Causal Complex of Medical Crimes in the Republic of Tajikistan

Rano A. Abdullayeva

Russian-Tajik (Slavonic) University, Dushanbe, Tajikistan

Keywords: determinants, health service, criminalizations, corruption, health worker, patient, causes of crime

Abstract

The article considers the causal complex of crimes, committed in the field of medical service. Currently, the

relevance of the issue of the responsibility of a health worker in the implementation of their professional

activity is increasing. This is due to the growth in number of claims and cases against them. In the existing

public health system, those defects that are detected during inspections are considered not as a system

weakness in the delivery of health care, but, unfortunately, as only a personal failure of any health worker or

a medical product, therefore, the usual method is still used to eliminate them - blame and punishment of this

health worker. Patient safety should be a key indicator of the quality of the entire public health system. In

Tajikistan, these issues require attention from sociologists, political scientists, criminologists, lawyers, as well

as physicians themselves. The modern legislation of the Republic of Tajikistan on health service requires

careful analysis and adjustment, to introduce changes, additions and the adoption of new regulations in the

public health system of the republic. The purpose of the work is to consider social relations, developing in the

field of public health service. An object. The object is the determinants (reasons and conditions), that have

served to commit offenses in the field of public health service. The subject is the legal framework in the field

of medical service. The author in his work relies on the fundamental provisions of criminal law, criminology,

medical law, medicine and pharmacy. The work is based on an comprehensive approach, all branches of the

health service sector are studied. The methodological basis consists of a systemic, comparative legal, formal

legal, logical and analytical method. Conclusions. Results. The author comes to the conclusion, that most of

the crimes committed in the field of public health service are committed, firstly, due to the lack of

professionalism, competence of health workers, and secondly, this is a reflection of low legal culture and the

spread of nihilism. The author concludes that a) it is necessary to systematize the legal regulations, controlling

public relations in the field of public health service, b) to carry out research and practice activities in medical

institutions and other relevant medical organizations as much as possible in order to improve the qualifications

of health workers.

1 INTRODUCTION

The sphere of medical services for the population is

understood as: "The field of public health service

(PHS) is a part of public service sector (PSS), its

subsystem, the functional purpose of which is to

provide the population with consumer (medical)

services through direct medical service" (Rustemov,

p. 68 , 2003). We fully support this definition.

Everyone has the right to a standard of living,

sufficient for health and medical service (Edward,

2009).

The subject "Law and Health" is widely taught (in

schools of law, medicine, public health service and

https://orcid.org/0000-0002-6389-8220

public health administration), practiced by “health

legislators” and analyzed by experts in various fields

of health service law, bioethics and health service

policy (Gostin, 2008).

The overall low detection of corruption-related

crimes is explained by the poor professional training

of employees of the Ministry of Internal Affairs.

Representatives of law enforcement agencies

(investigator, procurator, judge, etc.) should be

professionals, highly qualified personnel.

Crimes in the health service sector are generally

quite specific and have a number of features. Health

service is a strategic field of activity of the state and,

accordingly, the state should create conditions for its

development.

Abdullayeva, R.

Causal Complex of Medical Crimes in the Republic of Tajikistan.

DOI: 10.5220/0010661900003224

In Proceedings of the 1st International Scientiﬁc Forum on Jurisprudence (WFLAW 2021), pages 59-65

ISBN: 978-989-758-598-2

Moving to the determinants of medical crimes in

Tajikistan, we note, that there are both common

reasons and special ones in the field of public health

service.

As the notable criminologist of the CIS and

Europe, Professor D.A. Shestakov, “the criminal

manifestations of medical treatment should also

include:

1) widespread, but so far not specifically

criminalized, the imposition of unnecessary

therapeutic actions: surgical interventions, various

medical procedures, etc.;

2) treatment, certainly ensuring the resumption of

the disease after remission with the expectation, that

the doctor will receive additional income from

repeated treatment, etc.”. In addition, the rudeness of

the new medicine has something similar to the

behavior of the former Soviet sellers. Now the doctors

pass all bounds, feeling their "power", people depend

on them. In addition, they have not rightfully

deserved money (Shestakov, 2016).

2 METHODS

The studied issue of criminal law, criminological is

complex, interdisciplinary, in its development we

relied on the fundamental provisions of criminal law,

criminology, medical law, medicine and pharmacy.

In the course of work, general scientific and

special methods were also used: statistical, systemic,

comparative research, as well as specific sociological

methods: document analysis, observation.

The reliability and validity of the conclusions,

made in the research, are ensured by: the use of a

significant number of legislative, monographic,

periodical, Internet sources of legal, sociological,

psychological and criminological nature, prevention

programs and the State program "Salamatty

Kazakhstan".

