Olga Romanova: How “Law Enforcement” Works in Russia

calvey
Michael Calvey in court. Photo by Maxim Shemetov. Courtesy of Reuters and Republic

“We Give You Serebrennikov and You Give us Calvey”: How Law Enforcement Works
Olga Romanova
Republic
May 13, 2019

“Who would make the decision about your arrest?”

“My colleagues would betray me, but they would vet it with my bosses.”

“What about Vasya [a big businessman]?”

“Cops, the economic security squad. It’s enough for the word to come down from the district office to grab him. Vasya is a respected person. He’s a thief.”

“And me?”

“You’re an enemy of the state. If the neighborhood cops can decide to arrest Vasya, the Secret Chamber, so to speak, would have to give the orders to arrest you. The decision to arrest you would be made by no one lower ranked than Bortnikov’s deputy, although you’re naked and barefoot, and no one would ask the prosecutor’s office or the Investigative Committee to go after you. It’s creepy and pointless.”

This should give you an idea of the conversations I have with my acquaintances in the security forces nowadays. It helps to do business with people who know the score. None of them is surprised when you ask them who would arrest someone, how they would do it, and when they would do it. Everything would have been planned long ago, and there are no illusions. If a person has to be placed under arrest and charged, it is going to happen. If they do not need to be indicted, they can be kept in custody for a while. No one remembers, even for appearance’s sake, that there are courts in Russia, and courts decide whether to remand someone in custody after hearing arguments by all the interested parties. Everyone knows the decisions are not made in court.

Who Makes the Decisions?
Who made the decision to arrest Kirill Serebrennikov? Who decided to let him go for the time being? Who arrested Michael Calvey and the employees of Baring Vostok? Who let them out of jail? Why? Who made the decision to arrest Mikhail Abyzov?

There is no one with whom you can talk about these cases.

This is not quite true. My sources in all the law enforcement and security agencies, who can be frank with me as long as they remain anonymous, talk to me about these cases, too, but they look really worried when they do.

Rank-and-file law enforcement officers are confused. They do not understand why someone decided to back off the Serebrennikov case so abruptly and quickly. The train was rushing the director and filmmaker towards a sentence of the four years or so in the camps when a powerful hand jerked hard on the brakes. The passengers jumped off the train, of course, for they didn’t want to keep traveling in that direction, but the trainmaster, driver, and conductors were completely at a loss.

What should they do with the next train and its contingent of VIP passengers? Should they railroad them, as they were ordered to do, or should they avoid hurrying the case? After the emergency brake has been pulled, everyone emerges with injuries and bumps. Some of the crew were counting on promotions after they had wrapped up such a big case. Other members of the crew were acting on orders from a celestial. He will not forgive them because now they know there are tougher celestials in the system. He cannot forgive the people involved in the case for knowing that fact nor can he forgive the other celestials for intervening. The passengers could not care less. Either they get to where they are going or they do not get there, but the crew is always aboard the train.

True, a smart alec from the Investigative Committee told me something interesting about the procedural aspect.

“Why is everyone so angry? The Serebrennikov case was sent back to the prosecutor’s office, so what? You saw that the court ordered a forensic examination. The first forensic examination was really crooked. The judge in the trial of Serebrennikov’s accountant, Nina Maslyaeva,  wondered why everyone was so glad. Serebrennikov’s case would now be sent back to the prosecutor’s office because his circumstances are the same as Maslyaeva’s. You are mixing up cause and effect. The judge in the Maslyaeva case cannot reach a verdict because he understands the outcome of the forensic examination, which was the same as in the Serebrennikov case, will now be different, and Maslayeva will have to be re-indicted in the light of the new forensic examination in the Serebrennikov case.”

Translated into ordinary language, he means the case can still go any which way. Procedurally, all the cards are still on the table, and the haggling could continue. Things could go one way or the other. The powers that be could change their minds and send Serebrennikov to prison, but they could also let him go. They could arrest him again and send him down. The statute of limitations is a flexible thing.

Somewhere above the clouds, the thunder gods fight over the case. Invisible to the world, they communicate with ordinary people by making motions to conduct additional forensic examinations. Ordinary people make of it what they will. Police investigators are also part of the rank and file, part and parcel of Russia’s unwashed masses.

In ordinary times, this is not what happens to ordinary defendants in ordinary cases. Everyone would have gone down five years each per capita, and no would have batted an eye. In this case, the decisions are obviously political. Look who made the decision! Who telephoned whom? What levers did they use? Who or what did they offer in exchange? Freebies are for freaks, after all. We will return to this subsequently when we discuss other factors.

If the boring procedural hypothesis made by my anonymous source at the Investigative Committee is right, events should unfold as follows. The authorities will get the results of the new forensic examination in the Serebrennikov case. If the total damages are less than was claimed earlier (or, say, there were, miraculously, no damages at all), the charges against Serebrennikov and the other defendants will be dropped right in the courtroom. If, on the contrary, the sum of the damages is more or less hefty, a million rubles, at least, the defendants will be found guilty and sentenced to prison. Then you can appeal the verdict wherever you like.

No one would ask why a particular ruling was made. No one would ask what happened. Why are some people treated one way, while others are treated another way? The foot soldiers of law enforcement know the score. But when they do not know the score, they know it is better not to ask whether a mistake has been made but to follow orders.

