He knew too much. – What gives a hospital the status of an autonomous institution?

If you have not read the three previous articles, starting with “My Daughter Was Diagnosed with Cancer,” then read the previously published one first to understand what is being said here.
There are a lot of words, it will be boring to read, I warn you.
Just keep in mind, while these conversations are going on, everything continues as before, and people are dying without receiving medicines.

L.M. Pechatnikov, speaking at the city clinical and anatomical conference, spoke about the situation around the 62nd hospital. The website vademec.ru published a transcript of his speech.

The story that excited everyone so much Lately, is the story of the 62nd hospital. We don’t have Anatoly Nakhimovich [Makhson] here. - Vademecum]? Doesn't he come to us anymore? It's a pity.

The fact is that when in 2015, in full compliance with the law, we loaded inpatient care oncology into the MHI system… We resisted this for quite a long time, well, we could not resist, but we delayed it, knowing full well that the cost of treating cancer patients is practically, to put it mildly, not fully covered by the MHI tariffs.

And then Anatoly Nakhimovich came to me with a proposal - for the period of such adaptation, try to make an experiment: transfer hospital No. 62 to the status autonomous institution. He argued this very clearly. The autonomous institution had the opportunity to purchase drugs under the Federal Law No. 223, and not under the Federal Law No. 44, that is, in fact, from a single supplier. He convinced me that he would be able to negotiate with suppliers so that he would be given cheaper medicines for one hospital under this Federal Law No. 223.

Why could he have been given cheaper drugs? By the way, he never hid this, and it also seemed very reasonable to me - because he took drugs with an expiring date from them.

I also thought this was reasonable, since the drug is effective, but it has three to four months left on the package. But the patient, excuse me, doesn’t see the packaging, the drug is effective, and if you can save so much on this... Suppliers give the drugs three to five times cheaper, and sometimes just for free - it’s more profitable for them to just take it all out of the warehouse. I thought this was very reasonable. I spent quite a lot of time convincing both the Department of Economic Policy and the mayor that we make this exception. We made such an exception - it was the only hospital in Moscow; no other hospital working with cancer patients received such a privilege. But we gave Anatoly Nakhimovich such a privilege. Not for him, but for the patients, naturally, because everyone was supposed to benefit from this. And that’s exactly what happened. Using quotation methods, he asked companies to provide drugs with expiring dates; they sold them to him, and sometimes simply gave them as a gift. What neither the department nor any of you in the budget have the right to do is that you work within the framework of Federal Law No. 44, according to which you must set a condition of at least 80% of the remaining shelf life.

But the fact is that from January 1, 2017, Federal Law No. 223 ceases to apply in Moscow. Many people worked on it - state unitary enterprises, autonomous institutions, and joint-stock companies with government participation, everyone tried to work according to Law 223 in order to negotiate with a single supplier. When I say the word “negotiate,” I am not saying that there is anything criminal in it. In the case of Anatoly Nakhimovich, there was no crime - he negotiated for the sake of the patients. And this has absolutely no doubt in my mind. But others have abused it. And therefore, the mayor decided that from 2017 everything, including state unitary enterprises and autonomous institutions, and joint-stock companies with state capital... everyone must work under the terms of Federal Law No. 44. Therefore, remaining in conditions of autonomy turned out to be absolutely pointless, moreover, even dangerous.

I talked about the privilege, but there are also dangers, because an autonomous institution, unlike a budget institution, bears responsibility [for obligations. - Vademecum] with his property. And any accounts payable can be a risk to the hospital's assets, you know, yeah, what am I talking about?

An autonomous institution has the right... to take out loans from a commercial bank, but any accounts payable may be risky for the hospital's property. Therefore, an absolutely, in my opinion, neutral decision was made [On December 1, the Health Department issued order No. 963, changing the status of the city oncology hospital No. 62 from autonomous to budgetary. - Vademecum]…Moreover, the hospital worked like this for several years, the adaptation took place, we returned it to the budget.

Anatoly Nakhimovich’s reaction was peculiar: he said that under the conditions of Federal Law No. 44 he could not work, so he decided to retire at the age of 69. I asked him not to rush into this decision, moreover, I asked Alexey Ivanovich [Khripun, head of the Moscow Health Department. - Vademecum] consider the possibility - if he has already decided to resign from the position of chief physician - of offering him the position of president of the hospital. We have Leonid Mikhailovich Roshal as the president of his institute, Ermolov as the president of the Sklifosovsky Institute, Georgy Natanovich Golukhov as the president of the 31st hospital. And to talk with him about who he is going to leave and to whom he would like to transfer his brainchild - this, we must give him his due, the hospital he created is very good.

But instead, Anatoly Nakhimovich chose to go on sick leave, and then what he writes, I think you all read. Moreover, he does not indicate anywhere that he manages to buy so cheaply, due to the fact that he worked according to completely different rules. Then absolutely fantastic stories appear that the 62nd hospital is going to be closed, that his position has already been sold for $1 million.

Why he estimated his position at only 1 million, and precisely dollars, you have to ask him, he apparently calculated.

There are, to be honest, quite insulting stories for the Department of Health. Now, of course, all these publications are being checked, and this does not remain without a trace in our time. The Moskontrol checks, the President's Control Department checks, they check everything, and then, based on the results of the checks, we'll see what the result is. For our part, I think we will probably also check that the 62nd hospital shares its positive experience with us, so Andrei Vladimirovich [Saunin, Deputy Director of the Financial Control Service of the DZM. - Vademecum] I ask you and Parasochkina [Olga Parasochkina, Director of the Financial Control Service of the DZM. - Vademecum] also, for its part, ask to share a positive experience with us.

