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modern features trudopravovogo the status of the medical worker

Presence in medicine of considerable division and work coordination, mass character of their use and other circumstances creating additional risks, are essential features of modern medicine. Now the medicine has turned in certain

The "industry" making the help on health protection, i.e.

Became

- 226 difficult system having industrial character.

Especially attracts attention its such feature, as existence of the big number enough narrow experts as eventually specialisation level in medicine constantly grows. The jural significance is now given to division (specialisation) of medical work also. In particular, to make a number of kinds of special actions in medical sphere the state resolves only that from medical workers who have passed and-or have confirmed when due hereunder corresponding professional special preparation. Besides, the medical workers having various specialisation, are usually allocated with a miscellaneous

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trudopravovym the status.

Other modern feature of medical work — its coordination (cooperation) — is a consequence of growth of medical specialisation. Absence of cooperation between medical workers of various specialities did not allow to carry out appropriate balance of medical specialisation that led to sad consequences — to aggravation of a state of health and death of patients.

Such modern (additional in relation to traditional features) features of medical work as essential, legally significant and constantly increasing division (specialisation) the given [225 [226] works, and also cooperation of this work, have arisen enough recently. They have appeared during the social development, use of the new technologies assuming in some cases necessity of additional division (specialisation) of work became one of which consequences. At the same time thus became necessary and coordination of this work — coordination of activity of the medical workers assisting the concrete patient as medical aid rendering by one doctor-expert without taking into account it of recommendations of other doctors-experts threatened health of the patient.

As modern features of medical work allow to reveal certain features trudopravovogo the status of the medical worker, korrespondirujushchie it so far as it would be fair to call such features trudopravovogo the status also the modern.

Let's consider now the given features of medical work in more details to deduce from them modern features trudopravovogo the status, korrespondirujushchie it.

Let's address to begin with to specialisation of medical work.

The history of a division of labour in medicine shows, that existence already during times of a competition far enough from us in sphere of rendering of services in health protection [227 [228] became significant stimulus to it. As to the special form of division of medical work — its specialisations it also is known for a long time. In particular, we meet work specialisation vrachevatelej already in traditional medicine — a heritage of traditional societies existing in prehistoric times, the part from which (or which part of culture) has still remained now.

By the end of XIX century the medical science has reached, substantially owing to the specialisation, that condition when the impossibility of development of all its achievements by one person became obvious.

The recognition of importance of medical specialisation can be found out, in particular, in the international legal acts [229] and practice of the European Court under the human rights [230], prisoners concerning treatment in prisons.

Specialisation is used in the Russian medicine and now. The certificate of its special value for modern Russian public health services is that as one of the rights of the patient in podp. 3 items 5 of item 19 of Bases are fixed the right to reception of consultations of doctors - of experts. To this right evidently korrespondiruet a state duty how to provide specialisation existence in medicine and corresponding medical workers (experts), and properly to settle corresponding relations. To execute the given duty the Russian state does not ignore specialisation process in sphere of medical work, entering corresponding differentiation of legal regulation.

The legislative basis for similar differentiation of legal regulation in sphere of medical work is a general provision of item 143 TK the Russian Federation. Besides, there are also special bases of similar differentiation. In particular, item 2 of item 32 of Bases division (specialisation) of medical work — division by medical aid kinds is directly provided: 1) the primary medicosanitary help; 2) specialised, including hi-tech, medical aid; 3) fast, including fast specialised, medical aid; 4) palliative medical aid.

With a view of regulation of some the kinds of medical activity (specialities) representing special importance for health protection of citizens, — the antitubercular help, sanitary-and-epidemiologic supervision, the psychiatric help, etc., special federal acts [231] have been accepted. To execute positions podp. 5 items 2 of item 14 of Bases the Russian Federation from July, 23rd, 2010 № 541н have been approved by Order Minzdravsotsrazvitija the Uniform qualifying directory of posts of heads, experts and employees (in particular, section «Qualifying characteristics of posts of workers in public health services sphere»), and also other standard legal acts [232] are published.

