Work of medical and social examination. Nurse as a participant in medical and social examination. Determination of the degree of disability and disability group

The job responsibilities of specialists arise from the tasks of the medical and social examination bureau.

Head of the branch (primary bureau) performs primarily the functions of organizer of experts' activities and represents the bureau in relations with other institutions and with citizens undergoing examination (or their legal representatives) when discussing problems that arise during the examination.

The manager discusses the results obtained, makes a decision, and enters the decision into the medical documents. The head of the bureau can concurrently perform the functions of a medical expert in one of the specialties included in the bureau.

Traditionally in composition of medical experts included therapist, neurologist and surgeon . Responsibilities for examining citizens with various pathologies are distributed among them. As a rule, this corresponds to the classification of diseases adopted in practical medicine: nervous diseases and neurological conditions fall under the competence of a neurologist; disorders of the musculoskeletal system and the musculoskeletal system are within the competence of the surgeon; internal diseases are within the competence of the therapist.

Expert doctors have equal rights and responsibilities, and their activities differ only in the type of client’s illness.

This division is associated with the so-called “disabling disease,” i.e., a disease, the consequences of injuries, developmental defects, which are recognized (or chosen by the client together with his attending physician) as the main ones in the occurrence of restrictions on the body’s functions.

The responsibilities of the medical expert include:

· examine the medical documents submitted by the citizen being examined,

· collect the patient’s medical history (the client’s own characteristics of the condition),

Conduct a personal inspection

· report the results at the discussion of the members of the expert commission,

· make the necessary entries in the medical documents of the commission.

If necessary, the expert doctor may request additional information or refer the client (examined) for additional examination to other institutions.

IN The expert's responsibilities also include collection and registration of statistical information about citizens who have been examined by the bureau.

An expert doctor is obliged to maintain his qualifications at a high level, engage in professional self-training and self-education. From the point of view of professional activity, expert doctors must fundamentally take a different position in working with clients than attending physicians, i.e., doctors of the healthcare system. Their efforts are aimed not so much at identifying the presence of a disease or defect, but at determining the residual capabilities of the person being examined, the persistence of his pathological abnormalities that limit life activity.

The expert doctor does not establish treatment methods, he examines the pathological condition of the citizen and, based on his observations, determines the severity and persistence of the dysfunction.

In addition to specialist doctors making expert decisions, the expert composition includes a social work specialist, a psychologist and a rehabilitation specialist.

These are specialists new to the expert commissions, so their functions and job responsibilities have not yet been established. Moreover, objective contradictions have emerged between old and new specialties within the same expert commission. They stem from the fact that in the previous medical labor expert commissions, the role of researcher of the social problems of the examined citizen was performed by expert doctors, therefore, with the introduction of new positions, the specialists replacing them seemed to invade the old sphere of activity of the experts. Apparently, over time, the distribution of functions will become more defined, and each specialist within the bureau will occupy only his assigned place.

Some scientists see the responsibilities and work technologies of bureau specialists as follows.

Tasks of a rehabilitation specialist:

Conduct social diagnostics - assessment professional labor status(impaired, not impaired, work activity is impossible, possible with a decrease in intensity, possible in another profession, possible in specially created conditions); educational (violated, not violated, education is possible in ordinary or specially created conditions), social(self-care not lost, partially lost, completely lost; social skills not lost, partially lost, completely lost, personal safety not lost, partially lost, completely lost) and social-environmental status(violated, not violated, social independence not lost, partially lost, completely lost, social communication not lost, partially lost, completely lost, the ability to solve a range of personal problems not lost, partially lost, completely lost, the opportunity to play sports lost, partially lost, not lost), the opportunity to engage in cultural and leisure activities (not lost, partially lost, completely lost, the opportunity to engage in social activities not lost, partially lost, completely lost);

· assess rehabilitation potential and rehabilitation prognosis;

· assess the structure and degree of disability;

· determine the person’s need for rehabilitation.

