Mistakes and negligent attitude of medical workers to their duties lead to a violation of people's legitimate rights to life and health. In this regard, the legislation of the Russian Federation provided for the legal liability of medical workers for inaction or actions of an unlawful nature.
Legislative regulation
The legislation regulates the protection of the health and life of citizens in all directions. Therefore, the legal liability of medical workers is established in several acts of the state level:
- Constitution of the Russian Federation. Article 41 provides for the right of every citizen and person to provide medical care and protect his health.
- Federal Law No. 323- dated November 21, 2011, which regulates the basis for the protection by the state of the health of Russian citizens. Article 98 determines that medical workers are liable in accordance with Russian law for violating the provisions of the Constitution, as well as for causing harm to human health or life in the process of rendering (or not providing) medical assistance.
- Labor Code of the Russian Federation. Article 233 establishes the liability of medical workers for harm caused by the action or inaction of a medical nature.
- Civil Code of the Russian Federation. Civil law contains general provisions on the liability of the organization providing medical care for harm caused by their employees.
- Administrative Code of the Russian Federation. Administrative legislation provides for a whole chapter related to crimes related to offenses that infringe on the health, life and well-being in the epidemiological sphere. Many articles from Chapter 6 of the Code of Administrative Offenses are devoted to offenses committed specifically by medical workers.
- Criminal Code of the Russian Federation. The criminal norms enshrined in the Code contain serious types of liability of medical workers for violation of human rights by actions or inaction. Responsibility can be expressed in the payment of a fine or in the form of imprisonment for a specific period. An example is art. 125 of the Criminal Code of the Russian Federation “Abandonment in danger”.
Types of Responsibility
The entire set of responsibilities of medical workers can be divided into five groups:
- civil law;
- disciplinary;
- material;
- administrative
- criminal.
All types are enshrined in certain laws and penalties, ranging from disciplinary liability of medical workers in the form of comments and ending with imprisonment.
Civil liability
The onset of civil liability of medical workers depends on the presence of three mandatory signs:
- The fact of the offense.
- Causing the patient harm.
- The presence of a causal relationship between the offense and the harm the patient received.
Article 1068 of the Civil Code of the Russian Federation determines that the organization providing medical assistance bears civil liability for harm caused by its employees during the performance of official duties.
After compensation for the damage caused to the victim in monetary terms, the organization has the right to recover the amount from the guilty employee in a recourse order, on the basis of Article 1081 of the Code.
The harm caused by a medical worker is compensated only within the limits of real damage. In this case, the lost profit is not refundable, even if there is a causal relationship.
If the guilty employee was officially employed by the organization by concluding an employment contract, he may be held liable for the material nature of one of two forms: limited or full. If a civil contract has been concluded with an employee, the damage can be recovered from him in full.
Disciplinary responsibility
Labor legislation provides for the disciplinary liability of medical workers in relation to officially employed employees. The onset of responsibility arises when the employee commits disciplinary offenses, expressed in violation of labor and official discipline.
For employees of any field, including medical, types of misconduct of a disciplinary nature are established, for example, being late, not following the instructions and orders of the head, absenteeism, appearing intoxicated, etc.
Article 192 of the Labor Code of the Russian Federation establishes the following types of disciplinary liability:
- comment;
- rebuke;
- suspension from work (Article 76 of the Code);
- dismissal.
The institution’s charters, internal regulations for certain categories of employees and federal laws may provide for other negative consequences for the employee or disciplinary action.
In order to impose a penalty on an employee related to a violation of discipline, it is necessary to observe the six rules of Article 193 of the Code:
- Before a disciplinary sanction is imposed, the employer must require an written explanation from the employee.
- It is prohibited to apply penalties not provided for in the charters of the institution, internal regulations and laws of the federal level.
- For one misconduct of a disciplinary nature, one penalty may be imposed.
