Presumption of Guilt

beglovPetersburg Governor Alexander Beglov (in mask, on right) visited the city’s Maternity Hospital No. 9 on May 3. Photo courtesy of Sever.Realii

Beglov Explains Outbreak at Vreden Center Through Failure of Employee to Self-Isolate After Returning from Turkey
Bumaga
May 1, 2020

Speaking on TV channel 78, Governor Alexander Beglov claimed that the source of the coronavirus outbreak at the Vreden Traumatology and Orthopedics Institute in Petersburg was an employee who had returned from Turkey and failed to self-isolate.

“Again, we’re talking about conscientiousness, about people’s other qualities . . . One employee at the Vreden Institute came back from Turkey. By law, he should have stayed home fourteen days in self-isolation. He went out on the fourth day, engaged in certain activities and, consequently, brought the infection into the hospital. And a large number of people were infected, on the order of 150 people. Naturally, the hospital had to be closed,” Beglov said.

Beglov noted that during this time, a large number of patients were discharged and released to other regions of the country, thus “spreading” the coronavirus.

The governor did not directly respond to a question about whether any measures would be taken against the employee who did not self-isolate. “The law stipulates criminal liability. We have already opened five criminal cases. This is no a joke, ” Beglov said. The governor also cited the closure of three maternity hospitals where women in labor “forgot to warn” staff about their recent trips.

The Vreden Institute of Traumatology and Orthopedics has been closed for quarantine since April 9 due to the coronavirus. Doctors reported a lack of personal protective equipment. There is no official information about the number of cases, but according to media reports, sixty out of 260 employees tested positive. TASS reports that 300 people at the hospital have been infected.

[. . .]

fontankaPhoto by Mikhail Ognev. Courtesy of Fontanka

Presumption of Guilt: Petersburg Doctors Warned They Should Die from the Coronavirus Correctly
Alexander Yermakov
Fontanka
May 1, 2020

Not all doctors infected with COVID-19 will receive financial compensation from the city. The municipal public health committee has made it possible to shift responsibility to health workers and thus save the municipal government money.

The Smolny [Petersburg city hall] has given head physicians at the city’s hospitals the right to decide whether health professionals were “correctly” infected with the coronavirus or took ill due to their own negligence. Occupation health and safety experts see this as an acute conflict of interests and predict a wave of refusals to make cash payments to people whom President Putin has compared to soldiers fighting on the front line.

The Smolny decided two weeks ago on the amount of lump-sum payments to health professionals who have suffered while treating patients with COVID-19. The death of a hospital or ambulance employee has been valued at one million rubles [approx. 12,000 euros]; disability, at 500,000 rubles [approx. 6,000 euros]; and infection with no particular health consequences, at 300,000 rubles [approx. 3,700 euros]. Thirty million rubles [approx. 368,000 euros] have been allocated for this purpose. The small matter of outlining the procedure for determining whether a health professional was a victim of the virus remained. The task was assigned to the city’s public health committee.

While the committee has been designing this procedure, Petersburg health professionals began contracting the coronavirus in large numbers and dying. As of April 30, around 250 cases of COVID-19 had been registered among the city’s doctors, paramedics, and orderlies.  If each of these cases had resulted in compensation, Smolny’s thirty-million-ruble limit would now have been surpassed: eight million rubles would have been paid to the families of the dead, and 75 million rubles to infected health professionals [for a total of approx. 981,000 euros].

A few days ago, a draft order appeared on the public health committee’s website, establishing the procedure for recognizing a medical worker as a victim. The document indicated that the families of those who died with a confirmed diagnosis of COVID-19 would automatically receive payments.

On Friday, April 30, the final version of the document was published on the Smolny’s website. A significant addition has been made to it. The death certificate must cite the novel coronavirus infection as the cause of the medical worker’s death. If the medical worker died of concomitant diseases, their family cannot claim compensation. As cynical as it might sound, the family of Sergei Beloshitsky, an emergency room anesthesiologist at the Alexander Hospital, would not have received the million rubles promised by Governor Beglov had Beloshitsky died after April 30. The death certificate lists pneumonia-induced cardiopulmonary failure as his cause of death.

