This month´s featured article comes from Dr. Olga Usenko in Russia and highlights the problems that patients and their physicians face while trying to find access to pain treatment and relief.
In Moscow, on Friday, February 7, 2014, Admiral Vyacheslav Apanasenko shot himself with a pistol. The Admiral left a suicide note that clearly indicated his reasons, “I do not want to blame anyone, but the Ministry of Health and the Government. I am ready to suffer, but seeing suffering of my relatives is unbearable”. The Admiral was 66 years old and he was a brave and an extraordinary man.
The Admiral served on nuclear submarines of the Northern Fleet. As an expert of the Soviet Union, he participated in negotiations limiting the number of strategic offensive arms. He initiated and was one of the authors of comprehensive programs to reduce armaments. He implemented the Vienna Document on Confidence, Security and Cooperation in Europe and was awarded numerous orders and medals.
Mr. Apanasenko suffered from end-stage pancreatic cancer. He courageously endured his pain. In the morning, the Admiral was examined by a General Practitioner (GP) from the polyclinic. The Admiral´s wife came to the polyclinic at 14:00, where she received a resolution from the Oncologist that allowed the GP to prescribe morphine. After that, the Admiral´s wife approached the Senior Nurse, who needed to go to the Chief Nurse and with one “pink” prescription form for opioids and to bring it to the GP, who would fill out the prescription forms (one “pink” and two special white forms). The Senior Nurse had some questions concerning the dosage of morphine and Admiral´s wife needed to go back to the Oncologist and then to the Head of the Department.
After three hours of torment, the Admiral´s wife went up to the 7th floor to the Medical Director of the polyclinic for her signature and for the official stamp, but the Medical Director was not in her office. Meanwhile, the polyclinic was closed and any hope to receive the needed morphine was lost.
Olga Golodets, Deputy Prime Minister, gave one week to the Russian Ministry of Health to verify the reasons for refusing painkillers to Admiral Vyacheslav Apanasenko. In turn, Veronika Skvortsova, the Minister of Health, requested Roszdravnadzor to check how medical treatment was provided to the Admiral. However, doctors from the polyclinics say that they acted according to the official instructions.
Unfortunately, Admiral Vyacheslav Apanasenko met physicians who followed the bureaucratic regulations and instructions, because they did not want to be under investigation of the Federal Service for Drug Control.
At the same time, another case in the iterated Court in Krasnoyarsk continues against Dr. Alevtina Khorinyak, who, according to the state prosecution, illegally prescribed tramadol to Victor Sechin, a terminally-ill cancer patient. The prosecutor´s office insists on the indictment.
The importance of this Court cannot be overstated, because Dr. Khorinyak´s story is typical. Every day and throughout all of Russia, doctors are under threat of criminal prosecution and need to decide whether to follow bureaucratic rules or medical ethics and duty, mercy and compassion.
All of us who work in palliative care and pain relief need to keep working and advocating for measures to ensure that patients in need have access to appropriate treatment and care in Russia.
Olga Usenko MD, MPH, CCS
Hospital Corporation of America, South Bay Hospital, Lead HIM Coder
Sun City Center, FL, USA
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