Why doctors increasingly hide the existence of modern drugs from patients. Habit for the worst

Anatoly Makhson, former chief physician of the Moscow City Oncology Hospital No. 62

You may have heard about the scandal with the 62nd hospital. The story is very important, and I ask you to pay attention to it! Moscow City Oncology Hospital No. 62 is considered one of the best such clinics in the country. They could have been treated in this hospital ordinary people who do not have money for expensive foreign clinics. But the optimizers reached the hospital. Perhaps because the chief physician, Anatoly Makhson, uncovered schemes under which the Moscow government purchased medicines at prices that were several times inflated. Now Makhson has already resigned as chief physician, and a large-scale audit is being carried out at the hospital. And thanks to optimization, the goal of which is “improving the quality of service,” the hospital lost the ability to independently purchase the medications its patients needed.

Briefly about what happened and what is happening now:

WHAT'S HAPPENED?

November 25 Stalik stalic Khankishiev wrote a post about how his daughter was treated for cancer at the Moscow City Oncology Hospital No. 62. The post ended with the news that they decided to optimize the 62nd hospital. Stalik sharply condemned this decision and called on his readers to seek its cancellation.

WHAT IS BAD ABOUT OPTIMIZATION?

The optimization of the 62nd hospital consisted of its transfer from the category of autonomous to budgetary. That is, after optimization, she lost the right to independently purchase the medications she needed. Now she receives medicines from the Department of Health, which purchases them under the public procurement law.

WHAT IS BAD ABOUT GOVERNMENT PROCUREMENT?

Purchasing medicines through government procurement turned out to be very expensive. For example, in 2016 the state purchased the drug Irinotecan at a price 5,844 rubles per bottle, and the 62nd hospital in the same year purchased the same drug at the price 1,213 rubles(almost five times cheaper). The state purchased the drug Docetaxel at a price 19,474 rubles per bottle, and the hospital - according to the price 7,500 rubles(2.5 times cheaper). The state purchased oxaliplatin at a price ranging from 5 839 before 13,580 rubles, while the hospital bought it for 859 rubles(6-15 times cheaper). It turns out that the state is spending more money, but at the same time purchases a smaller amount of medicine. This has created a shortage of drugs in hospitals, which has become a deadly threat for patients with certain types of cancer. Previously, Hospital No. 62 could independently purchase the drugs necessary for their treatment using its own money. But after optimization, she lost this opportunity.

Hospital defenders believe that the decision to optimize is due to the Department of Health's desire to hide the fact of waste. After all, if the hospital does not purchase medicines five times cheaper, then there will be nothing to compare prices on government procurement with. And then no one will have any questions about why the Department of Health spends the money allocated for the purchase of drugs so ineffectively.