That's all, actually. I specifically wanted to tell this so that it would not be secret stories, and you would understand what was really happening. Anatoly Nakhimovich is right about one thing - and I don’t want to hide this from you either - the fact is that before, before 2015, when we traded in the Department of Health [ we're talking about on centralized procurement of medicines. - Vademecum], as the initial maximum price [of the procurement auction], they set the minimum ... price registered with the Ministry of Health. On January 12, 2015, all regions, not only Moscow, received a directive letter from the Ministry of Economy, which obliged us to set as the initial maximum price maximum price, registered with the Ministry of Health. They were guided by the fact that absolutely everyone could take part in the auction - because when we take the minimum price, then, as it were, only one participant, and if we take the maximum, then everyone can participate in the auction. They took everything seriously, did it, and the prices of medicines really went up.

When we say that we are ready to pay 100 rubles, well, what a fool would offer us 20 rubles each. This was the letter. Unfortunately, neither the Minister of Health, nor I, nor the mayor, we knew about this letter, it went through departments throughout Russia - therefore, prices began to rise throughout Russia. Remember, Skvortsova said that all governors buy more expensive than the Ministry of Health? Because all departments had this letter, but the Ministry of Health did not have it.

When I found out about this, I rushed to the mayor with this letter. I will not convey the emotions of Sergei Semenovich Sobyanin, he called ... called Skvortsova [Veronika Skvortsova, Minister of Health of the Russian Federation. - Vademecum], asked if she knew about it, she didn’t know anything either. Sergei Semyonovich went to the Prime Minister, and this letter was practically disavowed, and today we have returned to the methodology for determining the initial maximum price, which was before this letter from the Ministry of Economy. How the Ministry of Economy will continue to deal with this is no longer our business. The letter, even if it did not contain malicious intent, is stupidity, of course, was incredible.

When we returned to that method of determining the initial maximum price, we saved 1 billion 572 million rubles only at the last two auctions for oncological drugs - a lot of money, only for two drugs at two auctions.

Here Anatoly Nakhimovich is absolutely right when he says that the conditions for the formation of the initial maximum price have changed.

Another thing is that he, of course, did not know about this letter from the Ministry of Economy and accused the Department of Health of corruption and theft. Well, in the end, let us forgive him for this - he really did not know or suspect about this letter, and he apparently considered it beneath his dignity to ask. I'd like you to know what's going on.

Hospital No. 62 was and remains one of the best oncology hospitals not only in Moscow, but also, I think, in Russia. Of course, no one would have thought of encroaching on the 62nd hospital, but, unfortunately, what happened happened.

Since it was my LiveJournal that became the platform from which the discussion about the 62nd hospital began, Makhson A.N. sent his response to L.M.’s speech. Pechatnikov, including me. Here it is, I publish it as it is.

Response to the speech of L.M. Pechatnikov at the clinical-anatomical conference of the Moscow Department of Health on December 7, 2016.

Today I read in the magazine “VADEMECUM” a speech by L. M. Pechatnikov at a clinical-anatomical conference on December 7, 2016. And since I was not there due to my illness, I would like to comment on this speech.
The hospital tried to obtain the status of an autonomous healthcare institution starting in 2012. And indeed, with the help of L.M. Pechatnikov, we became autonomous, although not in 2015, but in April 2014. And for this I am really very grateful to Leonid Mikhailovich. True, the argument was not about the possibility of purchasing drugs with an expiring date, but about greater independence in conducting business activities. This is the meaning of an autonomous institution. If the State Autonomous Institution does not have enough funds to fulfill a state task, it must earn it or save it, or even better, both, which, by the way, was later fully confirmed. At the same time, Moscow remains the owner of the property, and in accordance with Federal Law No. 83, an autonomous institution is not liable for its obligations with real estate and especially valuable movable property, therefore it cannot be bankrupt (unlike what L. M. Pechatnikov claims). In accordance with the law, GAUZ is liable for its obligations only with property acquired on own funds. Indeed, GAUZ conducts trading and purchasing activities in accordance with Federal Law No. 223, it is indeed more friendly for the auction organizer and gives him more opportunities, but purchases from a single supplier have almost the same restrictions as in Federal Law 44, only the maximum quotation amount has been increased to 300 thousand rubles By the way, all the benefits of Law 223 relate to the purchase of not only medicines, but also everything else (equipment including). The overwhelming number of purchases are carried out using the electronic auction method, and they can be viewed on the same website - zakupki.gov.ru. All the more strange is Leonid Mikhailovich’s statement that the hospital bought drugs with an expiration date, as if the hospital could have expired drugs suitability. This is generally impossible, and the most a big problem, if upon inspection the hospital finds at least several bottles with expired expiration dates. The hospital did purchase drugs with a shortened shelf life, for example in 2016 with an expiration date until March 2017, but we ran out of these drugs before the end of the year. But the most interesting thing is that the hospital bought drugs from normal period shelf life, and they were also several times cheaper. This can be seen very clearly from the table.
comparison table medicines, received through centralized supply and purchased by MGOB No. 62 independently.

