HOW TO MAKE THE CASE OF DOCTORS OF THE INSTITUTE OF CANCER

The last two years, the most authoritative medical oncology clinic in Ukraine, have been rocked by high-profile scandals. Despite corruption allegations and evidence of embezzlement, none of the doctors and executives have been punished.

Back in early 2019, law enforcement officers received a report of criminal offenses at the National Cancer Institute. In a statement, the patient complained that the clinic systematically demanded money for medicines, which should be provided free of charge.

The case became unusual for law enforcement officers. After all, statements from patients or their relatives - about extortion by doctors - are an incredible rarity in Ukraine. People are afraid to report the illegal actions of doctors - they say, then patients will not be treated at all.

Therefore, on February 1, 2019, criminal proceedings were registered. Konstantin Khoriy, a senior investigator with the Investigative Department of the Main Directorate of the National Police in Kyiv, has begun investigating medical schemes.

IN THE BEGINNING, EVEN THE SIGHT WAS EVEN THE CHIEF DOCTOR

According to an extract from the Unified Register of Pre-Trial Investigations, during 2018-2019, officials of the National Cancer Institute, namely: Chief Physician Andriy Beznosenko, Deputy Chief Physician Oleh Voskoboynikov, Head of the Institute's Polyclinic Department Arkady Vysotsky, Oncologist Oleksandr Shechstra, Senior Medical Officer and a nurse allegedly conspired with a group of individuals to obtain money from cancer patients, demanding money from them for prescribing and receiving medications that were actually intended for free treatment of patients.

Investigating the case, the investigation identified four more victims (patients) who gave evidence and testimony regarding the payment of funds and the purchase of medicines.

Accordingly, the police launched search operations. In particular, hidden video recordings in the office of the head of the outpatient department and other premises of the National Cancer Institute.

By the decision of the Deputy Head of the SU GUNP in Kyiv E. Solovyov, on July 31, 2019, investigator Konstantin Khori was given a number of assistants - an investigative group was created.

On August 1, Mykola Shkiray, the investigating judge of the Holosiivskyi District Court of Kyiv, issued a ruling allowing searches of the premises of the National Cancer Institute and the outpatient department of the National Cancer Institute.

AND HERE THE CASE STARTED TO DROWN

It is not known what went wrong - whether there was a "leak" of information, or the case was banally "sold" - but after a search in mid-August 2019 in a medical institution, the suspicion was announced only two people, out of five - in respect of which investigation.

Therefore, the chief physician Andriy Beznosenko, his deputy for medical work Oleh Voskoboynikov, and a senior nurse came out from the attack.

Then - more.

The investigation changes the classification of criminal offenses. In the article - with a milder punishment. Thus, in the beginning it was about Part 3 of Art. 368 of the Criminal Code of Ukraine - and there was a prospect of five to ten years behind bars. But the most important thing is the confiscation of property.

And now, the head of the outpatient department of the National Cancer Institute and an oncologist have been suspected of committing crimes under Art. 184 of the Criminal Code of Ukraine. And this is an illegal requirement to pay for medical care in state or municipal health care facilities. That is - violation of the right to free medical care.

With punishment - a fine. Or at most - arrest for up to six months.

Another incriminated crime - part 2 and part 3 of Art. 191 of the Criminal Code of Ukraine - misappropriation, misappropriation of property or taking it by abuse of office, committed repeatedly.

The sentence is from three to eight years. But - according to these articles of the Criminal Code of Ukraine - confiscation of property to employees of the National Cancer Institute - no longer threatens.

Of course, any real term of imprisonment for doctors is dangerous. However, it should be noted that with the "new" alleged crimes, in which doctors were suspected, doctors have a much better chance of receiving suspended sentences.

Although, according to the author, this is an extremely dubious and fantastic moment, given that both the police investigation and the prosecutor's office are drowning and openly merging this case.

After all, after the key leaders of the National Cancer Institute came out from under attack, heavy artillery was reclassified to less lenient, with no confiscation of property.