How Things Go Down
The Calvey case bears a strong resemblance to the case against Vladimir Yevtushenkov. Yevtushenkov failed to take the hints. He was told directly what to do but refused to hand over his business. Then he was arrested and given a good talking. He and his captors came to an understanding. He was released and his business confiscated. Unlike Yevtushenkov, however, Calvey is as poor as a church mouse. Compared with Yevtushenkov, that is. Calvey does not own a Bashneft, after all.

The foot soldiers in the security forces have not been particularly surprised about how the Calvey case has unfolded. They expected something of the sort. They expected him to “cash out,” as they call it, and they believe he has, in fact, cashed out. They are uninterested in what this meant. It is not their war, and the spoils are not theirs to claim.

We should look at this more closely.

My source, whom I  trust, albeit warily, explains the obvious to me.

“All cases are business as usual except the cases in which there a phone call,” he says.

I have two questions for him right off the bat. What does he mean by “business as usual”? Who usually makes the  “phone call”?

He explains that people who follow high-profile cases and comment on them fail to take one important factor into account in their arguments. The high-profile cases are handled by another agency as it were. They involve the same players: the prosecutor’s offices, the courts, the remand prisons, and the Investigative Committee. All of them realize, however, when they are handling a special case involving the interests of high-ranking officials and elite businessmen. In these cases, they need to keep close track of which way the wind blows.

The bulk of cases are “mundane.” There is a huge number of such cases, and they can drag on forever. Take, for example, the Baltstroy case, the case of police anti-corruption investigator Boris Kolesnikov, and the case of ex-deputy culture minister Grigory Pirumov, cases that everyone has forgotten, and the Oboronservis case, the cases of the banks implicated in the so-called Russian Laundromat, and the case of Alexander Grigoriev, the man, allegedly, behind the Laundromat, who was mixed up with Putin’s cousin Igor Putin. New indictments in these cases are made all the time. More and more defendants are convicted in these cases and sent down. It never stops, but public interest in these cases is almost nil.

There are cases that collapse, however. Why does this happen?

Why was the case of ex-economics minister Alexei Ulyukayev not reviewed on appeal? Why was his prison sentence not reduced by four years during the sentencing appeal hearing? Does anyone know why? Perhaps the political spin doctors get it, but Russia’s law enforcers do not have a clue. What they understand is when an order comes down to reduce a sentence and when it does not. They leave the blabbing to the spin doctors.

Alexei Fedyarov is a former prosecutor from Chuvashia. Nowadays, he is the head of our legal department at Russia Behind Bars. He gave me permission to quote him.

“It happens. A case is going fine. In the morning, you have a meeting with your superiors. They tell you everything is great, keep pushing, you’ve got the bastards. I was handling a case against the management of the Khimprom factory in Novocheboksarsk. At briefings, I was told my group and I were doing a great job. We had done the initial investigation beautifully and now it was time to detain the suspects, remand them in custody, and put them away. I went to my office, where the city prosecutor was waiting for me. He asked me to hand over the case file. I gave him the case file and he told me it was over, I should forget it. He was personally going to deliver the case file to the head prosecutor of the republic and that would be the end of it.  There would be no supporting documentation or anything. The case really did disappear, although an hour before I had been told to push it.

“During that hour, the head prosecutor of the republic had got a message from the Russian Prosecutor General’s Office. A call from a deputy prosecutor general was enough for them to take the whole thing back, despite the fact it was a big, interesting case involving illegal wiretapping throughout the company and even the local police department and the tax police office. We had found tons of recorded conversations: they recorded everything. They were trying to protect themselves and investigate other people.”

Sources of the “Telephone Call”
How does the “telephone call” work?

The “telephone call” is a conventional name for the outcome of lengthy negotiations. We see only the reflection of this process: Calvey’s arrest, his transfer to house arrest, Serebrennikov’s arrest and his release on his own recognizance, Abyzov’s arrest.

I am going to quote my anonymous source verbatim. In this instance, the way he says what he says is as important as what he says.

“Anyone can hit the brakes. It could be Bortnikov. It could be Chaika. But it is the outcome of agreements among people, not an arbitrary decision. They do not do things that way. Maybe new factors have been brought into play, but there has to be someone who wants to negotiate on behalf of the accused person, who appeals on his behalf. He would be told, ‘Okay, fine. But you have to give us such-and-such in exchange.” Then it is a matter of talking with Lebedev [Chief Justice of the Russian Supreme Court] and everything is put into reverse. It could be like, ‘We’ll give up Serebrennikov if you take the heat off Calvey.’ You see, the siloviki are not all on the same side. There is no longer one side. Not even everyone in the FSB or its departments is on the same side. The Constitutional Department fights with the Anti-Terrorism Department. It’s the same thing in the prosecutor’s office and the Investigative Committee. In the Investigative Committee, there is the group loyal to Bastrykin and then they are the boys from the North Caucasus. There are also the guys from Tatarstan and Bashkortostan, who are filthy rich but live orderly lives and are also capable of getting things done.

“Anything goes at this level. Why are you inclined to exaggerate how this works? Number One basically does not care about this stuff.”

I should try and explain.

The Investigative Committee and Prosecutor General’s Office are still at serious loggerheads. The conflict has even intensified. It is a personal conflict and a clash of business interests and a fight over resources. The amount of resources has not grown. On the contrary, there are palpably fewer resources. Relations between the Investigative Committee and the Prosecutor General’s Office are currently not just strained, they are intolerably strained.

