Improper Provision Research Articles

Evaluasi Penyelesaian Temuan Pemeriksaan yang Tidak Dapat Ditindaklanjuti (TPTD) Hasil Pemeriksaan Inspektorat Jenderal

This study aims to evaluate the implementation of the TPTD settlement process from the Inspectorate General examination results compared to the applicable TPTD guidelines. The study was conducted at the Inspectorate General of the Ministry of Health. This research uses a case study research strategy with a qualitative descriptive data analysis method. The data sources used were obtained from interviews and documentation. The results showed that the implementation of the settlement has followed the applicable TPTD guidelines but it is necessary to update the follow-up guidelines and make technical follow-up instructions for the results of supervision or TPTD special guidelines that explain the operational definition of TPTD criteria regarding benchmarks and document limits from authorized agencies that must be met as TPTD requirements, work steps regarding the TPTD proposal mechanism from the work unit, discussion and determination of TPTD by the Inspectorate General, as well as the format of submitting TPTD proposals along with supporting data that must be completed. Recommendations of audit results that become TPTD due to improper provision of recommendations The Inspectorate General can carry out the development of APIP competence of the Inspectorate General on an ongoing basis. The findings decided by TPTD but seen from the follow-up carried out are not timely or protracted, it is necessary to monitor the follow-up carried out by the Inspectorate General every month and be actively involved in maintaining the time commitment. Keywords: Findings, follow-up Inspectorate General, TPTD, recommendations

Medical and legal aspects of the responsibility of medical workers in cases of improper provision of medical care

The article considers the concept of medical incidents of «improper provision of medical care», implying the action or inaction of a medical worker who violates the procedure for providing medical care established by regulatory legal acts and standards. The relevance of the study of issues related to the medical and legal norms of holding medical workers accountable when medical care is of inadequate quality is due to the importance of understanding offenses in the medical field and assessing the responsibility of medical workers, who act as criteria for the presence of problems in the medical field and the impetus for reforming the health system.

Сутність поняття “туризм”, “турист” та “туристичний кластер”

The article is devoted to the study of the concept’s “tourist”, “tourism”, “tourist service”, “tourist product” and “tourist cluster”. The analysis of the legislation of Ukraine, which regulates tourist relations, was carried out, in particular, regarding the definition of the essence of the concepts “tourism”, “tourist”, “tourist product” and their comparison with the interpretation and understanding in economic thought and statistics. The main characteristics of a tourist have been clarified, namely: physical person; travel time – from 24 hours to 1 year; the purpose of the trip is not related to earning income. A distinction is made between tourist service and tourist product, the collision that arises with the interpretation of the concepts of “tourist product” and “tourist service” in various sciences is investigated. Approaches to understanding the concept of “tourism” as an economic phenomenon, a place of commercial enterprises and their classification into those that directly satisfy the needs of tourists and those that indirectly take part in satisfying these needs are defined. The expediency of determining the legal nature and subject composition of the tourist service, which affects the possible ways of protecting the violated rights of the tourist and the correct identification of the person who will be responsible for the improper provision of services, has been clarified: if it is a tourist service, the subject of responsibility will be the tour operator, if it is another service, the relevant entity providing this service (hotel, transport company, tour guide, etc.). The article examines the concept of “tourism” through the prism of clustering as the most comprehensive approach to understanding this term. It has been studied that the concept of “tourism” as a branch of the economy should be considered in the context of cluster associations of enterprises and other entities that provide services to tourists. The author’s interpretation of the concept of “tourist cluster” is proposed, namely: it is a territorial association of enterprises, research, production and financial companies and other business entities that have vertical and horizontal relationships with the aim of achieving economic and social effects and satisfaction needs of tourists.