On September 19, 2019, the investigating judge of the Holosiivskyi District Court of Kyiv, Mykola Shkiray, is considering two motions of the senior investigator of the Investigative Department of the Main Directorate of the National Police in Kyiv, Konstantin Khoriy. The petitions were approved by the prosecutor of the Kyiv City Prosecutor's Office, Ihor Halyuk.

It concerns the removal of the suspects from the position of head of the outpatient department of the National Cancer Institute and an oncologist.

And the judge refuses, leaving the doctors at work.

The judge refuses, because there is simply no way out - because the petitions are made in such a way that in principle there are no legal grounds to satisfy them. Mistake - a mistake, a gross violation of the law.

In a word - "first grade, second quarter".

It is difficult to even assume that the prosecutor, the investigator, and their management are so unprofessional and inexperienced. Rather - it seems the opposite - probably their knowledge was enough to make a petition to ensure that doctors stay at work.

Thus, the investigating judge came to the conclusion that the petition was filed without complying with the requirements of Art. 155 of the Criminal Procedure Code of Ukraine.

According to this article, the petition indicates the legal qualification of the criminal offense with the indication of the article (part of the article) of the Law of Ukraine on Criminal Liability.

However, neither the investigator nor the prosecutor "notices" this requirement, and the legal qualification of the criminal offense, which is suspected of being committed by two employees of the National Cancer Institute, is not indicated in the petition.

Next.

According to item 3 h.2 Art. 155 of the CPC of Ukraine in the petition the statement of the circumstances giving the grounds to suspect the person of commission of a criminal offense, and the reference to circumstances is noted. However, the petitions do not refer to these circumstances.

And finally.

In accordance with paragraph 6 of Part 2 of Art. 155 of the CPC of Ukraine, the petition states the circumstances that give grounds to believe that the suspect, accused, while in office, will destroy or forge things and documents that are essential for the pre-trial investigation, will illegally influence witnesses and other participants in criminal proceedings or unlawfully will otherwise impede criminal proceedings.

The investigating judge concluded that the formal reference in the petition to the existence of sufficient grounds to believe that the cessation and prevention of further illegal conduct of suspected employees of the Cancer Institute to prevent criminal proceedings is impossible without disqualification is not a proper fulfillment of these requirements of the law.

So - because of a number of mistakes made by the investigator and not noticed by the prosecutor - and the head. departments, and the oncologist - remained in office.

Although, both the prosecutor's office and the police brazenly trumpeted that the two suspects had been taken into custody.

But law enforcement officers somehow gently bypassed the spicy detail - doctors actually immediately posted bail - about 161 thousand hryvnias for each.

That is, the court chose a precautionary measure - taking under vartu. However - with the right to make a deposit.

THE CASE CONTINUED TO DROWN

Meanwhile, in the public sphere, law enforcement officers reported on the detention of suspects, the prosecutor in the case - the prosecutor of the Kyiv City Prosecutor's Office I. Halyuk - filed an appeal against the court's decision to detain the suspects. He asks the panel of judges of the Kyiv Court of Appeal to change the precautionary measure!

The prosecutor probably thought to himself that the judge's decision was too strict to send doctors to a pre-trial detention center. And asks the court to choose a precautionary measure - bail.

Surprisingly, some time before, the same prosecutor approved the investigator's request for a measure of restraint - detention. And in a few days he radically changed his point of view.

The appeal was stuck in court for several months, in mid-April 2020, the prosecutor refused it altogether. Thus, the employees of the National Cancer Institute, who, according to the investigation, received money from patients for medicines that should have been provided free of charge, calmly continue to walk free and go to work.

WHY IS IT IMPORTANT?

The explanation can be read in the petitions of the investigator to the court. Thus, the police officer points out that “the risk of illegally influencing witnesses or other suspects in criminal proceedings is due to the fact that most of the persons who may be witnesses and related to the outpatient department of the National Cancer Institute are acquainted with Arkady Vysotsky in connection with professional activities. . Therefore, the suspect may resort to illegal influence on them in order to avoid criminal liability. "

But, it didn't work out ...