In court, they take the same side, but those are the rules of the game. If a case has gone to trial, you cannot come out against your colleagues: you would be digging yourself a hole. As a prosecutor, you did not reverse the indictment. You were involved in prolonging the suspect’s custody in remand prison, and you seconded all the motions made by the case investigator. The case investigator, of course, always plays along with the prosecutor. In criminal trials, they are the prosecution.

Even the “groundlings” find it easier to make a deal. The big bosses may be at war with each other, but down on the ground, the workhorses plow away and know the score. There is no love lost for Bastrykin among Investigative Committee officers just as prosecutors are not fond of Chaika. But it is like this everywhere: people like their bosses only when they are standing right in front of them. There is a certain difference, however. Chaika and his deputies at the Prosecutor General’s Office are all former case investigators. They have paid their dues. Bastrykin does not have this background: he is not a criminologist. Their workhorses thus complain about different things. Bastrykin’s underlings complain about incompetence, while prosecutors grouse about their bosses’ passion for business.

The Investigative Committee and the Prosecutor’s Office have an innate tendency to divide up into clans, which are defined geographically: there are Circassian clans, Bashkir clans, etc. They are local fraternities of sorts, and they do not go away when someone moves and transfers to a new job. The clans are often at odds with each other. This is something you must always factor in when dealing with Russian law enforcers.

Internal disunity has also been increasing day by day in the conglomerate known as the FSB. Even mid-level officers have trouble getting along. For example, M Directorate, which oversees the Interior Ministry, the Federal Penitentiary Service, and so on, is often combined, in many regions, with the Economic Security Department, and there is a big problem with compatibility in terms of the cases they pursue. But there is also K Directorate, aka the 8th Directorate, which oversees banks and the financial system. Regarded as “blue bloods,” they are strongly disliked by other FSB officers.

“A guy from K Directorate worked out at the World Class gym where I worked out. His driver took him to work in a Maybach. Now he has transferred his membership to the gym in Zhukovka. A membership there costs 600,000 rubles a year [approx. $9,500] and the swimming pool is filled with mineral water. ‘My clients work out there,’ he said to me, ‘so I moved my membership there,'” an athlete and retired FSB veteran told me.

The FSB’s Constitutional and Anti-Terrorism Departments are a whole other story. They oversee everyone who has any dealings with the opposition and they inspire no confidence whatsoever. For example, I am flattered Kirill Serebrennikov and I are overseen by the same FSB officers. But we are overseen by officers from the Constitutional Department, while the Anti-Terrorism Department are working-class blokes who specialize in completely different cases. They were merged into a single directorate in which the Anti-Terrorism Department, supposedly, is subordinated to the Constitutional Department. Naturally, they cannot stand each other.

What about the top bosses? They are busy with other things, which is why they are in charge. They are busy with politicking and intrigues. These quiet squabbles surface as cases like the recent arrest of Colonel Kirill Cherkalin from K Directorate. Did he really take a bribe? Maybe he did: anything is possible. It is more likely, however, he was arrested as part of a war for turf, turf that has been shrinking exponentially with every passing day. Fattened cows no longer graze on this turf: there are basically no cows left to milk. The entire herd has been devoured.

What to Expect
I will quote in full the monologue my anonymous source delivered when I asked him about the future. I do no think there is any need to decode it.

“The turbulence will increase. Until all the issues with Russia’s natural gas and its transit through Ukraine are settled, Number One won’t have time for things happening here. They have been outsourced to our guys. They have been told to go and bite everyone’s heads off. They have temporary permission to do it.

“But there are few fat cats. All the money has been sent abroad. Everyone is living on loans. All of Rublyovka is up to their ears in loans. There will be searches in some people’s homes, and some folks will be ripped to shreds. There will be a lot of this kind of stuff this year. The government will be purged, too. People love this sort of thing.

“Abyzov made no impression on anyone. No one understood what it was about. The only thing people will remember is that he offered to pay a billion rubles in bail. No one will forget him and the billion rubles.

“Circumstances are such that even the system’s insiders cannot make any forecasts. The settings are changing constantly. There is no stable paradigm.

“It is like with water. At room temperature, we understand how it acts. You can stick your finger in it and blow on it. But now it is being warmed. It has not boiled yet and vaporized, but you do not know what to do with it and how it will act next.

“The tax police are busy with major shakedowns. They are kicking everyone’s ass. When we ask them why they are doing it, they reply, ‘Crimea is ours, and our job is to get people to make additional payments.’ But additional payments and penalties are different things, especially penalties meant to wipe people out. They are going after people’s last rubles.

“I have a friend who works as a business court judge on tax cases. Whereas earlier, when she would be asked why she reduced a claim from one hundred million rubles to ten million, she could have an off-the-record chat with the head judge of the court and explain she was doing it so the person could keep their business, such chats are not kosher nowadays.

“Hard times are coming. The Syrian project fell through, and Russia failed to get control of the pipeline going through Turkey. Nothing that was planned in Syria has worked out, and both the South Stream and Nord Stream projects fell through [sic]. Nor will they replace the Ukrainian transit, although that was the goal. But it impossible to exit Syria, and now they have butted their noses in Venezuela. Their luck has been bad. People’s nerves are on edge up top.

