Why doctors are increasingly hiding the existence of modern drugs from patients. He knew too much
former head Office of Mayor Sergei Sobyanin Anastasia Rakova will now oversee social direction in the renewed Moscow government. Previously, this post was occupied by Leonid Pechatnikov - his name does not appear in the current composition of the government.
Sobyanin, whose inauguration took place the day before, on September 18, announced this in his blog. The decree on personnel changes also appeared on the website of the mayor's office. “He [Pechatnikov] is a practical man, wonderful doctor, and bureaucratic work was not entirely to his liking, as he told me more than once. I am very grateful to him that he agreed, although with great difficulty and reluctance, but nevertheless agreed to work for some time in the government of Moscow. Over the years, he has done a lot for the health care of the city. The most difficult and sometimes very painful, but necessary changes have passed. As a result, the industry has become more economically stable and better motivated for customers,” the capital’s mayor wrote, adding that Pechatnikov’s resignation was also connected with his transfer to another job. At the same time, Sobyanin hopes that Pechatnikov will remain "at least" his adviser.
Anastasia Rakova has been the head of the Moscow Mayor's Office since 2010. Prior to that, she worked in 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 medical and diagnostic association of the Ministry of Health Russian Federation, from where he moved to KGB No. 67 of Moscow as the chief therapist. In 2004 he became President of the European medical center(EMC).
In 2010, Pechatnikov headed the Moscow Department of Health, and two years later he moved to the social block of the Moscow government. In this position, 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 reductions in the capital's doctors and the merger of medical institutions. Pechatnikov himself said that the optimization "was completed good performance”, and to the then head of the State Duma Committee on Health Protection, Sergei Kalashnikov, who called the reform “genocide”, as follows: “It is pointless to comment on Kalashnikov’s statements. I found the answer to the deputy from Faina Georgievna Ranevskaya: “I blurted out like a p **** l in a puddle.”
In late 2016 - early 2017, Leonid Pechatnikov took an active part in a high-profile conflict between the then chief physician of the Moscow City Oncological Hospital No. 62 (MGOB No. 62) Anatoly Makhson and the DZM. The department issued order No. 963 dated December 1, 2016, changing the status of MGOB 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 Clinical Hospital No. 62.
Makhson statements to the FSB and investigative committee with a request to check the purchases of the Moscow Health Department and bring officials to criminal responsibility if violations are detected. The statement cited examples of the department's purchases of five cancer drugs and two units of medical equipment, the prices of which were overpriced 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 purchasing activities of the DZM did not reveal any violations.
In 2017, representatives of the "Dissernet" Vademecum community that they could not find the doctoral dissertation of the vice-mayor in the available sources. It was also not possible to find it by representatives of the Central Scientific medical library at the First Honey and the All-Russian Attestation Commission (VAK). The Department of Certification of Scientific and Scientific and Pedagogical Workers of the Ministry of Education and Science responded to a request from Vademecum that “information about the award of Pechatnikov Leonid Mikhailovich degree the doctors medical sciences... is not available in the registration database of the department.” In response, Leonid Pechatnikov said that he had defended his doctoral dissertation in France, but his doctoral dissertation could also be found in the databases of the Bibliographic Agency for higher education France, whose archives contain information about all the scientific works that have been defended in the republic.
Anatoly Makhson, chief physician of the Moscow City Oncological Hospital N62, explained why, in his opinion, the Moscow authorities decided to optimize the most successful capital hospital and what consequences this would lead to for patients.
"The Department Buys Overpriced"
What is the reason for the conflict between the 62nd hospital and the Moscow Health Department?
The fact that Moscow is trying to centralize all purchases under the pretext of saving budget funds. In fact, there are no savings. For your understanding, we have been an autonomous institution since 2014. Our only difference from the budget hospital is that we have more freedom for financial and economic activities, as well as trade and procurement activities, we conduct according to the 223rd law. And budget organizations conduct trade and procurement activities according to the 44th Federal Law - there full control, centralization.
