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Death without discrimination

How confusion, protracted investigations, and overburdened physicians make medical deaths an unanswered question—and without accountability

medical error — *^{The illustration was generated by the editorial team using AI.}*

On March 31, 2025, 46-year-old Magadan resident Elena Nosova, a leading specialist at the city's civil registry office, was waiting in line to see a cardiologist at a local clinic. She had been experiencing chest pain for several days. Now, she felt something was wrong, but there were two more people ahead of her, and the line was moving slowly.

Elena placed one hand on her heart and with the other took the hand of her ten-year-old daughter, who was sitting next to her. And then she died.

Perhaps the cause of death was medical error. Perhaps it was negligence. Or perhaps it was a coincidence. In the public consciousness, these two are conflated, and in almost every case, relatives "blame" the doctors for the death.

Using cases from the Magadan Region as examples, we examine how vague concepts, classified statistics, inspections without public reports, and overburdened physicians leave medical deaths without blame or conclusions.

🔶 Medical deaths in Russia often remain without a clear answer as to the cause and culprit: relatives face inconclusive investigations, protracted investigations, and a lack of public information about doctors' punishments.

🔶 The concept of "medical error" as "honest mistake" does not exist in Russia. Courts classify medical professionals' actions under articles of negligence, unsafe services, or improper performance of duties.

🔶 The scale of the problem remains unclear: official statistics from Roszdravnadzor are rarely published, and the available figures appear understated compared to international data and the large number of patient complaints.

🔶 Investigations into medical errors often drag on for years. Forensic medical examiners are overloaded, statutes of limitations expire, and many cases never reach trial.

🔶 The healthcare system, however, has no interest in harshly punishing doctors—they're already short on staff. The shortage of doctors and overwork make the risk of omissions a chronic problem.

🔶 The medical community and experts believe that reducing the number of errors is possible not through fear of criminal punishment, but through open, professional case reviews. However, such reviews are not practiced in the country.

People who were not saved

A few weeks before death Elena Nosova She complained of heart pain. She went to the doctors, who sent her on sick leave and for additional tests. On the morning of her death, says Nadezhda, Elena's friend, she couldn't get an appointment because of the long line. She returned a second time in the evening. She didn't make it to the appointment.

Before this, Elena sent her friend an audio message (available to the editors), where she talked about her health.

"I've been walking around with low blood pressure for four days now. I'd take a pill, it'd go up a little, and then it'd drop again. I'm so weak, so tired, I can't even work. And the doctors are laughing. They're saying I'm having a panic attack, a fear of death, and it's all just nerves. I'll try to see a cardiologist on Monday or Tuesday. My whole life, with a healthy heart, healthy kidneys—and now this happens so suddenly. My heart's fluttering like a bunny's tail, I can feel it, and my head's pounding, like someone's stomping in the hallway. And my blood pressure's weird. But I'm still walking around, we even went for a walk. The weather's wonderful, I feel like I want to live."

An investigation was conducted into this incident. It is unknown whether it had any consequences. There is no information available in open sources. The relatives did not attempt to hold the medical professionals accountable.

Magadan Yulia Khabarova She's trying to hold doctors accountable. For over two years, she's been seeking the results of an investigation into the death of her 60-year-old mother. She became ill on a December evening in 2023. Her father called an ambulance, and she was hospitalized. At the hospital, an electrocardiogram was performed, but it showed nothing, so she was taken back. She lost consciousness in the car, but according to her family, the doctors did not return.

"They stopped at the entrance with their emergency lights on and said to my dad, 'Lift her up.' My dad said, 'How can we lift her up?' They told him the most they could give him was a stretcher," Yulia says. "My dad went to get a neighbor, got a stretcher, and carried my mom. Half an hour later, she died at home. I pulled up, and the emergency room was there. My dad called them again... I got out of the car and approached the doctor. He asked, 'What's your relationship to the woman?' I said, 'My daughter.' And then he said, 'Oh, congratulations, your mom has died.'"

About 20 years Elena Ivannikova She worked as a medical professional - a nurse in the surgical department of the Regional Hospital.

Yulia believes the doctors didn't conduct a full diagnosis: they only performed an electrocardiogram, but not an echocardiogram. provided for Russian standards and clinical practice for a number of cardiovascular diseases, including heart failure i .

The Ministry of Health acknowledged Ivannikova's case and promised to conduct a "thorough investigation" and, if necessary, fire the employees who committed the negligence. Soon excited criminal case, head of the Russian Investigative Committee Alexander Bastrykin promised take him under personal control. Two and a half years later, the case is still under investigation.