“Number One is interested only in oil and gas, and so other parties have got involved in the game. If it were up to Number One, he would crush everyone and no one would breathe another word. He probably decided the lower ranks should take care of this stuff themselves. The very top bosses are not concerned with these matters at all right now. The lower ranks are running things and a huge amount of haggling has been happening.  We are witnessing a classic turf war.”

Welcome to the magical world of turbulence in a pot of boiling water.

Olga Romanova is the director of Russia Behind Bars, a charitable foundation that aids Russian convicts and their families, people who have been victimized by the Russian justice system. Translated by the Russian Reader

Open Left: Moscow Doctors Talk about Their Work-to-Rule Strike

“Two of us covered eight precincts for a week”: Moscow doctors talk about the work-to-rule strike
Alexander Grigoriev
April 22, 2015
Open Left presents a unique set of interviews with the doctors involved in the first protest in the Moscow medical care system since 1993
openleft.ru

italian 1Medical workers in Moscow have been on a work-to-rule strike since March 24. The work action has been sparsely supported: around twenty people in seven of the city’s medical centers have been involved. They oppose the downsizing of staff, regular unpaid overtime, and workplace management that is detrimental to standards of good medical care.

The current work-to-rule strike is the first in Moscow since 1993, when ambulance staff protested. Although it cannot be said that there had been no problems in the Moscow and Russian healthcare systems all this time, the situation has deteriorated markedly in recent years, and this is due primarily to ongoing reforms by the government.

Since Soviet times, clinics and hospitals have been funded by the state. This meant that all costs for medical care were covered. In addition, since the 1990s, compulsory health insurance (OMS) funds have been operation in Russia. They are financed by contributions from employers. Currently, the size of each contribution is 5.1 percent of a person’s salary, with the maximum salary capped at 624,000 rubles a year. Higher salaries thus contribute the same amount of money to the OMS funds as salaries of 624,000 rubles. The idea is that the OMS funds allocate money to cover costs incurred by medical facilities in providing care to patients. However, rates for services have been set disproportionately low. For example, a chest X-ray is estimated to cost 275 rubles whereas the real cost is around one thousand rubles. Costs have not been covered by OMS funds, so the entire system has continued to be financed by the state.

2010 saw the passage of the basic law governing compulsory health insurance. The idea was that the money from the funds would “follow” the patient, and medical care facilities would be financed from OMS funds every time they provided care to patients. At the same time, rates for services were not changed, so clinics continued to cover the shortfalls that arose with money from the state budget.

When Putin signed the so-called May decrees on May 7, 2012, it became clear that major changes were coming to the existing system. According to one of the decrees, by 2018, salaries of doctors had to be increased to a level twice the amount of the average salary in each region, but there was no question of correspondingly sharp increases in budgetary allocations. On the contrary, spending on health care has been falling with each passing year. In 2014, the economic crisis further exacerbated the shortage of funds.

The Moscow city government continued to finance municipal medical facilities under the old scheme for quite a long time, but gradually reduced its budgetary allocations. Beginning in late 2013, Moscow authorities researched the municipal health care system in order to identify possible options for redistributing costs. Several options were suggested: casualizing some employees, combining several positions into one and thus preserving the old system of positions and salaries, and increasing the specialization of hospitals.

italian 2Queue at a Moscow clinic

Officials settled on the option of reducing the number of facilities in two stages: merging facilities and turning some clinics and hospitals into affiliates of other clinics and hospitals, and subsequently eliminating some of them altogether. Conversion of a clinic or hospital to an affiliate implied the dismissal of specialists who were already officially on staff at the main facility or other affiliates. It was announced that a total of twenty-eight facilities would be closed, including fifteen hospitals.

All this took place amidst protests in the regions, where the situation has been even worse. For example, in 2014, ambulance staff in Ufa twice went on hunger strike. Their demands were generally similar to those being made now by the work-to-rule strikers in Moscow: increased staffing and additional pay for additional shifts. The government of Bashkortostan has repeatedly claimed that it fulfilled all the protesters’ demands, but in March of this year, the hunger strike in Ufa kicked off again and has continued for over a month.

In November and December 2014, there was a series of rallies against healthcare reform in its current form, staff downsizing, and hospital closures. According to organizers, up to ten thousand people attended the largest of these rallies in Moscow. Not only health professionals came to the rallies but also members of various political and grassroots organizations. However, the Moscow authorities chose not to enter into negotiations, claiming it was not medical workers who organized the rallies but outside forces. The demands of the protesters were not met.

The healthcare workers union Action (Deistvie), which originally formed in Izhevsk but is now a nationwide organization with three and a half thousand members in twenty regions, was actively involved in organizing the rallies. It is Action that has now organized the work-to-rule strike by doctors in Moscow.

Open Left has tried to get to the bottom of the situation by speaking with the principal figures in the strike.

 italian 3

Andrei Konoval

Andrei Konoval is managing secretary of the trade union Action. Under his leadership, the organization has carried out a number of protest actions. Konoval talked to Open Left about the reasons Moscow doctors went on strike, why this form of strike was chosen, and the goals the protesters are pursuing.

Andrei, what is the state of the trade union Action at the moment?

The trade union has around forty-five locals in twenty-five localities, cities, and regional centers, about three and a half thousand members in total.

Let’s move on to the work-to-rule strike. What caused you to declare it, and why was this form of protest chosen?