Before the transfer to CHI, the hospital had no problems at all. There was enough budget funding for almost everything. 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 ourselves conducted 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 for compulsory medical insurance, the level began to fall, because in CHI tariffs much is not included. Money has become much less. In 2015, we treated 1,000 more people (we had a stock of medicines and funds since 2014), and in 2015 we earned 40% less than we received from the budget. By the end of 2016, it became impossible to work - consumables and medicines are running out, the money has run out. I know that in other Moscow hospitals it has long been like this: there is an acute shortage of drugs, there are no many Supplies, patients are told: buy this, buy that. We never had it. And now we're on the edge.
This year, consumables and medicines for 590 million rubles were centrally purchased for us, but not everything was bought - there will be a shortage. If they gave us the money, as it was before, we would completely provide ourselves with everything we need for these 590 million rubles. There are many shortcomings in centralized procurement. We cannot influence purchases, and we know better what drugs and consumables we need.
Why would you buy more drugs worth $590 million than the health department at an auction?
Because the department is buying at an inflated price. We learned about it last year. The hospital wrote an application 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 returns - the department (without agreement with the hospital) threw out a number of drugs, without which our hospital cannot live. But the most important thing is that they not only redrawn our application. They also redrawn the application for the entire city under the DLO system (additional drug provision), 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.
And how did they explain the reduction of your application?
The main reason is the lack of funds. And the result of such an application formation is a lack of critical important drugs in hospitals and more than 3 thousand unsecured prescriptions only in the Northern and North-Western 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 is no saving of budgetary funds in case of centralized purchases. That our hospital buys a whole range of drugs at two, three, four, and even seven times cheaper than centralized purchases.
You know, I have been working in this hospital since 1972, and for almost 27 years now I have been the chief physician. When I became the head physician, we had nothing. AT cancer hospital there was no endoscopy, ultrasound, monitors. We had two or three old X-ray machines. How we worked, I do not know. But they worked, and not bad. 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 a year. And now - for comparison - we treat 15 thousand people in the hospital, 6.5 thousand operations per year, the mortality rate does not exceed 0.7% for many years. And we treat another 6,000 patients in the day hospital. No one in the city, except us, performs many operations. We have the only integrated 3D operating room in Russia. And we did it ourselves. Now we are no different from some good European clinic. We have three computer and two magnetic resonance tomographs, the only molecular biological laboratory in the city health care system, and much more.
And all this - thanks to autonomy?
Thanks to normal budget financing, the desire to work, and autonomy, among other things, because autonomy makes it possible to conduct business independently, including buying medicines 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 as a surgeon in the hospital for 17 years, 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”
How does centralized procurement work? Who determines the price?
The Pharmacy Department of the Health Department deals with the procurement of medicines. They own a central pharmacy warehouse, which supplies medicines to pharmacies and hospitals too.
Formation of initial prices for auctions starts at the registration price. The registration price of a drug is the price that the manufacturer claims when he registers the drug on the market. And it is the maximum. At one time, the Ministry of Health invented it as the maximum price for this drug. During the auction, it should be reduced. Often, for many drugs, especially for generics (drugs are not original, reproduced under license), the cost price 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 the price at 8 thousand, and the real cost is 300 rubles, then he may well sell for 4 thousand. And the customer then says: “The initial price is eight, we bought for four and saved half, we are great.” And if the hospital itself buys, according to the 223rd law, then we can buy more drugs at a lower price, because we are interested in this.
There was an auction this year where the drug anastrozole was sold. The total amount of the auction is 480 million rubles. How much do you think the price of the drug in the auction can fall? She fell 27 times. The auction price was announced - 8 thousand rubles. for packing. And in the end, the company won the auction at a price of 300 rubles. for a package or the whole lot - 18 million rubles.
Why such a high price for cheap drug initially?
The secret here is very simple. The auction is formed according to the international generic name- INN - "anastrazole". And the price was set at the cost of the original drug, which once cost just 8 thousand rubles. But now it's full of generic anastrozole, and original drug already, by definition, cannot win the auction. So the generic won. And it happens that the firms participating in the auction agree among themselves and reduce, for example, not up to 300 rubles, but up to 3 thousand. And they get a huge profit.