Tasks of a social work specialist:

Conduct social diagnostics

· assess the structure and degree of disability,

· take part in determining the rehabilitation potential and rehabilitation prognosis;

· determine a person’s need for social protection measures, including rehabilitation;

· determine the possibility of carrying out rehabilitation measures of IPR;

· establish conditions for the provision of rehabilitation services;

· determine the range of institutions for the implementation of IPR;

· determine the place and conditions for the acquisition of technical means of rehabilitation.

Its technologies are determination of a number of social characteristics of the person being examined: analysis of income, marital status, the role of the family in helping a disabled person, the availability of technical means and devices and the need for them, the equipment of housing for a disabled person.

Social work specialist must assess the possibility of a disabled person performing social and social and environmental activities , including:

· assessing the possibility of providing personal care;

· assessment of the possibility of personal safety (use of gas, electricity, water supply, transport, medicines, etc.);

· assessment of social skills (cooking, cleaning, washing clothes, shopping, etc.);

· assessment of the possibility of ensuring social independence (the possibility of independent living, enjoyment of civil rights, compliance with responsibility, participation in public activities), - assessment of the possibility of social communication;

· assessment of the possibility of solving personal problems (control of births, control of gender relations).

Psychologist's tasks:

· psychodiagnostics of mental development;

· determination of the structure and severity of disorders of higher mental functions;

· assessment of professionally significant mental functions, learning ability, emotional-volitional sphere, personal and socio-psychological characteristics and possibilities for correcting personality deformations;

· assessment of social adaptation;

· assessing socio-psychological, social and other statuses;

· assessment of rehabilitation potential and rehabilitation prognosis;

· assessing the structure and degree of disability of a disabled person;

· implementation of psychological support for the examination procedure, development of the IPR and its implementation, determination of measures of psychological rehabilitation.

The following comment can be added to this distribution of responsibilities. The psychologist is the leader in determining the rehabilitation prognosis for a given disabled person, since the rehabilitation effect depends on the desire of the citizen and his willingness to make efforts to attract his potential.

It must be said that the work of a psychologist in the bureau of medical and social examination is most aimed at establishing those personality traits of the client that will contribute to his rehabilitation. At the same time, other aspects of the personality of the person being examined must be ignored. It may be that the psychologist’s conclusions can, to a small extent, influence the fact that he is recognized as disabled and the group assigned to him, but this should not relieve him of responsibility for the collegial decision made.

A social work specialist should eventually become a key figure in the process of medical and social examination, since even the legislation emphasizes that the ultimate goal of the examination is to provide social assistance to a citizen who has applied to the bureau.

In the most general terms The bureau's decision is divided into two blocks :

1. recognizing a citizen as disabled and assigning him a disability group;

2. determination of rehabilitation potential and development of rehabilitation measures (individual program).

WITH first block of solution cope better medical experts, determining the degree of disability, with the assistance of a social work specialist who determines the degree of social disability.

But second block decisions can be executed more skillfully by efforts rehabilitation therapist, psychologist and social work specialist. At the same time, the main and very important role of the psychologist is to establish, and perhaps even form, the psychological readiness of the disabled person for rehabilitation.

The role of the remaining employees of the medical and social examination bureau is reduced to creating the necessary conditions for the activities of experts:

nurse- provides the material and technical basis of the expert procedure;

medical registrar- draws up all the necessary documentation, keeps minutes of commission meetings, issues relevant certificates.

Disability can be registered if there is:

• health impairment with persistent impairment of body functions caused by diseases, consequences of injuries or defects;
• limitation of life activity (complete or partial loss by a citizen of the ability or ability to provide self-care, move independently, navigate, communicate, control one’s behavior, study or engage in work);
• the need for social protection measures, including rehabilitation and habilitation.

The decision to recognize a person as disabled is made based on the results of a medical and social examination (MSE).

Depending on their health status, adults are assigned disability group I, II or III, and children under 18 years of age are assigned the category “disabled child.”

2. How to get a referral to the Bureau of Medical and Social Expertise?

Referrals for medical and social examination are issued by medical organizations (the legal form of the medical organization and your place of residence do not matter).