And such examples can be multiplied and multiplied.
The table shows that L.M. Pechatnikov’s statement that the hospital bought significantly more drugs due to expired drugs quoted from one supplier, to put it mildly, this is not true.
The statement that 44FZ obliges us to set the remaining shelf life to 80% is also untrue; there is no such rule in the law. In 2016, the terms of reference for drug tenders often include a residual shelf life of 12 or 18 months. While the shelf life of drugs is usually 2 or 3 years. Therefore, 12 months does not correspond to 80% of the remaining shelf life, but only 50% or even less.
L. M. Pechatnikov’s statement that the Ministry of Economy obliged to form the initial bidding price based on the registration price of the drug is also untrue. There are several options for forming the initial bidding price, and this can be clearly seen in the auctions formed in the regions. Legal links to the method of forming the initial (maximum) contract price are at the end of the article.
By the way, in 2011, having become the head of the Moscow Department of Health, Leonid Mikhailovich appointed me to the position of chief freelance oncologist in Moscow. When drawing up the first annual application for chemotherapy drugs under the DLO system for 2012, I was faced with the fact that the application, when calculated at the Pharmacy Department, turned out to be for 6.8 billion rubles, and in total 4 billion rubles were planned. I was offered to shorten the application, but then it was not clear how to treat sick Muscovites. At my request, Leonid Mikhailovich convened a meeting at which I showed that if you purposefully receive commercial offers from supplier companies, then the initial auction prices are significantly lower. Then L.M. Pechatnikov decided that the starting prices for the auctions would be commercial offers received from companies addressed to the chief oncologist of Moscow, and as a result, the application amounted to 4 billion rubles. there were more drugs than in the application for 6.8 billion rubles. Therefore, in 2012-2014 in Moscow there were practically no unsecured prescriptions under the DLO system. In 2014, there was a change in the chief oncologist of Moscow and the head of the Moscow Pharmacy Department, and the system of centralized procurement of chemotherapy drugs for the DLO system and oncology hospitals in Moscow immediately changed with a new principle of pricing. As a result, only in the outpatient department of Municipal Public Health Hospital No. 62, to which the North-Western Administrative District and Closed Administrative District of the city are attached in 2016, there were more than 3,000 unfunded prescriptions with a delay period of 7 to 46 days, despite the fact that significantly more funds were allocated for the purchase of drugs.
And it seems completely illogical to say that because of someone’s mythical abuses in Moscow, all enterprises that, in accordance with 83 Federal Laws, must conduct trade and procurement activities in accordance with 223 Federal Laws, are changing their form. It is completely unclear what prevented us from punishing these violators and thereby solving this problem. At the same time, the question immediately arises: what to call the centralized purchase of medicines using budgetary funds at a price several times higher than the price of a one-time purchase by an individual enterprise? Maybe it makes sense, on the contrary, to abolish centralized procurement and allow hospitals to trade independently in order to save money budget funds? Control over abuses in Moscow does not present any problems, because All trading is conducted through the EMIAS website, which allows you to control everything. Of course, you can liquidate the State Autonomous Institution "MGOB No. 62", and then there will definitely not be such a difference in prices, because this will simply become impossible.
And finally, L. M. Pechatnikov’s statement regarding my refusal from the post of honorary president. I actually had a reception with Leonid Mikhailovich and said that it was becoming almost impossible to continue working under the current conditions. In 27 years of working as a chief physician, I have never worked so hard, even at the very beginning, because then there was perspective and hope that everything would get better. The only thing that still holds me back is the fate of the 62nd hospital, where I worked for 44 years: 17 years as a surgeon, 1 year as a director surgical department and almost 27 years as chief physician. I was elected by the team (there was a period at that time, and in Moscow there were 2 elected chief doctors - the first was Georgy Natanovich Golukhov), and I was appointed to this position on January 29, 1990. At that time, the largest oncology hospital in Moscow had 2 x-ray machines and a domestic anesthesia and respiratory equipment. There was no endoscopy, ultrasound, intensive care monitors, etc. In February, less than a month after my appointment, the fuel oil boiler house stopped working. And they couldn’t launch it for three days. The only thing that saved the hospital and the village from evacuation was that in February the temperature outside was +5 degrees. The first years of work as chief physician were a complete nightmare.
Most big number The number of patients treated in the hospital before 1990 was 5,400 and 1,800 operations were performed per year, the mortality rate was 4.5%. In 2016, the hospital treated 15,000 patients in hospital and 6,000 in day hospitals, performed about 6,500 operations, many of which in the city system are not performed anywhere else, and the mortality rate has decreased by more than 6 times, and for many years does not exceed 0 .7%. By the way, the hospital was the most well-equipped oncological institution even before the start of modernization, because... The most modern equipment was purchased with sponsors' funds for more than $10 million (CT, MRI, ANGIOGRAPH, ultrasound and endoscopic equipment, etc.). Undoubtedly, modernization has allowed the hospital to be even better equipped. I showed Leonid Mikhailovich what was happening with procurement and said that I wanted to retire (though I’m not 69 but 67 years old) if a hospital employee who has a diploma in healthcare organization and has been working in the hospital for more than 5 years is appointed as chief physician , who knows and loves her and will fully cope with the task of preserving the hospital and developing it further. The second proposal was to transfer centralized procurement funds to the hospital, as was the case before 2015, especially since, according to Federal Law 83, there simply should not be centralized procurement at the State Autonomous Institution in 2016. Centralized procurement for the hospital - 590 million rubles). In this case, problems with financing would be eliminated. This request was simply not discussed. When asked about the new chief physician from the hospital, I received, albeit allegorically, a refusal, which was later fully confirmed. I was not offered any position of honorary president, although I would still have refused it if the new chief physician was appointed from outside.
Instead, on November 8, 2016, at the request of L. M. Pechatnikov, in order to improve medical care The Moscow government issued a decree on the transfer of the State Autonomous Institution MGOB No. 62 to a budgetary healthcare institution. True, it is not clear what to improve, because... Leonid Mikhailovich said in his speech that the hospital is the best not only in Moscow, but also in Russia. By the way, this resolution of the Moscow government was carried out in violation of the law, because according to Federal Law 83, the work of the hospital is assessed by the Supervisory Board based on the report of the chief physician, and if it turns out to be unsatisfactory, the Board may decide to transfer the institution to a budgetary one. The Chairman of the Supervisory Board is A. I. Khripun. At the same time, the Supervisory Board never met in 2016.
Therefore, I had no choice but to agree to the offered help. former patients, for whom the fate of the hospital is not at all indifferent and many of whom have long become friends. Thus, this conflict came to the attention of the public.
Leonid Mikhailovich’s hint about conducting inspections is clear, however, in October 2015, we completed a 1.5 month inspection of the financial control service and in 2016 there was a comprehensive inspection of Roszdravnadzor, during which no significant violations were identified in the work of the hospital. In general, the hospital undergoes more than 20 different inspections annually, we are no strangers to this.