Edukasi dan Pemberian Makanan Pendamping Air Susu Ibu (MP-ASI) Sebagai Upaya Peningkatan Gizi Balita di Desa Lolo Kabupaten Sigi

The problem of toddler nutrition is still unresolved in Indonesia. Improper provision of MPASI is one of the factors that causes growth disorders and malnutrition. This service aims to increase knowledge and understanding regarding complementary foods for breast milk (MP-ASI) from mothers with babies/toddlers in the Lolu Village area, Biromaru District, Sigi Regency. The method used in this service is the lecture and question and answer method. The team also distributed the porridge of chicken moringa MPASI as an example of MPASI made from local food. The service activities went well and achieved the expected goals, where the community could understand the educational activities well and have a positive attitude towards imitating MPASI from local foods.

Legal Training of Surgeons of the Republic of Tatarstan Based on the Experience of Participation in Criminal Proceedings in “Medical” Cases

Relevance In modern realities, medical workers, primarily representatives of surgical specialties, are increasingly faced with the need to have legal literacy, since medical activities associated with surgical practice are associated with high legal risks.Aim of study Studying the legal training of surgeons in the Republic of Tatarstan based on the experience of participating in criminal proceedings in cases related to improper provision of medical care.Material and methods During the period from May 15 to May 31, 2021, an anonymous survey of 124 surgeons from various medical organizations of the Republic of Tatarstan was conducted. The questionnaire consisted of 13 multiple-choice questions with an additional field for comments. The participation in the survey was voluntary, and the questions were devoted to the experience of participation in criminal proceedings in “medical” cases and the need for legal training in this matter.Results Among those surveyed, 51.5% of respondents at least once during the years of their career gave explanations to law enforcement agencies regarding the unfavorable outcome of medical care, and 38.7% were directly involved in a criminal case. According to 52.2% of respondents, the most common reason for complaints to law enforcement agencies is the inadequacy/bad manners of patients. The vast majority of doctors surveyed are guided in their activities by currently existing procedures, orders, standards and clinical recommendations. However, more than 37% of doctors have no idea how to act in the event of a criminal case being initiated due to an unfavorable outcome of medical care, and for 71.0%, medico-legal training is “highly relevant”.Conclusion The problem of criminal liability for improper provision of medical care for surgeons in the Republic of Tatarstan is extremely relevant. There is an urgent need to develop interdisciplinary formats for interaction between the medical, forensic and legal communities in order to improve the legal literacy of medical workers and reduce criminal risks in surgical practice.

Examinations of medical cases conducted in the Bureau of Forensic Medical Examination of the Tambov region

BACKGROUND: Over the past 5 years, the number of commission examinations on improper provision of medical care by the Bureau of Forensic Medical Examination of the Tambov Region has increased. These examinations were performed to identify defects in the provision of medical care and determine their effect on an unfavorable outcome for the patient.
 AIM: To analyze and evaluate forensic medical examinations performed at the Tambov Regional Bureau of Forensic Medicine in so-called medical cases.
 MATERIALS AND METHODS: To identify medical specialties with the most frequent cases of inadequate medical care, which are the direct cause of unfavorable outcomes, an analysis of examinations was conducted for 2017–2021. The study included examinations performed from both the Tambov region and other regions.
 RESULTS: The number of cases of inadequate provision of medical care, for which the examination confirmed a cause-and-effect relationship with an unfavorable outcome, remains approximately at the same level throughout 2017–2021, and the largest number of defects in the provision of medical care were identified in the profile “obstetrics and gynecology.” However, the identified defects in the provision of medical care do not directly correlate with the number of examinations prescribed.
 CONCLUSION: The analysis of medical cases showed that the number of examinations in which a direct causal link was established between defects in the provision of medical care and adverse outcomes remained low annually (not more than 9%). The largest number of defects in the provision of medical care was found in the profile “obstetrics and gynecology,” which relates to defects in diagnosis and treatment.