Meanwhile, as reported by the Kyiv City Prosecutor's Office, the pre-trial investigation was completed in the winter.

The indictment on criminal proceedings was transferred to the Holosiivskyi District Court of Kyiv on January 29, 2020.

But it is difficult to imagine that from the evidence base, after all the above, came to the judge.

WHO ARE THE PARTICIPANTS. VYSOTSKY

Head of the outpatient department of the National Cancer Institute - Arkady Vysotsky. PhD in Medicine. Professor. Author of 255 publications.

On the website of the private medical center "Onco Consulting Center" is listed as an expert consultant.

Interestingly, the address of registration and location of this private structure - the same as the National Cancer Institute - st. Lomonosova 33/43.

Russian. Born in St. Petersburg, married. He studied in Donetsk. He worked at the Donetsk State Medical Institute. M. Gorky - Professor of Surgery. He also worked as a thoracic surgeon at the Donetsk City Hospital. Kalinin. Mentioned as a lecturer at the National Medical University. O. Bogomolets. He has been working at the National Cancer Institute since October 2016. He regularly participates in international conferences.

And this is interesting - does he also give such instructions to his colleagues abroad as to Ukrainian doctors? After all, in the video released by law enforcement officers, hidden video surveillance cameras recorded interesting master classes. Brilliant trainings.

What can be "christened" - "how to properly extort money from patients."

A person like Arkady Vysotsky instructs other doctors on how to consult with patients and their relatives to get them to pay for the drugs they should receive for free.

In a video released by the Kyiv City Prosecutor's Office, Vysotsky probably gave instructions on how to properly communicate with patients to force them to pay money.

Q. - What about yesterday? How much at the box office? -

Doctor - Several people. Three or four. -

Q. - And the others? -

Doctor - Well, there were repeated. Someone said I had already paid. Someone, I can't, someone else something. -

Q. - Well, okay, Shepel will come, we'll find out. -

Well, you understand, right? Just like that, to chase the sick in solitude, so that they don't even help the institute? Although we are a hospital, but not quite a charity ...

And so, you ask for charity at the box office, that's for the Institute, yes ... and a check. You can speak more harshly in general.

Be a little artist too. We prescribed you medicines for 10 thousand, help the state a little.

Doctor - They start talking about the president. -

Q. - Let them tell about the president. Well, Zelensky will come, complain to him, please. (hear laughter). The people are as bad as a traffic jam. Until you do nothing yourself, no one will find anything.

Well, a patient comes to us ... We do him a lot of good, it's a big deal, right?

And he has at least some small business for us, but he has to help as well.

To help the institute or to help the doctor, to help the nurse, and to help there.

And that, medicines today can be free, and tomorrow it is necessary to buy.

We do not have a sanatorium. We do chemotherapy. We can go to a meeting, but you will help a little 200 hryvnias bring in cash desk. You understand, yes?

So guys, look, every patient should bring some benefit.

Try to ask the question like that, carefully, yes. -

...

The video shows an oncologist transferring money.

Further on in the video, law enforcement officers note that "the oncologist approached the manager's desk and handed him the money."

The person who transferred the funds is similar to Oleksandr Shepel.

V. - You know how, you always have to bring people to the golden mean ... That's what he has 50 thousand. -

Sh. - 130 thousand One infusion in each clinic. -

...

The accompanying text is shown below in the video.

Law enforcement officers point out: "The manager explains to the oncologist how to communicate with patients, offer different drugs, but that the patient chooses a free one and at the same time pays a monetary gratitude for it."

V. - This is our position ... The first is a good drug, immunotherapy ... The effect is good, let's say, well, again. You must understand that this is not a panacea. Our usual scheme - well, let's say we can provide. There is in general the optimum, I consider, for you preparation. Its cost is 3 thousand ...

Oh well, so cheap, free, we do not want, although ... 130 thousand, it's chemistry ... Well, come on!

Yes, well, so I'm spending that..that..that ... here, please.

No, I won't, I'll be that..that..that ..

You get 3,000 cycles much cheaper, you know, right?