Article 22 Federal Law dated 04/05/2013 N 44-FZ "On contract system in the field of procurement of goods, works, services to meet state and municipal needs" and Guidelines on the application of methods for determining the initial (maximum) contract price, the price of a contract concluded with a single supplier (contractor, performer), approved by Order of the Ministry of Economic Development of Russia dated October 2, 2013 N 567, provide for the use of one or more methods for determining the initial maximum contract price:
1) method of comparable market prices (market analysis);
2) normative method;
3) tariff method;
4) design and estimate method;
5) cost method.

Initially, in Letters dated December 19, 2014 No. D28i-2716, dated December 31, 2014 No. D28i-2909, dated April 3, 2015 No. OG-D28-4972, the Ministry of Economic Development explained that when forming the initial maximum price of a contract for the supply of drugs from the Vital and Essential Drugs list, tariffs should be applied method - the maximum value of the maximum selling prices of producers.

In the Letter of the Ministry of Economic Development dated August 6, 2015 No. D28i-2266, the position changed; the Ministry of Economic Development allowed the use of both the tariff method and the method of comparable market prices.

In Letters dated 01.03.2016 No. D28i-525, dated 18.04.2016 No. D28i-966, dated 10.05.2016 No. D28i-1199, the position changed again - the Ministry of Economic Development believes that it is necessary to use the method of comparable market prices.

However, letters from authorities are not regulations and are of a recommendatory nature.

I understand that reading such large texts difficult. But coping with serious illnesses without medications is even more difficult. But I sincerely hope that these two texts will help specialists understand the current situation. Which of the two doctors is not telling the truth is obvious!

Photo Kommersant

25.12.2018 | 05:49

A number of publications reported that the former Deputy Prime Minister of the Moscow government, in the past one of the most unpopular city officials, came under suspicion from law enforcement agencies.

It is assumed that the ex-official who oversaw the social block is accused of embezzlement in the amount of 3.5 billion rubles. Allegedly, the security forces are of particular interest in the case of the former Moscow vice-mayor in the purchase of medical equipment and medicines. Network media write that the mayor of the capital, Sobyanin, is already aware of the investigation. However, there has not yet been any official information from law enforcement agencies regarding Pechatnikov.

Let us recall that Leonid Pechatnikov came to the first government of Sergei Sobyanin as head of the health department from the post of director of the European medical center. It was Pechatnikov who became the author of the reform to optimize the capital’s healthcare, which caused sharp irritation in society. The reform turned out to be associated with a reduction in the number of doctors and a “merger” medical institutions.

In 2016–2017, Leonid Pechatnikov hosted Active participation in the conflict between the dismissed chief physician of the Moscow City Oncology Hospital No. 62 (MGOB No. 62) Anatoly Makhson and the Moscow Department of Health (DZM). The story caused a scandal, and information about probable corruption in the DZM got into the network.

In 2017, representatives of the Dissernet community told the medical publication Vademecum that there was no doctoral dissertation of Vice-Mayor Pechatnikov in available sources. It was not found in the Central Scientific medical library, nor in the scientific foundations of France, where this dissertation was allegedly defended.

In addition, Pechatnikov's name is associated with scandals around the use of special vehicles (ambulances) for "high-speed" detour of Moscow traffic jams, as well as with an electronic vote on the renaming of the Voikovsky district of the capital, the results of which, according to a number of opinions, were falsified.

On September 19, 2018, Sergei Sobyanin dismissed Leonid Pechatnikov, thanking him for his long service and great achievements. The former head of the mayor's office, Anastasia Rakova, was appointed to replace Pechatnikov.

The media are publishing opinions according to which the Moscow mayor is dismissing officials who have aroused “popular anger” in order to improve his image. However, as you can see, Maxim Liksutov and Isaac Kalina, whose work many Muscovites are categorically dissatisfied with, continue to perform their duties and are in no hurry to resign. According to the same opinions, it is not at all a fact that layoffs can affect the image of Sergei Sobyanin himself, who is remembered by Muscovites for his expensive “urbantina”, dubious optimization of the road network and problems with snow removal in winter.

The authoritative Telegram channel Nezygar, which is suspected of being associated with the presidential administration, reported that Leonid Pechatnikov, in the recent past the Deputy Prime Minister of the Moscow government, who oversaw the social block, was under investigation. According to the channel, he is accused of embezzlement in the amount of 3.5 billion rubles. In addition, the mayor of the capital, Sergei Sobyanin, is already aware of the conflict that has arisen.

Actually, if the information is true, Pechatnikov became the second vice-mayor of the capital, risking joining Ulyukaev, Belykh and other “illustrious prisoners.” But if Luzhkov’s deputy Ryabinin did not work in the government for long and was quickly caught in a bribe, without having time to become completely part of the capital’s elite, then Leonid Pechatnikov is a completely different figure in scale.