Because other ways of highlighting the systemic contradictions in the management of outpatient clinics would have been ineffective. We had to attract public attention. So we chose a form of protest with a flashy name—an “Italian strike” [the usual name for work-to-rule strikes in Russian]. Although the gist of it is simply that, on the spur of the moment, physicians start working in strict accordance with the Labor Code and the standards of medical care.

What are the reasons for the strike?

The reason is that now a medical clinic employee’s actual workday is ten to twelve hours long, sometimes even longer. This overtime is not taken into account and not remunerated properly, as per the Labor Code. Doctors are put into circumstances where they have to speed up the time spent examining patients, which objectively cannot help but affect the quality of care. Less than ten minutes are allotted for receiving and examining patients, which increases the risk of medical error and reduces the quality of work. Under these circumstances, people who work in health care facilities are deprived not only of the possibility of spending time with their families, raising their children, and relaxing after the workday but also of feeling that what they do is important and useful, because when the pace of work is such that is, their ability to perform their professional duties is discredited. Real professionals with a sense of duty cannot put up with this situation and they are opposed to it. So now we are trying to show that the Moscow healthcare system is totally underfunded, there is a real shortage of doctors, and something urgently needs to be changed.

Do you agree with the argument that the strike has failed?

The authorities are no longer saying this. They are silent on this score. This was said during the first week: it was just a PR attack. As we stated from the very beginning, at the press conference, we have around twenty strikers in six medical centers (seven, even). Others had wanted to join the strike, but they abandoned the idea under pressure. This is normal; there is nothing new here. Taking on the system is something that only people with a certain stamina and courage, and who are also well versed in the legal aspects of the issue, can do.

I want to emphasize that the strike’s success depends less on the numbers and more on the fact that we have provided an example of working the right way. Even if only one person in Moscow said that he or she were ready to undertake a work-to-rule strike—and survived the pressure—even then we would consider the protest a success.

But have you managed to achieve anything by striking?

Yes, at specific institutions. On the eve of the protest and especially in the early days, first they promised and then later they really began making changes to the work schedule in keeping with our wishes: to reduce the intake time, increase the time for house calls to patients, and change the standard exam time for a single patient from ten to twelve minutes, for example. Several strikers set individual appointment schedules in keeping with federal requirements and the real time demands for working with each patient. At Diagnostic Center No. 5, they managed to get the head doctor, who was planning to sack five hundred people, fired. And there are the little things, like the provision of stationery supplies, which previously one doctor had to buy at her own expense. In some clinics, they have stopped putting unpaid Sunday shifts on the schedule. Certain processes have been set in motion, but this is only at the local level, while our objective is to bring about changes to the way the medical system is managed. Our main achievement is that we have attracted the attention of the public and certain authorities to the problem.

Are you going to strike in other regions?

Our trade union operates from the grassroots, not from the top down. If our locals are ready to pose this question, then the central leadership supports them. A strike like this took place in April 2013 in Izhevsk and ended successfully: ninety percent of our demands were met. The know-how we are now amassing in Moscow will be summarized and used in teaching materials. In fact, it does not necessarily have to be used in a work-to-rule strike, because, strictly speaking, what is happening now in Moscow is not a strike at all. The goal of the work action is not to cause economic harm to the employer and, much less, to the patients. On the contrary, when our strikers see them, patients receive objectively better medical care. So we might not call it a work-to-rule strike, but simply introduce this know-how as a recommendation for protecting the rights of medical workers, resorting to the term “strike” only when we need to draw the public’s attention.

How do you see the future of the trade union Action?

Unions have to be massive. This allows them to have a serious impact on social and labor relations with employers. This is not an easy task, but there is no other way.

Open Left also contacted the strikers themselves and asked them about the reasons, goals, and outcomes of the protest.

 italian 4Yekaterina Chatskaya

Yekaterina Chatskaya is an OG/GYN at Branch Clinic No. 4 of City Clinic No. 180. She had struggled on her own to improve her working conditions, but had failed to change anything. After her little son tearfully begged her not to go to work, because he never saw her at home, she realized it was time for decisive action.

Tell us about the conditions in which doctors are now forced to work in the clinics.

Our situation is like this. Our workload had already been quite large. I work in Mitino, a young, growing district, at a women’s health clinic. We have a lot of pregnant women and, accordingly, women who have given birth, and female cancer patients.

We had always had a shortage of doctors, and yet management periodically took on new doctors, and the staff gradually expanded. This, of course, provided some relief. But when this optimization kicked in, the number of doctors at our clinic was dramatically reduced, and the service precincts were disbanded, but no one really counted how many women there were in the service precinct. The residential buildings were simply divvied up (it is not clear on what basis) and the patient load, of course, has increased significantly.

Even before this, UMIAS2 (Unified Medical Information Analysis System 2) had been installed. This was in 2013. By order of the Ministry of Health, an initial consultation with a pregnant woman should last thirty minutes, and a follow-up visit, twenty minutes, but UMIAS set the new time it should take to see one patient—fifteen minutes. That is, they deliberately reduced the time we have to see patients and made it impossible to really help a woman during this time. However, the numbers of high-tech care techniques, such as in vitro fertilization, grows, and so I end up in a situation where a woman comes to see me and, say, she has been infertile for many years or has suffered many miscarriages (some women have ten miscarriages, twelve miscarriages), and now she has finally become pregnant, as she wanted. How can I consult her in fifteen minutes? It turns out that doctors should just engage in a sham, roughly speaking. It is all just for show, for ticking off a box on a form: the patient came in, showed her face, and left. Everything else is outside the time limit. Or the second option is that the doctor does real clinical work, the whole appointment grid shifts, and the doctor does not have time to do anything during the time allotted for seeing other patients, and she starts seeing the remaining patients on her own time.