Problems of bringing to civil and criminal liability for improper provision of medical services

The purpose of this work is to consider the problems arising from the improper provision of medical services and bringing to civil and criminal liability for these actions of medical organizations and medical workers. The author investigates the issues of bringing to responsibility for violations related to improper provision of medical care in medical organizations of the healthcare system of the Russian Federation. Russian legislation enshrines the right of a patient to complain about the improper provision of medical services, both when applying to a state medical organization and when receiving medical care in private structures of the healthcare system. The problem of bringing to civil and criminal liability for improper provision of medical care in Russian healthcare has been standing for quite a long time, nevertheless, today it is coming to the fore, despite attempts to improve the legislative regulation of this issue. In conclusion, authors conclude that in order to achieve high-quality medical services, it is necessary not only to comply with the requirements for the contractor, provided by licensing of medical activities and accreditation of medical specialists, but also to establish requirements for the activities of medical workers themselves. Thus, the provision of medical services should be considered improper if they are provided in violation of the requirements imposed on the subject and are provided in an improper way, i.e. in violation of the requirements that must be met by medical workers.

Forensic medical examination in the case of suspicion of inappropriate provision of toxicological care (a case from practice)

As an example of practical observation, the basic principles of the forensic medical assessment of the therapeutic and diagnostic processes are demonstrated in the case of suspicion of improper provision of toxicological care in the case of ethylene glycol poisoning. This study highlighted the factors hindering the provision of toxicological care and its forensic assessment.
 Factors such as the lack of information from eyewitnesses or the patient himself about the oral intake of a liquid with potentially toxic properties and the possibility of reliably establishing the presence of ethylene glycol in the body only by chemical and toxicological examination can hinder toxicological care and its forensic assessment. Toxicological care, including antidote therapy with ethanol, can and should be used only if there is reliable information or if there is a sufficient possibility of assuming poisoning with ethylene glycol. Owing to the instability of hemodynamic parameters, which are inevitable with oral poisoning with ethylene glycol, the risk of natural complications during the transportation of the patient is obviously higher than when he is left in a specialized hospital with high-tech equipment and round-the-clock supervision.
 Cases of ethylene glycol poisoning, in which treatment does not bring improvements to the patient or at least stability of dynamics, do not automatically indicate that the medical care provided was inappropriate (incorrect). In acute oral poisoning with ethylene glycol, even proper medical care does not guarantee the prevention of a fatal outcome.

Обеспечение безопасности дорожного движения перевозчиком как условие надлежащего оказания услуг по перевозке пассажиров

Certain aspects of bringing the carrier to administrative responsibility for violation of requirements in the field of road safety in the provision of services of inadequate quality for the carriage of passengers are considered. Based on the analysis of legislation and judicial practice, the possibility of simultaneously bringing the carrier to administrative responsibility for violations in the field of road safety and liability for improper provision of services within the framework of administrative and civil law legislation is being investigated. It is stated that the fulfillment of public obligations to comply with road safety requirements is usually the requirements for the provision of passenger transportation services. It is proved that the simultaneous application of several liability measures to the carrier and its employees does not contradict the principle of inadmissibility of bringing twice to responsibility for the same act (non bis in idem), because the subjects of responsibility have different legal status, and legislation is aimed at protecting different protected interests. It is concluded that such an approach makes it possible to distinguish the administrative-legal consequences of violations of road safety requirements by drivers engaged in professional activities and drivers engaged in transportation for their own needs. Consideration of an administrative offense as the basis of civil liability in the field of passenger transportation makes it possible to guarantee road safety when transporting passengers simultaneously by public and private legal means.

Illegality of an Act (Omission of an Act) of the Executor in Cases related to Improper Provision of Medical Services

. The paper provides a comprehensive analysis from the position of doctrine, legal regulation and judicial practice of the features of establishing the wrongfulness of the actions (inaction) of the tortfeasor in the provision of medical services as one of the circumstances of civil liability. The problems of qualification of illegal behavior of the performer of medical services are revealed. It is determined that the wrongfulness of actions (inaction) is an independent condition of civil liability and implies a violation of the law, other regulatory legal acts, as well as a violation of subjective rights. Criteria for distinguishing lawful from unlawful harm to the patient’s health within the framework of medical intervention have been identified. The position was supported that the conduct of a forensic medical examination in a trial when considering this category of cases in the Russian Federation should be mandatory for a qualified assessment of the shortcomings made in the provision of medical services.