And how often does this happen?
It happens. There are very interesting auctions. Do you think it is possible to buy the same drug at different prices within the same 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 auction agree. Here we had a case - we bought a generic at a price of 7.5 thousand rubles. per package, and then received from one auction the same generic at a price of 25.3 thousand rubles. And when they began to sort it out, it turned out that four generics were purchased as part of one auction, with a cost of 17.9 thousand to 26.7 thousand rubles. for packing. This is how it happens: an auction is announced, the price is too high, firms come to an agreement, and within one auction there are several generics with a wide range of prices.
And how did you buy this generic for 7.5 thousand?
Just. We buy with our own money. Our task is to treat the sick, not to buy more expensive. We buy on our own, we announce the auction ourselves. As an autonomous institution, according to the 223rd law - we find a company, we bargain, we lower the price. We have a small price drop in the auction, but there is always competition. Once it was very interesting - we held an auction, where the price drop was 70%, because two dealers clashed. We bought the drug more and paid less. All this is possible when there is no centralization. But if we become a budget hospital, all tenders will be in accordance with the 44th Federal Law, and this is centralization, this high prices. We can no longer influence anything. This means that we will receive fewer drugs, we will treat fewer people, patients will have 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 the status budget institution, in violation of the law. What for? Why improve something if we are already the best?
Why in violation of the law?
Because by law, an autonomous institution main body- this is 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, the chief physician of the hospital (who is not a member of the supervisory board) makes a report on the results of the hospital, 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 activity for the next year. And if something goes wrong in an institution, the supervisory board can apply 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 throughput, we keep the quality. So it turns out that the transfer of us to a budgetary institution is illegal. For the sole purpose of returning us to the centralized procurement system, after which it will be impossible to see their inefficiency.
Usually 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 and whether you will receive it at all. Because the real supply can begin in June, in August, but it happened that we were supplied with the drug in October.
That is, at the end of the year? What have you been doing all year?
Well, we treated it through independent purchases. We were autonomous, and an autonomous institution, by law, cannot have centralized purchases at all. And other Moscow hospitals in such a situation will sit without medicines.
“The larger the auction lot, the less competition”
So why then are you deprived of autonomy?
Here we come to the crux of the conflict. When we become like everyone else, there will be nothing to compare prices from auctions with. Everyone will buy at the same price. There will be no 62nd hospital, which bought four, and sometimes even seven times cheaper, and then also showed the whole world this price.
Here in my hospital there are two absolutely identical devices for pathological anatomy. I can show you invoices. We bought one ourselves for 9 million rubles, we really needed it, and we decided to spend the money earned by the hospital. But one was not enough, we have 150 thousand biopsies a year, all devices are overloaded, and if one stops, then this is a disaster. And we ordered more. And they 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 through a centralized purchase for 13 million rubles.
As long as we are an autonomous institution, we can buy three times cheaper. And when we become a budget institution, we will be bought at centralized purchase prices. From my point of view, this explains a lot.
In addition, there is something to be interested in and the antimonopoly department. The larger the auction lot, the less competition. You imagine an auction for 500 million rubles. There will only be support for 50 million, very complicated logistics. Namely, such auctions are conducted by the department. That is, only very large firms can participate in this auction. All small companies will not go there. The whole system is set up to kill competition and support monopolists. Here, our hospital had about 20 suppliers, we knew from which one of them it was more profitable to buy which drug. Now there will be no competition. Moscow officials lobby for the interests of one or two firms. And the drug market is simply destroyed.
Mayor Sobyanin has already signed a decree on transferring the hospital to the status of a public institution, when will this actually happen?
While we are still independent. We will become budgetary when we register the charter of a budgetary institution with the tax office, and then it will be necessary to change a number of legal documents. These are enormous costs and headache because all seals, all letterheads, all signboards change.
What will happen to the hospital after the status change?