Thus, occurrence of such modern feature

Medical work as specialisation, has caused division trudopravovogo the status of the medical worker on two components: general (universal) and specialised (differentiated). This feature promoted also to the further division of the specialised (differentiated) component trudopravovogo the status depending on narrow specialities which medical workers can possess. Division of the specialised

(Differentiated) component trudopravovogo the status in this case occurs depending on the status of health of the patient as presence of this or that speciality is caused by occurrence at the patient of certain illnesses. Occurrence all new illnesses stimulated occurrence of new narrow specialities of medical workers in a society. Thus, in medical community there was an essential division of its representatives depending on specialisation available for them. It has provoked, in turn, occurrence in medical workers of the various new rights and duties and consequently, occurrence of various new components in trudopravovom the status, presence and which existence in trudopravovyh statuses of medical workers are caused by presence at them certificates of experts (till January, 1st, 2026), certificates on accreditation (after January, 1st, 2026) On a certain speciality. The given document testifies to acquisition by the medical worker of certain knowledge, skills on a certain speciality and grants to it the right to operate definitely. Besides, specialisation has generated and corresponding differentiation in legal regulation of work of the medical worker as work of medical workers of various specialities is regulated differently; elements trudopravovyh statuses of such medical workers (for example, in the field of a payment, leave, working hours) differ from each other and are caused by specialisation.

Specialisation of medical aid which is quite logical in modern conditions as it is mediated by introduction of scientific achievements in the field of medicine, on the one hand, and impossibility the separate expert-doctor objat and them to use all these achievements — with another, generates in practice rather serious legal issues connected with realisation of a constitutional law on health protection.

Growth of medical specialisation has led to occurrence of the big number of problems, the overwhelming which part has been caused by absence of necessary cooperation in sphere of medical work — the cooperations, allowing to balance specialisation existing in given sphere, to consolidate medical workers of various specialities round one patient in which treatment they are engaged. That on its basis the separate medical worker (doctor) has an access possibility to all file of knowledge and abilities which the medical community as a whole possesses testifies to advantage of cooperation in sphere of medical (medical) work at least. Such access represents the tool of achievement important for the medical worker (doctor) and the patient of the purposes — a choice and use of the most effective ways of the prevention and treatment of diseases.

Necessity for cooperation of medical work admitted already Gippokratom [233]. So, in the Hippocratic Oath it is possible to find out the promise of the doctor to inform manual, oral lessons and «all the rest in the doctrine» to the sons, sons of the teacher (according to this Oath the last were considered as his brothers) and pupils, «the connected obligation and an oath under the law medical», but to anybody to another [234 [235].

In present time in many cases (especially at treatment of the patient in large hospitals) absence of cooperation can lead to causing of essential harm of a life and health of the patient. Data speak about the importance of similar cooperation the following. The analysis of 2455 cases of injury of a life and to health of the patient on which it has been informed the Incorporated commission on accreditation of hospitals of the USA, has shown, that their basic precondition in more than 70 % of cases (from them approximately 75 % have terminated in death of the patient) was absence of appropriate interaction (cooperation) at medical aid rendering.

The similar problem — absence sufficient coordination of medical work and a continuity (continuity) of rendering of medical aid — exists and in France [236].

Acknowledgement to that absence of an appropriate legal mechanism of functioning of cooperation can be reflected extremely negatively in results of rendering of medical aid, it is possible to find and in results of the investigation spent by specially created Commission of the British

Parliament concerning Bristol royal hospital — one of the oldest hospitals in the Great Britain. The given investigation has shown, that: 1) during the period with 1988 on 1994 a death rate of children which has been connected with realisation of surgical operations on open heart, approximately that took place in other clinics of the Great Britain twice exceeded; 2) during the period with 1991 on 1995 30 children owing to inadequate rendering of medical aid by it on warm surgery have died at least. Thus according to results of investigation of one of principal causes of occurrence of a similar situation that there was no necessary interaction between employees of hospital (doctors, medical sisters and managers) was.

In Bristol royal hospital in many respects there was no necessary for maintenance of cooperation of medical work a general management, and there was no appropriate teamwork of medical professionals as a part of groups (brigades) [237 [238].

It is obvious, that in Bristol hospital there was an essential uncertainty regarding the accountability and responsibility, and the hospital personnel in which there was a significant division of medical work, did not work as uniform labour collective. As has shown the investigation, the similar situation is observed in many hospitals of the Great Britain.

In the recommendations made by results of spent investigation, it has been specially specified in an absolute must of partner relations (i.e. Actually work coordination) between the professionals working in sphere of health protection [239]. Also it has been specified in necessity of that employment contracts with doctors, medical sisters and administrative personnel consisted on similar conditions and that in them the clear model of the accountability of the given workers which would allow to provide rendering of the best help to patients has been provided. In particular, it was recommended, that with doctors-advisers the contract granting by hospital to the doctor-adviser for working hours of a workplace and the tools necessary for performance of work would be which conditions consisted, and the doctor-adviser should to agree, in turn, that at this time it will be in hospital and to perform work which is evidently provided by the contract [240]. Differently, it was recommended to pass from relations with hospital in which the doctor-adviser actually represented itself as the person concerning the self-occupied population (civil-law relations), to labour relations between hospital and the doctor-adviser.