“A very convenient approach - instead of putting things in order in the purchase of drugs, which are purchased annually for more than 5 billion rubles only for cancer patients in Moscow, to eliminate the opportunity for the 62nd Oncology Hospital to purchase them at normal prices, and then there will be nothing will compare. As Zhvanetsky said, “it’s difficult to change without changing anything, but we will.”
After this, something like a war began in the blogosphere. After the incident with Dolya, Stalik began accusing bloggers of being corrupt: in particular, nikitskij , who released strange revealing posts about Makhson; nemihail , who reproached Stalik for excessive wealth and dishonesty; losyara1975 , whose post was frozen before I had a chance to read it. Stalik and Makhson supported miss_tramell .
WHAT IS HAPPENING NOW?
At the end of December, Anatoly Makhson wrote an official statement to the FSB and the Investigative Committee about the overpricing he had discovered in the procurement of medicines. The application was accepted for consideration, but nothing is known yet about the results. - it says that in comparison with the hospital, the Moscow Department of Health overpaid for equipment and medicines 217,894,133.58 rubles.
In addition, Stalik and Anatoly Makhson received many letters about financial fraud and corruption in the field of healthcare. Stalik promised that he would publish this information as it was confirmed by documents. There is already a post about the fact that the Moscow Health Department spends a lot of money on purchasing unnecessary packaging materials for sterilization.
Meanwhile, the inspection continues at Hospital No. 62.
HOW MUCH DOES THE MOSCOW HEALTH DEPARTMENT OVERPAY FOR MEDICINES?
On January 13, Stalik published a series of posts analyzing the prices at which the Moscow Department of Health purchases medicines for cancer patients. He considered that the Department overpaid when purchasing 12 drugs more than 800 million rubles.
Below I present my own calculations based on the documents provided by Stalik. In his posts, he also provides links to auctions and contracts for government procurement, all information can be double-checked (, , , ,).
Capecitabine
4,161 - this is the number of packages purchased by DZM
21,002,439.45 ₽ - this is how much he would have spent if he had bought the medicine at the same price as the 62nd hospital
14,474,292.52 ₽ - this is how much DZM overpaid, buying medicine at an inflated price
2,867 - this is how many packages of medicine could be bought with the overpaid money
Gemcitabine
21,148 - this is the number of packages purchased by DZM
13,323,240 ₽ - this is how much he would have spent if he had bought the medicine at the same price as the 62nd hospital
60,558,210.32 ₽ - this is how much DZM overpaid, buying medicine at an inflated price
96,124 - how many packages of medicine could be bought with the overpaid money
Paclitaxel
43,357 - this is the number of packages purchased by DZM
52,028,400 ₽ - this is how much he would have spent if he had bought the medicine at the same price as the 62nd hospital
167,340,997.45 ₽ - this is how much DZM overpaid, buying medicine at an inflated price
139,450 - this is how many packages of medicine could be bought with the overpaid money
Bevacizumab
Dosage 16 ml