I cannot deal with a woman like this in only fifteen minutes. In the end, my working day lasts ten to twelve hours, sometimes even longer. Because I have to do paperwork for all the patients I see, and there are also a lot of reports, whose numbers grow constantly. And it turned out that no one had been taking this time into account, it was of no interest to anyone, and basically everyone got paid the standard salary.

The situation was already critical, and I had repeatedly appealed to management to clear up and resolve this situation somehow. They told me that we had to try and make do somehow, everything had been decided, they were powerless to do anything, and we had to meet the norms. Then we were set a norm of twelve minutes per person, which was even shorter, and were told there would also be layoffs. The time for seeing patients was increased, that is, the number of people we had to see increased. However, this standard is not written down anywhere: it is all a matter of verbal instructions.

So things have deteriorated even further since the reforms to the healthcare system began?

The situation has deteriorated dramatically.

I see. And you got no response at all from management?

Absolutely none. They tried to smother “in house” all our attempts to change anything so they would not go any further. I myself personally repeatedly offered to management to write about this to the higher authorities. I even drew up a document, but I got no support from management.

What was your point of no return? What finally convinced you of the need to protest?

For me personally, as a mother, it was when I would go to work in the morning, and my son would still be asleep, and when I would come home from work, he would already be asleep again. I simply did not see him. At some point, he woke up when I was heading off to work yet again. He grabbed my arm and started crying, “Mom, don’t go!” I just realized that was it, I had to change something. When I got home that day, he was already asleep, naturally, and I was very tired. I had had a very rough day. I came home and sat down. I was crying my eyes out. I simply did not know what to do. I plucked up my courage and wrote it all down. I described the whole situation, as it had come to be at our clinic, and sent it to the labor inspectorate. So far, there has been no response, though it has been almost two months.

In the end, I waited a couple of weeks, and then I realized that the matter would remain there, it would go no further. I started looking for like-minded people, because fighting alone, of course, is quite difficult. And so I found colleagues who also wanted to change something. I met with them and talked, and we came up with the idea of a work-to-rule strike.

Why do you think this strike has not yet evoked such a response within the medical community? Why have other doctors decided not to join you?

It’s all a mess. Doctors probably have a well-developed sense of passivity. Very many of my colleagues support me; I would say that almost all of them do. And no one has ever told me that I was wrong. On the contrary, everyone says more power to you, they are on my side, but very many of them are afraid of taking active steps. In our clinic, however, several colleagues have supported me; I am not the only one involved in this. And yet many people fear activism. We have a lot of retirees who just want to make it to retirement. We have a lot of people who have sized up this whole situation and begun to seek work elsewhere. They are planning to leave. When they leave, it is unclear what will happen.

At our clinic, for example, an ultrasound doctor was laid off. The load on the other doctors dramatically increased, and one doctor left: she could not stand the stress. We were left with one doctor who could do ultrasound tests on pregnant women in a huge district. In my opinion, it is simply absurd that, in the twenty-first century, a pregnant patient of mine should wait two or three weeks for an ultrasound. And it turns out that either I should “gently” hint that it would be nice if she paid to have it done (because it is urgent) or she has to wait, and I worry we will let something slip.

Twenty-four appointments for a pelvic ultrasound were issued for next week at our clinic. Only twenty-four appointments for an ultrasound and gynecology exam! This is an outrage. Ideally, every woman should have an ultrasound at least once a year, and those who have had problems, sometimes once a quarter, sometimes once a month. But we have no such possibility.

I have another question for you. These are not just your problems, after all, but the problems of your patients, of the populace. Does management not react to this in any way, either?

Absolutely not. We have instructions from the health department to increase the availability of appointments. Not the availability of health care, but the availability of appointments. In our clinic, it turns out that the overall time each doctor should receive patients has increased, while the time each patient can be seen has decreased. In addition, all repeat appointments have been abolished at our clinic, meaning that as a doctor I cannot make an appointment for someone to see me again; the woman has to make the appointment herself. But the earliest appointment is generally within two weeks. For example, a woman has come to see me to get a signed sick leave form. I give her five days of sick leave, but I cannot take her off sick leave in five days, because I have no room on my schedule. And I am forced to see her on a first-come-first-served basis, as it were, over and above my scheduled appointments.

In order to further increase the availability of appointments, so that they light up in green on the computer monitor at the health department, they do another really interesting thing. Registrars are given verbal instructions to randomly cancel three or four appointments for receiving physicians. While we are given orders, again verbally, to see both those patients who had appointments and those who had to get new appointments.

This increases your workload even more?

Of course. We are also required to see emergency patients, but that is not even up for debate. Rendering emergency aid is a doctor’s direct duty, and if a woman comes in with pain or bleeding, she has to be seen, too. The patient load is truly enormous.