On necessity of cooperation for sphere of medical work focuses and norm of item 46.1 of special Recommendations of Committee of Ministers already mentioned earlier to member states of the Council of Europe concerning the European prison rules, providing transfer in specialised agencies or civil hospitals of sick prisoners if the appropriate help cannot be rendered them in prison.

Cooperation in medical sphere recognises as legally significant circumstance and ESPCH [241].

In the Russian legislation the considerable number of the norms guaranteeing cooperation in sphere of medical work contains. In particular, the Oath of the doctor fixed in the Russian legislation (item 1 of item 71 of Bases) focuses on it. It orders to the doctor to concern benevolently colleagues, to address to them for the help and council if it is demanded by interests of the patient, and most never to deny assistance to colleagues and council. Besides, according to norm already mentioned earlier podp. 3 items 5 of item 19 of Bases, and also norm of item 4 of item 22 of the same Bases the patient have the right to reception of consultations of doctors - of experts. The norm of item 3 of item 26 of the Bases, regulating rendering of medical aid to the persons deprived of freedom has the similar maintenance also. Besides, according to item item 8 35 Bases exit emergency advisory brigades of the first help appear medical aid (except for hi-tech medical aid), including on a call of the medical organisation in which staff medical workers of an exit emergency advisory brigade of the first help do not consist, in case of impossibility of rendering in the specified medical organisation of necessary medical aid.

Special institutes, existence and which functioning is provided with coordination in sphere of medical work, the attending physician and the head physician (item 70 of Bases, etc.) are. The Head physician co-ordinates actions of all medical workers, carries out distribution of medical shots in the medical organisation so that medical aid has been rendered each patient who has addressed in the medical organisation most in due time and qualitatively. The attending physician will organise cooperation of doctors - of experts which should assist that patient in which direct treatment he is engaged.

Except the medical (medical) cooperation which are carried out exclusively in interests of the patient (further — positive cooperation), exists also medical (medical) cooperation which is accompanied by the conflict of interests of the medical worker (doctor) and the patient (further — negative cooperation).

Now in the Russian legislation there is a legal definition of concept «the conflict of interests» in sphere of medical activity (item 1 of item 75 of Bases). Existence of the conflict of interests in the given sphere leads to occurrence at the medical worker of some information duties — their putting on the legislator actually interferes with realisation of the given conflict in a direction of infringement of interests of the patient (item 2-4 of item 75 of Bases). With a view of prevention of occurrence of the conflict of interests in sphere of medical work the legislator has provided in norms podp. 1-6 items 1 of item 74 of Bases of a guarantee which limit freedom of professional actions of medical workers and heads of the medical organisations, interfering with occurrence of the similar conflict.

At the same time it is represented, that the medical worker (doctor) is obliged to inform on the existing conflict of interests not only to the head of the organisation or the authorised body as it is offered norm of item 2 of item 75 of Bases, but willows the first turn to this conflict can negatively affect what life and health, — to the patient. The given duty follows from norm containing in the law according to which the medical worker (doctor) should inform the patient — before reception from it the voluntary informed consent — all information which can affect its consent to medical intervention and to refusal of it (item 20 item 1, item 22 of Bases). Necessity of the message to the patient about existence of the conflict of interests admits, in particular, and practice of vessels of the USA [242 [243] [244].

One more guarantee of prevention in sphere of medical work of the conflict of the interests, operating it is destructive on orientirovannost the given work on interests of the patient, introduction by the Russian power of the special administrative control over such conflict is

(State and departmental) and korrespondirujushchego to it of special structure of administrative responsibility (item 6.29 KoAP the Russian Federation).

However meanwhile there are no standard legal acts, and also certificates of the courts of justice explaining concept «the conflict of interests» in medicine; it can create complexities with qualification sodejannogo.

Proceeding from norms of the law, and also taking into consideration some points

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The sight, stated in the literature and representatives of medical and pharmaceutical community [245 [246] [247], it is necessary to conclude, that the given situation needs to be considered as reception by the medical worker personally or through the representative of any compensation, benefits of property character from the various organisations (first of all pharmaceutical) for the purpose of "advancement" of a certain expensive medical product or a medical product and finally constraint of patients to their purchase (without a guarantee of positive pharmaceutical effect). As specifies A.A.Kirillovyh, the reception direct communication is thus observed by the medical worker of benefit and its further execution of the professional duties. It is represented, what exactly the further behaviour will not be equitable to interests of the patient. It can be expressed in compulsion of the patient to get in advance unnecessary medicine or a medicine necessary for treatment, but under in advance unprofitable (higher) price; to get more expensive analogue of a medicine with the same pharmaceutical effect or in the concrete pharmaceutical organisation.

