-examination. – These are two main documents. The main talk of the town is the lengthy examination and difficulties in completing the document for a medical and social examination.

A. NASIBOV: There are a lot of questions related to this: “Why do you have to undergo a medical and social examination again every year, and, moreover, from general practitioners?”

S. KOZLOV: We have prepared a project for the Ministry of Health and Social Development, it is now being approved, which regulates the timing of examinations in medical institutions. We offer - we have Form 88 - a referral for a medical and social examination, one within a month. This means, and from our point of view, from the moment of contacting medical institutions, he should be examined out of turn, a referral for a medical and social examination should be filled out, if there are grounds for this, and he should be examined in the near future. The question that you mentioned is precisely what Resolution 247 has been sent, which currently regulates the procedure for establishing the disability group of the “disabled child” category for persons under the age of 18 according to the period of observation. You see, the situation is such that for various diseases, well, basically, about two years is the minimum recovery period that is necessary in order to restore or compensate for functions through rehabilitation measures, treatment.

A. NASIBOV: Well, this question concerns, for example, people with amputations. It is clear that an arm or a leg will not grow on its own, but then why do they need to undergo new examinations every year?

S. KOZLOV: Today, the first two years of life are practically spent by people with this pathology. Let's say, a serious injury: the first six months, a year, physiological and rehabilitation measures that are aimed, they allow you to somehow compensate and prepare a person to be fitted with prosthetics. Let's say, the first year - this could be the second group. And in accordance with the convention, which the Russian Federation signed, disability is an evolving condition. By carrying out rehabilitation measures, either compensation or restoration of functions can be achieved. In the case of the absence of limbs, say, restoration of functions is impossible, but by making a prosthesis, teaching a person to use this prosthesis, and having him in the field of rehabilitation specialists, a disability group is established for this period of rehabilitation measures. Then the person is assigned a disability group for an indefinite period.

A. NASIBOV: Sergei Kozlov, head of the department of medical and social examination and social support of the Federal Medical and Biological Agency, is a guest of the “Back to the Future” program on radio “Echo of Moscow”. Send your questions and comments via SMS to +7 985 970-45-45. We continue our conversation. The difference between the Russian system of medical and social examination and foreign systems - what is the main difference?

S. KOZLOV: Let’s say, as part of preparing a concept for improving social expertise, we got acquainted with the work of a number of organizations that are involved in determining disability. And yet, it must be said that over time we became acquainted with the Canadian system. When we talked about the conditions in which our specialists work and what determines it, it was highly appreciated that we have a high social orientation. The main difference is that in other countries in Europe, America, Canada, the determination of disability is of a registration nature, and the person then decides for himself whether to apply for, say, rehabilitation, if he has insurance, or whether to apply for employment. Today we have interaction between medical institutions, because a large complex of institutions and organizations is engaged in the provision of rehabilitation services - these are healthcare, employment, cultural, educational institutions, prosthetic and orthopedic enterprises. There, a person is forced to walk with insurance himself. Here, based on the results of the examination, an individual rehabilitation program is developed for him. And we try to interact. Another change in the concept that we propose is to move away from Law 94 in providing disabled people with technical means of rehabilitation. Based on the results of the examination, there should be (inaudible) and the cost of expressions, that is, a certificate.

A. NASIBOV: And the person decides for himself?

S. KOZLOV: A person decides for himself which manufacturer to go to. There must be clearly defined amounts listed, for example, for a prosthesis. If a person has a desire, he can add funds and buy a new prosthesis.

A. NASIBOV: Or vice versa, cheaper.

S. KOZLOV: Or vice versa, yes. Here, as it were, if we have state or private prosthetic enterprises, then we supply them with information about the person’s consent, and it is no longer the person who goes to this enterprise, but the enterprise comes and says that I will install a prosthesis for you at home, I will bring it today. And the person will have a choice. When competition appears, quality will appear. Indeed, today, often those technical means that we recommend, which are supplied to a person, cannot be used by a person, because they quickly fail. This fact exists.

A. NASIBOV: Pensioner Alexander Bevzyukov writes: “When will the practice of annual confirmation of disability be eliminated?” And another question. Just a second... Grigory Mazurenko, a social worker, believes that in our country the main motive for receiving a disability group remains receiving a pension supplement.

S. KOZLOV: Well, it’s difficult to say here, because the disability pension does not always exceed the salary. And to say that people, as a rule, apply in order to compensate for some financial costs is difficult here. But, given that our medical and social examination is still socially oriented.

A. NASIBOV: You know, he is a social worker, he is “closer to the ground,” as they say. Here he writes: “In pursuit of material gain, our fellow citizens storm clinics and have rows with doctors.”

S. KOZLOV: I can’t say this about everyone. There are certain episodes when you want something more than you should. But the majority, nevertheless, apply for examination when it is absolutely unbearable! If we compare before the crisis broke out - this year we had an increase in the number of examinations - this suggests that people somehow held on to work and coped with their illness with all their capabilities. As soon as they have lost their jobs, in order to receive some kind of compensation or means of subsistence, they apply for examinations. Although, I say that there are cases when the desires of citizens do not always coincide with what they are entitled to.

A. NASIBOV: Valery Valeev, a pensioner, is interested: “Why do they keep increasing the service life of wheelchairs for disabled people?” – In my opinion, you partially answered the question about technical means.

S. KOZLOV: As of today, the deadlines have not been changed, they remain the same. Another question is that the wheelchairs that disabled people receive do not always meet these deadlines. And the question should be raised not about whether or not to increase the shelf life of wheelchairs, but the question should be raised about the fact that attention should be paid to the quality of technical means of rehabilitation so that they can withstand the periods for which they are designed.

A. NASIBOV: That is, if, according to your concept, a person himself will determine where to buy the same wheelchair and where to give this certificate. Am I right?

S. KOZLOV: Yes. He will choose himself, and of the best quality. And the company will be interested. When there are two companies, and one goes bankrupt because its quality is worse, this will pose a question to manufacturers: either the company goes bankrupt, or they have to do something. If the quality does not match, either reduce the price or increase the quality level so that this stroller is competitive.

A. NASIBOV: How will you relate the cost of this certificate to the average cost of these technical means on the market?

S. KOZLOV: We believe that we have now prepared, with the participation of the Ministry of Health, medical contraindications for the provision of technical means for rehabilitation. We believe that there should also be medical and social indications: for example, people of retirement age in rural areas who need the same prosthesis to restore mobility. There should be funds for the purchase of this prosthesis, or a technical means of rehabilitation in somewhat smaller quantities, say, if a person is of working age, plays sports, has an active life position, then the percentage of wear of this technical means of rehabilitation will, as a rule, be greater, and he you need to change it more often. – The intersection of these two indicators - medical-technical and medical-social - should determine the average cost. Plus, there must also be a pricing policy that must take into account the delivery of this technical equipment, because we have a large country, this must also be taken into account.

