A young Moscow dental surgeon was attacked and beaten in his own office after submitting a complaint to the Mayor's Office over reforms to the city health system.
Ivan Stepanov, 24, a dental surgeon at children's dental clinic No. 26 in the northwest of the city, filed an online complaint on June 15 to Moscow Mayor Sergei Sobyanin about some of the new rules introduced as part of a major city health care reform program enacted last year.
On Wednesday, the dentist left his place of work in an ambulance with numerous injuries including a suspected concussion after being beaten up in his own office, allegedly by the clinic's head doctor and her deputies.
Stepanov was not alone in disagreeing with the reforms. More than 20 hospitals in Moscow were shut down as a result of them, and thousands of doctors were laid off, leading to an increased workload for the rest. The reform sparked street protests by doctors last year but to no avail: The reforms went ahead, and many doctors now claim their work has been made more difficult as a result.
Amid the litany of complaints aired by doctors, Stepanov's was not one of the harshest. It concerned the electronic system through which all appointments at municipal clinics are made, the IMIAS (Integrated Medical Information and Analytical System). The system restricts patient visits to no more than 15 minutes, which many doctors — including Stepanov — have said is simply not enough for doctors to do their job properly.
Stepanov also stated in his letter to the mayor that the number of patients he was supposed to see every day had increased under the reform, meaning he had to work longer hours and no longer had time to take a break for lunch or anything else.
"There were supposed to be seven dental surgeons at our clinic, but in reality there are only two of us working," Stepanov wrote in his complaint, quoted on the LiveJournal blog of Andrei Konoval, a member of the doctors' professional union Deistviye ("Action").
Reprisals at Work
Four days after the letter was submitted, the surgeon was summoned to a meeting with the clinic's head doctor Olga Sagina. He was asked to withdraw his complaint. It was not immediately clear through what process Sagina had been made aware of the complaint.
"I refused to withdraw it, and they started putting pressure on me," Stepanov told The Moscow Times by phone on Thursday.
According to the dental surgeon, the clinic's management acted swiftly to make his working conditions impossible. "For example, they made me write explanatory letters every time I left my office, even if it was to go to the bathroom," he said.
Nor did the clinic's management stop at the explanatory letters, the doctor claimed. The administration of the institution went out of their way to catch Stepanov in violation of bureaucratic regulations, and every time, he had to provide a written explanation.
Stepanov's story is not an isolated case. Other Moscow doctors who have expressed opposition to the reforms have come under other kinds of pressure. Some have started an "Italian strike" in which they continue to do their job, but strictly according to the rules and regulations.
Like Stepanov, some of them have been accused of violating rules and forced to write explanatory notes. Other say they have been put in an untenable situation by the clinic administration allowing too many patient visits, forcing the doctors to work overtime and leaving them without breaks.
On Wednesday, Stepanov was in his room with a patient when Sagina and several of her associates entered his office, he said.
"They attempted to force me to sign a piece of paper [claiming another rule violation]. I refused to sign it, so they threw me on the floor and I was injured," he told The Moscow Times.
"I tried to record a video of what was happening with my cell phone, but Olga Sagina snatched it while the others were hitting me," he said.
Some of his attackers held the door closed while he was under attack, but eventually Stepanov managed to escape, he said. One of the patients in the corridor had heard the commotion inside and called the police.
The police arrived together with an ambulance, which took the doctor to Moscow's Hospital No. 67 with symptoms of concussion.
Within hours, he had been discharged.
"I was thrown out without even being properly diagnosed," he told The Moscow Times.
According to Stepanov's discharge papers posted on Konoval's blog, the concussion diagnosis was dropped. He was found to have multiple injuries and bruises, none of which were deemed serious enough to admit him.
"He fainted several times and was experiencing nausea and dizziness. I'm a doctor myself, I know what a concussion looks like," Yekaterina Chatskaya, co-chair of the Deistviye union who was present at the hospital, told The Moscow Times on Thursday.
She expressed suspicion at the way Stepanov had been treated. "They had given him a CT scan and an X-ray by the time I got to the hospital, but no physical examination," Chatskaya said.
"They only did so later, and the doctor didn't even ask him to undress. What kind of examination is that?" she said.
Then the doctors told Stepanov he was free to go.
"Ivan could barely walk. We called another three hospitals since he obviously needed medical care, but all of them turned us down, saying we should go back to the hospital that had initially dealt with Ivan," Chatskaya said.
Order From Above?
Stepanov said he believes he knows why. "I have information that the [Moscow] health department instructed all the medical institutions in Moscow to reject me," he told The Moscow Times.
According to him, the same instructions were given to the administration of the first hospital. "I heard the doctors talking — they'd had a call from the health department about [not hospitalizing] me," Stepanov said.
The head doctor of hospital No. 67, Andrei Shkoda, firmly denied any such order had been given.
"The hospital is an independent institution," he told The Moscow Times by phone Thursday. "We have never received any instructions of that sort," he said.
Representatives of the city's health department declined to comment on the incident to The Moscow Times, saying it would not be appropriate to do so while an investigation launched by the police is ongoing.
On Wednesday, however, the Interfax news agency quoted an unnamed department representative as saying Stepanov had violated regulations on many occasions during his work at the clinic.
The source was cited as saying that on Wednesday, Stepanov had refused to sign a document obligating him to write an explanatory note concerning one of the violations, behaved aggressively, threatened and in the end attacked Sagina.
She was hospitalized and diagnosed with a concussion, numerous bruises and a wrist injury, Interfax cited the representative as saying.
Sagina was unavailable to comment for The Moscow Times on Thursday. Her assistant said she was on sick leave and could not be contacted.
A request for comment sent to City Hall had not been answered by publication time.
Both Sagina and Stepanov reported the situation to the police — with their various interpretations, and both have been suspended from work until the investigation is concluded, Interfax cited another unnamed health department spokesperson as saying Thursday.
Chatskaya said that while they were in the hospital, a man named Sergei turned up, claiming to be from the police and saying he was there to investigate a complaint filed by Sagina. He did not show any ID, Chatskaya said.
"He asked some routine questions at first, but then mentioned that some of 'his people' would contact us to help 'settle things without a fuss.' It wasn't something you would expect from a police officer, so we decided to end the conversation at that point," the union representative said.
Stepanov told The Moscow Times there were a lot of witnesses who would testify in his favor.
Interfax cited a health department spokesman as saying that Alexei Khripun, head of the department, had held a meeting with employees of the children's dental clinic where Stepanov worked on Thursday.
Sixty doctors and nurses of the clinic had signed a petition Thursday addressed to Mayor Sobyanin calling for Sagina and her deputy to be fired, Netreforme.org, a civil initiative website set up to monitor education reform, reported.