When determining whether you have signs of disability, your doctor must rely on diagnostic tests, treatment, rehabilitation, and habilitation results. Therefore, it is best to contact your attending physician for a referral to MSA. But you can also go, for example, to the chief doctor of the medical organization where you are being treated.

By Decree of the Government of the Russian Federation dated February 20, 2006 No. 95 “On the procedure and conditions for recognizing a person as disabled.”

If you are denied a referral, request that you receive a written refusal. With this certificate, you have the right to contact the ITU office yourself. In this case, the staff of the ITU bureau will prescribe an examination for you, and based on its results they will determine whether there is a need for a medical and social examination.

After you receive the referral, you will be scheduled for a medical and social examination at the ITU office.

3. What documents are needed to register a child for ITU?

To register your child for a medical and social examination, you will need:

• application (children over 14 years of age fill out and sign the application on their own; for children under 14 years of age this must be done by legal representatives);
• identification document (for children under 14 years old - birth certificate, for children over 14 years old - passport);
• medical documents indicating the citizen’s state of health (outpatient card, hospital extracts, consultants’ reports, examination results - usually issued by the doctor who issued the referral for medical examination);
• SNILS;
• passport of the parent or guardian;
• to the guardian (representative of the guardianship and trusteeship authority) - a document establishing guardianship.

4. What documents do adults need to register for ITU?

To sign up for a medical and social examination, you will need:

• application (can be filled out by both the citizen himself and his representative);
• identity document (original and copy);
• referral to medical examination issued by the attending physician;
• work book (original and copy);
• professional and production characteristics from the place of work - for working citizens;
• medical or military medical documents indicating the citizen’s state of health (outpatient card, hospital extracts, consultant reports, examination results, Red Army or military record book, certificate of injury, etc.);
• SNILS;
• if the documents are submitted by a representative - a power of attorney for the representative and his passport.

In some cases it may be necessary Additional documents (depending on the specific case):

• act on an industrial accident in form N-1 (certified copy);
• act on occupational disease (certified copy);
• conclusion of the interdepartmental expert council on the causal relationship of the disease, disability with exposure to radioactive factors (certified copy, original presented in person);
• ID of a participant in the liquidation of the consequences of the accident at the Chernobyl nuclear power plant or living in the exclusion or resettlement zone (copy, original presented in person);
• for foreign citizens and stateless persons permanently residing on the territory of the Russian Federation - a residence permit;
• for refugees - a refugee certificate (to be presented in person);
• for nonresident citizens - a certificate of registration at the place of residence;
• for those discharged from military service - a certificate of illness drawn up by the Military Military Commission (a certified copy, the original must be presented in person).

An application for a medical and social examination can be considered up to one month from the date of submission of the application.

5. Which ITU office should I contact?

Medical and social examination is carried out at the ITU office at the place of residence. In some cases, MSE may be carried out:

• in the ITU Main Bureau - in case of appeal against the bureau’s decision, as well as in the direction of the bureau in cases requiring special types of examination;
• in the ITU Federal Bureau - in case of appeal against the decision of the ITU Main Bureau, as well as in the direction of the ITU Main Bureau in cases requiring particularly complex special types of examination;
• at home - if a citizen cannot come to the bureau (ITU Main Bureau, ITU Federal Bureau) for health reasons, as confirmed by the conclusion of a medical organization, or in a hospital where the citizen is being treated, or in absentia by decision of the relevant bureau.

6. How is the examination carried out?

During the examination, the bureau’s specialists will study the documents you submitted and analyze social, professional, labor, psychological and other data.

In some cases, ITU specialists may prescribe additional examination for you. You can refuse it. In this case, the decision to recognize you as disabled or to refuse to recognize you as disabled will be made based only on the data you provide. Your refusal will be reflected in the ITU protocol, which is maintained during the examination.

Representatives of state extra-budgetary funds, the Federal Service for Labor and Employment, as well as specialists of the relevant profile (consultants) can participate in the medical and social examination at the invitation of the head of the bureau with the right of an advisory vote. You also have the right to invite any specialist with his consent, he will have the right to an advisory vote.