Causal Relationship in Cases Related to Compensation for Harm Caused by Improper Provision of Medical Services

The paper studies some peculiarities of establishing by the court of a causal relationship between the unlawful action (inaction) of the tortfeasor and the resulting harm in considering compensation cases for harm caused due to improper provision of medical services. Having analyzed the judicial practice, the author considers the way the court classifies a legally significant causal relationship. The author raises a question about the significance and assessment by the court of a forensic medical expert opinion in establishing a causal relationship between defects in the medical service provided and the resulting harm. The experience of establishing a causal relationship in the litigation of England and Germany has been studied. The use of the doctrines of res ipsa loquitur, сondicio sine qua non, «fully managed risks» in the process of establishing a causal relationship when considering this category of cases, taking into account the specifics of the organization of medical activity, including in complex clinical cases, is considered.

ПРОГНОЗИРОВАНИЕ ДЕЙСТВИЙ ПОТРЕБИТЕЛЯ ПРИ НЕНАДЛЕЖАЩЕМ ОКАЗАНИИ СТОМАТОЛОГИЧЕСКОЙ УСЛУГИ

Subject. Settlement of disputes between consumers and providers of dental services related to their inadequate quality is a complex multifactorial problem. The successful solution of this problem can be helped by a predictive algorithm of consumer actions, built taking into account three important factors: 1) the time for making a decision about the nature of consumer actions; 2) the leading motive of the consumer when he decides on the nature of his actions; 3) the most likely options for the consumer to protect their rights in a dispute related to the improper provision of dental services.
 Goal. Formulation of proposals for the effective settlement of disputes between medical organizations and citizens based on a predictive algorithm for consumer actions in case of improper provision of dental services.
 Methodology. The actions of patients in resolving a dispute related to the improper provision of dental services were studied; the methods of questioning, variational statistics are applied in the work.
 Results. A statistically significant difference was found in the responses of patients and dentists about the factors in the settling of disputes associated with the improper provision of dental services. In this regard, two predictive algorithms for consumer actions are presented. The first corresponds to the patient's real intellectual and volitional representations. The second reflects the view of doctors, which does not match them.
 Findings. Dentists should strive to effectively resolve the dispute related to the improper provision of services within 2–3 days (during the balance of the patient's emotional and rational moments of consciousness). The leading motive of the consumer is to receive compensation for the harm caused to health and compensation for moral damage, therefore, in order to effectively resolve the dispute, it is important to focus on agreeing on an adequate amount of the corresponding compensation. Doctors in the course of direct negotiations with the patient should ensure accessibility to any format of communication, including the use of modern information and communication technologies.

Wound Care and Management: A Review

This study aimed to identify the importance of wound care and management. The study also looked into the different effects that result from the improper provision of wound care. On the other hand, there was also the provision of initiatives that enhanced the healing process. The study was qualitative and embraced the use of primary and secondary research sources to obtain information on the importance of embracing wound care and management. From the findings, improper wound care was associated with increased patient stress levels. Similarly, there was also the provision of two forms of wound dressing that entailed the traditional and modern. The traditional methods are most preferred because of their cost-efficient nature. However, the modern ones are the most ideal because of enhancing healing. On the other hand, patients experience a high medication cost through improper wound care that significantly impacts them. The mentioned initiatives in enhancing the healing process encompassed dressing the wounds, use of antibiotics, and medicinal plants. Additionally, incorporating general practice practitioners and nurse practitioners also enhanced the healing process. This is because these individuals are usually empowered on the different measures to implement in taking care of patients; therefore, it is possible to reduce cases of amputations that have been so prevalent among diabetes patients. In conclusion, wound care and management have been termed critical approaches to enhancing the overall health of individuals. Through this approach, individuals can avoid the increased cost of care, stress, and amputation, among other cases.