We will roll back in the treatment of patients ten years ago. The hospital will not be able to carry out a number of modern schemes chemotherapy, requiring many days of continuous administration of the drug, which requires special consumables (which are not paid under the CHI system). A number of other diagnostic and medical techniques become inaccessible to our patients. If we were supplied centrally with everything we need, we would not 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 purchasing 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 an application for one year in advance, and there have been attempts to make such applications for 2-3 years in advance. How is this possible? The composition of patients is changing, and unpredictably. We had a line in gynecology, suddenly for some reason it disappeared, and in another department it grew. A flexible approach is needed here. You can buy something simple centrally. For example, syringes, dressings.
Why are there not enough medicines in public hospitals today? For example, there is the drug 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 similar mechanism action, registered only when 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 in our country, it is quite complicated, because there must be a two-day continuous administration of 5-fluorouracil. If this FOLFIRI regimen is not done, then aflibercept has no benefit at all. But bevacizumab is bought in insufficient quantities, and aflibercept is bought 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 scheme, it cannot be used practically anywhere.
Or another example: the drug cabazitaxel is bought, good drug used for cancer prostate, but very toxic, causes grade 4 neutropenia. Therefore, the consumption of the drug is minimal, it is used very little in clinics, elderly patients tolerate it very poorly.
We're pretty much the only institution that uses it, so we're running out of seven bottles a month. But in our clinic at the end of last year, there were 300 bottles of this drug in the pharmacy kiosk. We will have enough of them for four years, but there the expiration date will already be out, and they bought more. It would seem, why did so many people buy this drug for us? And then, that there is a manufacturer, and you need to buy from him. Do you understand? If you are interested, you can now go and see the stocks of this cabazitaxel, which was purchased centrally. It is impossible to use it. I don't know how they will write it off, and this medicine costs hundreds of millions of rubles.
Why did they buy it?
Should have bought from this company. And no one is interested in how much the drug is needed.
The department accuses you of buying expired drugs.
Here I am showing a certificate for the Control Department of the Administration of the President of the Russian Federation: the drug irinotecan. We bought in 2016 for 1023 rubles. per package, it has an expiration date - until September 2018. And we centrally received the same drug with a shelf life until March 2019 - at a price of 5121 rubles. for packing. But we used up this drug in 2016. What's with the expiration date? We used to buy a drug in the summer of 2016 with a shelf life until March 2017. So he does not live up to the end of the year, we all use it. 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 more expensive.
They show that someone bought antibodies for the immunohistological 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 use up. And they have 10 thousand - 50 tests. Thus, one test purchased centrally with a total purchase of 10,000 rubles turned out to be one third more expensive than one test purchased by us in a purchase of 35,000 rubles. And most importantly, it's normal if prices were lower even by 30% during centralized procurement. This is normal, for this they came up with centralized auctions. But the department does not explain why centrally bought the same thing at two, four, and sometimes seven times more. They are silent about this.
Your doctors say that the hospital is checked a lot and often. And now a new test. What are they looking for?
Previously, there were checks as checks. Many, different, but they checked and left, they never found significant violations. And now an unscheduled check has come from the Moscow Health Department, the 18th in a row this year. And these inspectors have been sitting with us for a week, digging, ruining all the work. Every day 10-12 people come. They are on a mission to find something. They wanted to prove that we do not 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. Everything matched. He says: "This cannot be, you have prepared." Their task is to find at least something. Every day a meeting is held in the department, where they discuss who dug up what and who.
There are two ways to resolve this conflict. It was possible to deal with purchases, put things in order and withdraw the decision to transfer the hospital to a 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 Roza Tsvetkova
What will the correspondence dispute between the head physician of the 62nd hospital and the vice-mayor of Moscow lead to? Business FM conducted a special investigation into the drug procurement system
Vital important prices. How can the conflict around the 62nd hospital end? What problems did the correspondence discussion between the head physician of this oncology clinic and the vice-mayor of Moscow reveal, and what do doctors from other institutions say?