3 RESULTS

It should be noted, that on average in Republic of

Tajikistan, every 1/3% of the offender committed a

crime while being in a state of alcoholic intoxication,

every 8.2% - in a group. Most of all identified

persons, who committed crimes, were unemployed

82.1%. Every 4th murder, every 29th infliction of

grievous bodily harm are committed in a state of

alcoholic or drug intoxication (Statistical data of the

MIAC of Ministry of Internal Affairs, 2020).

In the existing public health system, those defects,

that are detected during inspections, are considered

not as a system weakness in the delivery of health

care, but as, unfortunately, only a personal failure of

any health worker or a medical product, therefore, the

usual method is still used to eliminate them - blame

and punishment of this health worker. The state is

carrying out various reforms in health service, trying

to adopt the rich experience of other developed

countries. Patient safety should be a key indicator of

the quality of the entire public health system. Today,

medical care has moved into the category of medical

services, which means, that the doctor has become a

service provider.

The practice of the so-called "paid (commercial)

medicine" led, in particular, to the formation of a

rather peculiar moral and psychological "doctor -

patient" relations, while patients formally did not

have the right and opportunity to materially influence

the quality of medical service.

Illegal ways of encouraging the work of health

workers began to spread, which ultimately led to the

moral decay of a separate part of the medical staff.

This can be avoided by introducing a flexible system

of remuneration of health workers, depending on their

qualification and the volume of medical service. Low

material interest of health workers leads to a decrease

in the level of medical service, and as a result, a lag

in the introduction of new medical technologies.

Many of the skilled health workers quit medicine

entirely or moved abroad.

The growth of poorly protected population

segments (single pensioners, disabled people, persons

without a permanent place of residence, refugees,

internally displaced persons, other visitors, who have

temporarily lost social bonds, etc.) leads to the fact,

that their disappearance remains completely

unnoticed, or is detected too late for effective search

measures to be taken. The murder of such a person

with the subsequent hiding of the corpse allows the

criminal to shirk responsibility for a long time.

Very capacious and the most complete

articulation of the situation in modern health service!

Most of the crimes committed by health workers have

remained in high latency, because the victims did not

file a report with the law enforcement agencies. They

themselves were the "instigators" of such crimes as

illegal abortion, HIV infection, illegal medical

treatment. In addition, the still low legal culture of the

population and legal nihilism contribute to the

commission of most crimes in the field of the

Ministry of Education and Science.

Preventing crimes from registration by law

enforcement agencies was widespread in the former

WFLAW 2021 - INTERNATIONAL SCIENTIFIC FORUM ON JURISPRUDENCE

USSR. This phenomenon did not sidestep our country

either. However, doctors, in the process of

anonymous interviews, showed, that now the victims

- patients or their relatives - report to law enforcement

agencies as a result of, from their point of view,

insufficient explanations about the reasons for death,

serious consequences of illness, injuries, etc. Claims

for repair of material damage are increasing from year

to year.

As it was rightly noted, the concept of “crime

fighting” should have an appropriate meaning and

take it correctly, since it is impossible to immediately

and completely abandon this term, which is

confirmed in a number of legislative acts (Boskholov,

p. 39, 2005).

Low wages, frequent late payment of it, poor

quality and inadequate provision of hospitals with

medicines, inventory, instruments and modern

medical multidiscipline equipment can push doctors,

especially beginners, to commit acquisitive crimes.

This explains the increased staff turnover, in addition

to staff reductions (annually, quarterly). So, for

example, the monthly average nominal accrued

wages of employees by type of economic activity as

of November 2019 in health service and social

services amounted to 910.09 somoni, or 80 USD, and

increased compared to the same period in 2018 by

only 3%. Wage arrears decreased by 0.7%, but in the

service sector it increased by 5.9% (Socio-economic

situation of the Republic of Tajikistan, p. 9, 2019). As

a result, skilled personnel quit or emigrate, creating

and exacerbating a serious problem of shortage of

human resources and further undermining the

country's public health system.

4 DISCUSSION

In recent years, we have seen the number of wrongful

acts among health workers. Among them are such

crimes as causing various harm to health, theft,

violation of the established rules for dealing with

drugs, psychotropic, poisonous substances, negligent

homicide, misuse of budgetary funds, allocated for

medical needs, forgeries and appropriation of drugs,

prescribed for fictitious patients, fraud and etc..

In addition, the reasons for crimes in the field of

public health service are the lack of legal support

when establishing appropriate prohibitions or

permits, the low legal culture of the health workers

themselves. The country does not publish or replicate

the Laws and Codes of the Republic of Tajikistan for

a wide range of readers by typographic method.

Health workers - officials get to know them on the

Internet, there are no stitched texts. Ordinary medical

and pharmaceutical workers have no time to watch

the Internet, they are busy with medical activities,

prevention of diseases after treatment, etc.