The next cycle, we will provide you with drugs in general, then, then, then, look.

Oh, that's what I want ...

The patient was informed, he chose there ... such, or received information there, he chose such ...

Insisted on carrying out such a scheme, that's all.

Sign then what you and I have chosen ... Then they tell you what you have there ??

"And sho, where?" Everything, no prosecutor's office for you, no ones there. Informed? Informed, is there a signature ?? There is a record. ---

...

So from the video recordings we can conclude that the person looks like Arkady Vysotsky, in fact openly mocks the President of Ukraine Volodymyr Zelensky. Moreover, she is so fearless that the prosecutors are on her shoulders.

The anti-corruption commissioner at the Cancer Institute told reporters that the manager allegedly received his share of the money every week. "It is 20 thousand hryvnias," Ponomarenko said. He also said that in fact there are many more victims, but patients do not want to testify. "Patients say they can pay, but I will not testify. I need to take two more courses of chemotherapy," Serhiy Ponomarenko told reporters.

THE SECOND ATTENDANT IS ALEXANDER SHEPEL

Oncologist. Chief physician of the outpatient chemotherapy office. He was born in Luhansk. He worked at the Luhansk Regional Clinical Oncology Dispensary - head of the chemotherapy department. Listed on the website of the private MC "Mediland" - as a consultant in the clinic.

He also travels to Barcelona for international conferences, or Amsterdam, for example.

Today - works in a private oncology center "Good prognosis".

WHY LAW ENFORCEMENT AGAINST SUSPECTED

Organized by Arkady Vysotsky and executed by Oleksandr Shepel, an illegal demand for payment for medical care in state health care institutions and in the seizure of someone else's property by an official abusing his official position was committed repeatedly.

What is the reason for the suspicion?

According to Art. 49 of the Constitution of Ukraine, everyone has the right to health care, medical assistance. In state and municipal health care facilities, medical care is provided free of charge.

Article 8 of the Law of Ukraine “On the Fundamentals of the Legislation of Ukraine on Health Care” stipulates that the state guarantees the citizens of Ukraine and other persons designated by law the provision of necessary medical services and medicines at the expense of the State Budget of Ukraine.

Oncological diseases are included in the List of categories of diseases in case of outpatient treatment of which medicines are dispensed free of charge, approved by the Resolution of the Cabinet of Ministers of Ukraine 301303 of August 17, 1998 "On streamlining free and preferential dispensing of prescription drugs and for certain categories of diseases. "

According to the investigation, during 2018-2019, acting jointly and on the instructions of the head of the polyclinic department of the institute Arkady Vysotsky, doctors developed and organized an illegal scheme aimed at violating patients' rights to receive free medical care in the polyclinic department by receiving money from patients for appointment and use of medicines that are actually purchased from the budget and are intended for free treatment of cancer patients.

The investigator points out that Arkady Vysotsky, performing administrative and economic and organizational-administrative functions, being an official and abusing his official position, by prior agreement with his subordinate oncologist Oleksandr Shepel, acting in accordance with the developed plan, created conditions under which patients were admitted. misled as to the lack of the necessary amount of drugs for the course of chemotherapy with appropriate drugs, and seized the money of patients allegedly for providing the necessary drugs: money for a total of UAH 12,000; acting repeatedly - UAH 18,000; 2000 UAH; 6000 hryvnias; 1500 грн.

The materials of the pre-trial investigation contain the testimony of five victims regarding the circumstances of treatment and the conditions for receiving medication for chemotherapy.

...

On September 30, 2020, the Holosiivskyi District Court of Kyiv finally held a preparatory hearing.

According to the court, Arkady Vysotsky continues to work at the National Cancer Institute as a doctor-surgeon-oncologist.

Instead, Oleksandr Shepel is an oncologist at the Good Prognosis private clinic.

It seems that the defense of the accused does not particularly strive for openness and publicity. After all, defense counsel V. Rybin applied to the court with a request to hold a closed court session. Substantiating the petition, he noted that the materials of the criminal proceedings contain medical secrecy, and therefore, taking into account the requirements of Art. 27 of the CPC of Ukraine, the trial should be conducted behind closed doors.