A. NASIBOV: Alexander from Volgograd believes that the degree of disability is, in fact, a ban on the right of a Russian citizen to work. He proposes to abolish the concept of degree of disability.

S. KOZLOV: I think the question here is not about the degree of loss of ability to work, but the degree of limitation of work activity. Currently, disability is established depending on seven categories of disability, the component of which is the limitation of the ability to work. Pensions are currently paid depending on the degree of restriction on work activity. And therefore, people with visual impairments of the first group, who have limitations in communication, movement, and self-care, have the first group of disabilities. But, given that they can work in specially created conditions, they have restrictions on work activity of the second degree and they receive a pension in the second group. At the suggestion of the Ministry of Health and Social Development, a justification has been prepared. And if you read in the press, a bill is being prepared, which, starting from the new year, if everything goes well, will be amended, and the disability pension will be paid depending on the disability group, and not on the degree of limitation to work. – This is also a proposal that came from us.

A. NASIBOV: Sergei Kozlov, head of the department of medical and social examination and social support of the Federal Medical and Biological Agency, is a guest of the “Back to the Future” program on the waves of radio “Echo of Moscow”. Please ask your comments and questions via SMS by sending them to the number +7 985 970-45-45. In the second half of the hour we will begin, perhaps, with the question of medicines for the disabled. Let's try to start with this question and then continue the topic of those very certificates that are now used for admission to a higher educational institution. There is a lot of interesting things here.

(News).

A. NASIBOV: The radio station “Echo of Moscow” is working. Ashot Nasibov at the microphone. This is the Back to the Future program. Today we are discussing assistance to the disabled and the so-called fake disability. Sergei Kozlov, head of the department of medical and social examination and social support of the Federal Medical and Biological Agency, is a guest in the studio. Send questions and comments to +7 985 970-45-45. There are already several questions about medications for the disabled. Could you say a few words about this?

S. KOZLOV: Well, this group of issues indirectly relates to our management, because we are organizing a medical and social examination. But, depending on the disability group, a number of categories have certain preferential conditions for receiving medications. The main group is those with disabilities who have not refused the social package - they have the right to be provided with medicines in the prescribed manner when applying to medical institutions.

A.NASIBOV: Sergey Ivanovich, in recent days the topic of so-called “fake” disabled people has been on our lips, thanks to my fellow journalists. Just today I saw a report on one of the federal television channels, where a person said that when entering state-funded institutions of higher education, there are almost entirely two categories of applicants: the category of winners of summer school Olympiads and people who have provided certificates of disability. Regarding the second half of this question, we are familiar with this situation.

S. KOZLOV: Yes, we are familiar with this situation, this is a rather painful issue for us. I believe that representatives of higher educational institutions and the press formulated the question rather incorrectly. If we put our heads together, this situation was predictable. If in past years, people with disabilities, including, like all beneficiaries, took exams on a general basis, and if they received an unsatisfactory grade, they were not accepted for enrollment, but now, you all know, we have the Unified State Examination, a new grading system students' knowledge, which was based on the old information base. According to the head of Rosobrnadzor, there are one hundred and fifty-three preferential categories for enrollment when entering a university.

A. NASIBOV: One hundred and fifty-three categories of beneficiaries for enrollment in a university?

S. KOZLOV: Yes, including disabled beneficiaries. Those statements about what managers don’t see include the fact that these are beneficiaries. And we analyzed this situation: there were multiple accusations that the number of disabled people who received disability in May and June increased, that the group of the “disabled child” category was established for several months, only for a period - this is not true. To date, we have received information from sixty-nine of our main bureaus for the constituent entities of the Russian Federation.

A. NASIBOV: Sixty-nine regions, in fact, right?

S. KOZLOV: Yes. Sixty-nine regions received data. And we have virtually no increase in the number of people on disability compared to last year. We commissioned a check to compare the number of disabled children who were assigned the category “disabled child” from 16 to 18 years old, and the groups of people 18 years old and older - these are the categories by which disability groups are established. And we have a clear ratio, we have no increase compared to last year for this period. This is the first situation where there is no increase. We also analyzed qualitatively the numerical composition. The majority of people represented in this contingent are disabled people whose disability was established at the beginning of the “disabled child” category - this was in 2004–2005. And their next examination coincided: May-June, or January. Rosobrnadzor presented us with lists of students at two higher educational institutions in Moscow: the Higher School of Economics and the Financial Academy - 80 and 42 people. We asked our institutions, the main bureaus for the constituent entities of the Russian Federation provided us with information: the main body - the disability group was established with reason. The fact that purely physically they do not see that this is a disabled person, this suggests that more than 80 percent are persons who have been diagnosed with a disability with somatic diseases. These are mainly bronchial asthma and diabetes mellitus. That is, it is not visible purely visually on a person; a few percent are people with paralysis, with cerebral palsy, something that we, ordinary people, see as a manifestation of disability. To say that the certificates are fake: we checked, we do not have confirmation for only three persons.

A. NASIBOV: From what quantity?

S. KOZLOV: Out of 122.

A. NASIBOV: Of 122.

S. KOZLOV: Yes.

A. NASIBOV: There is no confirmation of three persons?

S. KOZLOV: There is no confirmation for three persons, but we were provided with very brief information, that is, last name, first name and patronymic, and the serial number of the certificate, and the subject. So, these three people - one in Moscow, one in the Moscow region, the other from the Chelyabinsk region - did not undergo examination. We will now make a request for the rest of our institutions in the Russian Federation, because inaccurate information may have been provided; these persons could have gone to another of the regions. The abundance of disabled people, as well as in general, the number of people who have applied to higher educational institutions, is due to the fact that it is allowed to apply to several educational institutions this year. So, therefore, the list of, say, representatives of Kalmykia with disabilities, out of 16 people who applied to the Higher School of Economics, they also submitted applications to the Financial Academy. Thus, one gets the impression that a large number of people are disabled. Therefore, I would ask you to be very correct in this regard, because disabled children who have now acquired the opportunity to receive an education - we, after all, signed the convention, including, there are clauses on education without discrimination, and create equal opportunities. If today the regulatory framework allows them to go to college, then, as a rule, I want to answer that such children are more diligent, more demanding both in work and in school, therefore, the situation that is now playing out, from my point of view , very incorrect.

A. NASIBOV: Tell me, please. But did representatives of Rosobrnauka, representatives of those same universities, the same developers of new rules for admission to higher education institutions contact you before this whole situation began to develop? Did anyone consult you? Perhaps you offered your advice to the Graduate School to prevent such misunderstandings?