The 62nd hospital is considered the best oncology clinic in the country. Its chief physician, Anatoly Makhson, went on vacation, from which he will not return to his previous post. And this was preceded by an absentee dispute between Makhson and the vice-mayor for social sphere Leonid Pechatnikov. The subject of the dispute is the status of the hospital. The city made the institution budgetary. Previously, the clinic had autonomy, which allowed it to negotiate prices directly with drug and equipment suppliers.
Now everything is like everyone else - the hospital writes an application, the authorities pay for everything from the budget. Is that all? It depends on the size of this budget.
Officials say that when a hospital has the right to negotiate directly with a supplier, there is a risk of corruption. At the same time, there were no claims against the 62nd clinic earlier. And the city, according to the authorities, will also save money due to the wholesale order.
Chief Physician Makhson is confident that with centralized procurement, thousands of cancer patients may be left without medicines. In the 62nd clinic, such a threat has already arisen, and the hospital itself bought more the right medicine with the money earned. Moreover, according to Mahson, she bought almost five times cheaper than the health department. The 62nd hospital purchased Irinotecan at a price of 1,213 rubles per pack. And Moscow paid 5,844 rubles for the same medicine. Machson published several more similar examples in a table comparing purchase prices. The health department later responded. Your table. Officials, defending the idea of centralized procurement, also compared the prices at which the city buys goods for clinics with the prices that the 62nd hospital managed to negotiate. Thunderbeat devices were bought by the Moscow Health Department for 73 thousand, and the 62nd hospital for 243 thousand! Overpayment - 231%, a set of certain tests, according to the department, the hospital bought 255% more expensive than the city with a centralized purchase, and so on. Makhson commented on the claims. According to him, the authors of the table did not specify that Moscow purchased the devices in question with one handle (whatever that means), and the 62nd hospital with five. According to the tests, the city indicated the price for 50 pieces, and for the hospital published the cost of buying 250 packs. As a result, according to Makhson, for all the items listed by the department, it turned out that the prices that the hospital managed to agree on turned out to be lower than the price in the centralized purchase, and the list can be continued, Anatoly Makhson says.
Anatoly Makhson head physician of the 62nd hospital“In our hospital we have two devices in the same laboratory, absolutely identical, from the same company, bought with a gap of three months. Here one device costs 5 million, another device costs 13 million. There is only one difference, because for 5 million we bought it ourselves, and for 13 million we received it through a centralized purchase of the Health Department.”
It was not possible to get a comment from the Business FM department. The press service said that they would be ready to discuss this topic only after checking the 62nd hospital. And it will only end next year. By the way, this is already the 18th check in a year, and it was initiated immediately after the head physician began to argue in absentia about the prices and the fate of the hospital with Vice Mayor Pechatnikov. The official once commented on Mahson's claims at a clinical and anatomical conference. A transcript of Pechatnikov's speech is available on the Vademecum portal. He clarified that he himself once helped to ensure that the hospital was left with autonomy, and explained the success of the 62nd clinic in saving by the fact that the hospital buys drugs with an expiring expiration date at a discount, and the budget cannot do this by law. Machson later added that drugs run out before their expiration date and that the hospital buys cheaper not only such drugs, but also completely new ones.
If medicines are of high quality and suitable for use, and they can be bought cheaper, why should this be stopped, and not taken into service?
Nikolay Zhukov department head drug treatment tumors of the Rogachev Moscow Cancer Research Institute“Even if the 62nd hospital bought medicines cheaper due to the fact that there is a shorter expiration date, but she managed to transfer all this before the expiration date, there is no crime in this. The difference, as it were, is, for what reason these drugs were cheaper if they are of high quality, if they are certified, and so on. Taking into account the insufficient provision of cancer patients with drugs, every extra ruble is not just a ruble, but someone's saved life or extended life.
The conflict around the 62nd hospital made it possible to ask a more global question: is the procurement system in the country generally organized correctly? So, from the message of Makhson it follows that the same drug "Irinotecan" in 2014 cost 518 rubles per bottle. In 2016, it more than doubled in price for the hospital, and 11 times for the state. Arguing with each other, Makhson and Pechatnikov found themselves united in one thing. It's about about the reasons for the sharp rise in the price of medicines.