Our service precincts had not been calculated, and when we began our protest, they finally counted the number of people attached to our clinic. By order of the Ministry of Health, the gynecological norm is 2,200 women per doctor. But after the calculations were done in Moscow, it turned out that there were service precincts with 2,900 women per doctor, and precincts with 7,000 women per doctor. So they just divided all the service precincts in half, and now we all have 5,500 women per doctor in each precinct. But each doctor gets only the standard salary.

And the last question. How do you see the future of your movement and the trade union Action in general?

Our trade union is gaining momentum. More and more people are joining it, because they see the real outcomes of our fight. I think the scenario looks positive.

As for our protest, I am still hoping for dialogue with the authorities. We have already had one meeting at the Ministry of Health’s Public Chamber. They took the proposals that we drew up for them, in which all the problems had been laid out. They took all this and promised to get in touch with us. So far, however, they have been silent, but they promised they would call, so we are waiting.

So there have been no breakthroughs so far?

Sundays had also been made working days at our clinic, though officially we have a five-day workweek. This was done without additional agreements or even oral instructions. They would just make appointments for a doctor on Sundays, and that was that. It was assumed the doctor was obliged to go in to work that day. After my written request to management (I asked them to clarify on what basis appointments had been made for me), such shifts were abolished at our clinic and declared illegal. This is one of our victories

 italian 5Elena Konte

During the course of a week, Elena Konte had to cover eight service precincts along with another doctor, after which she decided to start fighting for her rights. So far, Konte has seen no major positive changes, but she remains optimistic.

Could you tell us about the conditions in which doctors are now working in the clinics.

Well, there is a lack of personnel. In our department, four doctors are covering eight service precincts.

This was a major problem for you?

Yes, and the instability of wages. A lot depends in this instance on incentive payments, but now they are here, then they are gone, and it is unclear what percentage of extra pay they will give you, and so on.

What impact have the recent reforms had on the situation?

The most direct impact.

It was right after them that the firings began?

Yes. Our GPs were not dismissed, but our specialists were. The physiotherapist, the opticians, and some others were dismissed. Lab technicians.

I see. And how did management behave?

You mean—

The clinic’s management. You probably complained to them about the shortage of specialists. Did they react somehow?

Of course. But these were not written complaints. They were oral complaints at the general clinical conference that is held once a week. They said the same thing in response to all our recommendations: it was a done deal, no one is going to change anything, so that is why we switched to this scheme of working, work as you like, but be patient and keep working, because nothing is going to change, everything was decided long ago. It is standard practice.

I see. But when exactly was your point of no return, the point at which you decided you needed to go on a work-to-rule strike?

Ha! It was after another doctor and I covered eight care precincts alone for a week!

Why do you think many doctors are hesitant to join your movement?

I think it is this “great Russian patience,” passivity.

Last question. How do you see the future of the trade union Action and the strike itself?

That is a great question. I think the trade union Action has a bright future. More and more people are beginning to understand that it is a trade union that is worth joining and that can really solve our problems. For example, many of our doctors are now quitting the state-sponsored trade union.

As for the work-to-rule strike, to be honest, I have the sense that for now we are looking at an indefinite action, because it still has not solved anything at all.

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Anna Zemlyanukhina

Anna Zemlyanukhina is one of the strike’s coordinators. She presented a broader picture of what is happening now at the leadership level. She made the decision to strike after facing the total incomprehension of her clinic’s management. She is confident in the trade union’s successful future.

Could you say a few words about the conditions in which doctors work today.

The main difficulty is that there are not enough doctors. They are laying off not so much pediatricians as narrow specialists. So the flow of patients to the remaining doctors is quite large, and often it is a problem getting an appointment to see a particular doctor.

In addition, the Moscow City Health Department has announced a campaign for improving access to healthcare, but given the shortage of doctors this is implemented by lengthening a doctor’s workday and reducing the time an individual patient can be seen. But since it is impossible to examine a patient humanely in that amount of time, we have to go beyond the time limits, and in fact the physician’s workday is increased.

How have the recent reforms in the health sector affected this situation?

Frankly, until January of this year, things were more or less normal. Of course, they were hard, but they have gotten worse. Most importantly, the reforms have led to the closure of inpatient facilities, and now it is much harder for a patient to be admitted to an inpatient facility. There are verbal orders from above not to admit patients to hospital, and when a doctor refers a person to an inpatient facility, the ambulance service refuses to hospitalize him or her. A patient might be refused admission three or four times. Patients are admitted only when they are already quite ill.

What role is played in all this by clinic management? What is their stance?

They are subject to their superiors, who send them their orders.

Meaning that they do not try and meet you halfway?

It depends a lot on the individual. Some try. Typically, the lower-level bosses—the department heads—are mostly competent people, and try and meet you halfway, but at the higher levels… No, there are competent people there, too, but they are hamstrung. They get these orders from the top brass and are forced to follow them.

What was your point of no return, when you realized that protest was the only solution?

My point of no return was the increase in mortality rates among patients. And the top brass’s reaction to our protests. At a meeting with them, we raised all these questions—that it was impossible to see a patient in that amount time, that it was impossible to do our work—and the response was the same: “The decision has been made.” People are trying to get across that this is wrong, and they are told it was decided at the top and nothing can be done about it.

That is clear. Why, in your opinion, has your movement not yet engendered a broad response among other doctors? Why have they not joined?