S. KOZLOV: I understand the question. No, there were no such requests to us. We had an appeal after this situation took place. Here is the direction through Rosobrnadzor of the lists of two universities of the Higher School of Economics. Well, in our letter that we prepared to Rosobrnadzor, we communicated these instructions to the heads of the main constituent entities of the Russian Federation: in the case of requests from representatives of universities, justified requests, confirm the validity of issuing a certificate. - Whether this certificate appears to have been validly issued, whether such a person has passed through, and whether it is false - provide all possible assistance. I can say that in parallel, the social security authorities contacted the main bureau for the Krasnodar Territory: the Kuban Academy also submitted a list of 36 people. It’s as if all decisions are also correctly justified. That is, such work is also already underway in the regions. And, if doubts arise, then, let’s say, there was a very large appeal to MSTU. Bauman, a large number, but, as a university representative said: “Not a single false certificate was identified.” And before making such statements about the dominance of false certificates, you could still contact the Federal Medical and Biological Agency.

A. NASIBOV: Do you have a database of all issued certificates?

S. KOZLOV: We can give instructions on the subjects, our subjects have this database, and we can give instructions to check in the shortest possible time. And if there is such a need to indicate passport data, place of residence, because the Russian Federation is large, and, naturally, some of the applicants and disabled people want to study at universities in the capital.

A. NASIBOV: As far as I understand, the situation boils down to the fact that this year the Unified State Exam was introduced, and all the flaws, “fleas”, shortcomings came to light - this is not only due to the large number of disabled people entering universities, but also with the emergence of one hundred percent results on the Unified State Exam in a number of cases. This is probably a trial year.

S. KOZLOV: Yes.

A. NASIBOV: Have you drawn any conclusions for yourself?

S. KOZLOV: We have drawn conclusions for ourselves, and we are preparing appeals to Rosobrnadzor to meet together and discuss the proposals being made - after all, there was a proposal to reduce the number of beneficiaries - that is, so that this does not happen to the detriment of those people we called upon to protect. There must be reasonable cuts, some reasonable approach, so that this procedure will be simplified for the next entrance exams at universities, and there will not be such a rush.

A. NASIBOV: Waldemar Green asks another question: “What areas in medical and social expertise need to be developed to eliminate the possibility of false disability?” – One thing you mentioned is the development of this very database, and checking against the databases, if you are approached. What else could it be?

S. KOZLOV: What else? This means, again, the concept provides for a change in the very procedure for referral for examination in the use of computer electronic equipment. We are now preparing a regulation based on the fact that our medical institutions should have electronic medical records and electronic outpatient records. And in the case of a referral for an examination, neither the doctors of the medical institutions nor our specialists had the opportunity to, well, to put it mildly, play pranks. Because electronic documents have an access level, and if someone entered and changed some results in one direction or another, you can always track who did it. From our point of view, the procedure for referral for examination will change again. Apparently, we are proposing to simplify the procedure - in some cases this will be done in absentia, without inviting the person, and the examination procedure itself will change, it will be simplified. – Therefore, all this will allow us to make a transparent procedure for sending an examination and obtaining results, thereby eliminating the possibility of any falsification. Literally on the tenth, as part of the delegation of the Ministry of Health and Social Development, together with Minister Tatyana Alekseeva Gulikova, we were in Krasnoyarsk, where, as a pilot project, premises were opened for a branch of the main bureau for the Krasnoyarsk Territory, on the basis of the Siberian Clinical Center. This institution is a prototype of what we want to see - large, spacious halls, a large games room, bright. To be honest, our institutions do not always meet the standards that they should have. There are no ramps, sometimes they are replaced on the upper floors without elevators, so this is now receiving a lot of attention from both the Ministry of Health of the Russian Federation and the Federal Medical and Biological Agency.

A. NASIBOV: But I also know from the municipalities that in Moscow there is also a corresponding program.

S. KOZLOV: Well, currently we have a problem with placement, and basically most of the subjects in the Russian Federation. Providing premises for our institutions is a very big issue, a very painful issue. So, in Krasnoyarsk, in addition to everything that there is a premises, we are moving to a fairly new level: information terminals have been installed, a single information service with a telephone number has now been launched in Krasnoyarsk, it is announced, a person can call by phone during business hours. We proposed that the operators of this help desk should be people with disabilities, including those with limited mobility, who have remote access - a computer, a telephone line - who are specially trained, who have, say, a legal education - there are such persons too. And regarding medical and social examination of pension provision, you can contact revolutionary services, and if the operator cannot answer any questions, then you will be switched to specialists of the appropriate level. Further implies an electronic account, and based on the results of the examination, a person will receive a login and password, can log into his personal account via the Internet, look at the results, and can instruct this service to remind him in the form of either an email or an SMS message that, say , he needs to undergo re-examination in advance - there may be different situations. If, in the event of a written appeal regarding disagreement with the decision of the institution, a person will be able to trace the movements of the complaint: when the complaint was received, who is considering it, when he received the answer. – This is what we are working on. Several subjects have now been selected to participate in the pilot project. And I think that by the time we prepare the concept, which we will have to report to the president, we will already be able to show some concrete results in implementing individual elements of this concept.

A. NASIBOV: Telephone number for the live broadcast of the Ekho Moskvy radio studio: 363-36-59, Moscow year 495. We are starting to receive your calls. Ask questions to Sergei Kozlov, head of the department of medical and social examination and social support of the Federal Medical and Biological Agency. We are discussing the so-called fake disability. – 363-36-59. The first phone calls came. Put on your headphones, Sergei Ivanovich. First call, we are listening to you. Hello!

LISTENER-1: Hello, good afternoon!

A. NASIBOV: What is your name? Where are you calling from?

LISTENER-1: I’m from Moscow, my name is Oleg.

A. NASIBOV: Listen, Oleg

OLEG: I would like to ask the guest a question. Can you tell us about the practice of teaching people with disabilities in higher education institutions?

A. NASIBOV: More specifically. What does practice mean?

OLEG: Well, how do you actually work with them in practice, how comfortable are they in learning? Because as far as I know, in fact everything rests on individual people who, on their own initiative, somehow pull these people, often despite the administration of higher educational institutions, and so on.

A. NASIBOV: Thank you!

OLEG: You're welcome!

S. KOZLOV: I have to agree somewhere that in some cases it is quite difficult for people with disabilities to study in our universities, simply physically: in some places there are no ramps, in others there are no elevators. Persons with disabilities simply cannot come and go to this university. Currently there are groups at MSTU. Bauman, who work quite widely with people with disabilities, are developing new distance learning systems. So, I have already said that the Russian Federation has signed the convention, including clauses in education. And therefore, now all steps must be taken, and the situation in a similar case must be corrected, and conditions for normal study must be created. If a person cannot attend, say, higher educational institutions, medical and social examination institutions of various forms may be offered. For people with disabilities, full-time and part-time courses can be offered, for example, home-based learning or distance learning. And now there is every opportunity to introduce these proposals into the concept, which will be aimed at improvements.

A. NASIBOV: Is this the one you are developing?

S. KOZLOV: Yes.

A. NASIBOV: Are you planning to put these provisions into the concept? Am I right?

S. KOZLOV: Yes.

A. NASIBOV: 363-36-59. Next call. Hello.

LISTENER-2: Hello!