In 2014, the auction for the purchase of medicines was structured as follows: the customer, determining the starting price, took the lowest possible price. That is, he said: "We are ready to buy this medicine for 100 rubles." Suppliers began to offer their options, someone, for example, said: “We can do it for no less than 200”. And someone agreed to sell for 170. As Pechatnikov explained, the Ministry of Economic Development decided that this is how they cut off potential competitors and everyone should be allowed to trade. The ministry proposed to reverse the rules and set the maximum price as the starting price, so that later the bidders would compete by lowering the price. Of course, if the maximum price for the same conditional drug is 2,000 rubles, a pair of applicants will compete and offer 1,900 and 1,800 for the sake of appearance. But no one will sell this medicine for 170 rubles, especially if there are few competitors, and they can agree on that this tender is won by one, and the next by another. Loses budget. By negotiating deliveries privately, prices can be reduced. This, of course, is not about the difference of 5 or 11 times, which is written by users of social networks who defended the 62nd hospital, but it is really possible to save money, says Ekaterina Chistyakova, Program Director of the Give Life Foundation.
Ekaterina ChistyakovaProgram Director of the Gift of Life Foundation“Prices, indeed, during purchases can be very different, and I want to say that the drugs that our fund purchases are purchased 20-30% cheaper than the same happens for public procurement. This is achieved by targeted work with suppliers, purposefully, because it is really important for us to save the philanthropist's money.”
The Vice Mayor, commenting on this sharp jump in prices due to a letter from the Ministry of Economic Development, said amazing story. According to him, the regions received the letter on January 12, 2015.
Leonid Pechatnikov Vice Mayor of Moscow “Everyone was saluted, performed, and medicines really got more expensive. It was such a letter. Unfortunately, neither the Minister of Health, nor I, nor the mayor, we knew about this letter, it went through departments throughout Russia, so prices began to rise throughout Russia. All departments had this letter, but the Ministry of Health did not have it. When I found out about this, I rushed to the mayor with this letter. I will not convey the emotions of Sergei Semenovich Sobyanin, he called the Minister of Health of Russia Skvortsova, asked if she knew about it, she also did not know anything. Sergei Semenovich went to the Prime Minister, and this letter was practically disavowed.”
How could the Moscow Health Department, the Mayor, the Minister of Health and the Prime Minister not know about the letter, which changed the rules for the purchase of medicines throughout the country? And who, then, generally “took under the hood and performed”?
The press services of the vice-mayor and the Department of Health have not yet answered these questions from Business FM. Experts interviewed by Business FM did not find suitable words either.
The authoritative Nezygar Telegram channel, which is suspected to be connected to the presidential administration, reported that Leonid Pechatnikov, a former deputy prime minister of the Moscow government who oversaw the social bloc, has come under investigation. According to the channel, he is charged with 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 on a bribe, not having time to become completely his own for the capital's elite, then Leonid Pechatnikov is a figure of a completely different scale.
In the first government of Sergei Sobyanin, he came to the post of head of the health department from the post of director of the European Medical Center. That is why he was known as a specialist in advanced, in terms of the present time, medicine, that is, moving to self-sufficiency at the expense of the patient. Actually, it is precisely with the name of Pechatnikov that a very controversial reform to optimize the capital's health care, built on a reduction in the number of doctors and a merger (aggregation) is connected. medical institutions. This reform met with sharp condemnation of both patients and doctors themselves. Prominent deputy of the State Duma, in the past social minister Kalashnikov compared it to genocide.
Leonid PechatnikovEvgeny Samarin/RIA Novosti
Meanwhile, the activities of the "optimizer" were marked by the promotion to the rank of Deputy Prime Minister for Social Affairs. And I must say, 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 Minister of Health of Moscow in urgently emigrated to Switzerland, feeling that the smell of fried. In a distant country, he had a solid alternate airfield in store. But Pechatnikov behaved as if nothing had happened. However, the next minister Khripun did not show himself in any way. Doctors even began to recall with longing the times of Luzhkov's minister, the 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 sciences said that he had defended his dissertation in France, but there was no formal confirmation there either.