Dosage 4 ml

In total

9,454 - how many packages of medicine could be bought with the overpaid money
Topotecan
163 - this is the number of packages purchased by DZM
2,255,594 ₽ - this is how much he would have spent if he had bought the medicine at the same price as the 62nd hospital
873,729 ₽ - this is how much DZM overpaid, buying medicine at an inflated price
63 - how many packages of medicine could be bought with the overpaid money
Trastuzumab
4,503 - this is the number of packages purchased by DZM
223,979,445.15 ₽ - this is how much he would have spent if he had bought the medicine at the same price as the 62nd hospital
74,030,986.11 ₽ - this is how much DZM overpaid, buying medicine at an inflated price
1,488 - how many packages of medicine could be bought with the overpaid money
Panitumumab
2,500 - this is how many packages DZM purchased
99,962,500 ₽ - this is how much he would have spent if he had bought the medicine at the same price as the 62nd hospital
15,507,571 ₽ - this is how much DZM overpaid, buying medicine at an inflated price
387 - how many packages of medicine could be bought with the overpaid money
Oxaliplatin
17,049 - this is the number of packages purchased by DZM
28,983,300 ₽ - this is how much he would have spent if he had bought the medicine at the same price as the 62nd hospital
108,158,237 ₽ - this is how much DZM overpaid, buying medicine at an inflated price
63,783 - how many packages of medicine could be bought with the overpaid money
Irinotecan
24,160 - this is how many packages DZM purchased
24,715,680 ₽ - this is how much he would have spent if he had bought the medicine at the same price as the 62nd hospital
95,367,509.85 ₽ - this is how much DZM overpaid, buying medicine at an inflated price
93,223 - how many packages of medicine could be bought with the overpaid money
Docetaxel
Before the price jump
3,392 - this is the number of packages purchased by DZM
3,392,000 ₽ - this is how much he would have spent if he had bought the medicine at the same price as the 62nd hospital
18,704,531.75 ₽ - this is how much DZM overpaid, buying medicine at an inflated price
5,514 - how many packages of medicine could be bought with the overpaid money
After the price jump
6,864 - this is the number of packages purchased by DZM
51,480,000 ₽ - this is how much he would have spent if he had bought the medicine at the same price as the 62nd hospital
122,237,346 ₽ - this is how much DZM overpaid, buying medicine at an inflated price
16,298 - how many packages of medicine could be bought with the overpaid money
In total
140,941,877.75 ₽ - this is how much DZM overpaid, buying medicine at an inflated price
21,812 - this is how many packages of medicine could be bought with the overpaid money
Vinorelbine
5,810 - this is the number of packages purchased by DZM
3,341,853.9 ₽ - this is how much he would have spent if he had bought the medicine at the same price as the 62nd hospital
11,242,746.9 ₽ - this is how much DZM overpaid, buying medicine at an inflated price
19,546 - how many packages of medicine could be bought with the overpaid money
Bevacizumab
Before the price drop
2,549 - this is the number of packages purchased by DZM
34,422,307.76 ₽ - this is how much he would have spent if he had bought the medicine at the same price as the 62nd hospital
72,806,398.77 ₽ - this is how much DZM overpaid, buying medicine at an inflated price
5,391 - how many packages of medicine could be bought with the overpaid money
After the price drop
1,920 - this is the number of packages purchased by DZM
6,482,016 ₽ - this is how much he would have spent if he had bought the medicine at the same price as the 62nd hospital
13,717,785.6 ₽ - this is how much DZM overpaid, buying medicine at an inflated price
4,063 - how many packages of medicine could be bought with the overpaid money
In total
86,524,184.37 ₽ - this is how much DZM overpaid, buying medicine at an inflated price
9,454 - how many packages of medicine could be bought with the overpaid money
This is what you get when you add up the numbers:
RUB 861,544,526.64- total amount of overspending
457 651 - so many packages of medicines could be bought with the overpaid money
Every year in Russia approximately 500,000 people become ill with [cancer] (for the first time). Of these, 290,000 die in the first year of the disease. This means that, in fact, there was no fight for their lives... They are not being treated, medicines are not reaching them!
And we only counted for Moscow, let’s say, roughly speaking, 10% of the country’s population lives here. This means that approximately 29,000 people who became ill for the first time died in Moscow during the year. And here are 427,000 packages of drugs! Some of them are very expensive. Almost 15 packages of drugs not received for every person who died from cancer. Need I say that these medicines, this allocated money, these 844 million of our rubles could save many of these 29,000 people?
Can you imagine how much this is - 29,000 people per year? Do you think it’s nonsense that women give birth to new ones? That's 80 people a day. One subway car, a full trolleybus. Every day one carriage leaves us for the cemetery. And in each of them - our family, loved ones, friends, acquaintances.
HOW DID THE MINISTER OF HEALTH REACT TO THE SITUATION?
Veronika Skvortsova said that Anatoly Makhson and Leonid Pechatnikov should resolve all their differences themselves.
“We need to find a common language and somehow decently resolve this situation<...>If it turns out that they [Makhson and Pechatnikov] cannot find it now common language, well, then they will meet in my office, and the three of us will talk.”
Veronika Skvortsova, Minister of Health of the Russian Federation

Skvortsova speaks of the dispute between Makhson and Pechatnikov as a personal conflict that can be resolved by conversation. She did not mention the situation with the purchase of medicines at many times inflated prices. It remains unclear how a personal conversation between two people in her office will help solve the problem of huge overspending of budget money when purchasing medicines. And from her words it is not clear whether she is going to solve this problem at all or not.
I ask you not to pass by and connect to this story. Tell us about what is happening on your social networks, follow the news about the 62nd hospital, and do not remain indifferent.

Former head of staff of Mayor Sergei Sobyanin Anastasia Rakova will now oversee social direction in the renewed Moscow government. Previously, this post was held by Leonid Pechatnikov; his name does not appear in the current government.

Sobyanin, whose inauguration took place the day before, on September 18, announced this on his blog. The decree on personnel changes also appeared on the city hall website. “He [Pechatnikov] is a practical person, a wonderful doctor, and he didn’t quite like bureaucratic work, which he told me more than once. I am very grateful to him that he agreed, albeit with great difficulty and reluctance, but still agreed to work for some time in the Moscow government. Over the years, he has done a lot for the city's health care. We have gone through the most difficult and sometimes very painful, but necessary changes. As a result, the industry has become economically more stable and better motivated by clients,” wrote the capital’s mayor, clarifying that Pechatnikov’s resignation is also related to his transfer to another job. At the same time, Sobyanin hopes that Pechatnikov will remain “at least” his adviser.