A. NASIBOV: Hello! Turn down your radio, please.

LISTENER-2: Hello!

A. NASIBOV: Hello! Turn down your radio please!

LISTENER-2: I see. Hello.

A. NASIBOV: What is your name and where are you calling from?

LISTENER-2: Leningrad region, Kashinsky district.

A. NASIBOV: What is your name?

LISTENER-2: Georgy Alexandrovich.

A. NASIBOV: Listen, Georgy Alexandrovich.

G. ALEXANDROVICH: So, I am a disabled person of the third group, injured at work. I had it back in '62. Since 1962, I have been ordering something similar to a prosthesis from the Leningrad prosthetic enterprise. In general, in short, the function of the leg is completely impaired. I have been ordering this device since 1962. It was always without any problems, I came to the plant... Yes, I have permanent disability group 3.

A. NASIBOV: Georgy Alexandrovich, what is the question?

G. ALEXANDROVICH: I recently went to a rehabilitation program, it only consisted of me going through all the rooms. Four times I went from my village to the regional center to see all the doctors. I have to go through all the doctors so that they can write me a certificate stating that I benefit from the rehabilitation program so that I can harden this prosthesis. Do you understand what's going on?

A. NASIBOV: Do we understand?

G. ALEXANDROVICH: I asked the doctor: “What, we’ll meet in two years?” - By the way, it lasts me two years, I can still fix it myself, and so on. In two years, do I have to go through the same system again?

A. NASIBOV: Thank you, Georgy Alexandrovich. Now let's try to find out the answer. Thank you! This is where we started our conversation.

S. KOZLOV: Yes. Problems exist. And, say, with government decree 240, from April 7, 2008, it is stipulated that an individual rehabilitation program for a disabled person, a disabled child, can be developed for a year, for two, or for an indefinite period, or for children until they turn 18 years old. The rehabilitation program for the victim is currently being developed for the recovery period.

A. NASIBOV: For a period?...

S. KOZLOV: For the recovery period, the degree of loss of professional ability to work as a percentage. This means that in this case, either a year or two is established for a person. We are now preparing documents stating that the PRP (Victim Rehabilitation Program) can and should be issued indefinitely in such cases. And upon contacting the same prosthetic company, we should simply change this tuter purely automatically, and eliminate this “hellish” circle of going to medical institutions to fill out Form 88, then visiting a medical and social examination institution. A PRP will be issued, say, for an indefinite period. If, if the condition worsens, there is a need for some additional measures, he can contact the institutions himself.

A. NASIBOV: It is you who put into this the very concept that begins to operate from the 10th year.

S. KOZLOV: Well, as the government decides.

A. NASIBOV: How the government will accept it. Thank you! 363-36-59 – live telephone number. We are listening to you. Hello.

LISTENER-3: Hello!

A. NASIBOV: Hello!

LISTENER-3: My name is Natalya.

A. NASIBOV: Where are you calling from, Natalya?

NATALIA: From Moscow.

A. NASIBOV: Let's listen.

NATALIA: So I have the following problem: three years ago I completely lost my sight. Since I was 16 years old, I have been disabled in the first group of the second degree in vision. Sorry, I'm worried.

A. NASIBOV: Don’t worry, Natalya. Don't worry. We are here to answer your questions.

NATALIA: At the moment I have a second degree disability. The fact is that one eye I have is a prosthesis, the other completely does not even see light. The group is given a second degree rating. Naturally, I can’t work, I can’t get to work. I can hardly walk with a stick either.

A. NASIBOV: What kind of work did you have?

NATALIA: I am an opera singer, soloist and vocalist, I worked in the theater.

A. NASIBOV: I see.

S. KOZLOV: At the moment I am trying to find opportunities to engage in my professional activities, but it is now impossible to get a job in the Philharmonic Society. These can only be private concerts. Unfortunately, this is very bad now.

A. NASIBOV: I understand correctly, your question still concerns work for those who have disabilities?

NATALIA: Yes. This concerns not only work: I am now receiving a pension under the second group - that is, I have completely lost my vision, but nothing has changed for me. I receive the same pension as I received when I saw and when I had the opportunity to work. At the moment I am at home, I receive the same pension, I am dependent on my mother, a pensioner, who receives a minimum pension, she has a 2700 pension in Moscow. And, unfortunately, I have another question: I was given the opportunity for rehabilitation, in everyday conditions I sort of rehabilitated myself, I believe that I can adapt myself at home. Walking with a cane is very difficult, I can’t get a guide dog either, because I live in a hostel, the conditions don’t help. They give me the opportunity to travel on a voucher, but, again, the first group of the second degree does not have the right to get the opportunity to have an accompanying person. That is, I can go by myself, but I cannot have an accompanying person.

A. NASIBOV: I see. A whole range of questions.

NATALIA: The complex is very large. Unfortunately, I am now in such conditions that I cannot help but go anywhere, turn anywhere.

A. NASIBOV: Natalya, let's try to hear at least the answers to some of the questions you asked.

NATALIA: Thank you!

A. NASIBOV: First, regarding employment.

S. KOZLOV: The question here is about non-employment, here we are talking about what we talked about. That being a visually impaired person of the first group, Natalya has a second degree limitation in her ability to work, which means she receives a pension, as in the second group before. That is, there is no difference here. – This is the most vulnerable contingent, which, due to the limited ability to work, turns out that even if a person is employed and works, it turns out that we are punishing him. He can work with the first group of disability. But the rest, even if they have the second group, if they have the ability to work at the third degree level, they receive a pension like disabled people of the first group.

A. NASIBOV: Do I understand correctly? For me, as a person a little from the outside, I still want to understand for myself. Do I understand correctly that if a disabled person with a second disability group gets a job, or tries to get a job, he loses part of his income?

S. KOZLOV: No.

A. NASIBOV: Incorrect?

S. KOZLOV: Wrong. According to restrictions on the ability to work, Natalya is in the first group.

A. NASIBOV: Yes.

S. KOZLOV: But our pension is now paid according to the limitation of the ability to work; it can work in specially created conditions.

A. NASIBOV: Oh, that’s it.

S. KOZLOV: Yes. And she receives a pension, as disabled people of the second group previously received. And in accordance with the current legislation... Yes, she clearly said that these people, they are well socialized at home, in their region, but when they go for treatment to another region, they are completely independent. They can't navigate. But, according to current legislation, an accompanying person is provided not to disabled people of the first group, but to persons with restrictions on work activity of the third degree, and she has a second degree. That is, she is deprived of this right. This is what I said at the beginning: if everything works out and the draft law passes, then from the new year the disability pension will be paid not depending on the degree of restriction on work activity, but as before, according to the disability group. That is, whether she works or not, she will receive disability depending on those functional impairments in the first disability group. That is, her pension will increase and she will receive the right to have an accompanying person to go to the same health center for treatment, with the same mother, or with another person who will accompany her. – This is what we talked about.