He came to the first government of Sergei Sobyanin as head of the health department from the post of director of the European Medical Center. Therefore, he was known as a specialist in advanced, in the terms of the current time, medicine, that is, moving to self-sufficiency at the expense of the patient. In fact, it is with the name of Pechatnikov that a very controversial reform to optimize the capital’s healthcare is associated, built on reducing the number of doctors and merging (consolidating) medical institutions. This reform met strong condemnation both patients and doctors themselves. A prominent State Duma deputy and former social minister, Kalashnikov, compared it to genocide.

Leonid PechatnikovEvgeniy Samarin/RIA Novosti

Meanwhile, the activity of the “optimizer” was marked by his elevation to the rank of Deputy Prime Minister for social issues. And I must say, for a very long time Leonid Mikhailovich was, as they like to say, absolutely Teflon, that is, the waves of scandals that arose around his name did not cause any harm to his career.

It began with the fact that his chosen successor as Minister of Health of Moscow in urgently emigrated to Switzerland, smelling something fried. In a distant country he had a solid reserve airfield. But Pechatnikov behaved as if nothing had happened. However, the next minister Khripun did not show himself in any way. Doctors even began to remember with longing the times of Luzhkov’s minister, famous surgeon Seltsovsky.

Somehow, inopportunely, it turned out that introducing himself everywhere as a doctor medical sciences, Pechatnikov cannot document his high scientific achievements. In the end, the cornered doctor of sciences said that he had defended his dissertation in France, but there was no formal confirmation there either.

Meanwhile, signals were multiplying that far from everything was in order in the sphere of metropolitan medicine. The climax was a public showdown between the vice-mayor and the well-known oncologist Anatoly Makhson, who accused the leadership of the capital's health care of inflating the cost of purchasing drugs. There was even a figure for overpayments of almost 200 million rubles. In response, Pechatnikov tried to accuse his opponent of economic abuses. In general, there was a lot of noise. But at the center of the disassembly of medical men was the same “optimization”, which seemed especially egregious in the field of oncology.

Pechatnikov was also known for his unexpected support of the liberal Leonid Gozman, who compared the NKVD and the Gestapo. And when the KP journalist recalled that the Nazis made lampshades from the skin of Gozman's ancestors, Pechatnikov said that he would no longer have business with Komsomolskaya Pravda. However, he quickly came to his senses.

It must be said that when dismissing Pechatnikov after his next election, Mayor Sobyanin made a heartfelt speech about the merits of Leonid Mikhailovich and his irresistible desire to return to practical medicine. All decorum was observed. Although everyone understood that the emerging information about strange suppliers of the largest metropolitan hospitals registered in Cyprus and other offshore countries did not remain without some consequences. After all, among their official founders there were, for example, people from the same European Medical Center, which Pechatnikov headed for a long time.

Now, if you believe Nezygar, they could unwind the entire chain through which government billions went to offshore companies. We are waiting for details.

According to Nezygar, Sobyanin’s former deputy for social development Leonid Pechatnikov is being developed by the departments of Bortnikov (FSB) and Bastrykin (TFR). It should be noted that there were always enough questions about Pechatnikov’s activities as deputy mayor, but this did not affect him in any way. Now the situation is different: for some time now experts have been stubbornly linking the above telegram channel with the Kremlin administration...

The authoritative telegram channel Nezygar reported that Leonid Pechatnikov, who was dismissed from the post of vice-mayor of Moscow after the September elections, came under investigation. According to the channel, he is accused of embezzlement in the amount of 3.5 billion rubles. In addition, the mayor of the capital, Sergei Sobyanin, is already aware of the conflict that has arisen.

Actually, if the information is true, Pechatnikov became the second vice-mayor of the capital, risking joining Ulyukaev, Belykh and other “illustrious prisoners.” But if Luzhkov’s deputytcnbntkm Ryabinin did not work in the government for long and was quickly caught in a bribe, not having time to become completely one of the capital’s elite, then Leonid Pechatnikov is a completely different figure in scale, notes News.ru (https://news.ru/obshestvo/ pechatnikovdelo/).

In fact, it is with the name of Pechatnikov that a very controversial reform to optimize the capital’s healthcare is associated, built on reducing the number of doctors and merging (consolidating) medical institutions. This reform was met with sharp condemnation from both patients and doctors themselves. A prominent State Duma deputy and former social minister, Kalashnikov, compared it to genocide.

Meanwhile, the activity of the “optimizer” was marked by elevation to the rank of “vice” for social issues. And it must be said that for a very long time Leonid Mikhailovich was, as they like to say, absolutely Teflon, that is, the waves of scandals that arose around his name did not cause any harm to his career.

It started with the fact that his chosen successor as the Minister of Health of Moscow urgently emigrated to Switzerland, feeling that it smelled like something was fried, the News.ru publication further says. In a distant country he had a solid reserve airfield. But Pechatnikov behaved as if nothing had happened. However, the next minister Khripun did not show himself in any way. Doctors even began to remember with longing the times of Luzhkov’s minister, the famous surgeon Seltsovsky.

Somehow, inopportunely, it turned out that while introducing himself everywhere as a Doctor of Medical Sciences, Pechatnikov could not document his high scientific achievements. In the end, the cornered doctor of science said that he defended his dissertation in France, but there was no formal confirmation there either, the online publication continues.

Meanwhile, signals were multiplying that not everything was in order in the sphere of capital medicine. The culmination was a public showdown between the vice mayor and the famous oncologist Anatoly Makhson, who accused the capital’s healthcare management of inflating the cost of purchasing drugs. There was even a figure for overpayments of almost 200 million rubles.