The decision to recognize a person as disabled or to refuse to recognize him as a disabled person is made by a simple majority vote of the specialists who conducted the medical and social examination, based on a discussion of the results of the medical and social examination.

Based on the results, a medical and social examination report is drawn up. You have the right to request copies of both the act and the protocol.

In addition, the bureau’s specialists, after conducting a medical and social examination, will prepare an individual rehabilitation and habilitation program (IPRA) for you.

7. What documents are issued after the examination?

A citizen recognized as disabled is issued:

• a certificate confirming the fact of disability, indicating the disability group;
• individual rehabilitation or habilitation program (IPRA).

A citizen who is not recognized as disabled, at his request, is issued a certificate of the results of a medical and social examination.

If it is necessary to make changes (new personal data, technical errors) to the IPRA or if it is necessary to clarify the characteristics of previously recommended types of rehabilitation and (or) habilitation measures, there is no need to undergo a new medical and social examination. It is enough to write an application to the ITU bureau that issued the document. You will be given a new IPRA.

The date of determination of disability is the day the bureau receives an application for medical examination. Disability is established until the 1st day of the month following the month for which the next ITU (re-examination) is scheduled.

8. How to get re-examined?

Re-examination of disabled people of group I is carried out once every 2 years, disabled people of groups II and III - once a year, and disabled children - once during the period for which the category “disabled child” is established for the child.

Re-examination can be carried out in advance, but no more than 2 months before the expiration of the established period of disability.

If disability is established without specifying the period for re-examination, or if re-examination needs to be carried out earlier than the established period, it can be carried out:

• at the personal request of a disabled person (or his legal or authorized representative);
• in the direction of a medical organization due to a change in health status;
. More information about the work of the ITU Bureau can be found on the website

To increase your chances of receiving disability, it is important to know how the VTEK commission proceeds. To do this, the patient collects the relevant documents and applies for an examination. A detailed description of the sequence of actions, as well as how to behave correctly when communicating with the commission, is presented in the article.

It must be said right away that a person needs to know how the medical and social examination of the ITU, and not the VTEC, for disability is carried out. The fact is that despite the use of both terms, from a formal point of view, the patient applies specifically for an ITU examination, which includes passing:

• doctors' commissions;
• social worker;
• psychologist;
• other specialists (as necessary).

Therefore, despite the fact that the term “VTEK” is still used very widely, in fact we are talking about ITU. To pass the commission, you must contact the local ITU Bureau on your own initiative or (usually this way) in the direction of:

• attending physician;
• or the Pension Fund.

Step 1. Collection of necessary documents

Along with the application for the commission, the patient also submits his passport and medical documents:

• outpatient card;
• conclusion of a medical commission;
• test results;
• results of diagnostic procedures that are associated with the disease.

Other documents to be submitted:

• diploma or certificate of education;
• employment history.

In some cases, an N-1 form may also be needed, which registers an industrial accident (if disability is supposed to be assigned specifically in connection with this incident).

Documents can be submitted by the patient himself, his legal representative (parents of children, guardians) or a person acting under a power of attorney, which must be notarized.

The work may also request a production specification that describes in detail:

• what exactly are the job responsibilities;
• what is the duration and mode of the working day, the number of shifts per month;
• were there any breaks in work due to registration of sick leave;
• whether the person uses facilitated conditions.

Thus, the patient needs to worry in advance about exactly what documents will be needed, and prepare a full set of required papers by the date of appointment of the commission.

Step 2. Passing the commission

On the appointed day, the patient arrives at the medical facility and undergoes a commission. Basically, the procedure takes place in the form of answers to questions from doctors, a psychologist and a social worker. To understand how the VTEC disability commission goes, it is better to prepare for it in advance - dress neatly and modestly, and also be prepared to communicate (this is described in detail below).