A. NASIBOV: Sergey Ivanovich, quickly prepare your concept! Prepare a draft on new laws quickly! Judging by the number of calls and SMS messages we have received, people really need what you are doing now.

S. KOZLOV: These are very painful questions, always when it comes to health. And we are now inspecting our institutions a lot and meeting with representatives of the disabled community, meeting with citizens, and how we discuss and verify these concepts. Therefore, we will try, well, as quickly as possible, taking into account all the comments and proposals that exist, to implement them. And the point is that for people who are in trouble, in this misfortune, it would still be at least a little easier to live.

A. NASIBOV: Sergei Kozlov, head of the department of medical and social examination and social support of the Federal Medical and Biological Agency, is a guest of the “Back to the Future” program on the waves of “Echo of Moscow”. Leave your comments and suggestions on the Ekho Moskvy radio website and on Tatyana Fengelgauer’s blog. The “Back to the Future” program is aired thanks to cooperation with the public council of the state corporation Rosatom. I say goodbye to Ashot Nasibov! See you in a week! Thank you, Sergey Ivanovich, for your participation!

S. KOZLOV: Thank you! Goodbye!

Listen

Head - Chief Federal Expert on Medical and Social Expertise of the Federal State Budgetary Institution "Federal Bureau of Medical and Social Expertise" of the Ministry of Labor and Social Protection of the Russian Federation

In 1993 he graduated from the Moscow Medical Academy. THEM. Sechenov, Faculty of Medicine.

Since 2002 - Deputy Chief Physician of the Clinic of the Federal Scientific and Practical Center for Medical and Social Expertise and Rehabilitation of the Disabled. Coordinated the work of all departments that took part in the medical and social examination and rehabilitation of citizens of the Russian Federation.

From 2005 to 2010 - Deputy Head of the Federal Bureau of Medical and Social Expertise. His area of ​​responsibility included the creation of the structure and subsequent functioning of the expert bureaus of the Federal State Institution "FBMSE", interaction with the main ITU bureaus for the constituent entities of the Russian Federation, as well as the development of a unified policy...

when carrying out medical and social examination of citizens of the Russian Federation, analysis of the level and causes of disability in the Russian Federation and its individual constituent entities, coordination of work on expert rehabilitation diagnostics.

In 2003 and 2004, he took an active part in international programs of the Russian-European Foundation dedicated to the rehabilitation aspects of socially vulnerable categories of the population and disability, independent life of persons with disabilities; has internship certificates from higher educational institutions in Austria and Great Britain in relevant areas.

In 2005, 2006, he worked as part of the Russian delegation at the 6th, 7th and final 8th sessions of the UN Ad Hoc Committee on the Development of the International Convention on the Rights of Persons with Disabilities.

In 2007 and 2008, he twice took part in sessions of the UN Economic and Social Commission for Asia and the Pacific on food security, demographic development, health care financing, as well as gender issues and disability issues.

By Order of the Ministry of Labor of Russia No. 84-KR dated September 4, 2013, he was appointed to the position of Head - Chief Federal Expert for Medical and Social Expertise of the Federal State Budgetary Institution "Federal Bureau of Medical and Social Expertise" of the Ministry of Labor and Social Protection of the Russian Federation.

Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia on issues of improving medical and social examination and rehabilitation of disabled people - a doctor for medical and social examination.

In 1984 he graduated from the Smolensk State Medical Institute, majoring in General Medicine.

In 2004 he graduated from the Oryol Regional Academy of Public Service (Smolensk branch), with a degree in State and Municipal Administration.

1985 - 2001 - expert doctor, chairman of the VTEK, head of the main bureau of the Smolensk region.

2001 - 2004 - head of the state service for medical and social examination - chief expert of the Smolensk region.

2004 - 2007 - Head of the quality control department of the organization of social assistance to the population, Federal Service for Supervision in the Sphere of Healthcare and Social Development of the Russian Federation.

2007 - 2010 - Head of the Department of Medical and Social Expertise and Social Support of the Population of the Federal Medical and Biological Agency.

2010 - 2012 - Deputy Head for General Issues of Activities of the Federal State Institution “Main Bureau of Medical and Social Expertise in the Moscow Region.”

Since 2012, he has been Deputy Head - Chief Federal Expert on Medical and Social Expertise on Improving Medical and Social Expertise and Rehabilitation of People with Disabilities.

Carries out:

Coordination and control of the activities of the divisions of the Federal State Budgetary Institution Federal Budgetary Institution MSE of the Ministry of Labor of Russia, participating in the provision of public services for conducting medical and social examination and rehabilitation of disabled people;

Organization of interaction between federal institutions of medical and social expertise in the constituent entities of the Russian Federation and the Federal State Budgetary Institution FB MSE of the Ministry of Labor of Russia, including on issues of information support for the activities of institutions of medical and social expertise.

He is a candidate of medical sciences.

Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia for organizational issues

In 1991 she graduated from ShTIBO, Faculty of Technology.

Since 2003 - Scientific Secretary of the Federal Scientific and Practical Center for Medical and Social Expertise and Rehabilitation of the Disabled.

From 2010 to 2011 – head of the educational and organizational department of the educational and methodological center of the Federal State Institution “FBMSE”.

Since 2012 – Deputy Head of the Federal State Budgetary Institution FB ITU of the Russian Ministry of Labor for organizational issues.

He is a candidate of technical sciences, associate professor, author of more than 40 published scientific works, including 5 guidelines, 1 patent invention.

Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia for Economics and Economic Development Forecast

In 1997, she graduated from the Russian State Open Technical University of Transport, Moscow, with the qualification of Engineer-Economist with a degree in Economic Informatics and Automated Control Systems.

In 2010, she graduated from the Financial University under the Government of the Russian Federation with a degree in Accounting, Analysis and Audit.

1999-2003 – Chief Accountant of the Federal State Institution Blood Center of the Federal Medical and Biological Agency of Russia.

2006-2011 – Deputy Head of the Department for Expenditure Planning of Healthcare and Educational Institutions of the Planning and Financial Directorate of the Federal Medical and Biological Agency of Russia. The scope of her activities included planning and distribution of federal budget funds between subordinate institutions, implementation of current financing for the payment of salaries of institutions, the priority national project “Health” in terms of payments to the district service, emergency medical services and FAPs.

2011 – Head of the Planning and Economic Department of the Federal State Institution “FB MSE”.

2012 – Deputy Head of the Federal State Budgetary Institution “FB MSE” of the Russian Ministry of Labor.

2012 – present Deputy Head of the Federal State Budgetary Institution “FB ITU” of the Russian Ministry of Labor for Economics and Economic Development Forecast.

Deputy Head of Information Technology

In 1979 Completed full-time graduate school at the Moscow Institute of Radio Engineering, Electronics and Automation.

In 2009, preparation for the training program for senior managers DBA “Doctor of Business Administration” (Higher School of Management).