- The maximum term for the application of a disciplinary sanction from the moment of discovery is one month, with the exception of the time for taking into account the position of the trade union body, as well as the duration of the illness of the guilty employee, while on vacation. The total maximum period of prosecution is six months. If the foreclosure was preceded by an audit, audit or financial and economic audit, the maximum period shall be extended to two years.
- A disciplinary sanction can be appealed to the authorities considering individual labor disputes or the state labor inspectorate.
- An order or order of the head to impose a disciplinary sanction should be handed over to the employee within three days (excluding weekends) against signature.
Material liability
The legal liability of medical workers in the form of a monetary penalty is also provided for by the Labor Code of the Russian Federation. Article 233 of the Code indicates the onset of liability of medical workers for harm caused by action or inaction.
An institution can only recover actual direct damage from an employee. The employee is not required to reimburse lost profits (unearned income). In the event that expensive equipment was damaged by his careless actions, his cost is recovered from the guilty employee. The inability to use broken equipment and the non-receipt of this benefit by the employee is not subject to compensation.
Administrative responsibility
The administrative responsibility of medical workers is established by the relevant code - the Code of Administrative Offenses of the Russian Federation. As in other cases, liability arises in the event of an unlawful act or omission of an employee.
When bringing to administrative responsibility it is necessary to prove the existence of one of the forms of guilt. Administrative Code in Article 2.2. establishes two forms of guilt: negligence and intent.
An offense committed with the recognition of the unlawful nature of its action or inaction, with the anticipation of the onset of harmful consequences and the desire for their manifestation (or the assumption of an indifferent attitude to the consequences) is considered intentional.
An offense is considered to be a crime committed with the expectation of preventing dangerous consequences, the occurrence of which the guilty person foresaw and allowed.
Chapter 6 of the Code of Administrative Offenses provides for liability for a large number of administrative offenses in relation to a medical worker in the process of performing the functions of a medical worker or an official of a medical institution.
Administrative offenses include:
- Concealment of the source of infection with HIV or a sexually transmitted disease, as well as concealment of contacts that pose a danger to infection - Article 6.1.
- Occupation of folk, informal medicine on illegal grounds - Article 6.2.
- Violation of Russian legislation governing the provision of sanitary and epidemiological welfare of the population, and violation of sanitary and epidemiological requirements - Article 6.3.
- Turnover of drugs of a narcotic, psychotropic type or analogues of such substances on illegal grounds; storage or transportation of narcotic plants or parts of plants - Article 6.8.
- Failure to comply with the rules for the circulation of drugs of a narcotic, psychotropic type or precursors of such substances; storage or transportation of narcotic plants or their parts - Article 6.16.
- Failure to comply with the rules for the handling of medical devices - Article 6.28.
- Failure to provide information regarding a conflict of interest arising in the process of carrying out medical and pharmaceutical activities - Article 6.29.
- Concealment of information about the possibility of citizens receiving medical assistance under programs for the provision of free services at the territorial and state levels - Article 6.30.
The indicated grounds for bringing administrative personnel to medical responsibility impose a fine on the guilty employee and, in some cases, disqualifications. Also, the subject of liability may be an official of a medical institution (head physician, department head, head nurse, etc.).
Criminal liability
The criminal liability of medical workers occurs when committing an act that qualifies as a crime, if there are signs of a criminal offense.
Signs of crime are the following components:
- A subject is a person who has committed a crime (a medical professional).
- The subjective side is the psychic (internal) attitude of the offender to the act committed by him (motive, purpose and guilt). If the crime is committed with intent, guilt is expressed in the form of indirect or direct intent. If the crime is committed through negligence, guilt is expressed in the form of frivolity or negligence.
- An object is a public relation protected by the Code.
- The objective side is a list of aggregate features expressing the external characteristics of the crime. These include place, time, situation, causal relationship, inaction or action, etc.
The grounds for criminalizing medical workers are the relevant articles of the Criminal Code. These include the failure to provide the patient with timely assistance, harm to health, etc.
Unlike the offenses regulated by the Code of Administrative Offenses of the Russian Federation, misconduct involving the use of criminal liability are considered more dangerous to society. Therefore, the types of legal liability of medical workers for such crimes are more stringent.