Another case: in July 2023, a planned operation was performed at the Magadan regional hospital - a pleural puncture. 65-year-old patient. This is a common procedure - a puncture under local anesthesia, during which a small amount of air is removed from the pleural cavity. cavities i They take fluid, blood, or pus. However, during the operation, the doctor damaged the patient's spleen. The man was able to return to the ward, but soon died of hemorrhagic shock i .

Doctor fired from the hospitalA criminal case was opened under the article on causing death by negligence. An expert examination confirmed the doctor's error, and the surgeon admitted guilt. The court sentenced him to eighteen months of restricted freedom and disqualified him from practicing medicine for two years.

These stories vary: in one, the patient didn't receive help, in another, doctors failed to recognize a threat that required immediate action, and in a third, death occurred after medical intervention. They all have one thing in common: neither the family nor the public ultimately received a clear answer as to what exactly went wrong.

Why?

Firstly, the very concept of “medical error” is vague

In all of the cases mentioned, journalists refer to "medical error." This term is now used to describe virtually any action or inaction by doctors that leads to a patient's death or serious complications. However, legally, such a term does not exist.

In 1928, Academician Ippolit Davydovsky given The definition of medical error that experts and researchers still refer to today is: "a consequence of a physician's honest error in the performance of his professional duties."

The main difference between a medical error and "other defects in medical practice" is the exclusion of intentional criminal acts: "negligence, carelessness, and ignorance." The legal dictionary defines medical error as "an incorrect diagnosis of a disease by a doctor (diagnostic error) or an incorrect medical procedure (surgery, prescription of a medication) caused by the doctor's honest mistake."

An error may be the result of objective reasons - the complexity of the case, the unpredictable reaction of the patient, or a lack of information.

However, courts lack the ability to classify medical professionals' actions as "error due to honest mistake." Typically, they must choose from the following options:

improper performance of professional duties (Part 2, Article 109 of the Criminal Code of the Russian Federation);
provision of services that do not meet safety requirements (Article 238 of the Criminal Code of the Russian Federation);
negligence (Article 293 of the Criminal Code of the Russian Federation);
failure to provide assistance without good reason (Article 124 of the Criminal Code of the Russian Federation).

Secondly, the scale of the problem is unclear

Punishment of doctors almost never connected with actual imprisonment. Most often, courts impose suspended sentences, as well as restrictions on freedom and professional activity. But the fear of losing jobs and reputations, according to Semyon Galperin, president of the Doctors' Defense League, forces medical professionals hide mistakes. On paper, the situation appears to be improving, but reality remains unchanged.

We don't even fully understand what this reality is. Roszdravnadzor collects statistics, but only publishes summaries of complaints. Figures leak into the public domain only occasionally, when they are released by officials or experts. For example, in 2020, Russian Health Minister Mikhail Murashko He claimed, that medical errors and unprofessionalism lead to complications in 70 patients annually. The official noted that the agency also has data on fatalities, but he "will not specifically disclose it."

On results of In 2022 (the most recent data we could find), the so-called "proportion of discrepancies between clinical and pathological diagnoses" decreased: from 4,4% in 2018 to 2,6% in 2021. The level is abnormally low: the proportion of discrepancies between antemortem and postmortem diagnoses worldwide isAccording to various sources, the rate ranges from 12% to 33%. It's worth noting that such a discrepancy doesn't necessarily indicate medical error, but it does provide some objective data that can be relied upon.

The distrust of the digital data is reinforced by the high number of requests to the Federal Service for Surveillance in Healthcare: almost half a million signals for 2021–2023, according to research restrictions on the work of medical workers who violated healthcare legislation.

Authors the report The pathology service acknowledges that all cases of discrepancies in diagnoses "require on-site verification based on an analysis of primary medical documentation." They propose combating "padding" and concealment of actual statistics through cross-checking: when specialists from one region review the reports of another, this helps avoid pressure from local health ministries.

Thirdly, investigations into cases are falling apart.

In Russia, investigations into medical deaths often end in nothing. For example, in 2023, 95 out of 2332 cases reached court. excited, that is, less than 4%. The key systemic failure is the delay in the process. Forensic examinations in cases of negligence and medical errors occupy from two to eight years.

Lawyers believe the reason for this is an order issued by Alexander Bastrykin, head of the Investigative Committee of the Russian Federation, which in 2022 designated a single location for reviewing medical malpractice cases—the Forensic Expertise Centers (FEC) of the Investigative Committee of the Russian Federation. There are nine such institutions—one in Moscow and one branch in each federal district. This means, for example, that all 7,8 million residents of the Far Eastern Federal District are served by a single FEC.

The statute of limitations simply expires while waiting for an expert examination. Legal researchers Antonina Chuprina and Evgeniya Chernykh they write, Most often (around 80%), criminal cases against medical professionals are initiated for improper performance of professional duties. This is a minor offense, and the statute of limitations for it is two years.