Besides, it is possible to carry to the conflict of interests and such situation when, for example, to the medical worker (doctor) can become economic that the patient was treated by it, instead of its colleague, and despite the fact that what the colleague could — for the reasons objective and known to the doctor — to reach the best results. The similar situation usually arises, when medical workers (doctors) start to "pay extra" to colleagues for that the last directed the patients to them.

The concept «the conflict of interests» is provided in item 10 of the Federal act from December, 25th, 2008 № 273-FZ «About corruption counteraction» [248] in which it is understood much more widely; besides, in the same Law the concept "partiality" [249] is given. In view of complexities arising in practice with qualification sodejannogo the Ministry of Labour and Social Protection of the Russian Federation in the Circular from October, 15th, 2012 [250] has specified the concrete typical situations falling under this concept, and also measures of their prevention and settlement.

As in the listed cases it is a question of the state, municipal service, service and work in bodies of the Ministry of Internal Affairs of the Russian Federation both other bodies and the organisations (the public companies, the state corporations, etc.), the given norms cannot be applied directly at the resolution of conflict of interests in the medical organisation. It is obvious, that considered kinds of activity have various objects (though also similar among themselves to some signs).

Considering mainly noncommercial character of activity of the medical worker, and also its ethical orientation, it is possible to assume, that the conflict of interests in medical activity is capable to arise not only at any property (material) interest of the medical worker, but also at its partiality in view of other circumstances. In that case the partiality of the doctor will negatively influence execution of the labour duties by it on treatment of the patient properly or even at all will make their execution impossible. The similar situation can to arise, for example, in a case, when the doctor renders medical aid to the close relative or, on the contrary, the person, which has done essential harm (moral or material) to the given doctor or his family (or to close relatives of members of a family) [251]. In view of possibility of occurrence of all circumstances set forth above negatively influencing qualitative rendering of medical aid, it is necessary to concretise concept «the conflict of interests» in medicine, having added item 1 of item 75 of Bases after a word of "advantage" other partiality »arises words« or. Besides, it is expedient to Ministry of Health of the Russian Federation to publish, in our opinion, the corresponding standard legal act explaining the term «the conflict of interests», specifying in typical situations which fall under this concept, establishing measures of prevention and settlement of such conflict. The given standard legal act would provide correctness and objectivity in application to the medical worker of such measure, as dismissal in case of nonacceptance of measures on settlement of the conflict of interests (item 7.1 ch. 1 items 81 TK the Russian Federation). Would be as a result concretised an order and conditions of realisation of such element trudopravovogo the status of the medical worker, as responsibility for nonacceptance of measures on settlement of this conflict.

Speaking about the conflict of interests, it is necessary to notice also, that in some countries for medical workers the duty is fixed to inform the employer (head physician) about unfair, nonprofessional

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Behaviour of the colleagues which actions are directed against interests of patients. In Russia at level of the separate medical organisations already there is a similar practice, however while it is not fixed at level of the law [252 [253]. Similar norms contain in the Russian documents of ethical character [254]. Meanwhile taking into account the constitutional importance of the right of citizens on rendering of qualitative medical aid, possibly, the order of the message of such data the medical worker to the employer should be approved and at legislative level.

In connection with situations of the conflict of interests such modern feature of medical work as necessity of its coordination with other persons, can enter the conflict to other feature — an autonomy of the medical worker (doctor). Really, the autonomy of the medical worker (doctor) in sphere of medical work assumes its independence, i.e. Its accountability (under the general rule) in the given sphere only to itself and colleagues in a medical trade, and also the independent permission

Situations of the conflict of interests by means of its bar of claim by lapse of time. During present time the medical worker is accountable and, accordingly, is actually obliged to co-ordinate (expressly or by implication) the actions with the patient who frequently is not carrying out its appointments, and other persons, including with the employer (with the medical organisation), with the bodies licensing medical activity, with private and public persons,

Carrying out the control over the medical worker (in particular, with vessels and the insurance organisations).

Necessity of similar coordination (and she is usually statutory) assumes situation existence in which the medical worker is obliged to show so-called double adherence (dual loyalty): adherence simultaneously and to objective interests of the patient in sphere of protection of its health, and to interests of others public and private persons [255]. Differently, double adherence actually represents legally legal conflict of interests in sphere of medical work.