Meanwhile, signals were multiplying that far from everything was in order in the sphere of metropolitan medicine. The climax was a public showdown between the vice-mayor and the well-known oncologist Anatoly Makhson, who accused the leadership of the capital's health care of inflating the cost of purchasing drugs. Even the figure of overpayments was called almost 200 million rubles. In response, Pechatnikov tried to accuse his opponent of economic abuses. In general, the noise was great. But at the center of the disassembly of medical men 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 business with Komsomolskaya Pravda. However, he quickly changed his mind.
It must be said that when sending Pechatnikov into retirement after his regular elections, Mayor Sobyanin made a heartfelt speech about the merits of Leonid Mikhailovich and his irresistible desire to return to practical medicine. All propriety was observed. Although everyone understood that the emerging information about the strange suppliers of the largest metropolitan hospitals with registration in Cyprus and other offshore companies did not remain without some consequences. After all, among their official founders came across, for example, people from the same European Medical Center, which for a long time was headed by Pechatnikov.
Now, according to Nezygar, they could unwind the entire chain along which government billions went offshore. We are waiting for details.
Until recently, Anatoly Makhson was not a very media figure. Well, except that he appeared a couple of times in the yellow press, when he argued that Zhanna Friske in Russia would have been cured better than in the West, and complained that healthy young women are difficult to convince that, following the example of Angelina Jolie, they need to remove both their breasts . But serious publications remembered one of the best oncologists in the country only when it was necessary to take an on-duty interview by February 4, international day fight cancer.
Anatoly Makhson. Photo: Artem Geodakyan/TASS
Nevertheless, the authorities, especially those in Moscow, despite the now popular assertions that Makhson had an uncomfortable character, always loved him. When, in 1990, the forty-year-old Makhson, who had headed the department at the 62nd Cancer Hospital for only a year, headed the collapsing medical facility with the support of the staff, Yuri Luzhkov came to his aid. Then the main building was completely renovated, the construction of an extension to the radiological building was completed, by 2002 a new surgical building was commissioned, equipped with last word technology.
The new government loved Makhson even more than before. Equipment, money, preferences. Makhson was made Moscow's chief oncologist, and with the full support of the Moscow government, he began a drastic reorganization of the capital's oncology service. The optimization of Moscow oncology according to Makhson ended with the fact that he cut off one of the city dispensaries to his hospital and achieved special management rules for himself. And before retiring, the respected oncologist again decided to thank the city government in his own style.
Moscow officials still cannot understand what made the respected doctor become the hero of a high-profile scandal and attack the mayor's office last fall with loud revelations. Some say that the matter is in the inspection, which, back in the spring of last year, discovered minor violations in the 62nd hospital at that time. Others claim that Makhson wanted to interfere with the optimization and almost the closure of the hospital, which no one was going to close.
Makhson himself, in the midst of a scandal, suddenly surprised everyone with a statement that he had started a hype only because the city authorities allegedly refused to appoint his creature, Dmitry Kanner, head of the department of the same hospital, to the head physician's vacant post. It is hard to believe this: Kanner is now the head of the hospital. It is hard to believe that Anatoly Makhson suddenly decided to join the anti-corruption fighters.
In the course of the scandal he started due to non-competitive purchases of drugs for cancer patients by the Moscow government, it turned out that the 62nd hospital under the leadership of Makhson, saving on some drugs, noticeably overpaid on others, moreover, often specially creating for certain suppliers unique conditions participation in tenders, cutting off their competitors.
"Anatoly Makhson inherited diligence, tolerance and compassion for the sick from his parents," one of the doctor's complementary biographies says. They forgot to add: "and the 62nd hospital." In the same biography, it is noted that Anatoly Makhson spent his childhood on the territory of the hospital; leadership position and the family lived here in a separate cottage. Now Anatoly Makhson himself lives in it with his wife and daughter.