A fresh example of how this happens, in detail stated The Novy Kaliningrad publication. After surgery, Kaliningrad resident Irina Zaychenko was paralyzed. A case was opened, but it immediately began to stall: the first investigator disappeared, the trial was suspended three times under the pretext of "unidentified person," then the case was inexplicably transferred from Kaliningrad to Gurevsk, which again wasted time. They couldn't appoint an investigator there for a long time, the documents for the examination lay dormant for months, and the examination only began a year later. During this time, seven investigators were replaced, and the family complained of perfunctory interrogations, the disappearance of evidence, and the refusal to submit an audio recording of the conversation with the doctor. By the time the examination confirmed defects in the medical care, the law had changed, and the case had to be reclassified first as negligence, then as causing harm through negligence. After that, it was quickly closed due to the expiration of the two-year statute of limitations.

In the United States and a number of European countries, the system of responding to defects in medical practice arranged not like in Russia.

At first, medical malpractice insurance is widespread.
SecondlyMost patient complaints are reviewed by professional regulators—medical councils, disciplinary committees, and other bodies that monitor compliance with professional standards. In severe cases, a physician may lose their license, and criminal liability is possible for gross negligence.
Thirdly, in many countries exist Developed systems for public analysis of medical errors and information exchange within the community. There is so-called peer review, regular conferences with analysis of severe complications, patient deaths, poor decisions, and diagnostic errors. Database "adverse events." All this соответствует international practice of patient safety (a direction in healthcare related to the prevention of medical harm) and principles learning healthcare system.

Fourth, the system is not interested in transparency

Courts don't always deprive healthcare workers of the opportunity to continue working, note Antonina Chuprina and Evgeniya Chernykh. This, the researchers conclude, is "entirely justified, given the extremely acute shortage of medical personnel": "Especially since the authors' analysis shows that problems with the quality of performance of their duties arise among doctors in the most in-demand professions. Surgeons were found guilty most often—40-43%, obstetricians/gynecologists in 15-17% of cases, anesthesiologists/resuscitators in 13-14%, and pediatricians and therapists in 20-21%." Only 10% of cases involved nursing staff.

At the same time, medical professionals themselves believe the same staff shortages and overworked physicians are the main causes of shortcomings in medical practice. If the system becomes more transparent, the problem will inevitably come to light.

"You're talking about medical errors... But few people talk to doctors, many of whom are already on the brink. As a general practitioner, I have up to 35-40 patients a day who need to be examined, diagnosed, or referred to another specialist, each with their own data entered into the program. Naturally, at this pace, any doctor will miss something. And I won't even mention surgeons; people are on call for two or three days at a time because there's a shortage of specialists. Honestly, I don't know who in their right mind would study to become a doctor these days. And if they decide to, let them talk to any specialist in the city or regional hospital, and the desire will immediately disappear," comments Magadan general practitioner Yulia Z. (she asked that her last name not be used).

"One in three doctors (36%) cited workload and staffing shortages as the main causes of medical errors. One in six (17%) blamed the atypical course of the disease for the errors, another 15% blamed the lack of necessary equipment at the medical facility for a full examination, and 13% cited 'contradictions in the standards and clinical recommendations of the Ministry of Health,'" Medvestnik reported. (for an unknown reason, the link to this publication was removed at the time of publication, and it was also not preserved in the web archive).

To punish cannot pardon

What's the bottom line? When it comes to investigating medical errors and learning from them, the Russian healthcare system is simultaneously sluggish, opaque to patients, and toxic to doctors themselves. It reacts slowly to failures, explains little to patients, and makes doctors afraid to admit it. And most importantly, it fails to address its own mistakes.

Ninety-two percent of medical professionals who participated in the aforementioned Medvestnik survey supported the creation of an independent professional regulator, independent of healthcare authorities. Currently, this role is fragmentedly fulfilled by the National Medical Chamber, the Action trade union, and the Doctors' Defense League. League President Semyon Galperin is convinced that the fight against medical errors should be carried out not so much by the law enforcement system as by the professional community itself:

"The only way to combat this is to openly discuss mistakes and find the causes. But to do this, doctors must not be afraid to admit it. They must understand that admitting a mistake will not result in punishment, but rather in support from the medical community. Then the number of errors will decrease. At least, their colleagues won't repeat them."

So far, the opposite is happening. The system's opacity and the risk of criminal prosecution are only exacerbating the medical personnel crisis. According to Galperin, doctors are trying to leave the specialties most often associated with prosecution following complications and patient deaths: surgery, anesthesiology, and obstetrics. Those who remain, the expert believes, will inevitably face a choice between an effective but difficult solution and a less effective but safer one.