Anastasia Rakova has headed the Moscow Mayor's Office since 2010. Before that, she worked in the Tyumen region together with Sergei Sobyanin, and also held the posts of Deputy Secretariat of the Head of the Administration of the President of Russia and Deputy Minister of Regional Development.

Leonid Pechatnikov is a graduate of the First medical institute them. THEM. Sechenov, he graduated from the university in 1979. Then in 1981 he completed his residency training in the specialty " internal illnesses" Until 1994 he worked as the chief therapist of the Central Republican clinical hospital Ministry of Health of the RSFSR, and from 1994 to 2001 he served as chief therapist of the diagnostic and treatment association of the Ministry of Health Russian Federation, from where he moved to KGB No. 67 in Moscow as chief therapist. In 2004 he became President of the European medical center(EMC).

In 2010, Pechatnikov headed the Moscow Health Department, and two years later he moved to the social bloc of the Moscow government. In this post, he repeatedly found himself embroiled in various scandals - from the purchase of medical equipment and drugs to questions about the education of the vice mayor himself. The name of Pechatnikov is associated with the optimization of the Moscow healthcare system, which began in 2014 and was associated with large-scale layoffs of the capital’s doctors and the consolidation of medical institutions. Pechatnikov himself said that optimization “has been completed good performance”, and to the then head of the State Duma Committee on Health Protection, Sergei Kalashnikov, who called the reform “genocide”: “It makes no sense to comment on Kalashnikov’s statements. I found the answer to the deputy from Faina Georgievna Ranevskaya: “I blurted it out like a p****l in a puddle.”

At the end of 2016 - beginning of 2017, Leonid Pechatnikov took an active part in the high-profile conflict between the then chief physician of the Moscow City Oncology Hospital No. 62 (MGOB No. 62) Anatoly Makhson and the Department of Health. The department issued order No. 963 dated December 1, 2016, changing the status of MGB No. 62 from an autonomous to a budgetary institution. Then, by order of December 5, Anatoly Makhson was dismissed from the post of chief physician of the Moscow City Hospital No. 62.

Makhson made a statement to the FSB and the Investigative Committee with a request to check the purchases of the Moscow Health Department and bring officials to criminal liability if violations are identified. The statement cited examples of the department purchasing five oncological drugs and two units of medical equipment, the prices for which were inflated by 217.8 million rubles. Leonid Pechatnikov refuted Makhson’s arguments, tried to convict the hospital of illegal business and, in the end, announced that inspections of the procurement activities of the Health Department did not reveal any violations.

In 2017, representatives of the Dissernet community Vademecum said that they were unable to find the deputy mayor’s doctoral dissertation in the available sources. Representatives of the Central Scientific Research Center also failed to find her. medical library at the First Honey and All-Russian certification commission(VAK). The Department of Certification of Scientific and Scientific-Pedagogical Workers of the Ministry of Education and Science responded to Vademecum’s request that “information on the award of the scientific degree of Doctor to Leonid Mikhailovich Pechatnikov medical sciences... not available in the department’s registration and accounting database.” In response, Leonid Pechatnikov said that he defended his doctoral dissertation in France, but his doctoral dissertation was also found in the databases of the Bibliographic Agency for higher education France, whose archives contain information about all scientific works defended in the republic.

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 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 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. How 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 chief physician 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 therapeutic 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 no one cares about how much the drug is needed.

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? It happened that in the summer of 2016 we bought a drug with an expiration date until March 2017. So it doesn’t last until the end of the year, we use everything. 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 are 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, this is why centralized trading was invented. 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

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. Actually, it is with the name of Pechatnikov that a very controversial reform to optimize the capital’s healthcare is connected, built on reducing the number of doctors and merging (enlargement) 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 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 began with the fact that his chosen successor as Moscow Minister of Health 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 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.

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.

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.

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.

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.