Despite the fact that what in the Russian right at law level (item 1 of item 71 of Bases) the general principle of the resolution of conflicts in sphere of medical work in favour of the patient (the doctor should operate exclusively in its interests) is fixed, possibility of existence of legally legal conflict of interests in the given sphere can change (and in many respects already changes) those real possibilities, which millenia the medical worker (doctor) possessed. It in certain degree deforms social, and together with it and trudopravovoj the status of the worker, its role in a society.

Legal coherence of the doctor other relations in many respects clashing with objective interest of the patient, leaves in practice all time a narrowed field of free-hand for the doctor. And absence of free agency and actions is the basis which as it is represented, interferes with putting on on the doctor not only legal, but also social responsibility for its actions (inactivity). However objectively caused change of its role (social and trudopravovogo the status), in certain aspects adverse for the concrete patient as practice shows, with the big work admits a society.

It testifies that such modern (new) feature of medical work as essential cooperation, and its traditional features — domination of interest of the patient in health protection over own interests of the medical worker and trust between the medical worker and the patient — in certain situations compete with each other. Cases of negative cooperation in sphere of medical work will always cause questions concerning domination of interest of the patient in health protection over own interests of the medical worker and will operate razrushajushche on trust between the medical worker and the patient. The interdiction of similar behaviour contains, for example, in the International code of medical ethics according to which the doctor should not receive any financial benefits or other encouragement is exclusive for transfer of patients or vypisyvanie special products.

With a view of bar of claim by lapse of time of a competition of the given modern feature (if it is expressed in negative cooperation — legally legal conflict of interests) with traditional features of medical work the medical worker is obliged to adhere to traditional features of the activity nevertheless. In this case it should realise first of all most important of traditional elements of the trudopravovogo the status: a duty to render qualitative medical aid continuously at any time (item 71 of Bases) and the duty to refrain from the actions creating the conflict of interests (item 74, 75 Bases).

It is obvious, that the effective decision of a problem of cooperation of medical work probably by means of creation of the legal mechanism guaranteeing existence of similar cooperation, and also absence of the essential conflict of interests. In this connection it is necessary to notice, that in Russia labour co-operation of medical workers, i.e. Its coherence and interconditionality (actually system character of the given work), is guaranteed:

1) the general constitutional norms (it first of all norms ch. 1 and 2 items 41 of the Constitution of the Russian Federation);

2) the special guarantees providing necessary cooperation of medical work in the Russian system of public health services (podp. 4 items 5 of item 19, item 22 item 4, item 26 item 3, item 8 of item 35 of Bases);

3) the major institutes of cooperation of the doctors, existing in the Russian system of public health services since times of the USSR, — institute of the head physician — the head of the medical organisation, and institute of the attending physician (see about it above) [256].

Trudopravovoj the status of the head physician provides realisation in the medical organisation of the general coordination of actions of all medical workers. The head physician should organise the general process of rendering of medical aid to all patients addressing for reception of medical aid. For these purposes it is allocated by the legislator group of imperious powers: to appoint and head the medical commission (item 48 item 1-2, item 3. Item 59, item 2 of item 63 of Bases) to appoint the attending physician and to organise its replacement (item 1, 3 items 70 of Bases), under certain circumstances to transfer separate functions of the attending physician to other medical workers — to the medical assistant or the midwife in the order established by authorised federal enforcement authority (item 7 of item 70 of Bases), and also to carry out other imperious powers.

The attending physician as it has been specified above, is appointed the head of the medical organisation (division of the medical organisation) or gets out the patient taking into account the consent of the doctor (item 1 of item 70 of Bases). It is represented, as in the latter case investment of the doctor with the status of the attending physician of the concrete patient should be issued the decision of the head of the medical organisation (division of the medical organisation), as according to ch. 6 items 20, item 22 TK the Russian Federation the employer in the name of the head of the organisation or the person authorised by it, instead of the third parties (in our case — patients) gives tasks to workers of the organisation. In this case such power of the head physician would add it trudopravovoj the status, allowing to carry out the general coordination in the medical organisation.

Trudopravovoj the status of the attending physician assumes not only independent treatment of the patient by it, but also the organisation of the timely qualified inspection and treatment of the given patient (if the attending physician does not possess the necessary knowledge, skills and abilities for rendering of this help owing to specialisation available for it), including the invitation on request of the patient or its legal representative for consultations of doctors - of experts and if necessary convocation of a consultation of doctors. Thus to special powers of the attending physician, statutory, the establishment of the diagnosis to the patient concerns, and recommendations of advisers are realised only in coordination with the attending physician, except for cases of rendering of emergency medical aid (item 70 of Bases).