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Abstract. Introduction. Tourism for many countries is a priority for the national economy, as this industry has a positive multiplier effect on other economic activities. The high degree of riskiness of tourist activity necessitates the use of insurance mechanisms and insurance protection for all participants in the tourist market. Insurance allows you to optimize resources for the organization of insurance protection. It contributes to the rational structure of funds aimed at preventing (or promptly eliminating) the effects of risks that hinder the activities of economic entities. Purpose. The aim is to determine the role of insurance in ensuring the economic security of the tourism business and to develop practical recommendations for the development of insurance protection in the field of tourism. Results. Ensuring the safety of life and health of tourists and excursionists in Ukraine is a necessary condition for quality in the organization of tourist and excursion programs and a priority for all actors in the hospitality industry. The system of services to provide insurance protection against risky situations during a tourist trip is quite complex. This is due to the heterogeneity of probable adverse events that may occur at a particular time or under certain circumstances. Such services include insurance of life and health of the tourist, his property and liability, etc. Specific types of insurance against tourist risks are insurance in case of transport delays, bad weather during the stay of insured persons on vacation, as well as failure to provide or improper provision of services specified in the tourist voucher, etc. The current state of development of the domestic market of insurance services and travel insurance is analyzed. It is determined that the largest segment of the travel insurance market in Ukraine is health insurance. Insurance companies are currently creating insurance systems that, depending on their cost, may include a range of services, including evacuation and first aid services, as well as a range of services such as: payment for visits by relatives to the injured tourist in the host country, dental help, etc. Conclusions It was found that the main factors hindering the development of tourism insurance are: low insurance culture of tourists, owners and employees of tourism enterprises; public distrust of financial institutions; cases of insurance fraud against consumers of tourist services; imperfect legal framework and organizational and economic support, etc. A number of measures at the macro and micro levels are proposed for the development of tourism insurance in Ukraine, which will minimize threats to the safety of tourists and help ensure the economic security of the tourism business.

THE TACTICS OF INTERACTION BETWEEN THE INVESTIGATOR AND SPECIALISTS IN ORDER TO RESOLVE TYPICAL INVESTIGATIVE SITUATIONS IN THE INVESTIGATION OF CRIMES RELATED TO IMPROPER PROVISION OF MEDICAL CARE

On the basis of the analysis of the scientific approach and provisions of the current law, the author of the article considered the content of the concept of ‘special knowledge’ in relation to the professional activities of the investigator. The author designated the degree of effectiveness of the use of professional knowledge in the field of medicine during the investigation of criminal cases related to the improper provision of medical care based on the results of questioning the employees of the investigating authorities of the Investigative Committee of the Russian Federation. On the example of the practice of the investigative authorities of the Investigative Committee of the Russian Federation, a classification of typical investigative situations during the investigation of crimes related to the improper provision of medical care was formed and specific tasks of their resolving were identified, requiring the attracting of knowledgeable people. The tactical complexes aiming at the organization of effective interaction between the investigator and people with special knowledge in the field of medicine were formulated.