Pechatnikov responded by accusing his opponent of economic abuse. In general, there was a lot of noise. But at the center of the showdown between medical husbands was the same “optimization,” which seemed especially egregious in the field of oncology.

Leonid Pechatnikov was also known for his unexpected support of the liberal Leonid Gozman, who compared the NKVD and the Gestapo. And when the KP journalist recalled that the Nazis made lampshades from the skin of Gozman’s ancestors, Pechatnikov said that he would no longer have anything to do with Komsomolskaya Pravda. However, he quickly came to his senses.

Although everyone understood that the emerging information about strange suppliers of the largest metropolitan hospitals registered in Cyprus and other offshore countries did not remain without some consequences. After all, among their official founders there were, for example, people from the same European Medical Center, which Pechatnikov headed for a long time.

Now, if you believe Nezygar, they could unwind the entire chain through which government billions went to offshore companies. We are waiting for details.

The chief physician of the Moscow City Oncology Hospital N62, Anatoly Makhson, explained why, in his opinion, the Moscow authorities decided to optimize the capital’s most successful hospital and what consequences this will lead to for patients.

“The department buys at an inflated price”

What is the reason for the conflict between Hospital No. 62 and the Moscow Health Department?

The fact is that Moscow is trying to centralize all purchases under the pretext of saving budget funds. But in reality there is no saving. So that you understand, we have been an autonomous institution since 2014. Our only difference from a budget hospital is that we have more freedom for financial and economic activities, and we also conduct trade and procurement activities in accordance with Law 223. A budgetary organizations conduct trade and procurement activities in accordance with Federal Law 44 - there is complete control and centralization.

Before the transfer to compulsory medical insurance, the hospital had no problems at all. There was enough budget funding for almost everything. The patients did not buy anything from us, I say this responsibly. Muscovites did not pay for anything. Were paid services only for out-of-town patients. We conducted our own trading and purchasing activities. We bought what we needed, and we had enough for everything.

In 2015, the hospital was transferred to single-channel financing under compulsory medical insurance; the level began to fall, because much is not included in the compulsory medical insurance tariffs. There was significantly less money. In 2015, we treated 1 thousand more people (we still had a supply of medicines and supplies from 2014), and in 2015 we already earned 40% less than we received from the budget. By the end of 2016 it became impossible to work - they were running out Consumables and medicines, money ran out. I know that in other Moscow hospitals it has long been like this: acute shortage medications, many consumables are missing, patients are told: buy this, buy that. We've never had this before. And now we are on the brink.

This year, consumables and medicines worth 590 million rubles were centrally purchased for us, but not everything was purchased - there will be a shortage. If they had given us the money, as it was before, we would have fully provided ourselves with everything we needed with these 590 million rubles. There are many disadvantages to centralized procurement. We cannot influence purchases, but we know better what drugs and consumables we need.

Why would you buy more drugs 590 million than the Department of Health at the auction?

Because the department buys at an inflated price. We learned about this last year. The hospital wrote a request for chemotherapy drugs, they are always purchased centrally. We wrote it in July. We were told that the application would be fully satisfied. But in November our truncated application was returned - the department (without agreement with the hospital) threw it out whole line drugs that our hospital cannot live without. But the most important thing is that they not only revised our application. They also redrawn the application for the entire city under the DLO (additional drug supply) system, there were more than 5 billion rubles, and within this amount they increased the purchase of some drugs and did not buy others. I refused to sign our application. Since this all started.

How did they explain the reduction in your application?

The main reason is lack of funds. And the result of such formation of the application is a critical shortage important drugs in hospitals and more than 3 thousand unsecured prescriptions only in the Northern and Northwestern districts of Moscow with a delay of up to 46 days (this is data for 10 months of 2016).

Well, since we had a conflict, we began to understand the situation. And it turned out that there are no budget savings with centralized procurement. That our hospital buys a whole range of drugs at two, three, four and even seven times cheaper than through centralized procurement.

You know, I have been working at this hospital since 1972, and for almost 27 years now I have been the chief physician. When I became the chief physician, we had nothing. There was no endoscopy, ultrasound, or monitors in the oncology hospital. We had two or three old X-ray machines. I don’t know how we worked. But they worked, and not badly. True, the mortality rate was 4.5%. At that time, we had 700 beds in the state, we treated a maximum of 5.5 thousand patients and performed 1,800 operations per year. And now - for comparison - we treat 15 thousand people in the hospital, 6.5 thousand operations per year, the mortality rate for many years does not exceed 0.7%. And in day hospital We are treating another 6 thousand patients. Many operations are not performed by anyone in the city except us. We have the only integrated 3D operating room in Russia. And we did it ourselves. Now we are no different from any good European clinic. We have three computer and two magnetic resonance imaging scanners, the only molecular biological laboratory in the city healthcare system, and much more.

And all this is thanks to autonomy?

Thanks to normal budget financing, the desire to work and autonomy, among other things, because autonomy makes it possible to lead economic activity independently, including purchasing medications and consumables. Over the years, we have formed a very strong team. By the way, the team chose me. Because the hospital was dying. And I had an idiot's dream - to work in normal conditions. And I did everything to create these conditions. I worked at the hospital for 17 years as a surgeon, headed the department for a year, then became the chief physician. He continued to operate. The hospital was home.

“Our task is to treat the sick, not to buy more expensive things”

Tell us how centralized purchasing works? Who determines the price?

The pharmacy department of the health department is responsible for the purchase of drugs. They own a central pharmacy warehouse, which supplies medicines to pharmacies and hospitals too.