Thus, trudopravovoj the status of the attending physician (elements of the given status) allows to provide cooperation of other doctors-experts for the purpose of rendering of appropriate medical aid by them to the concrete patient.

On the general rule provided by item 15 TK the Russian Federation, the worker performs the work personally (independently). However it is obvious, that the situation described above with the attending physician represents an exception of the given rule as labour activity of other medical workers operating on the instructions of the attending physician, as a matter of fact, is activity of the attending physician (differently, actions of such medical workers are caused by will, desire, the imperious order of the attending physician).

Besides, from described above elements trudopravovogo the status of the attending physician follows, that its labour activity in certain degree has imperious character as it consists in a summer residence of orders to other workers. Usually such lines of activity in labour relations are inherent not in the worker, and the employer. However there are exceptions to the rules when some persons from among the organisation administrative personnel, not authorised to speak on behalf a name of the employer as a whole, nevertheless carry out separate imperious rabotodatelskie power as such powers are caused by their labour function.

As fairly marks N. G.Aleksandrov, in legal relations under the internal labour schedule on the party of the employer the persons of administrative personnel who are the nearest responsible heads of works act. These responsible heads in quality "sosubektov" labour legal relation on the party of the legal person possess the certain rights and to duties, answering independently for default of the last. That person to whom operative independence in use of a labour of known group of workers and applications of a known part of means of production (such workers is given can be considered as the responsible head of works there can be, for example, chiefs of shops). In one labour legal relation such responsible head of works himself acts as rabotopoluchatel as the management of works is too a kind of the work which are carried out on labour legal relation. But the maintenance of this kind of work includes realisation of certain competences and duties on the party of the employer on labour legal relations with other workers [257]. From the told follows, that process of the organisation of work within the limits of modern manufacture has the difficult system character demanding relative independence of separate structures of system, and consequently, presence at the head of such structural part of certain powers for management, on the one hand, and coordination establishments between these separate parts within the limits of the system — with another.

Thus, it is necessary to recognise, that investment of the attending physician with an autonomy (independence) of higher heads (the chief of branch, the head physician) at decision-making on treatment of the patient limits in this matter of law of the employer (the head of the medical organisation, the head physician) and, besides, allocates the attending physician who is, as a matter of fact, the executor, a part of the rights of the employer at coordination of activity of other workers by it (first of all the medical personnel).

It is represented, that the following follows from the described above and fixed powers described above in the law (elements trudopravovogo the status) the attending physician: the attending physician is the worker who is carrying out not only professional medical, but also organizational functions which under the general rule belong to the head of the organisation and consist in a summer residence of tasks to other workers of the organisation. It is obvious, that the attending physician is the person directly responsible for all treatment of the patient in the organisation and having all necessary for it imperious, including control, powers and powers in cooperation of medical work. At the same time with a view of more successful functioning in the medical organisation of institute of the attending physician it is obviously important, that in it the local certificates concretising it organizational functions have been accepted.

Summing up, we will notice, that cooperation allows to balance existing medical specialisation. By means of cooperation begins possible to consolidate medical workers not round illness, and round the concrete person — the patient sick of certain disease, to eliminate the borders arising in the course of its treatment (these borders can be connected with absence of continuity in medical aid rendering, absence of appropriate intermediate supervision of the patient in a break between rendering of various kinds of medical aid etc.) . Trudopravovoj the status of the medical worker by means of its certain elements caused by cooperation of medical work, helps to eliminate professional division of medical workers in connection with presence at them various skills, abilities and the knowledge caused by different medical specialities, and to render the most qualitative help to each patient taking into account its specific features. The basic and most significant roles in such cooperation of medical workers round one patient play trudopravovoj the status of the attending physician, and also trudopravovoj the status of the head physician of the medical organisation. The head physician by means of the powers (elements trudopravovogo the status) will organise the general (organizational) cooperation in the medical organisation, consisting in the appropriate organisation and management of activity of all its personnel including all medical workers of the medical organisation. Realisation of these powers assumes, in particular, creation of the medical commission, appointment of the attending physician, transfer of its function in case of need to average medical workers etc. The attending physician allocated with the law by organizational-administrative powers, constituting its elements trudopravovogo the status, carries out individual (professional) cooperation of medical workers round the concrete patients in which treatment he is engaged, — assembles a consultation, invites doctors - of advisers, directs patients to other medical organisation for rendering of specialised medical aid in the planned form, authorises for realisation of recommendations of doctors-advisers etc.