However, Judge M. Didyk refused.

...

Militiamen note that A. Vysotsky organized and together with the oncologist of the polyclinic department of the institute Oleksandr Shepel created conditions under which patients were not able to use the right to free medical care provided by the Constitution of Ukraine. He later organized an illegal scheme aimed at violating the rights of patients to receive free medical care in the polyclinic department of the institute by obtaining money from patients for the appointment and use of drugs that are actually purchased from the budget and intended for free treatment of cancer patients.

In particular, the investigation established that one of the suspects allegedly received UAH 12,000 for providing the drugs docetaxil and cisplatin;

According to the investigation, another patient, Oleksandr Shepel, on the direct instructions of Arkady Vysotsky, misled, saying that it was necessary to buy drugs "oxaliplatin" and "cacitabine" - in the pharmacy, in the amount of 18 thousand hryvnias.

Meanwhile, the decision of the council decided to issue these drugs from the Institute.

The investigator also points out that another patient was forced to pay a charitable contribution for providing docetaxel and carboplatin.

"Oxaliplatin" and "capecitabine" - for 6 thousand hryvnias were bought by the next patient. Although, similarly to the decision of the council, it was decided to issue these drugs from the Institute.

Another patient was sent to the pharmacy for paclitaxel and cisplatin. And here, too, was the decision of the council.

“Doctors assured patients that the number of free drugs was limited. To get them, demanded in and under the guise of charitable assistance, - told reporters gazeta.ua, Nadiya Maksymets from the capital's prosecutor's office. - The same was demanded from suppliers of drugs. The state pays from 1.5 to 18 thousand hryvnias for one course of chemotherapy. In order for a particular producer to receive this money, he had to return 15-20 percent of the total value of the transactions by rollback.

MUTUAL WARS OF THE LEADERSHIP OF THE INSTITUTE OF CANCER

In August 2019, when searches were conducted at the head of Arkady Vysotsky - in the outpatient department of the National Cancer Institute - at the same time searches took place at the place of work of Chief Physician Andriy Beznosenko.

Later, the latter wrote on the social network Facebook that the search "was ordered."

Be that as it may, Chief Physician Andriy Beznosenko was removed from office.

The relevant order number 123, "On the establishment of a commission to conduct an official investigation into the involvement of officials and officials of the Institute in the illegal receipt of illegal benefits", was signed on 19.08.2019 - a few days after the searches.

On September 4, 2019, a meeting of the Commission to conduct an official investigation into the involvement of officials and officials of the Institute in the illegal receipt of illegal benefits created by the order took place. Based on the results of the meeting, the Commission decided, in particular, to consider the issue of removal from office of the chief physician of the institute DP Beznosenko. and other employees of the Institute for the period of the official investigation by the Commission.

Andriy Beznosenko appealed to the District Administrative Court of Kyiv - with a claim to the National Cancer Institute - to declare illegal and cancel the order of 19.08.2019 №123.

And the scandal was gaining momentum. On September 12, the National Cancer Institute canceled the results of a tender for the purchase of medical equipment worth about UAH 32 million, which was won by a medical company.

In a few days, on September 20, the Ministry of Health of Ukraine issues an order № 100-Adm, to conduct an unscheduled internal audit of the National Cancer Institute. It is carried out by the Internal Audit Department of the Ministry of Health of Ukraine under the leadership of the then Minister - Zoryana Skaletska.

The period is from January 1 to September 20, 2019. The audit revealed numerous violations.

Thus, in particular, unreasonably large residues of the drug Methotrexate Teva (adult oncology), more than 4 thousand packages, but the average annual use is about 800 vials.

In addition, the auditors found that expensive equipment is not used to treat patients, but is in stock. In particular, the Varian Clinac iX linear medical accelerator purchased in 2011 was not put into operation. A total of 7 units of medical equipment are not used.

And finally - the lack of computer equipment in the warehouse in the amount of 149 units for a total of about 700 thousand hryvnias.