Private traders could publish them and

successfully sell them. The population, like the

doctors themselves, are often in the dark of changes

and amendments to the legislation as a whole. In

general, the medical factor complex of crime in the

country continues to be a crisis of the physical and

mental health of the population: it is the lack of

quality medical service for the majority of the

population; availability of life-threatening medicines;

as well as such social phenomena as drug addiction,

prostitution, vagrancy, begging, less often alcoholism

and parasitism.

It is necessary to highlight the conditions

conducive to the commission of crimes in the field

of public health service. These, first of all, include

those mistakes, that were made during carrying out

reforms in the health service sector. The transition

from health insurance to the current system of “family

doctors” did not produce positive results, large funds

were invested, and insurance payments were not used

for their intended purpose. This is still observed.

Incorrect privatization of medical institutions, which

takes place almost everywhere, did not produce the

expected results. This is still facilitated by the

imperfection of the tax system. The conditions,

contributing to the commission of crimes, are

understood as facts of reality, that do not directly

cause the crime itself, but their presence in many

cases contributes to the emergence of a person's

intention to commit a crime. These facts relate to

various specific manifestations of crime and are

rooted in various fields of social relations. Conditions

are much easier to identify, than to identify and

uncover the reasons for criminality and crime.

One of the conditions, contributing to the

commission of medical crimes in the Republic of

Tajikistan, is widespread HIV / AIDS. The most

subject to this are women aged 30-39 years and men

of the same age. As the doctors themselves note,

“despite the relatively low corresponding indicator of

HIV / AIDS in the republic, it constitutes a medical

and social danger. The number of HIV transmissions

from HIV-infected mother to child is increasing,

which indicates the HIV / AIDS epidemic in

Tajikistan” (Rafiev, Azizov, Rafieva, Abdullaev,

2018).

"Radio Ozodi" noted, that “World AIDS Day is

celebrated this year at a time, when the world is faced

with another, no less severe virus. The number of

people, diagnosed with HIV / AIDS, in Tajikistan is

Causal Complex of Medical Crimes in the Republic of Tajikistan

12876 people, for 9 months of this year, 890 people

were registered with a positive result for HIV

infection. In 2019, 67 people died from this disease in

the Republic of Tajikistan, which is 10 cases more

than last year.

According to the updated data of the Ministry of

Health of Tajikistan, during the pandemic, 22 patients

with HIV / AIDS were infected with coronavirus, one

of them died. As of November 30, 2020, the total

number of people, infected with coronavirus in

Tajikistan, reached 12194 people, 86 people died

since the beginning of the pandemic. The head of the

Joint United Nations Program on HIV / AIDS

(UNAIDS) Vinnie Byanyima believes, that the lack

of investment and measures to combat HIV and other

pandemics made the world vulnerable to Covid-19.

“Covid-19 showed, that investing in health not only

saves lives, but also creates the basis for a strong

economy. HIV health service programs should be

fully funded in both economic boom and crisis

times”. Ms Byanyima also noted that the world needs

to learn on mistakes of the HIV response, when

millions of people in developing countries died while

waiting for treatment. Unfortunately, at the end of

2019, there were 38 million people living with HIV

in the world. In total, more than 33 million people

have become victims of HIV in the world. In

Tajikistan, from 1991 to October 1, 2020, 12,876

patients were registered, men - 8228, women - 4648,

children under 18 years old - 1070. Most of the

infected are in Dushanbe, the districts of republican

subordination and the Sughd region (World AIDS

Day: in Tajikistan, a HIV patient died of coronavirus,

2020).

However, so far, unfortunately, there has been no

tightening to ensure patient safety. Safety issues are

either not considered at all, or are resolved at the

lowest level. "The main threats, posing a danger to

medical inpatient institutions and affecting the safety

of medical care:

a) appropriation of medicines, equipment and

other property, as well as personal belongings of

patients and staff;

b) illegal entry of interlopers into the wards and

rooms of medical institutions;

c) technogenic accidents (fires and other

emergencies and damage to engineering electrical,

heating, sewerage, water supply, ventilation

networks);

d) violation of the safety and functioning

procedures;

e) antisocial actions and actions of personnel,

visitors, patients and their caretakers in the rooms and

in the adjacent territory;

f) disclosure of personal data by medical

personnel and violation of medical secrecy”

(Krasilnikov, Aidarov, 2017).

The crisis associated with the Covid-19 pandemic

identified shortcomings in the public health system

around the world, including the unreadiness of

medical institutions and specialists for such

situations. However, in some countries, public health

system shortcomings are part of deeper and more

chronic problems. This is the case in our republic,

where there is also a shortage of medical institutions

for serving the population of 9.5 million people, while

a fairly large number of existing medical institutions

are in an inadequate condition. In addition, the

country saw a significant decline in the number and

quality of health workers. Harsh working conditions

and very low wages for doctors and nurses discourage

young people from working in this field, extensively

propel corruption and encourage doctors to emigrate

to other countries.