Taking into account all above-stated such modern features of medical work as specialisation and cooperation, it is possible to base on base structure special trudopravovogo the status of the medical worker. This structure in this case can be defined through groups of certain specific elements of the given status. The first group of such elements is caused by specialisation of the medical work, the second — cooperation of this work. Both groups of elements given trudopravovogo the status are defined by presence of a constitutional law of the patient on reception of qualitative medical aid.

Thus, under elements special trudopravovogo the status which existence is caused by specialisation of medical work, it is necessary to understand:

1) the legal obligations as which example serve:

Group of the general duties of the medical worker directed on

Rendering of specialised medical aid according to available qualification, duty regulations, office and official duties, usages and standards of rendering of medical aid (podp. 4 items 10, podp. 5 items 2 of item 14, podp. 3 items 5 of item 19, item 37, 73, podp. 2 items 1 of item 79 of Bases, the Uniform qualifying directory of posts of heads,

Experts and employees, section «Qualifying characteristics of posts of workers in public health services sphere» and other subordinate legislation [258]);

Group of special duties of the medical worker, concerning rendering of separate kinds of specialised medical aid:

— A duty to render the primary medicosanitary help, specialised, including hi-tech, medical aid, fast, palliative medical aid in the emergency, urgent and planned form (item 2 item 3-4, podp. 17 items 1 of item 16, item 2 and podp. 1 items 3 of item 21, item 3236, podp. 1 items 1 of item 79 of Bases, and also a number of subordinate legislation standard legal acts [259]);

— A duty to render separate kinds of specialised medical aid (medical examination, physical examination and medical examinations — item 46, gl. 7 Bases; medical aid to women — item 52, 56 Bases; medical aid

The minor — item 7, 54 Bases; medical aid in the field of reproductive technologies — item 51, 55, 57 Bases; medical aid in the field of a donor service and transplantation of bodies and fabrics of the person — item 47 of Bases; other kinds of specialised medical aid — item 40-44, item 66 item 5, item 1 of item 67 of Bases and other standard legal acts [260]);

2) corresponding interdictions to which it is necessary to carry, in particular, an interdiction for refusal of medical aid rendering in the emergency form (item 2 of item 11 of Bases);

3) the special rights and the powers given to medical workers, for example:

— The right to vocational training, retraining and improvement of professional skill (podp. 1 items 1 of item 72 of Bases);

— The right of the doctor-expert (under the invitation of relatives or the legal representative died) to participate in pathoanatomical opening (item 6 of item 67 of Bases);

— The right of medical workers of some specialities (the attending physician, the medical assistant, the dentist) to give out an invalidity leaf (item 2 of item 59 of Bases);

— The right of the head of the medical organisation to assign certain functions of the attending physician on medical workers of other specialities — the medical assistant or the midwife (item 7 of item 70 of Bases).

Under elements special trudopravovogo the status which existence is caused by cooperation of medical work, it is necessary to understand:

1) the legal obligations as which example serve:

— Duties of the head of the medical organisation (head physician) to appoint the medical commission (item 48 item 1-2, item 3. Item 59, item 2 of item 63 of Bases) to appoint the attending physician and to promote a choice the patient of other attending physician (item 1 of item 70 of Bases), to organise replacement of the attending physician (item 3 of item 70 of Bases), to organise interaction of the medical organisation with other medical or other organisations, with the state bodies and local governments with a view of medical aid rendering (item 6 item 2, item 9 of Bases);

— Duties of the attending physician to organise the timely qualified inspection and treatment of the patient, on request of the patient to invite for consultations of doctors of experts, if necessary to assemble a consultation of doctors, to authorise for realisation of recommendations of doctors - of advisers in case of their expediency (item 48 item 3-4, item 3. Item 66, item 2 of item 70 of Bases);

— A duty of the attending physician to direct patients to the medical organisations for reception of specialised medical aid in the planned form (item 4 of item 21 of Bases);

— A duty of the medical worker to inform in writing the head of the medical organisation on occurrence of the conflict of interests (item 2 of item 75 of Bases);

— The duty of the medical worker benevolently to concern colleagues, to address to them for the help and council if it is demanded by interests of the patient (item 1 of item 71 of Bases);

— A duty of medical workers of various specialities to give to patients of consultation (podp. 3 items 5 of item 19, item 22 item 4, item 26 item 3, item 8 of item 35 of Bases);

— A duty to render medical aid as a part of uniform labour collective (ch. 1 and 2 items 41 of the Constitution of the Russian Federation) [261];