The formation of initial prices for auctions begins at the registration price. The registration price of a drug is the price that the manufacturer declares when registering the drug on the market. And it is the maximum. At one time, the Ministry of Health came up with it as the maximum price for this drug. During trading it should be reduced. Often, for many drugs, especially generics (drugs that are not original, reproduced under license), the cost has nothing to do with the registration price. They prescribe it, let’s say, 10–15 percent cheaper than the original drug. And the cost can be 30 times less. And if the seller set a price of 8 thousand, and the real cost is 300 rubles, then he may well sell for 4 thousand. And the customer then says: “The original price was eight, we bought it for four and saved half, we’re great.” And if the hospital buys it itself, according to Law 223, then we can buy more drugs at a lower price, because we are interested in it.

There was an auction this year where the drug anastrazole was sold. The total auction amount is 480 million rubles. How much do you think the price of the drug can fall at auction? She fell 27 times. The auction price was announced - 8 thousand rubles. per package. And in the end, the company won the auction at a price of 300 rubles. for a package or the entire lot - 18 million rubles.

Why such a high price for cheap drug originally?

The secret here is very simple. The auction is formed according to the international generic name- INN - “anastrazole”. And the price was set according to the cost of the original drug, which once cost just 8 thousand rubles. But now there are a lot of generics of anastrazole, and original drug by definition, cannot win the auction. So the generic won. And it happens that companies participating in the auction agree among themselves and reduce, for example, not to 300 rubles, but to 3 thousand. And they receive a colossal profit.

And how often does this happen?

Happens. There are very interesting auctions. Do you think it is possible to buy the same drug at different prices within one auction?

Probably not.

That's right, with a reasonable approach. But in practice it is possible. And this happens when the firms participating in the bidding come to an agreement. Here we had a case - we bought a generic at a price of 7.5 thousand rubles. per package, and then received the same generic from one auction at a price of 25.3 thousand rubles. And when they began to look into it, it turned out that four generics were purchased as part of one auction, with a cost from 17.9 thousand to 26.7 thousand rubles. per package. This is exactly what happens: an auction is announced, the price is inflated, firms negotiate, and within one auction there are several generics with a wide range of prices.

How did you buy this generic for 7.5 thousand?

Just. We buy with our own money. Our task is to treat the sick, and not to buy more expensive things. We buy on our own, we announce the auction ourselves. As an autonomous institution, according to Law 223, we find a company, bargain, lower the price. Our auction prices drop slightly, but there is always competition. One time it was very interesting - we held an auction where the price dropped by 70% because two dealers fought. We bought more of the drug and paid less. All this is possible when there is no centralization. But if we become a budget hospital, all tenders will be according to the 44th Federal Law, and this is centralization, this high prices. We will no longer be able to influence anything. This means that we will receive less medicine, we will treat fewer people, and patients will be forced to buy what they should receive for free.

If you remember, Pechatnikov said that our hospital is not only the best in Moscow, but also the best in Russia. But nevertheless, he petitioned the mayor to transfer us to budgetary institution, in violation of the law. For what? Why improve if we are already the best?

Why in violation of the law?

Because according to the law, an autonomous institution main body- This is a supervisory board. It is formed according to the principle: one third is the owner of the property (health department), one third is representatives of the public, one third is representatives of the hospital (but not the hospital administration), one person is a representative of the Moscow Property Department. The chairman of our supervisory board is Khripun, the Minister of Health of Moscow. Every year, the chief physician of the hospital (who is not a member of the supervisory board) makes a report on the results of the hospital’s work, reports on financial and economic activities, medical indicators, and so on. The Supervisory Board hears him and accepts or does not accept his report. Approves the plan of financial and economic activities for next year. And if something is not going well in the institution, the supervisory board can petition to change the type of institution - for example, from autonomous to budgetary. Our supervisory board did not meet whole year. Nobody listened to me. And we work well, every year we increase our throughput and maintain quality. So it turns out that our transfer to a budget institution is illegal. With the sole purpose of returning us to the centralized procurement system, after which it will be impossible to see their inefficiency.

Typically, centralization is needed to optimize costs.

Correct, but in this case this optimization is not in favor of hospitals and patients. With centralized procurement, you cannot predict when you will receive the drug or whether you will receive it at all. Because the actual delivery can begin in June, in August, and it happened that we were supplied with the drug in October.

That is, at the end of the year? What did you use for treatment all year?

Well, we treated ourselves through independent purchases. We were autonomous, and according to the law, an autonomous institution cannot have centralized procurement at all. And other Moscow hospitals in such a situation will be left without medicines.

“The larger the auction lot, the less competition”

So why then are you being deprived of your autonomy?

Here we come to the essence of the conflict. When we become like everyone else, there will be nothing to compare auction prices with. Everyone will buy at the same price. There will be no 62nd hospital, which bought four and sometimes seven times cheaper, and then showed this price to the whole world.

Here in my hospital there are two absolutely identical devices for pathological anatomy. I can show you the invoices. We bought one ourselves for 9 million rubles, we really needed it, and we decided to spend the money we earned from the hospital. But one was not enough, we have 150 thousand biopsies a year, all the devices are overloaded, and if one stops, it’s a disaster. And we ordered more. And we received the same device through the department, through centralized procurement, for 20 million rubles. We bought another device for this laboratory for 5 million rubles. and received exactly the same one through centralized procurement for 13 million rubles.

While we are an autonomous institution, we can buy three times cheaper. And when we become a budgetary institution, we will be bought at the prices of centralized procurement. From my point of view, this explains a lot.