From 1979 - 1993 Research Institute of Automatic Equipment named after. Academician V.S. Semenikhin. Deputy Chief Designer for Software and Information Support, Head of Department.

From 1993 - 1997 Commercial companies. Director of Information Technology.

From 1997 - 2000 Pharmaceutical trading company "Vremya". Deputy Financial Director for Information Support.

From 2000 to 2003, RUSAL - Management Company (Russian Aluminum Management) was the management company of the holding vertically integrated corporation Russian Aluminum. Director of the Information Technology Department.

From 2003-2004 State University Higher School of Economics. Director of Information Technology.

From 2004 - 2007 SSU "Russian Federal Property Fund". Deputy Head of the Information Technology Department.

From 2007 - 2008 ANO GRP Inform-expertise. Director, Chief Designer of the State Automated System (GAS) “Management”, Chairman of the Board of Designers of the State Automated System “Management”, Deputy Head of the Interdepartmental Working Group (IWG).

From 2008 - 2010 Ministry of Health and Social Development of the Russian Federation. Director of the Department of Informatization.

From 2010 - 2014 Medical Information and Analytical Center of the Russian Academy of Medical Sciences (MIAC RAMS). Director of Information Technology.

From 2013 - 2014 Portal of the Russian Academy of Medical Sciences. General manager.

From 2014 - 2014 Intourist Hotel Group (since July 2014 Cosmos Hotel Management Company). Member of the Board, IT Director.

From 2015 to 2016 Deputy General Director of SMO Medstrakh. Director of the Information Technology Department.

From 2012 - 2016 Health modeling technologies. General Director, member of the Expert Council of the Russian Ministry of Health on the use of ICT in healthcare.

From 2016 to present Deputy Head of the Federal State Budgetary Institution FB ITU of the Russian Ministry of Labor for IT.

He is a candidate of technical sciences, associate professor, and author of 65 published scientific works.

Head of the Federal Center for Scientific, Methodological and Methodological Support for the Development of a System of Comprehensive Rehabilitation and Habilitation for People with Disabilities and Children with Disabilities – Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia

1988 - Kuibyshev Pedagogical Institute named after. V.V. Kuibysheva.

1994 - St. Petersburg State University, specialty: “Practical psychology in the healthcare system.”

2000 - Institute of Psychology and Pedagogy, Moscow, specialty
"Psychological counseling."

From 1998 to 2004 - medical psychologist at the State Institution “GB ITU for the Samara Region”.

From 2004 to 2018 - Director of the State Budgetary Institution of the Samara Region "Social and Health Center "Overcoming".

Since 2019 - Head of the Federal Center for Scientific, Methodological and Methodological Support for the Development of a System of Comprehensive Rehabilitation and Habilitation for People with Disabilities and Children with Disabilities - Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia.

He is a candidate of psychological sciences (2004), the author of more than 30 published works.

Deputy Head of the Federal State Budgetary Institution FB ITU Ministry of Labor of Russia | Honored Worker of Social Protection of the Russian Federation

In 1975 she graduated from the Ryazan Medical Institute named after Academician I.P. Pavlova with a degree in general medicine.

From 1975 to 1979 - Inspector-doctor of the Department of Medical Labor Expertise of the Ministry of Social Security of the RSFSR.

From 1979-1981 - clinical residency in the specialty: "internal diseases" Central Research Institute for the Examination of Working Capacity and Labor Organization of Disabled People.

From 1981 to 1992 - Head of the territorial department of the Office of Medical and Labor Expertise of the Ministry of Social Security of the RSFSR.

From 1992 to 2000 - Head of the MSE department of the Department for Rehabilitation and Social Integration of Disabled Persons of the Ministry of Labor and Social Protection of the Russian Federation.

From 2000 to 2004 - Deputy Head of the Department of the Ministry of Labor and Social Protection of the Russian Federation.

From 2004 to 2008 - Head of the Department for Disability Issues of the Department for the Development of Social Protection of the Ministry of Health and Social Development of the Russian Federation.

Since 2009 - head of the center for documentary support of the activities of expert bureaus of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia.

Since 07/14/2014 - head of the expert teams of the Federal Bureau, deputy head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia (Order No. 6 35-l dated 07/14/2014)

Head of the information and reference center for citizen support - deputy head

In 1984 she graduated with honors from the Moscow Aviation Institute. Sergo Ordzhonikidze with a degree in Spacecraft Dynamics and Flight Control with qualification as a systems engineer.

In 1994, she graduated from the International Academy of Marketing and Management with a degree in Finance and Credit with a Master of Science in Economics qualification.

In 2007, she graduated with honors from the Russian Academy of Public Administration under the President of the Russian Federation with a degree in Personnel Management with the qualification “Manager”.

From 1996 to 2012 - Director of the state budgetary cultural institution of the city of Moscow "GBUK DK "Astrum".

From 2012 to 2014 - Vice-Governor of the Primorsky Territory for health, education, culture, social protection, physical education and sports.

Since 2015 - Head of the Information and Reference Center for Citizen Support - Deputy Head of the Federal State Budgetary Institution FB ITU of the Ministry of Labor of Russia.

Why are children denied disability? How will ITU be reformed? Who should I complain about experts to? These questions were answered by Deputy Head of the Ministry of Labor Grigory Lekarev and Deputy Head of the ITU FB Sergey Kozlov

The Ministry of Labor continues to reform the system of medical and social examination. The Federal Register of Disabled Persons will soon be created, the requirements for medical experts will change, public councils will be created at the ITU bureau, and audio and video recording of the examination procedure will be introduced. Despite the changes, the work of ITU still raises many questions: what kind of help can seriously ill people who have been denied disability receive from the state; what is being done to improve the accessibility of the premises where examinations are carried out; why the number of denials of disability to children has increased, how corruption schemes operate in the ITU, etc.

Reforms of medical and social examination

Grigory Lekarev, Deputy Minister of Labor and Social Protection of the Russian Federation

During the monitoring, the ministry identified for which diseases the number of refusals to establish disability for children has increased. What is the reason for the increase in refusals?

Medical and social examination is a very complex procedure; it concerns the health and life of a large number of people. Each situation is unique, and the same diagnosis can have completely different effects on quality of life.

The reform of medical and social expertise began back in 2010, when the concept of its improvement and development was adopted. Until 2015, ITU Bureau experts were guided by such criteria as significantly expressed, pronounced and moderately expressed violations. At the same time, how exactly to determine the degree of severity was not prescribed, and almost always the expert made a decision on the disability group based on his professional knowledge and skills, that is, there was a certain amount of subjectivity.

It was to eliminate the subjective approach that the decision was made to develop new classifications and criteria. Their development was initially fraught with the risk that some health conditions would not be clearly defined. Therefore, we agreed with patient and public organizations that, while introducing them, we will jointly monitor their use.

This general monitoring was carried out throughout 2015. And this year we decided to conduct separate monitoring to determine the disability of children in 2015.

The monitoring results showed not only an increase, but also a decrease in the number of refusals to establish disability for certain nosologies.