DEADLINE FOR MAKING A DECISION. After completing the questions and examination, the patient leaves the office, and the commission begins to discuss opinions. The decision is made by a simple majority of votes, of which the patient is notified by mail or telephone. The deadline for making a decision is 6 working days. In any case, the patient is given an examination certificate, and if the decision is positive, then of the established form.

front side

Step 3. What to do in case of refusal

In case of refusal, you must contact a higher authority (the regional Bureau, and then the federal one). In exceptional cases, they file a statement of claim in an attempt to protect their rights in court.

Peculiarities of registration of disability for certain groups

If we talk about how VTEC is carried out, how the commission that registers a patient for disability works, in general terms, the procedure is almost always the same. However, there are also features that depend on the specific groups of some patients.

7 rules on how to behave at ITU

The patient needs to immediately understand: specific decisions are made by specific people, so the presence of certain documents does not always guarantee the assignment of a degree of disability (with the exception of obvious cases of severe health impairment, which require registration of the 1st degree).

Therefore, even before visiting the VTEC disability commission, you should have a good idea of ​​how it goes, how best to tune in psychologically, and what questions can be asked. Here are 7 useful tips that will certainly help you understand the features of this procedure:

1. The basic principle is that a person needs show your real helplessness more-less. You can take with you a cane if you usually use one, a standard set of medications that you take several times a day, and other medical supplies. That is, the commission members must get a clear idea that you really need some care and support from the state.
2. Another important rule - to the patient You should not clearly demonstrate your financial interest in the commission's decision. It is clear that assistance from the state is the main purpose of visiting VTEK. However, commission members should not get the impression that they are looking at a fairly healthy person with minor disabilities who simply wants to apply for benefits and other types of support without sufficient grounds.
3. The tone of communication with members of the commission should be neutral, correct, and fairly polite, but not too warm. Familiarity, “kinship,” and familiarity are not allowed, since this may be negatively regarded as an attempt to influence the decision.
4. It is better for the patient to look quite modest– for example, girls do not need to wear bright makeup or dress too attractively, as they are used to in everyday life. The external image of a person should not attract attention, much less make a dubious impression.
5. At the same time appearance must be impeccable– neat, neat, clothes without specks of dirt, protruding threads, seams, clean. In addition, it is worth keeping in mind that a person may be asked to partially undress - for example, in case of diseases of the spine, bones, the back or feet are examined, etc.
6. Don't be too active or ask questions, the answers to which you can find out yourself (in a medical institution, in open Internet sources, brochures, etc.). Aggressive tone, threats, phrases like “I will complain”, etc. are excluded. It is important to understand that there will be no second chance to make a first impression. This is a very important rule of how the VTEC disability commission proceeds.
7. On the other side, It’s important to be prepared for uncomfortable questions from any member of the commission. Some phrases may seem incorrect because they will be too personal, but it is better to immediately tune in to this and pass the test with restraint and communicate correctly. The patient must show his interest in recovery, as well as the fact that he carefully monitors his health - for example, he keeps a diary recording blood pressure readings, regularly takes medications and follows all other doctor’s orders.

Doctors in most cases have a negative attitude when a person tries to self-medicate. Therefore, even if you use folk remedies, you should not talk about it - the information will not be perceived as a fact of the patient’s concern for his health.

On October 1, the Public Chamber launched a “hotline” on issues of accessibility and quality of work of institutions of the medical and social examination system, press service of the RF OP. Citizens who are not satisfied with the work of the MTU system can contact it. You can call the hotline from any region of Russia, all calls are free.

“The hotline will not act as a help desk,” said Ekaterina Kurbangaleeva, deputy chairman of the RF OP commission on social policy, labor relations, interaction with trade unions and support for veterans, “we collect all the necessary information on the appeal, analyze it, try to solve it, but if If we don’t resolve the issue at the level of our legal and organizational support, then we transfer it to ITU.”

Let us recall that on March 29, 2018, the Russian government adopted Resolution No. 339, which significantly simplified the methods of examination and re-examination of people with disabilities. A specific list of diagnoses has appeared for which disability is given during the initial examination before the age of 14 or 18. Previously, children with disabilities had to prove their status every year. The changes also affected the individual rehabilitation and habilitation program (IPRA). “If a person, for example, needs to change the size of diapers, for this he does not need to go through the entire lengthy procedure - from doctors to the ITU, which sometimes lasts for two months, now you can simply come to the ITU and make changes to the IPRA,” explained Kurbangaleeva.