In addition, there is something to interest the antimonopoly agency here. The larger the auction lot, the less competition. Imagine an auction for 500 million rubles. There will only be 50 million worth of security, very complex logistics. And it is precisely these auctions that the department conducts. That is, only very large companies can participate in this auction. All small companies they won't go there. The whole system is set up to kill competition and support monopolists. Our hospital had about 20 suppliers, we knew which of them was the most profitable to buy which drug. Now there will be no competition. Moscow officials are lobbying the interests of one or two companies. And the drug market is simply being destroyed.

Mayor Sobyanin has already signed a decree on transferring the hospital to the status of a budget institution, when will this actually happen?

We are still autonomous for now. We will become budgetary when we register the charter of a budgetary institution with the tax office, and then we will need to change a number of legal documents. These are colossal costs and colossal headache, because all the seals, all the forms, all the signs change.

What will happen to the hospital after the status change?

We will go back ten years in the treatment of patients. The hospital will not be able to carry out a whole series modern circuits chemotherapy that requires many days of continuous administration of the drug, which requires special consumables (which are not paid for under the compulsory medical insurance system). A whole range of diagnostic and medical techniques will become inaccessible to our patients. If we were centrally supplied with everything we need, we wouldn’t mind. Do you think I want to buy? I want to provide modern treatment to our patients. And to provide it, I know how much and what I need. Centralized procurement is crazy for oncology. Every year new drugs, new methods and consumables for them appear, treatment regimens change, and the department wants us to submit applications one year in advance, but there have been attempts to make such applications 2-3 years in advance. How is this possible? The composition of patients is changing, and unpredictably. We had a queue at the gynecology department, suddenly for some reason it disappeared, but grew up in another department. A flexible approach is needed here. You can buy something simple centrally. For example, syringes, dressings.

Why is there a shortage of medicines in public hospitals today? For example, there is a drug called bevacizumab. It is registered for many indications in oncology, normal drug, good. But the drug aflibercept appears on the market, which is twice as expensive as bevacizumab, has a similar mechanism of action, and is registered only for colorectal cancer in the second line of chemotherapy and only with the FOLFIRI regimen. And with centralized procurement they buy aflibercept. At the same time, it has been proven that it helps only with a certain chemotherapy regimen, which is actually done only here; it is quite complex, because it requires a two-day continuous administration of 5-fluorouracil. If this FOLFIRI regimen is not used, then the drug aflibercept has no advantage at all. But bevacizumab is bought in insufficient quantities, but they buy aflibercept for the whole of Moscow, despite the fact that it is twice as expensive and, in accordance with the indications and a clearly defined administration regimen, cannot be used practically anywhere.

Or another example: the drug cabazitaxel is purchased, good drug, used for cancer prostate gland, but very toxic, causing grade 4 neutropenia. Therefore, the consumption of the drug is minimal, it is used very little in clinics, and elderly patients tolerate it very poorly.

We are practically the only institution that uses it, so we use seven bottles a month. But in our clinic at the end of last year pharmacy kiosk there were 300 bottles of this drug. They will last us for four years, but the expiration date has already passed, and they bought more. It would seem, why did they buy us so much of this drug? And then, there is a manufacturer, and you need to buy from him. Do you understand? If you are interested, you can now go and look at the stock of this cabazitaxel, which has been centrally procured. It is impossible to use it up. I don’t know how they will write it off, but this medicine is worth hundreds of millions of rubles.

Why did they buy it?

It was necessary to buy from this company. And how much the drug is needed is no longer of interest to anyone.

The department accuses you of buying drugs with an expiration date.

Here I show a certificate for the control department of the presidential administration of the Russian Federation: the drug irinotecan. We bought in 2016 for 1023 rubles. per package, it has an expiration date of September 2018. And centrally we received the same drug with an expiration date until March 2019 - at a price of 5121 rubles. per package. But we used up this drug in 2016. What does expiration date have to do with it? We used to buy a drug in the summer of 2016 with a shelf life until March 2017. So he does not live up to the end of the year, we all use it. We ourselves know how much we need. We are not interested in overpaying or buying more than we can use.

The department also says that some drugs you buy more expensive.

They show that someone bought antibodies for the immunohistology laboratory for 10 thousand rubles, and we for 35 thousand. But we buy 250 tests, since we have a very powerful laboratory, and it is profitable for us to buy a lot, we still buy them We'll use it up. And for 10 thousand they have 50 tests. Thus, one test purchased centrally with a total purchase of 10 thousand rubles turned out to be a third more expensive than one test purchased by us in a purchase of 35 thousand rubles. And most importantly, it would be normal if, with centralized procurement, prices were even 30% lower. This is normal, for this they came up with centralized auctions. But the department does not explain why it centrally bought the same thing at two, four, and sometimes seven times more expensive. They are silent about this.

Your doctors say that the hospital is checked a lot and often. And now there is a new test. What are they looking for?

Previously, there were checks as checks. Many, different ones, but they checked and left; no significant violations were ever found. And now an unscheduled inspection has come from the Moscow Department of Health, the 18th one this year. And these inspectors have been sitting with us for a week, digging, destroying all the work. Every day 10–12 people come. Their task is to find something. They wanted to prove that we don’t change gloves for every dressing. The chief epidemiologist looked at how many dressings there were, then dumped all the used gloves on the floor and counted them. Everything coincided. He says: “This cannot be, you have prepared.” Their task is to find at least something. Every day the department holds a meeting to discuss who has dug up what.

There are two ways to resolve this conflict. You could sort out the procurement, restore order there and revoke the decision to transfer the hospital to budgetary status, or you could try to prove that the hospital was to blame for everything and that it was making noise unreasonably. Although the questions raised by the hospital concern the entire Moscow healthcare system. They chose the second path.

Interviewed by Olga Allenova and Rosa Tsvetkova