Journal of Pain & Palliative Care Pharmacotherapy. 2014;28:178–179. ISSN: 1536-0288 print / 1536-0539 online DOI: 10.3109/15360288.2014.911803
LETTER TO THE EDITOR
Editor’s Note: This letter was shared with the journal by Liliana De Lima, Executive Director of the International Association for Hospice and Palliative Care (IAHPC). The letter originally appeared in the IAHPC electronic newsletter. It is reprinted herein with the permission of Dr. Usenko and Ms. De Lima.
duce armaments. He implemented the Vienna Document on Confidence, Security, and Cooperation in Europe and was awarded numerous orders and medals. Mr. Apanasenko suffered from end-stage pancreatic cancer. He courageously endured his pain. In the morning, the Admiral was examined at home by a General Practitioner (GP) from the local polyclinic. The Admiral’s wife went to the polyclinic at 14:00, where she received a resolution from an Oncologist that allowed the GP to prescribe morphine. After that, the Admiral’s wife approached the Senior Nurse, who needed to go to the Chief Nurse to obtain one “pink” prescription form for opioids and to give it to the GP, who would fill out the prescription forms (one “pink” and two special white forms). The Senior Nurse had some questions concerning the dosage of morphine and Admiral’s wife needed to go back to an Oncologist and then to the Head of the Department. After three hours of torment, the Admiral’s wife went up to the 7th floor to the Medical Director of the polyclinic for her signature and for the official stamp, but the Medical Director was not in her office. Meanwhile, the polyclinic had closed and any hope to receive the needed morphine was lost. Olga Golodets, Deputy Prime Minister, gave one week to the Russian Ministry of Health to verify the reasons for refusing painkillers to Admiral Vyacheslav Apanasenko. In turn, Veronika Skvortsova, the Minister of Health, requested Roszdravnadzor to check how medical treatment was provided to the Admiral. However, doctors from the polyclinics say that they acted according to the official instructions. Unfortunately, Admiral Vyacheslav Apanasenko met physicians who followed the bureaucratic regulations and instructions, because they did not want to be investigated by the Federal Service for Drug Control.
A Russian Tragedy
Admiral Apanasenko In Moscow, on Friday, February 7, 2014, Admiral Vyacheslav Apanasenko shot himself with a pistol. The Admiral left a suicide note that clearly indicated his reasons, “I do not want to blame anyone but the Ministry of Health and the Government. I am ready to suffer, but seeing suffering of my relatives is unbearable”. The Admiral was 66 years old and a brave and an extraordinary man. The Admiral served on nuclear submarines of the Northern Fleet. As an expert of the Soviet Union, he participated in negotiations limiting the number of strategic offensive arms. He initiated and was one of the authors of comprehensive programs to re-
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Letter to the Editor
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prosecution, illegally prescribed tramadol to Victor Sechin, a terminally-ill cancer patient. The prosecutor’s office still insists on the indictment. The importance of this Court cannot be overstated, because Dr. Khorinyak’s story is typical. Every day and throughout all of Russia, doctors are under threat of criminal prosecution and need to decide whether to follow bureaucratic rules or medical ethics and duty, mercy, and compassion. All of us who work in palliative care and pain relief need to keep working and advocating for measures to ensure that patients in need have access to appropriate treatment and care in Russia.
Dr. Khorinyak At the same time, another case appeared in Court in Krasnoyarsk for the second trial against Dr. Alevtina Khorinyak, who, according to the state
C
2014 Informa Healthcare USA, Inc.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. Olga Usenko MD, MPH Eastern and Central Europe Palliative Care Task Force E-mail: [email protected]
Copyright of Journal of Pain & Palliative Care Pharmacotherapy is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
LETTER TO THE EDITOR
Editor’s Note: This letter was shared with the journal by Liliana De Lima, Executive Director of the International Association for Hospice and Palliative Care (IAHPC). The letter originally appeared in the IAHPC electronic newsletter. It is reprinted herein with the permission of Dr. Usenko and Ms. De Lima.
duce armaments. He implemented the Vienna Document on Confidence, Security, and Cooperation in Europe and was awarded numerous orders and medals. Mr. Apanasenko suffered from end-stage pancreatic cancer. He courageously endured his pain. In the morning, the Admiral was examined at home by a General Practitioner (GP) from the local polyclinic. The Admiral’s wife went to the polyclinic at 14:00, where she received a resolution from an Oncologist that allowed the GP to prescribe morphine. After that, the Admiral’s wife approached the Senior Nurse, who needed to go to the Chief Nurse to obtain one “pink” prescription form for opioids and to give it to the GP, who would fill out the prescription forms (one “pink” and two special white forms). The Senior Nurse had some questions concerning the dosage of morphine and Admiral’s wife needed to go back to an Oncologist and then to the Head of the Department. After three hours of torment, the Admiral’s wife went up to the 7th floor to the Medical Director of the polyclinic for her signature and for the official stamp, but the Medical Director was not in her office. Meanwhile, the polyclinic had closed and any hope to receive the needed morphine was lost. Olga Golodets, Deputy Prime Minister, gave one week to the Russian Ministry of Health to verify the reasons for refusing painkillers to Admiral Vyacheslav Apanasenko. In turn, Veronika Skvortsova, the Minister of Health, requested Roszdravnadzor to check how medical treatment was provided to the Admiral. However, doctors from the polyclinics say that they acted according to the official instructions. Unfortunately, Admiral Vyacheslav Apanasenko met physicians who followed the bureaucratic regulations and instructions, because they did not want to be investigated by the Federal Service for Drug Control.
A Russian Tragedy
Admiral Apanasenko In Moscow, on Friday, February 7, 2014, Admiral Vyacheslav Apanasenko shot himself with a pistol. The Admiral left a suicide note that clearly indicated his reasons, “I do not want to blame anyone but the Ministry of Health and the Government. I am ready to suffer, but seeing suffering of my relatives is unbearable”. The Admiral was 66 years old and a brave and an extraordinary man. The Admiral served on nuclear submarines of the Northern Fleet. As an expert of the Soviet Union, he participated in negotiations limiting the number of strategic offensive arms. He initiated and was one of the authors of comprehensive programs to re-
.
178
Letter to the Editor
179
prosecution, illegally prescribed tramadol to Victor Sechin, a terminally-ill cancer patient. The prosecutor’s office still insists on the indictment. The importance of this Court cannot be overstated, because Dr. Khorinyak’s story is typical. Every day and throughout all of Russia, doctors are under threat of criminal prosecution and need to decide whether to follow bureaucratic rules or medical ethics and duty, mercy, and compassion. All of us who work in palliative care and pain relief need to keep working and advocating for measures to ensure that patients in need have access to appropriate treatment and care in Russia.
Dr. Khorinyak At the same time, another case appeared in Court in Krasnoyarsk for the second trial against Dr. Alevtina Khorinyak, who, according to the state
C
2014 Informa Healthcare USA, Inc.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. Olga Usenko MD, MPH Eastern and Central Europe Palliative Care Task Force E-mail: [email protected]
Copyright of Journal of Pain & Palliative Care Pharmacotherapy is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