Last year, the administration of the President of the Russian Federation received more than 130 thousand complaints about the work of medical and social examination: about the incompetence and bias of specialists, about corruption and frequent mistakes. Every week, the Public Chambers of the regions register dozens of appeals from citizens.

The situation in the ITU system is out of control, according to Vladimir Slepak, Chairman of the Commission on Social Policy, Labor Relations and Quality of Life of the OPRF. The head of the Interregional Center for Independent Medical and Social Expertise, Doctor of Medical Sciences Svetlana Danilova, agrees with this. Before the interview, Svetlana Grigorievna sent a letter to the editor from a young disabled woman talking about her trip to the next commission. She showed that journalists understood what people with disabilities face. There are no generalizations or analysis of problems, but there is resentment, frankness, and just real life... We immediately contacted the author: is it possible to publish? "Why not? “I don’t mind,” answered wheelchair user from Bashkiria Lyudmila Simonova.

“Grandma is disabled, she has diabetes, and she’s been in line for 7 hours...”

“I have been disabled group I since 2008. Trauma to the cervical spine, dysfunction of the pelvic organs, explains Lyudmila Simonova. — I live in a village. I recently went to see my doctor and got tested. He wrote a messenger letter and sent it to the city to a urologist, neurologist, and so on.

I’m going to the city of Beloretsk, a hundred kilometers away. Doctors see you at different times and on different days - depending on who is lucky enough to make an appointment. I had to live in the city for a week to get around everyone. I couldn’t find a proctologist, so I went to the next city – Magnitogorsk. Another hundred kilometers... The building is not suitable for wheelchair users, the room is old, the plaster is falling off, it’s damp and cold inside. People wait in line for hours. From one o'clock in the afternoon until seven in the evening we sat with the thought: “When will we be invited?” One grandmother came at 11 and left eight hours later. She said: “I plowed my shift.” Another was crying, begging to be accepted. The old woman is disabled, she has diabetes, she wanted to eat, but she stood in line for 7 hours. ITU workers walked by with stone faces and pretended not to notice anything.

Recently, there is no ITU in Beloretsk; experts from Ufa come to us on certain days. I had to live in Beloretsk and wait for the specialists to arrive. Well, my relatives let me in, and it’s good that I have a friend who dragged me to the 3rd floor. Otherwise, I can’t imagine how long it would take to travel from village to city on off-road roads (we don’t have asphalt), and hire a car, because our buses are not equipped for wheelchairs.

This time, workers from ITU Bureau No. 6 in Ufa came to us. According to my ideas, I should have been invited to the office at the appointed time. Ask what problems I have, give advice and recommendations on the entire list of technical rehabilitation means that would make life easier and help me adapt. It’s not for nothing that the word “habilitation” was added to the individual rehabilitation program. I thought that ITU should work for people with disabilities, but I was mistaken. I sat in line, they called me in, looked at me and said: “If we are redoing the IPR, then we will remove half of what you have written in; according to the new rules, you are not allowed to do this. Better leave the old program and go home.”

How do they clean it? By what law? It turned out that I wasn’t eligible for an electric wheelchair, but I’m a “neck” and my hands don’t work well. Yes, I use an active stroller around the house, it’s easy to put it in the trunk, take me up the steps to the third floor when I’m visiting my sister in the city, but for walking around my village without asphalt with holes and bumps, I need an electric stroller. And in 2012 it was added to my program. Now they said: “We don’t care where you live.”

The experts did not agree with many of the decisions of the attending physicians and ignored their recommendations. They treated me and other disabled people as if we had come to them to beg, they were rude. The commission gave a friend a disability group, and then called her to Ufa for a re-examination. I was given a month to appeal the decision to the main bureau of the region. But this will be a huge problem - you will have to travel not a hundred, but three hundred kilometers, spending your money by hiring a car. This is how people with disabilities are helped to live in our country, everything is for them.”