For example, there used to be more refusals for celiac disease, bronchial asthma, neoplasms and autism spectrum disorders. In 2010-2011, autism was rarely diagnosed at all.

And for diseases such as phenylketonuria, congenital cleft lip and palate, monitoring showed a certain increase in the number of refusals.

This is not due to the fact that the classifications and criteria are somehow incorrect. The fact is that for some diseases they were not spelled out clearly enough, and this allowed some experts to interpret them in a more stringent manner.

In some cases during the monitoring, we had to change the decision; in absolute numbers, this is several dozen people.

Also, when analyzing the situation, we made the necessary changes and clarified the classifications and criteria. Regarding phenylketonuria, the latest changes came into force on August 9. Now experts have a clear guideline that in severe forms of this disease, disability should be established.

We are now preparing an order to continue monitoring the decisions of the medical and social examination in order to analyze the practice of 2016.

The Ministry continues to reform the ITU system; a special roadmap has been developed for this purpose. What are the main points in it?

The beginning of the reform was associated with a change in approaches to establishing the disability group, with the development of a unified normative act. The continuation will concern the scientific and methodological support of ITU. After all, new methods and methods of treatment are emerging, more accurate and sensitive diagnostic tests are being used. And medical and social expertise must justify expert decisions, relying, among other things, on the achievements of modern science. To keep up with the times, it is also necessary to improve the level of qualifications of personnel.

Another direction is organizational. We make certain efforts to eliminate the conditions for corruption as much as possible. For example, we plan to introduce an electronic queue and independent distribution of cases between expert panels into the practice of ITU. This will, in our opinion, ensure an objective and impartial consideration of cases by experts.

Nowadays, many complaints are related to the rude, insufficiently sympathetic behavior of doctors, and our task is to make the examination more transparent for the population. For this purpose, we propose to create public councils at the main ITU bureaus. Councils will be able to quickly respond to people's complaints in case of unethical behavior of experts.

We also plan to create an institute of independent medical and social expertise in order to equip people with a professional independent opinion regarding the indications for establishing disability. They will be able to use this opinion when appealing decisions of federal ITU institutions, including in court. The Institute of Independent Expertise should help resolve many questions regarding the subjectivity of decisions of a particular ITU institution.

What public councils can do

Tell us more about the public councils at ITU. How can citizens use them to influence the situation?

We assume that the public councils at the main bureaus will include regional public figures, representatives of human rights organizations, human rights ombudsmen, and children's rights ombudsmen. The council should consist of people who rely on public institutions and represent the interests of a large category of citizens.

I am far from thinking that we will be able to analyze the essence of the decision made (about the disability group) in a public council, because this is a highly professional area. But from the point of view of maintaining order, the public council can do a lot.

We want to define the powers of the public council so that its decisions have serious weight. Most likely, this will require the development of special regulations.

- Who will be responsible for improving MTU methods?

Firstly, this is the Federal Bureau of Medical and Social Expertise. This is not only the highest authority, where particularly complex cases are considered or decisions of lower bureaus are appealed, but also a clinical base. Professionals in the field of cardiology, pulmonology, nephrology, etc. work there.

Secondly, the ministry has jurisdiction over a number of educational and scientific institutions. For example, the St. Petersburg Institute for Advanced Training of Medical Experts (SPbIUVEK) is an educational organization that organizes advanced training of experts or retraining of doctors to work in medical and social expertise.

Another organization is the Albrecht Institute (St. Petersburg Scientific and Practical Center for Medical and Social Expertise, Prosthetics and Rehabilitation of Disabled People named after G.A. Albrecht).

Novokuznetsk Scientific and Practical Center for Medical and Social Expertise and Rehabilitation of Disabled People specializes in spinal injuries and issues related to vascular dysfunction. He also performs surgical operations.

These institutions have the largest concentration of candidates and doctors of medical sciences who did their scientific work specifically in the field of ITU.

- You mentioned the need to improve the qualifications of experts. What will they be taught first?

First of all, of course, this is the regulatory framework, classifications and criteria. The second is the development of an individual rehabilitation program, including the appointment of technical means of rehabilitation. The third aspect is organizational issues, personnel and logistics.

- How can a disabled person prove that a medical expert behaved unethically?

When we talk about the examination procedure, we must not forget that the expert does not make decisions alone; he is not alone in the office. There are always witnesses who can confirm or refute the fact of unethical behavior. The draft “road map” includes video and audio recording of the examination procedure. If the patient wants the recording not to be kept, he can always declare this, but the expert will not have such a right.

We understand that to store these records we will have to increase server capacity. All data will be protected, and access to it by third parties will be limited as much as possible. Even an expert will not be able to modify, change or shorten the entry. When appealing or in cases of violation of the rights of a disabled person, the recording can be used as evidence. It is planned to provide access to it by the public council, judicial or investigative bodies.

Deputy Head of the Federal State Budgetary Institution FB ITU Sergei Kozlov clarified in an interview with Miloserdiy.ru: “In many regions, audio recording is already underway. This disciplines both sides. For experts, this is a kind of guarantee that, if necessary, they will be able to prove their innocence. And if audio and video recording is not carried out by the institution, the applicant can come with a voice recorder himself. This is not prohibited. But the person must notify us about this in advance. Otherwise, the recording cannot be used as evidence of certain violations during the examination.”

- What to do if a person is seriously ill, but his disability is not determined?

Now experts from the Bureau of Medical and Social Expertise must not only explain the decision made, but also inform a person for whom a disability has not been established what support measures he is entitled to. Our main bureaus, together with regional authorities, have developed relevant leaflets.

For example, drug provision, according to government decree No. 890, applies not only to people with disabilities. There is a list of nosologies for which it is provided. Our task is to orient a person where to go, how to get help, what address, phone number, e-mail he should contact.

What to do about corruption

What work issues and gaps in legislation are usually used by employees prone to corruption?

- “Loopholes” for corrupt officials are found at almost every step, because during the examination there is always a certain amount of subjectivity. For example, this may be the recognition as disabled of a person who has no signs of disability. True, in this case, medical organizations are also involved, writing that there is a disease that in fact does not exist.

Establishing interdepartmental electronic interaction with medical organizations would help in the fight against corruption. We have such plans. In particular, we would like to receive form 088/у (referral for examination) in electronic form. Because during inspections, it sometimes turns out that such a form is missing in the file or the stamp on it is unclear.

Already now, a unified automated MTU system is a good tool. Since 2013, medical and social examination institutions have completely switched from paper examination to electronic examination.

The system records all changes made by the expert. Moreover, access to this information is available both in the main bureau and in the federal bureau of ITU. Why is this important? Sometimes during corruption schemes there is a desire to correct or change something, to make some clarifications. Sometimes experts are in such a hurry that they don’t fill out anything at all: there is a certificate of disability, but there is no file. The system records this.

