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Kazakhstan May Introduce Compulsory Insurance against Medical Errors

In Kazakhstan, the government allocates billions of dollars every year to the public health system, yet the quality of medical services leaves much to be desired.

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Since 1996, the structure of the Ministry of Health of Kazakhstan has changed every two years with every new minister. In 1996, the agency was abolished as an independent administrative body and was integrated into the united Ministry of Health, Education and Sport. The ministry of health became an independent agency only in 2002.

Back in the 2000s, the country developed two comprehensive reform programmes – the state programme of healthcare reform and development for 2005-2010, and the state programme for healthcare development for 2011-2015 “Salamatty Kazakstan”. Nearly 1 billion dollars were allocated to public health of Kazakhstan in 2005, and after 2011 this expenditure item was increased by more than a thousand times.

The state allocated 8.63 billion dollars to public health system in 2018-2020. However, the quality of medical services leaves much to be desired.

Only in 2014 to 2017, the Unified Register of Prejudicial Inquiries had 1,736 criminal offences related to medical services registered. Out of them, 1,635 cases were related to article 317 of the Criminal Code “For medical or pharmaceutical malpractice”.

About 3.5 thousand complaints, including 50 per cent of complaints about the quality of medical services, were lodged to the Health Protection Committee of the Ministry of Health last year.

In 2014, six medical workers were sentenced to custodial restraint, two to suspended sentence, three were sentenced but released by pardon. In 2017, 17 persons were released by pardon, and four medical workers were sentenced to suspended sentence.

Left to die

According to the health minister, about 2.5 thousand infants die every year in Kazakhstan.

In early October this year, a shocking incident took place in Atyrau.  Physicians killed a new born baby because they didn’t want to alter the documents.

The maternity home in Atyrau, where 156 new born babies died in 9 months. Photo: CABAR.asia

According to the deputy chair of the Anti-Corruption Agency, Shyngys Kabdula, after birth the baby was registered as still born by medical error, although it was alive. When physicians saw it, they decided to act according to the documents and left the baby to die instead of taking emergency measures.

The reason for these actions was the documents filed in the database, which couldn’t be amended. It was found out incidentally when the chief medical officer was wire-tapped on suspicion of corruption.

Now criminal cases have been initiated against the chief physician of the maternity home and the obstetrician-gynaecologist. They may face up to 20 years of imprisonment.

Photo courtesy of Dilmira Maksutova

Last November, 33-year-old Dilmira Maksutova died right after childbirth. Her relatives said she had a sudden heavy bleeding after childbirth. Dilmira was taken to the operating room, but the surgeon appeared 40 minutes later. His colleagues tried to keep her going and during the heart massage they broke three of her ribs.

12 years ago, 150 children were infected with HIV in Shymkent in several hospitals in town. Later on, violations of health and epidemiological standards and rules were found in medical facilities. Medical workers used non-sterile instruments, while donors were suspicious persons, including vagrants and illegal residents.

Nine deaths from various infections were reported in the first years after the infection. 16 physicians were imprisoned on corruption and negligence charges.

In early August this year, a son of the head of Almaty police, Nursultan Kudebaev, fell off the four-wheeler in the mountains. At first, the injured was delivered to the city hospital No. 7, and then to the city hospital No. 4, where he had a shoulder blade and collarbone surgery. Afterwards, the young man fell into a coma. At the initiative of his relatives, Kudebaev was transported to a German clinic, where he died.

Afterwards, the chief physician who performed the surgery and the anaesthesiologist were arrested.  The physician’s wife applied to the president, who demanded to deal with the situation. Later on, the physicians were released. Now, medical workers of Kazakhstan demand that medical errors be decriminalised.

In fear of prison

Azat Shpekov. Photo: CABAR.asia

Azat Shpekov is a neurosurgeon and performs very difficult surgeries that last 20-25 hours each. He said many physicians he knew left the country. The reason was not their salaries.

According to the health minister of Kazakhstan, Yelzhan Birtanov, last year 300 criminal cases were initiated against physicians in the country, so specialists quit their jobs or move abroad.

“A physician should be excited to work. Some patients and their relatives, when they are told that there is a risk and lethal outcome may follow, blame us. A physician should not live in constant fear of prison,” Shpekov said.

According to experts, low salaries and shortage of personnel make physicians work 1.5-2 shifts. It causes stress, fatigue and medical errors. 

A physician should not live in constant fear of prison.

According to the information provided by the deputies of parliament, the regions lack up to 40 per cent of physicians, and about 60 per cent of physicians will reach retirement in 4-5 years. Medical universities of the country educate the sufficient number of medical specialists, yet they prefer to work in a private sector.

According to the director of a private clinic, Kuanysh Kerimkulov, the average salary of a physician in the country is 100-120 thousand tenge (258-310 dollars). But young specialists don’t want to work for a salary under a million tenge (2,583 dollars).

“When my deputy offers a job to a physician for an initial salary of 600 thousand tenge (1,550 dollars), the latter leaves immediately, without saying a word,” Kerimkulov said.

Ainur Takenova. Photo: CABAR.asia

However, Kazakhstanis don’t trust private clinics either. According to the Almaty resident, Ainur Takenova, they register patients 2-3 weeks in advance, they have no highly specialised paediatricians, if you are pregnant, you should pay the bribe to a physician in advance to avoid any problems during childbirth.

“Medical certificate No. 086 is available on the internet, it costs 4,000 tenge (10 dollars), and it is delivered right to your house.  I am afraid of giving birth. Just recently, I called an ambulance for my mother, the physician googled for my mother’s diagnosis. What quality of medical services can we talk about?” Takenova said.

Insurance against medical errors

Health minister Yelzhan Birtanov said no physician, even a great one, can guarantee there would be no complications. Therefore, Kazakhstan is planning to record medical errors by the example of developed countries.

Every medical organisation’s website will have a section “Performance report at the year-end”, which will demonstrate not only the scope of services, but also the medical error report. Every patient resorting to a given organisation will get full information about the quality of services provided and see every physician’s portfolio.

Health ministry also makes amendments to the criminal and administrative legislation to humanise punitive measures against physicians. In particular, it suggests eliminating the provision on prosecution for the failure to comply with medical service standards from the administrative code, and reducing the terms of additional punishment, i.e. deprivation of the right to engage in a determined activity, from three to one year in the criminal code.

However, the ministry wants to clarify the legislation and to differentiate between undeliberate errors and medical errors. According to the WHO requirement, the concept of “medical error” should be eliminated and replaced with the concept of “medical incident”.

Ainur Aiypkhanova. Photo: tengrinews.kz

According to Ainur Aiypkhanova, General Director of the Republican Health Centre, unlike the developed countries, insurance against professional errors is still optional in Kazakhstan and is mainly practiced by medical organisations that are in the “risk group”.

 “There are medical errors in developed countries, too, but physicians are not put in prisons, but are fined or their licenses are cancelled. Instead, once they start their career, they are bound to obtain malpractice insurance and in case of a medical error, the patients can get a compensation in moral damages,” Aiypkhanova said.

Kazakhstan suggests the similar system in the country. The draft law was introduced to the mazhilis of the parliament a month ago and it is going to be approved by the end of the year.

This article was prepared as part of the Giving Voice, Driving Change – from the Borderland to the Steppes Project.

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