Director of the National Cancer Institute Olena Kolesnyk accuses A. Beznosenko.

Instead, the chief physician insists that the director is to blame for the violations and abuses.

FOR REFERENCE

The director of the National Cancer Institute is responsible for the institution's administrative decisions and staffing issues. Instead, the chief physician is solely treating patients.

...

The struggle is developing in the public sphere. Part of the media is on the side of the chief physician. Another is actually supporting the director, spreading "incriminating" investigations into Beznosenko's activities. In response, the chief physician filed a number of lawsuits - for the protection of honor and dignity. As of today, one of the cases is being heard in court. In addition to journalists, Serhiy Ponomarenko, the Commissioner for Anti-Corruption at the National Cancer Institute, is also a co-defendant. In the media, he spoke sharply and critically about the activities of the chief physician. Of course, Andriy Beznosenko did not like that.

...

Meanwhile, from November 8, 2019, the Ministry of Health of Ukraine will remove the director of the National Cancer Institute Olena Kolesnyk.

On December 18, 2019, the Acting Director of the National Cancer Institute issued Order № 223 “On conducting an official investigation”. Pursuant to Clause 4 of Order № 223, A. Beznosenko, Chief Physician of the National Cancer Institute, O. Voskoboynikov, Deputy Chief Physician of the Medical Department and Head of the Oncogynecology Department were suspended from their positions (with salary retention) for the duration of the official investigation.

Again, in January 2020, Andriy Beznosenko, represented by his representative, filed a lawsuit with the Holosiivskyi District Court of Kyiv against the National Cancer Institute, requesting that the №223 order of the National Cancer Institute "On conducting an official investigation" be declared illegal and revoked.

ATTACKS

The culmination of the confrontation is two attacks in the spring of 2020. First, two men beat Andriy Beznosenko, the chief physician of the National Cancer Institute. He insisted that the attack was linked to the current conflict at the Institute.

On May 25, Anatoliy Shudrak, a doctor at the National Cancer Institute, was attacked in Kyiv.

Andriy Beznosenko reports that the commission, which includes Shudrak, previously recorded a shortage of material values ​​at the Institute by almost 9 million hryvnias.

The heat of "passion" decreased when the contract of the director of the National Cancer Institute Olena Kolesnyk expired in the middle of spring.

NEW CORRUPTION CASE

And while the internal strife continued, law enforcement officers gathered a lot of interesting information. In particular, criminal proceedings were registered for the theft of funds allocated to the Cancer Institute. The pre-trial investigation is conducted by the State Bureau of Investigation.

From the court materials and petitions of the investigator it is seen that the officials of the Ministry of Health of Ukraine, acting by prior agreement with officials of the State Enterprise "DBC MOH of Ukraine", officials of LLC "DBK Project Engineering" and other unidentified persons, appropriated budget funds. large-scale, by abusing their official position, which are allocated by the Government for the implementation of the state investment project "Reconstruction and expansion of the National Cancer Institute."

There are two sums in court rulings - 27,521,866 hryvnias and 1,483,571 hryvnias.

POSITION OF THE PARTIES

As mentioned above, after searches at the National Cancer Institute, Andriy Beznosenko stated that the search was ordered.

Therefore, in order to provide objective information, we asked for comments not only from the accused in the criminal proceedings, Arkady Vysotsky and Oleksandr Shepel, but also to the chief physician of the National Cancer Institute, Andriy Beznosenko.

As of the date of publication, neither Oleksandr Shepel nor Arkady Vysotsky provided answers to the questions.

If, after the publication of this material, they express a desire to present their point of view, the editors undertake to publish it in full.

Instead, Andriy Beznosenko, the chief physician of the National Cancer Institute, provided the answer.

However, whether this can be considered an answer to the questions is questionable.

Andriy Beznosenko said that the answers to the most socially significant questions can be read in the publication of another publication.

We provide Mr. Beznosenko's answer in full.

15.12.2020

This material was prepared and funded by The European School of Oncology (Milan, Italy) - https://www.eso.net/