I will say that the system disciplines ITU employees with regard to deadlines. As soon as a person submits an application for examination or for changing the IPRA, the deadlines established by the administrative regulations are included. They oblige us, in particular, not to delay sending information to the Pension Fund so that the disabled person immediately begins to receive payments.

This year we are completing the formation of secure communication channels for transmitting data about a person, since they are not only personal in nature, but also contain information about medical confidentiality. Now such channels have been formed between the Federal Bureau and all subjects, with the exception of Crimea and Sevastopol, which will also soon join the system.

- When is it planned to create a Federal Register of Disabled Persons, and why is this being done?

On January 1, 2017, the federal register of disabled people will begin to operate, which will consolidate a wide variety of information about disabled people.

I’ll immediately answer the question why it is needed. States that have signed the Convention on the Rights of Persons with Disabilities are obliged to establish end-to-end statistical records of people with disabilities in order to record their needs, demographic composition and develop balanced, correct management decisions. But we went a little further.

A personal account for each disabled person will be created in the federal register, in which he will be able to see at any time what support measures are provided for him, what has been done, and who is responsible for their implementation. A person will be able to compare the information posted in the register with the activities actually completed and, if he is not satisfied with something, file a complaint.

Among other things, the register will reflect information related to vocational education. We want to see how many children with disabilities enter the labor market every year. This will allow both employment services and employers to know in advance what jobs can be offered to them.

Unfortunately, we have sad statistics: half of disabled children who enroll in professional educational organizations drop out for some reason. We have to figure out why they left the race early.

The register should be operational from January 1, but not all of it, but only part of it, since not all cases in ITU institutions have yet been transferred to electronic form. I have already said that all ITU institutions have been working in a single system only for the last three years, and those paper files that are stored in archives need to be digitized.

Cases regarding disabled children will be completely digitized by January. Next year, at the second stage, we will process and upload all the rest to the register.

The premises where ITU offices are located are not always accessible to people with disabilities. What is being done about this?

The ITU network is very extensive, with about 2,600 branches throughout the country. We try to keep the main offices in their own premises. For such institutions, funds are provided annually for repairs and additional equipment.

But ITU offices are often located in rented premises or in the buildings of medical organizations, for example, clinics. Therefore, when they do not have accessibility conditions, we cannot, at the expense of the federal budget, equip them to meet the special needs of people with disabilities. In our opinion, the public council can provide significant assistance in resolving these issues through agreements with local authorities.

At the same time, it is important that local authorities understand: not only the premises must be accessible, but also the surrounding area, be it a public transport stop, sidewalks, or parking areas.

Of course, on-site surveys are carried out, especially in hard-to-reach areas and in mountainous areas. Sometimes experts have to travel many hundreds of kilometers. For this purpose, ITU offices are provided with vehicles. No one can see this work, but it is being done.

- Previously, the issue of transferring MTU to the Ministry of Health was raised. How would you comment on this initiative?

It's not up to us to decide. The Russian Ministry of Labor is vested with its powers by an act of the government. But from my professional point of view, this would not be the right move. Issues of medical and social examination are mainly in the area of ​​providing social support to a person in a difficult life situation. In addition, ITU institutions are federal institutions, and hospitals are mainly regional. Are the regions ready to assume such powers? This will be an additional burden for them - both financial and organizational.

Why are people denied disability?

Sergey Kozlov, Deputy Head of the Federal Bureau of Medical and Social Expertise

- How will the responsibilities of ITU staff change in the near future?

On behalf of the Minister of Labor and Social Protection, changes were made to the job descriptions of ITU specialists regarding compliance with the rules of ethics and deontology, correct behavior in relation to persons being examined. The duty of ITU specialists has been established to explain the expert decisions taken and inform the person about the benefits that should be provided regardless of the “disabled” status.

The ITU Federal Bureau proposed to ensure “observation of children outside the expert setting” to improve the quality of examinations. What are we talking about? About the video camera?

A child’s presence in an expert environment (undergoing an examination) is always a stressful situation for a person, and especially for a small child. Therefore, his behavior during the examination may not be exactly the same as in a normal daily environment.

But a playroom with a mirrored wall allows specialists to observe children’s actions in their usual environment and objectively assess how the child has mastered basic movements, that is, how he moves in the playroom, climbs, slides, and stands up.

At the same time, you can also note the presence or absence of shortness of breath, the level of development of fine motor skills.

Unfortunately, not all institutions have the opportunity to organize such game rooms. But most offices that accept people under 18 years of age have either a lounge with a play function or a playroom where a social work specialist, rehabilitation specialist, or just a doctor can come in and see how the child behaves. The time of such observation depends on the workload of specialists.

Often parents complain that the child is treated, he gets better, and immediately after that his disability is removed, thereby depriving him of rehabilitation and medications, as a result of which his condition worsens again.

We know of cases where parents are incorrectly informed and are led to believe that if their child is recognized as disabled, they will receive high-tech medical care without waiting. This also applies to the provision of expensive medicine.

At the same time, Decree of the Government of the Russian Federation No. 890 clearly states what assistance should be provided by the region, including citizens who are not disabled. All regions, regardless of financial situation, must comply with this government regulation.

It must be remembered that medical care is provided on the territory of the Russian Federation in accordance with the compulsory medical insurance program (basic and territorial) and rehabilitation measures should be carried out for everyone who needs it, without reference to disability.

Moreover, high-tech methods of medical rehabilitation are used to improve the quality of life of a patient with a chronic disease and are aimed at preventing disability.

Most often, parents of children with certain diseases express concern about denials of disability. For some, decisions have already been made, for example, on phenylketonuria. What about others?

Decisions have also been made regarding cystic fibrosis, as well as congenital cleft lip, hard and soft palate. After they came into force, the tension subsided.

On instructions from the ministry, we continue to develop common approaches when conducting medical and social examinations of children. The Federal Bureau has now prepared changes and additions to the rules for recognizing a person as disabled regarding the timing of the determination of disability. In our opinion, it would be correct to create another list of diseases and irreversible nosological changes, in which the category of a disabled child would be established for a period of five years, until the age of 14 or 18 years.

For example, with Down syndrome - immediately up to 18 years of age. For diseases such as cystic fibrosis, diabetes mellitus - up to 14 years. With such serious illnesses, there is no point in undergoing a medical and social examination every year.

Parents of children with diabetes believe that at the age of 14 it is still impossible to independently control the disease.

When conducting a medical and social examination of a child with diabetes, in each specific case the expert decision is made strictly individually. The examination is carried out on the basis of a comprehensive assessment of health status, analysis of social, psychological, and pedagogical data.

In the age group over 14 years, the influence of the puberty period with the peculiarities of hormonal regulation of metabolism and psychological aspects of adolescent behavior, affecting the ability to independently control the course of the disease and maintain optimal blood sugar levels, is taken into account.

During this period, children can behave completely differently. But we also rely on the records of observing doctors. If they indicate that the child calculates and makes injections independently, we take this into account.

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