ФІНАНСОВА ГРАМОТНІСТЬ НАСЕЛЕННЯ: ВІТЧИЗНЯНИЙ ДОСВІД ТА УКРАЇНСЬКІ РЕАЛІЇ

The article proves the need to master the financial literacy base for all segments and categories of citizens (pupils, students, adults), establishes the interest of the state and financial institutions, in particular in the financial literacy of its citizens, the impact of the level of population’s financial literacy on the development of the financial market, the shadow economy, the attitude of the population of Ukraine to reforms and government initiatives. It is determined that due to insufficient competence in financial matters and insufficient financial literacy Ukrainians suffer from lack of funds and actions of fraudsters. It has been established that Ukrainians focus on the short-term perspective - they live in the present and do not save for the future. It has been conducted a study of the state of financial literacy of Ukraine, as well as comparing it with domestic experience. An analysis of the national financial literacy survey was conducted, which calculated the OECD Financial Literacy Index for Ukraine, and the results were compared with thirty other countries. It is established that financial literacy is one of the components of financial well-being of the population. The main factors that affect the well-being of the population of Ukraine are identified: the availability of control over expenditures, loans for everyday needs. The reasons for low financial literacy of the population of Ukraine have been identified (lack of training of Ukrainian citizens on the basics of financial literacy; improper provision of quality financial information to potential consumers of financial services; failure of the majority of the population to understand financial knowledge as necessary; low level of material and financial well-being of the majority of the population of Ukraine; lack of a single organization (at the level of the National Bank of Ukraine and the Ministry of Finance of Ukraine) which would promote financial literacy of the population; lack of approved university and school programs that would teach students the basics of financial literacy in a market economy). It is proposed to create a new program, which would be solved by the state with the support of financial organizations and business structures.

Improper provision of medical services as a basis for compensation for moral damage in civil law

Improper provision of medical services as a basis for compensation for moral damage in civil law

To ensure the safety of the property of a medical institution in the conditions of digital transformation: a note to the accountant

The digital transformation of the activity of a medical institution, the development of telemedicine technologies, the rise in the cost of property IT facilities assigned to a medical institution increase the requirements for ensuring the safety of this property. The mechanism of the organization of financial responsibility, including the contractual procedure for imposing full financial responsibility, restrictions on the categories of employees with whom these contracts can be concluded, and other cases of full financial responsibility are considered. The analysis of the employer’s obligation to provide conditions for financially responsible employees and the employer’s responsibility in case of improper provision of such conditions is carried out. The article considers the procedure for transferring material values when dismissing employees who are fully financially responsible.

Medical error when providing medical care as a basis for applying to the court for judicial protection

Issues of the quality of medical care in the Russian Federation are actively discussed by both scientists and practitioners, in addition, this issue is of particular interest to the direct recipients of this assistance, i.e. citizens. In this paper, in order to comprehensively study the effective protection of violated rights of patients, we study the nature of medical errors, as well as the attitude of patients and doctors to them. In this work, formal legal methods were used. The article examines in detail the algorithm of actions before applying to the court of an interested person whose right is violated by poor-quality medical care, in the context of their impact on the final result of judicial protection, which is carried out by making a legitimate and reasoned decision on the case. The author analyzes the actions, the Commission of which is necessary in cases when suffered injury improper provision of medical services is a medical facility or by a doctor carrying out private practice from the moment of establishment of the fact of committing a medical error by examination and ending with the preparation and filing of a claim in the court in accordance with article 131 and 132 of the code of civil procedure of the Russian Federation. The article examines the subject composition of persons in cases on the protection of patients ' rights, issues of jurisdiction, requirements for the form and content of the statement of claim. The work is illustrated by examples from judicial practice, indicating the variety of cases of violation of patients ' rights, the difficulties that may arise in the process of proving the plaintiff's position in the case, as well as the exclusivity of individual means of proof in this category of cases, such as the expert opinion.

THE LIMITS OF EXPERT COMPETENCE AND THEIR LEGAL CONSEQUENCES IN FORENSIC EXAMINATIONS AT CIVIL TRIALS IN RUSSIA

The article deals with the issue of determining the limits of expert competence in forensic examinations in case of improper provision of medical care in civil proceedings. The practical example shows the features of legal evaluation of expert opinion by the court in case an expert goes beyond the limits of specific knowledge. Special attention is paid to objective difficulties in differentiation of an expert legal assessment and a lawenforcement act, which arise while performing examinations on materials of medical malpractice.