Crimes committed by medical personnel can be divided into three types:
- Criminal offenses against health and life.
- Criminal offenses against morality in society and public health.
- Crimes in the field of ecology.
Criminal offenses against health and life
The first criminal offense enshrined in criminal law is death through negligence (Article 109). The Criminal Code of the Russian Federation defines the onset of death as the result of the action or inaction of an employee of a medical institution. Most often, this is due to a gross violation or failure to comply with the rules of assistance, negligence, inattention or arrogance.
Causing death by negligence under Article 109 of the Criminal Code of the Russian Federation is considered to be such if it is proved that the perpetrator had no intention of causing fatal harm to the victim, there is a causal link between the action (or inaction) and the resulting death (for example, blood transfusion is incompatible for the patient group, giving the wrong medicine, etc.).
Infection with HIV - infection under Article 122 of the Code provides for responsibility for committing a "double" crime - creating the risk of infection and inadequate performance by a medical worker of his duties, which entailed infection of a healthy patient with infection. With rare exceptions, such crimes are committed in the field of health and medical care.
The subjects of the crime are medical workers (excluding cases when the infection occurred as a result of conscious actions by a person with HIV - infection). In this case, the crime is a violation of professional duties (non-compliance with sanitary measures, inadequate blood donor testing, use of non-sterilized instruments, etc.), as a result of which infection has occurred.
The fault of medical workers in this case is expressed in frivolity or negligence. Even if the victim escaped infection due to the characteristics of his body, the crime is complete.
Article 123 of the Criminal Code of the Russian Federation on the conduct of unlawful abortion determines the responsibility for a woman to terminate a pregnancy by another person. An abortion is considered unlawful if it was not performed in a hospital hospital, carried out by a person without a medical higher education, or carried out without taking into account contraindications to its implementation.
Criminal liability for illegal abortion under the Criminal Code of the Russian Federation occurs even if the woman has indications for an abortion and she agrees to the operation. If such a procedure was carried out more than once, this is considered an aggravating circumstance.
Under article 124 of the Code, liability is provided for the refusal to provide assistance to a sick person. Immediate assistance is the direct responsibility of medical personnel. In addition, liability may be imposed on the next of kin, who are nearby.
A refusal to render assistance shall be recognized as valid if the person who is obliged to help is at that moment with another sick person or suffers from a disease. Lack of qualifications in a particular area is not a valid reason for refusal.
According to Art. 125 of the Criminal Code, the danger is the situation when the perpetrator deliberately left the person in a situation or condition dangerous to health and life, when the victim cannot help himself because of his age, illness or state of helplessness. Responsibility occurs when the guilty person was obliged and had the opportunity to help, or put the victim in a condition that is dangerous to her health and life.
Obligatory persons include parents (children), children (parents), educators and teachers (pupils and students), nurses (patients under a contract).
Criminal offenses against morality in society and public health
Articles 228, 229 and 233 of the Code are related to the acquisition, transportation, storage, manufacture, extortion and theft of narcotic, psychotropic drugs (analogues of such substances) or narcotic plants (plant parts), as well as violation of the rules for their manufacture and receipt under fake recipes .
In this case, responsibility lies with persons who, by virtue of their duties, deal with drugs of a narcotic, psychotropic type (analogues of such substances) or drug-containing plants (parts of plants), and also have a license to act with them.
Art. 235 of the Criminal Code provides for liability for illegal practices of a private nature or pharmaceutical activities by a person without a license. Licensing must go through all legal entities and individuals who wish to engage in medical activities.
Illegal practice of private medical practice in any form subject to licensing is punishable in accordance with criminal law. The list of licensed activities in the field of medicine is established by the Ministry of Health, and the process of providing permits is carried out by the executive authorities in the relevant entities.
If an individual or legal entity has a diploma of secondary or higher medical education and a certificate for engaging in a certain type of activity, this person is entitled to a license.
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