2) corresponding interdictions to which it is necessary to carry, in particular:

— Will lock to make a complex of certain actions, for example to enter into with the pharmaceutical company of the agreement on appointment or recommendations to patients of medical products, medical products, and also to make other similar actions (item 74 of Bases);

— Will lock to refuse to colleagues — to medical workers in the help and council (item 1 of item 71 of Bases);

— An interdiction for participation in consultation structure on an establishment of the diagnosis of death of a brain of the experts who are taking part in withdrawal and transplantation (change) of bodies and-or fabrics (item 3 of item 66 of Bases);

3) the special rights and the powers given to medical workers, for example:

— The right of the head of the medical organisation (head physician) to assign certain functions of the attending physician on the medical assistant or the midwife (item 7 of item 70 of Bases);

— The right of the doctor-expert (under the invitation of relatives or the legal representative died) to participate in pathoanatomical opening (item 6 of item 67 of Bases).

As to special responsibility (including disciplinary) medical workers its precondition in all cases set forth above is the complex of special duties and powers in the field of labour activity of medical workers. As the basis of occurrence of responsibility non-observance of these duties, interdictions and default of powers acts. For some

Offences in the field of specialisation and cooperation of medical work are provided special structures administrative or the criminal liability (for example, item 6.29 KoAP the Russian Federation, item 123, 128 UK the Russian Federation). The given offences can become simultaneously and the basis for disciplinary responsibility application. Fulfilment of the actions provided in item 7.1 can become the special basis in that case. ch. 1 items 81 TK the Russian Federation.

More in detail about the rights, duties and responsibility of medical workers as about its elements special trudopravovogo the status it was already spoken in paragraph 2.2 of the present work.

Thus, modern features of medical activity are considered by the legislator in the form of the norms giving to medical workers the special rights and imposing on them special duties to operate definitely. The norms established by the legislator about responsibility of medical workers are applied in case of non-observance of these specific duties by them. As the granted rights, duties and responsibility for non-observance of duties are based on modern features of medical activity so far as they are modern elements trudopravovogo the status of the medical worker (modern features trudopravovogo the status). The specified features trudopravovogo the status of the medical worker give it specificity in comparison with trudopravovymi statuses of workers of other categories, allow to provide qualitative rendering of medical aid to citizens and pursue achievement of one of the main constitutional purposes — the timely organisation and granting of the qualitative medical aid directed on preservation of a life and maintenance of health of the patient.

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A source: Belokolodova Tatyana Igorevna. MODERN trudopravovoi the status of the medical WORKER And ITS FEATURE. The DISSERTATION on competition of a scientific degree of the master of laws. St.-Petersburg - 2017. 2017

More on topic modern features trudopravovogo the status of the medical worker:

  1. CHAPTER 3. TRADITIONAL And MODERN FEATURES TRUDOPRAVOVOGO of the STATUS of the MEDICAL WORKER
  2. Traditional features trudopravovogo the status of the medical worker
  3. the Maintenance trudopravovogo the status of the medical worker
  4. differentiation of legal regulation as the tool of formation special trudopravovogo the status of the medical worker
  5. general terms and the bases of occurrence, maintenance, change, stay and the termination trudopravovogo the status of the medical worker
  6. CHAPTER 1. GENERAL CHARACTERISTIC TRUDOPRAVOVOGO of the STATUS of the MEDICAL WORKER
  7. CHAPTER 2. The MAINTENANCE And DYNAMICS TRUDOPRAVOVOGO of the STATUS of the MEDICAL WORKER
  8. a legal status, a legal status of the worker, trudopravovoj the status of the medical worker: concept and elements
  9. § 1.1. The Legal status of the medical worker and the medical organisation
  10. Modern features of the labour law status of a medical employee
  11. Belokolodova Tatyana Igorevna. MODERN trudopravovoi the status of the medical WORKER And ITS FEATURE. The DISSERTATION on competition of a scientific degree of the master of laws. St.-Petersburg, -2017 2017
  12. CHAPTER 3. TRADITIONAL AND MODERN FEATURES OF THE LABOUR LAW STATUS OF A MEDICAL EMPLOYEE
  13. Traditional features of the labour law status of a medical employee
  14. The content of labour law status of a medical employee.
  15. 3. DifTerentiation of legal regulation as an instrument of establishment of the special labour law status of a medical employee
  16. § 3. The Legal status of the medical and spiritual personnel in the course of confrontations
  17. 2.2 General conditions of and grounds for the emergence, maintenance, modification, suspension and termination of the labour law status of a medical employee