Andrey Rylkov Foundation
for Health and Social Justice

Tver resident wins case against Ministry of Health

22 April 2012

Alina Kolker,

In Tver, an amazing event has occurred. For the first time in Russia, the court satisfied an ordinary citizen’s demand to recognize the actions of the regional health ministry as unlawful. It took almost a year for Maksim Malyshev to ensure justice.

As is known in Russia, hepatitis C treatment for people with HIV infection is available free of charge. This is evidenced by the Federal Law “On Prevention of the spread of the disease in Russia caused by the human immunodeficiency virus (HIV).” The main line of this law states that “HIV-infected health care is provided to citizens free of charge.”

However, it turns out that the federal law is not written for Russia’s regions. Maksim Malyshev learned that firsthand when he decided to treat hepatitis C.

The Tver resident has spent about eight years working in drug advocacy, so he knows HIV laws well. Imagine his surprise when, having turned to the Tver Regional Centre for Disease Prevention and Control of AIDS, the patient learned that nobody was going to treat him.

“I was told upfront that the treatment is free, but I would have to pay for diagnostics,” says Maxim. “That’s strange. I have long thought that diagnostics is an integral part of treatment. And then, all the tests, and infectious disease consultations in the course of treatment must be paid for by the patient. By my conservative estimate, these additional costs would have cost about five thousand rubles … I work at the Andrew Rylkov Foundation, and together with the Foundation’s lawyer we have made a complaint to the chief physician at the AIDS center.

With this complaint began an epic that lasted nearly a year…

Maxim wrote the complaint and brought it to Oleg Nozdrevatykh, chief of Tver Regional Center for Prevention and Control of AIDS and infectious diseases. In order to not only read the complaint, but also to look into the eyes of the person with whose silent agreeement free treatment costs the patients a lot of money. The doctor turned out to be absolutely honest man.

“Well what can I do?” The doctor shrugged. “I am sending requests to the Ministry of Health in the Tver region almost every day. They respond that the money to purchase test kits for the diagnostics isn’t available and will not be.”

The chief physician shrugged his shoulders, and Max went home to wait for an official response to the complaint. A month later he received it. A letter written in boring bureaucratic language and full of links to many articles, said: there is no money for the purchase of test kits in the region, so if you want to be treated, open your own wallet.

“I am an ordinary person, and I sometimes think that officials should be made to answer complaints in ordinary human language,” Max is outraged. “But the meaning of the text, I finally figured it out. And it was like this: Of course, we all understand, but there is no money, and the Regional Ministry of Health does not provide the money. Which was something that I’d expected all along…

The next step was to appeal the actions by head physician at the AIDS center to the then Department of Health of Tver region. By law, the answer to the complaint must come within 30 days. However, it did not arrive even after two months. Unable to stand this, Maxim called the ministry. The answer was: “Please appreciate our situation, we have an administrative hitch. Will send you a reply as soon as possible.” However, “as soon as possible” was again delayed. Two weeks later, Max went to the regional Ministry of Health. “Well, why do you all have to come here? We said we’d send you a response, so we’ll do that,” the medical officials said.

“I guess I really got too excited. The people are busy. I asked them to tell me when exactly to expect the answer. They promised it within a week. After a week, nothing came,” Max continues. “I went back again. Just in case, I filed a complaint on their inaction. I was recognized there, they were smiling at me. “We have responded,” they said. As a result, having  written my first complaint in May, I received the expected response only in October. And it is was an almost word for word repetition of the letter by the head physician of the AIDS Center: “We provide free care, but you must pay a little extra.”

Seeking justice, Maxim went to the district court to apply to the Ministry of Health of Tver region. Not really looking forward to success, he and his lawyer still produced documents that clearly showed that the truth was on their side.

“At the beginning of the meeting the lawyer who represented the defendant offered a peaceful resolution, because the Ministry of Health had purchased the testing kits,” says the man who took a risk by going against the bureaucracy. “Of course, I was against it. Yes, I will be diagnosed for free, but if I don’t finish the job, other people will still have to pay for their treatment. Both the Ministry of Health’s lawyer and the judge looked at me like I was insane, obviously not knowing what else I wanted. And I’m just trying to fight for the rights of all who are living with hepatitis C. Most do not have the courage, patience or knowledge to get to court. They open their wallets and continue treatment at their own expense. And that, apparently, is what the regional Ministry of Health wants. The federal government sends to the regions huge sums to support patients with hepatitis C and HIV, but in whose pockets this money is deposited – that remains a mystery …

The hearing was postponed. However, the Ministry of Health of Tver region began moving in in the right direction, and confirmed in writing before the end of December 2011 that it planned to purchase the tests for quantitative analysis of HCV RNA and test the applicant free of charge.

“I believe that our application to the department played an important role because of the unofficial talks with the Ministry of Health officials and employees of the AIDS Center, we learned that each of our statement had been discussed at the ministry and the problem of the lack of hepatitis C diagnostics became a little clearer in the bureaucrats’ heads. They realized that it wasn’t enough to purchase  high-quality tests, and that the patients were willing to sue them in court,” said Maxim.

At the second court session the hero of this article was in high spirits, expecting to win. What was his surprise when the court ruled that the applicant’s claim to the Ministry of Health and the Center for AIDS was … unlawful!

In general, no surprise, because winning a legal battle with the state structure in our country is practically impossible. However, one can only envy Maxim’s persistence. The young man filed an appeal to the Regional Court, and the third trial session was held on April 12.

This time the case was considered by a panel of judges. Lawyers from the Ministry of Health did not appear in court – apparently, they were absolutely sure of their victory. But the jury, after hearing all the arguments of the plaintiff, considered otherwise. The court found the actions by the Regional Ministry of Health and Tver Regional Center for Prevention and Control of AIDS and infectious diseases unlawful. And this is the first step to obtain treatment for the people who are entitled to free treatment!

“I do not know what to say. Until now, I haven’t come around,” Maxim smiles. “In my view, the court was an appendage of some Ministry of Health. It turns out I was wrong, and justice exists. This means that we ourselves can change the world around us. Now we need to ensure that the court’s decision works in real life. Today, I am sure of only one thing: patients must go to courts, plead, and demand. And in absence of that, formal replies from the bureaucrats and references to absurd law articles will continue. Until people learn to claim their due by law, our healthcare system will not budge.”

The article in Russian

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