“This item [on the exact cause of death] was added at the approval stage of the draft municipal government decree ‘On the procedure and conditions for providing lump-sum payments to injured medical workers’; it is a clarification,” Fontanka was informed by the public health committee.

According to the committee’s order, payment to infected health professionals is almost entirely contingent on the opinion of the head physician at the institution where the person works.

Medical workers must append a whole stack of documents to the compensation application, including—and this will be the main obstacle to receiving money—a “certification of injury caused by rendering assistance to sick patients.”

For a medical worker to obtain this certification, he or she will be subjected to an investigation carried out by a commission convened at the hospital where the infected person works. The commission will include the hospital’s deputy head physician, the worker’s immediate supervisor (for example, a department head), someone from the hospital’s occupational health and safety office, and a trade union member.

The hospital’s head physician will have to approve (or deny) the certification of injury.

The investigation must not merely confirm or deny that the health worker contracted the coronavirus in the line of duty (and not in the subway), but also name a specific factor, for example, violation of sanitary regulations, working conditions, failure of ventilation systems, or lack of personal protective equipment. In addition, the commission has the power to determine in percentages the degree of the medical worker’s own liability.

For example, on April 30, Sergei Sayapin, an emergency room anesthesiologist at the Pokrovskaya Hospital, filed an application to be certified injured as a result of having treated a patient with a confirmed case of COVID-19. Sayapin was infected and underwent treatment at the Botkin Infectious Disease Hospital.

The Pokrovskaya Hospital will investigate this claim. The investigation’s findings will be approved (or denied) by the head physician, Marina Bakholdina. Sayapin claims that he was infected due to a lack of personal protective equipment, which was allegedly not provided by Bakholdina. In order for Sayapin to be entitled to compensation in the amount of 300,000 rubles, his hospital’s head physician must declare herself guilty.

“No hospital director in their right mind will take responsibility and sign a certificate recognizing their employee as a victim,” said Oleg Shvalev, an occupational therapist and associate professor of occupational medicine at the Mechnikov Northwestern State Medical University. “Under the usual procedure for certifying occupational illnesses and injuries, an independent commission headed by an official from Rospotrebnadzor runs the investigation.”

It is obvious that head physicians are not interested in recognizing medical workers as victims. Rostrud (the Russian Federal Labor and Employment Service) has already proposed deeming each case of coronavirus infection an acute occupational illness, running an investigation (involving Rospotrebnadzor), and holding the management of medical institutions accountable. It is entirely possible that while a hospital’s own commission could deem individual medical workers guilty of their own infections (thus depriving them of the right to compensation from the Smolny), the social security disability assessment board would find the hospital liable.

A source at city hall told Fontanka that the city had already clearly decided on its method for counting COVID-19 cases and did not plan to change it.

“Our statistics include people who died from covid, not with covid,” the official said. “There are dozens of instances when patients with confirmed cases of the coronavirus have had cancer, heart failure, or pneumonia listed as their cause of death. The same method will be applied to medical professionals.”

The Petersburg public health committee confirmed that the death of every medical worker would be investigated by the commission for the analysis of deaths from influenza and severe forms of other SARS, including COVID-19. Only if the death certificate lists the cause of death as infection from the novel coronavirus will families of the deceased be eligible for compensation.”

Fontanka asked the Moscow health department how they keep their statistics. All patients with a positive test result for the novel coronavirus infection and a confirmed diagnosis of pneumonia are counted in Moscow. “The cause of death could be another concomitant disease, but it does not matter for our statistics,” an official at the department added.

According to the head of the working group on combating the coronavirus, Yevgeny Shlyakhto, director of the Almazov Medical Center, only half of the healthcare professionals in Petersburg who have fallen ill with COVID-19 contracted it directly through their work. Most likely, infected doctors working in non-specialized hospitals will not automatically be covered under the Smolny’s compensation order.

Thanks to Dmitry Kalugin and Vadim Klebanov for the heads-up. Translated by the Russian Reader

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