“When I first heard that disability group II costs 450 thousand rubles, I didn’t believe it”

We are talking with the head of the Interregional Center for Independent Medical and Social Expertise, Doctor of Medical Sciences Svetlana Danilova .

— Svetlana Grigorievna, is everything that Lyudmila Simonova writes about true?

- Certainly. Russian disabled people overcome so many obstacles to pass a commission, obtain a status, or receive preferential medications that mother, don’t worry. Nowadays it’s impossible to get an appointment with a specialist without going through a therapist—he gives referrals. First you go to him, then to the doctors, then again to him with the results. A disabled person travels 100 kilometers to one city, another hundred kilometers to another. And, in theory, he should be examined and receive help at his place of residence. The task of the ITU is not to challenge the diagnoses established by clinicians, but to determine the limitations of life activity. In our country, experts change diagnoses, cancel doctors’ recommendations, and say: “The patient has no obvious disorders.”

In the Federal Law of November 24, 1995 No. 181-FZ “On the social protection of disabled people in the Russian Federation,” disability is interpreted as “social insufficiency due to health impairment with a persistent disorder of body functions, leading to limitation of life activity and the need for social protection.” In accordance with this, in addition to expert examination, ITU institutions are entrusted with the responsibility for developing individual rehabilitation programs for people with disabilities and determining their needs for social protection measures.

- This is according to the law, but as in life ?

— And in life, the main problem of medical and social examination is the duration and complexity of obtaining a disability group and rehabilitation services for citizens with disabilities through the examination procedure at ITU institutions. Currently, people with disabilities often refuse to go through bureaucratic procedures and solve problems at their own expense. The legal rights of people with disabilities are violated. ITU forces people to undergo unnecessary examinations, collect unnecessary tests, arguing that they are supposedly disciplining a disabled person: “At least once a year he undergoes a medical commission, otherwise you won’t be forced to do so.” But, in fact, the ITU bureau today is a complex bureaucratic apparatus that creates various obstacles and problems for people with disabilities.

The entry into force of the Order of the Ministry of Labor of Russia dated October 11, 2012 No. 310n “On approval of the Procedure for the organization and activities of federal state institutions of medical and social expertise” called into question the need for the existence of the ITU itself as a separate structure.

According to paragraph 4 of this law, a necessary condition for forming the composition of the bureau is the presence of at least one ITU doctor. However, the doctor’s specialty is not indicated...

— Is there really only one doctor included in the bureau, and who are the rest of the experts? Officials?..

— When there were VTEK, there were three doctors on the commission. Then we tried to include 5 specialists. There are currently three experts working, one of them on medical and social issues. Moreover, clarifications about the doctor’s specialization were removed from the documentation. Specialists do not apply to the ITU because it is impossible to obtain a category; it is not taken into account.

General ITU bureaus examine citizens with a wide variety of diseases, and no matter how competent a doctor is in ITU, it is almost impossible to navigate well in all nosological forms. And the psychologist and rehabilitation specialist who are part of the bureau are not at all competent in the matter of establishing disability.

In addition, according to the rules approved by Decree of the Government of the Russian Federation of February 20, 2006 No. 95, the decision to recognize a citizen as disabled or to refuse is made by a majority vote of the specialists who conducted the MSA. If there is one doctor for medical and social examination, the objectivity of such a vote is questionable - the main condition for recognizing a person as disabled to this day remains the type and degree of severity of impaired body functions, which can only be determined by a doctor according to medical examination (with the exception of mental functions).

In other words, the ITU bureau is turning into a bureau for issuing disability certificates, which significantly increases the corruption component and significantly reduces the objectivity of the decision made.

— Disabled people complain about the low professional level of ITU specialists in the regions. They say that they even confuse the diagnoses. The mother of a child with a serious illness recently showed a copy of a document in which experts call adrenogenital syndrome... diabetes mellitus. Where are they prepared?

