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Wednesday, March 26, 2008

Annals of Russian "Healthcare"

The Washington Post reports:

When a new cardiac unit opened at the municipal hospital here last month, Russian Health Minister Tatyana Golikova sent a letter of congratulations, calling the new facility a "vivid example" of the medical community and private donors working together to improve the lives of ordinary Russians.

The good feeling didn't last long.

Three days after the unit's opening, Tarusa's mayor fired the hospital's head doctor and sent in the police to check for possible fraud in the refurbishing of the hospital, all of which had been financed privately.

Doctors at the hospital said the crackdown was the culmination of a two-year campaign by local officials to wrest control of tens of thousands of dollars that were to transform the once-crumbling hospital into a model of preventive medicine in a rural community.

The hospital funding was a bright example of the growing philanthropy of Russia's wealthy. But it was also a window into the stifling role Russia's bureaucracy can play, even in a sector deemed a national priority by President-elect Dmitry Medvedev.

"Every improvement caused difficulties," said Maxim Ossipov, a Moscow cardiologist who works three days a week at the Tarusa hospital. "Bureaucrats have to fight for their existence, and if they don't control something, then they are no longer bureaucrats. They are a real disaster for today's Russia."

Tarusa is a river town of 9,000 people about 85 miles south of Moscow. Popular with Muscovites, such as Ossipov, who maintain second homes in the region, the town's summer population swells to 80,000.

In an interview, Ossipov said he started volunteering at the 135-bed hospital in 2005 as a route back into regular practice, which he had abandoned in the 1990s to open a medical publishing company in Moscow. He had old ties to the town -- his grandfather, also a doctor, was exiled there after a prison camp term during the repressive rule of Joseph Stalin.

"By Western standards, it was not a hospital at all," said Ossipov, who was a research fellow at the University of California at San Francisco in 1991 and 1992.

Ossipov said he began turning to friends and colleagues for equipment, such as defibrillators, and even basic drugs to improve the quality of care. At the same time, the Russian government's $6.5 billion spending plan to improve health care brought a much-needed ambulance and pay increases for the hospital's medical staff.

The effects were quickly apparent, doctors at the hospital said. Its mortality rate was halved, and the death rate in Tarusa from heart attacks, a major killer in Russia, was cut by five-sixths, according to regional government figures.

"I have problems with my heart and I remember when they couldn't help me here and they would immediately sent me to Kaluga," the provincial capital, said Pyotr Dovbnyak, a 65-year-old pensioner. "Now they call me on the phone and invite me in for examinations."

In 2006, the hospital was offered a new X-ray machine through the "national projects" led by Medvedev. But the hospital's electric wiring was unable to support the new equipment. Mayor Yury Nakhrov refused to upgrade the hospital's power supply, the doctors said. Irina Oleinikova, the head doctor, reluctantly turned down the X-ray machine.

Nakhrov was reprimanded by the regional administration for "frustrating" the national projects, and he, in turn, reprimanded Oleinikova for "safety violations" and for failing to properly treat a patient. Oleinikova appealed to the courts and the reprimands were overturned, which she said infuriated the local administration.

Nakhrov was not available to answer a reporter's questions; officials in his office said no one else could comment.

In the meantime, Valery Balikoyev, a Moscow businessman, committed approximately $130,000 to renovate one of the hospital's wings for the new cardio-therapy unit. According to the doctors, Nakhrov told Oleinikova her "sponsor" should visit him to introduce himself. She declined to make the introduction. Nakhrov also told her she should move the town's pharmacy -- which was located on a prime piece of real estate -- into the hospital. She again refused.

In another example of bureaucratic pressure, Ossipov said that an official, whom he wouldn't name, suggested overbilling -- doubling the amount on an invoice for some new equipment that another wealthy sponsor was willing to buy, so that the balance could be used for other purposes. Ossipov declined.

Researchers at the Russian Academy of Sciences have estimated that corruption absorbs about 35 percent of all health-care spending in Russia. Ossipov said the hospital deliberately never accepted cash donations, only equipment or physical improvements, to avoid any suggestion that its personnel could benefit financially.

"My language is as impossible for them to understand as theirs is for me," Ossipov said of the local officials who, by his account, found it hard to believe that the doctors had no personal stake in the improvements.

Local officials eventually tried to close the hospital on grounds of fire safety violations, according to Oleinikova, but a higher court blocked the effort.

On March 3, Mayor Nakhrov fired Oleinikova and ordered a criminal probe into the construction of the cardiac unit. Ossipov, Balikoyev and others appealed to the regional governor, who ordered a separate investigation. He also recommended that that the local council fire Nakhrov, but it refused.

The mayor later checked into a Moscow hospital where he could not be reached by either investigators or the news media; Oleinikova was reported Thursday to be headed back to her job after the investigation by the regional government.

"We are taking the whole thing as a slap in the face," Ossipov said. "Small bureaucrats don't believe in philanthropy and they can't stand any independence on their own territory."

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