It is no coincidence that some people point out that long years the hereditary doctor Makhson began to treat the hospital as a hereditary allotment, especially since it was located in a noble estate of the 17th century. And like a good estate, the hospital brings a good income to the clan of doctors.
A vivid example is a certain "Society of Plastic and Reconstructive Oncology", where the doctor is the president, is actively cutting down the forest next to the hospital for cottage development. And the builder of the cottage settlements growing around the hospital is OOO NP Stepanovskoye. By coincidence, NP Stepanovskoye LLC is a co-founder of NIL PME CJSC, another co-founder is a certain Valentina Iosifovna Makhson - the full namesake of the head computed tomography 62nd hospital and the wife of its head physician. The general director of the construction company is a certain Nikolai Petrovich Kozin, while CJSC NIL PME - the Research Laboratory of Freshwater and Marine Ecosystems - is headed by his namesake - Elena Nikolaevna Kozina.
There was a time when Anatoly Makhson created and headed the consumer garage-operating cooperative "Doctor". He worked and agriculture, by creating LLC "Agrariy" in the capital, and financial services,
However, Makhson did not forget the main specialty. And therefore, in addition to the still existing established and headed by them public organizations and charitable foundations, worked at one time as the founder of Onco-Test LLC, which provides services in the same area as the hospital subordinate to Makhson. and.
But it seems that the main business of the former head physician of the 62nd hospital still lay in a different area. Former business partner of Makhson in the company "ONKO-test" Maria Glebova now CEO and co-owner of the company "Promedica". In 2016, this company signed six contracts with Makhson to supply hospital No. 62 medical equipment, tools and consumables. Makhson's partner in LLC "Agrariy" - Valery Glavatsky - is concurrently one of the owners of LLC "ChOP" Truvr ", guarding the territory of the hospital. And if in 2012 security services cost the hospital 20.5 million rubles, then a year later they rose in price four times - up to 98.4 million rubles In 2016, a contract for 40.7 million rubles was signed immediately after the announcement of the impending resignation of Makhson. guess, is engaged in the supply of medical equipment.
It is worth mentioning another scandalous story with Makhson's purchases for the 62nd hospital, which turned out to be the only one in the capital that purchased the scandalous drug "Beyodyme" from the Swiss company Roche. The monopoly seller of the drug in Russia is R-Pharm. The peculiarity of "Beyodyme" is that it consists of two combinations, of which, as the test carried out in the hospital found out, only one was used in the treatment of patients - trastuzumab. The second - "pertuzumab was often not used and disappeared without a trace." The first question is why having a cheaper market domestic drug, which was acquired by all metropolitan hospitals, Makhson chose an expensive Swiss one, the investigators will probably answer.
It is noteworthy that, despite all the scandals and tantrums, the now ex-head of the 62nd hospital, the city authorities, recognizing Makhson's experience and respecting him as a doctor, offered him to remain president here. At first, he even began to set conditions that, they say, if the team asks, then I will stay and help the new head physician. He probably remembered the 1990s, when the team presented him with a hospital on a silver platter, electing him as the head physician. But the team did not ask. After that, the offended Makhson declared that he was not going to return to the hospital in any capacity and immediately went to court to demand reinstatement as head physician. He lost the trial, so he will not return to the 62nd hospital. But as far as we know, Anatoly Makhson is not going to take a well-deserved rest either. They say that now he will work for the Medsi company from the AFK Sistema holding company, where millionaire Vladimir Yevtushenkov gathers retired academicians and other medical stars.
Probably, the businessman hopes that the luminaries of medicine will finally pull out his medical business, which is plunging into the abyss of losses: if in 2014 the company's revenue was estimated at 8.3 billion rubles, and the loss was 400 million rubles, then in 2015 these figures amounted to 6.8 billion and 1.2 billion rubles, respectively. But what Makhson will cut here, one can only guess.
