Summary. If unfavorable outcome of the course of a disease (=trauma) occurs, it is not necessarily a consequence of undue performing of professional duties by medical staff, and it could be well related to natural course of the pathologic process, or unsatisfactory conditions existing for providing medical care, or else to incautious actions (even to inaction) of a patient himself, predetermined by his low level of medical awareness, lack of patient’s medical measures that were ought to be taken. Nevertheless, the very fact or even hint of involvement of physicians/nurses in such occurrence is, as a rule, a clear indication for bringing criminal or civil suit against the staff involved.

In court examination for such civil/criminal suits, the evidence basis, related to undue performing of professional duties by medical staff, usually involves conclusion of a commission of forensic experts. A commissioned forensic expertise is generally considered one of the most sophisticated tasks to fulfill. Regretfully enough, requirements to expertise descriptions of the content, results, evaluation of the results, methods of investigation to this end, though quite clearly stated in normative juridical acts, are not apt to give a true representation or picture of expertise thinking in resolving the questions that had arisen, first of all, on the nature of relationship between conditions and organization of diagnostic and therapeutic procedures and medical intervention, on the one side, and unfavorable outcome (=trauma), on the other. The whole story not rarely happens en route, for example, in railroad context, which is to further intricate the situation. The Criminal Trial Code of the Russian Federation, when tackling the theme of expertise investigation, demands that an expertise conclusion should clearly indicate the content, results, and methods of the investigation performed (article 204, item 9 of this Code). Article 25, part 2 of the Federal Law No. 73-ÔÇ(=FL) from May 31, 2001 (On activity of state forensic expertise in the Russian Federation) demands also that conclusions of an expert/commission of experts should clearly indicate the content, results, evaluation of the results, and methods of the investigation performed, as well as foundations of conclusions, which conclusions should be in proper wording and unequivocally correspond to the concrete issues put forward in connection with the current investigation. Nevertheless, all given elements for the conclusion-making do not fully reflect the content of the investigation prescribed, and though they are usually helpful in formalizing sensual cognitive sphere of expertise investigation, they do not fully elucidate the train of thought of the experts as concerns their activity for solving the issues put forward in connection with the current investigation, first of all, the issue of quality of provided medical care in cases of unfavorable outcome.

Besides this, in many cases of organization and performance of commissions of experts of that kind, their close content relationship to expertise of quality of provided medical care is not strictly taken into account or not consistently followed.

Key words. Analysis, quality of medical care, insurance, railroad stations, diseases, traumas.

References

1. Kartashov V.T. Metodicheskiye i prakticheskiye podkhody k upravleniyu kachestvom meditsinskoy pomoshchi v krupnom poliklinicheskom uchrezhdenii [Methodological and practical approaches to medical care quality management in a large out-patient clinic]. Voyenno-meditsinskiy zhurnal 2004;(4):15-23.
2. Kartashov V.T. Pravovoye regulirovaniye obyazatelnogo meditsinskogo strakhovaniya v Rossiyskoy Federatsii [Legal regulation of Mandatory Health Insurance in the Russian Federation]. Voenno-ekonomicheskiy vestnik 2005;(3):124-126.
3. Krayevoy S.A., Kudrin V.A. Rabota spetsializirovannykh peredvizhnykh meditsinskikh formirovaniy v sisteme zdravookhraneniya na zheleznodorozhnom transporte [Operation of special mobile medical caravans in the health care system of railway transport]. In: Novyye tekhnologii v sovremennom zdravookhranenii. Moscow: RIO TsNIIOIZ; 2007. P. 234-237.
4. Lebedev A.A., Goncharova M.V., Serebryanskiy O.Yu., Lebedev N.A. Innovatsii v upravlenii meditsinskimi organizatsiyami [Innovations in health care facility management]. Lisitsyn Yu.P., editor. Moscow: Littera; 2010. P. 172.
5. Maksimova T.M. Sovremennoye sostoyaniye, tendentsii i perspektivy otsenki zdorovya naseleniya [Present day condition, tendencies and prospects for assessing population health]. Moscow: PERSE; 2002. 79 p.
6. Medik V.A., Tokmachev V.S., Fishman B.B. Statistika v meditsine i biologii: rukovodstvo v 2 t. [Statistics in medicine and biology: Guidance in 2 volumes]. Komarov Yu.M., editor. Moscow: Meditsina; 2000. Vol. 1. 412 p.
7. Prokofyeva M.Yu., Popov V.S. Organizatsionno-ekonomicheskiye osnovy sotsialnoy zashchity naseleniya: federalnyye i regionalnyye aspekty [Organization and economical basis for social protection of population: federal and regional aspects]. Moscow: GUU; 2009. 35 p.
8. Savashinskiy S.I. Prinyatiye upravlencheskikh resheniy v organizatsii lechebno-diagnosticheskogo kompleksa [Managerial decision-making in organization of health care facilities]. In: Problemy territorialnogo zdravookhraneniya. Issue 7. Moscow: RIO TsNIIOIZ; 2005. P. 13-19.

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