— In Russia, experts are trained in internships in St. Petersburg - there is an institute for advanced training of doctors there. And in the federal bureau of ITU. The level is really low. There are few professionals: the leaders are weak, sometimes it is embarrassing to listen to them - they do not know regulatory documents, are poorly versed in the legislation, and experts in the regions lack the knowledge and competencies to understand and implement the orders of the Ministry of Labor of the Russian Federation. This is sad because the ITU system is an absolute monopoly. Its decisions cannot be challenged. In the pre-trial procedure, an appeal is carried out in the service itself: one group, another, and then you have to contact the federal bureau, where often the sent documents are not opened at all. I defended my candidate’s and doctor’s thesis there and repeatedly saw how meetings were held, how the experts did not see the patient, did not study the documentation, but immediately took the decisions of the main bureau of the region as a basis. Decisions change extremely rarely. Sometimes courts, when considering claims of disabled people, rule: undergo an examination in any region of your choice. Which region will change its decision after the federal bureau?

No independent expert can approach the service, since by law there is no independent ITU - the license is given only to federal institutions. Therefore, no matter how objective and fair the independent expert’s conclusion is, it will not affect the change in the decision of the ITU federal institution.

— The Public Chamber of the Russian Federation proposes to consider “the mistakes of the ITU from the point of view of the Criminal Code of Russia” and gives examples of corruption in the Ulyanovsk and Volgograd regions...

— And there is corruption, and, unfortunately, the regions have their own stakes. I’ll probably put the tariffs on the card soon - there are a lot of complaints from people with disabilities. I remember when they first told me that in Vorkuta, group II disability costs 450 thousand rubles, I didn’t believe it. And then people confirmed it. In the same Vorkuta, a surgeon was caught red-handed. It’s especially scary when they extort money from real disabled people. Alas, this is also part of the system. It needs to be changed, but I no longer believe the talk about reorganizing the ITU. Three years ago, this question was already raised; the Ministry of Economic Development of the Russian Federation was asked to calculate how much the reforms would cost. They counted a lot, wrote a lot, and didn’t offer anything concrete.

No reorganization of the ITU at this stage will be able to solve the problem. Examples are the largest regions, such as the Krasnodar Territory and Rostov-on-Don. The managers were removed several years ago, and the local specialists from the primary bureaus continued to work and continue to work. Nothing has changed in the service. The monopoly was and remains.

I believe that the determination of disability groups can be carried out by a medical commission of a medical organization on the recommendation of the attending physician on the basis of data from primary medical documentation, without filling out a referral for medical examination. Currently, the attending physician submits to a medical commission a patient with a temporary disability, a disabled person with a deteriorating condition, for the purpose of prescribing and correcting treatment, therapeutic and diagnostic measures. Therefore, the chairman of the commission is usually aware of the peculiarities of the course of the disease of such patients. And specialists from the ITU bureau determine the disability group without knowing anything about the patient (unless we are talking about re-examination) and rely only on the submitted medical documents and a one-time examination of the patient within a few minutes.

I consider it advisable to abolish the MSA service, and to entrust the conduct of MSA to the medical commissions of healthcare organizations, especially since most of the functions are currently performed by the medical commission to one degree or another. Reform will require changing the procedure for medical institutions to conduct examinations of disability, revising the functional responsibilities of medical commissions of primary care medical organizations. But it will shorten the route of travel for citizens with disabilities, simplify the examination procedure, improve the quality and expand the scope of medical and social rehabilitation services provided to disabled people.

The liquidation of the ITU service by transferring its functions to medical commissions of medical organizations will allow:

reduce social tension among disabled people and citizens initially sent to MTU (the long procedure of filling out referrals to MTU and subsequent examination at the bureau will be eliminated);

reduce federal budget expenses for maintaining the ITU service;

reduce the burden on specialists of the medical commission and doctors of the medical organization by eliminating the need to fill out a referral for medical examination;

increase the availability of examination for the population, because medical commissions exist in all medical organizations, while the ITU bureau is created at the rate of 1 bureau per 90,000 people, and citizens of small settlements are forced to travel considerable distances at their own expense to get to the ITU bureau;

eliminate the corruption component on the part of ITU bureau specialists;

legislatively approve an independent ITU.