In fact, some have decided to join. Why is this not happening en masse? Because our system “works” well. In many institutions, as soon as doctors show the desire to join up, the top brass immediately gets involved. They coerce them. They promise to get them put in jail, I don’t know, or fired or something else. And god forbid there should be any leafleting. After that, as a rule, the desire to join up diminishes.

And the last question. How do you see the future of your trade union and your protest action?

I see the future of the union as something quite positive. Many doctors are now exiting the official trade union as they no longer trust it, while our organization is gaining in popularity.

Have there been any concessions on the part of the authorities and top management?

For now, the main and only concession is that they have increased the time for seeing each patient. It is fifteen minutes again. Previously, it had been twelve minutes, and they were thinking about reducing it even more.

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Maria Gubareva

The last person with whom we were able to speak was Maria Gubareva. Before the strike, she had had to see thirty-six patients in seven hours or so, which is quite a lot for a gynecologist. She tried to appeal to the Ministry of Health, but received no reply. In her opinion, the protesters have managed to achieve some success, but they have not yet achieved any major changes in the healthcare system.

Could you tell us about the conditions in which doctors are forced to work today in clinics.

Specifically, in our clinic, the length of time we see patients and the number of patients we see during this time have increased. In other words, the grid interval in UMIAS has been reduced. In particular, after all these changes, the daily intake for gynecologists (I am a gynecologist) is seven hours and twelve minutes, and thirty-six patients. This exceeds all conceivable norms. It is physically impossible, agonizing both for patients and doctors. Plus, it is impossible to refer patients for tests (at our clinic, these are usually ultrasounds, blood tests, and such) because some ultrasound doctors have also been sacked, the workload has increased, and when it went critical, they started quitting, because it is also impossible to work in this way. Well, as for tests, you have to sign up for a blood test ten days in advance. Many other tests are just not done at all anymore, quotas on blood clotting test were introduced, and so on.

In addition, some of our midwives were fired. (We work with midwives, not with nurses.) The doctors work alone: there are one or two midwives for several doctors. The midwife is planted in a separate room and “services” patients there. In other words, the women first go see the doctor. He or she makes recommendations. Then the women sit in the queue to the midwife for another hour or two, go berserk, and go ballistic on each other and the midwives. The midwives are supposed to assign them tests and write out prescriptions, make appointments for them to see specialists through UMIAS, and so on. Basically, it is torture for everybody, for doctors and patients.

All these changes occurred as part of the reforms to the healthcare system? The reforms have had such an impact on the situation?

Yes, the changes have been very serious.

And how does clinic management act given the shortage of specialists and the increased load on doctors? Have you appealed to the authorities about this?

Before the start of the work-to-rule strike, we tried, but no one listened to us. When it was first announced, three months ago, that the workload would increase, I personally asked the deputy chief physician, “How is this possible? It is a violation of labor laws and basically just cannot be done.” To which I was told, “Anyone who does not like it can quit. The country is in a crisis: everyone has to tighten their belts.” It is like. “Everyone off to work. Work, while the sun is still high!”

I see. And what exactly made your cup of patience run over and forced you to go on strike?

It was when I was seeing patients in this crazy way for a week. Even before all the layoffs. I had written about all of it to the Ministry of Health and the labor inspectorate, but had gotten no replies from them. Then a week passed, the week when we had this crazy intake, and it became clear that working this way was just impossible. Either I had to do something or I had to leave.

Why have others not dared to follow your example? Why has the strike not taken on a broader scope?

Because people do not believe you can change anything in this country. The general opinion is that fighting the system is useless. Because the changes are implemented from the top down, they are government policy, Ministry of Health policy, everyone thinks the system cannot be moved. It will just crush its tiny functionaries—that is, those of us who do not agree with it. Plus, those who at first had almost decided to go on strike with me (they, as I have said, were in a really difficult situation) immediately came under pressure with the aim of putting the whole thing to a stop. Management acted against us with all possible means, mainly verbal. They accused us of sabotage and treason. They told us that the state had given us a job, and now we had gone against the state. And so on. Many people simply abandoned the idea. They decided to spare themselves the trouble.

How do you see the future of the union and the work-to-rule strike?

I haven’t especially thought about the future of the union. I guess if its membership grows, it will gain strength and might be able to start solving some of our workplace management issues, to do what a trade union is supposed to do: protect the legal rights of its members.

As for the strike, I cannot give you a clear answer, because the statement by the authorities that the strike failed is ambiguous. When viewed from the perspective of the twenty people who have taken part in the strike, all of our demands have been satisfied, because they were legitimate. It turned out that management has had nothing to counter us with: everything had been done strictly according to the law, in keeping with all the norms. And we have observed all the requirements, so now I see a humane number of patients, I have a humane amount of time to see them. Basically, everything is as it should be.

But this does not solve the overarching problem of healthcare, which would have happened had a significant number of people joined the strike. In our department now, where I am the only one on strike, the patients who do not get in to see me are simply fobbed off onto the other doctors. So they are seeing their own patients and that other guy’s patients, and that other guy is me. But if we had all said we would see patients as they should be seen, then half the patients would have been unable to make an appointment to see a doctor. They would have attacked the head physician and the health department, and ultimately management would have had to hire staff, which, in fact, would have solved the problem.

Alexander Grigoriev is a student in the history faculty at Moscow State University.

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Photos courtesy of Open Left. Translated by The Russian Reader