A shortage of medical personnel, especially in

rural areas, is also a reason for medical crime. Who

treats us, how does he treat us? In Tajikistan, low

wages contribute to an outflow of personnel, do not

stimulate them to improve their professional level,

legal nihilism and a low legal culture are inherent in

both doctors and patients.

It should also be noted that doctors claim, that a

dreary unhealthy diet leads to problems of overweight

and obesity, cardiovascular diseases, arterial

hypertension, diabetes mellitus. In turn, the

population of the republic is concerned about the

import of substandard and synthetic food products. In

addition, prohibited or harmful fertilizers are widely

used. The high cost of fresh fruit and membership in

fitness studios hit pockets a lot.

However, after several years, this problem

became an object for the study by legal theorists and

medical workers N.A. Zykov, M.S. Rivenson, V.I.

Akopov, Yu.D. Sergeev, I. F. Ogarkov, T. A.

Pashinyan, A.G. Blinov, V.A. Glushkov, Yu.S.

Zalmunin, O.S. Kapinus, G.R. Rustemova et al

(Popova, 2016).

5 CONCLUSIONS

It is necessary to agree with the opinion, that “the

absence of statistically recorded iatrogenic crime

leads to a high level of its latency, the passivity of

organizing preliminary investigations in cases of this

category, impunity for criminals and, as a

consequence, to an increase in the number of crimes,

WFLAW 2021 - INTERNATIONAL SCIENTIFIC FORUM ON JURISPRUDENCE

committed in the field of professional medical

activity” (Ognerubov, 2014).

It is necessary to distinguish between crimes

committed by a health worker and a medical error. A

medical error is a innocent mistake of a doctor, in

which there is no elements of the crime and which

arises from the imperfection of medicine. It is

necessary to develop medical ecology - a section of

medical deontology, the theory of professional

mistakes. Iatrogenic diseases should be considered a

special type of medical errors. Moreover, diagnostic

iatrogeny occurs in 20% of cases, while therapeutic

iatrogeny occurs in 56%. In the literature, the

following fields or stages of iatrogeny are

distinguished: diagnostic, treatment-and-

prophylactic, tactical-strategic, informational,

organizational iatrogenic fields. In general, all acts

(actions or inactions), that caused improper treatment,

are divided into errors, accidents, iatrogenies, as well

as intentional professional crimes and careless actions

(Nesterov, 2019).

The field of pharmacy should be noted separately.

Provision of the population with the necessary

medicines is directly related to the problem of their

quality and safety for human health. The world os on

the rise of the pharmaceutical industry. Protection of

the population from dangerous, substandard,

adulterated medical products should be reliable,

especially the fight against adulteration of medicines

of frequent and daily consumption should be

escalated.

The Criminal Code of the Republic of Tatarstan

has one article 210-1, while in the Criminal Code of

the Russian Federation, for example, there are 3 new

articles, that establish responsibility for the right and

circulation of adulterated medicines and dietary food

supplements". But the Criminal Code of the Russian

Federation does not establish responsibility for

pharmaceutical piracy. In addition, trade through

online pharmacies is fraught with violations of

storage, transportation, and dispensing of medicines.

The Internet trade of medicines is not legally

confirmed in our country in Tajikistan either. Our

republic is still lagging behind in terms of the

development of the pharmaceutical market. Russia,

for example, ranks 7th among the world's leading

pharmaceutical markets. At the present stage of

development, the pharmaceutical market is a

complex, multi-level, multifunctional institution with

consistently high rates of growth of production, sale

of goods and, accordingly, indicators of profitability.

“The pharmaceutical market is a field of interaction

between subjects, directly related to the law, sale and

consumption of medicines and medical products;

engaged in the searching, research, development of

methods for the production activity, processing,

manufacture and storage of medicines, drugs and

materials, used in medicine and veterinary medicine,

as well as solving issues of their standardization,

purchasing and selling medicines in order to meet the

needs of end consumers and obtain economic

benefits" (Ilikbaeva, 2018).

Therefore, the widespread and public danger of

such acts served as determinants of the

criminalization of pharmaceutical crimes.

Health service experts from three countries -

Russia, Kazakhstan and Uzbekistan - conducted a

deep scientific research on the confrontation between

patients and doctors and taking the heat out of. The

reasons for the conflict situation are divided into two

groups - explicit and implicit. Patient dissatisfaction

is associated with inappropriate communication of

doctors, associated with partnerships between

patients and health workers. The second reason is the

nonavailability of modern, high-tech medical care.

One should always take into account “the nature

of the neuropsychic overload of a particular doctor or

doctors” (Tyagunov, Samoilichenko, 2007). Medical

trade unions exist only on paper, they have not

exercised public control over the observance of labor

legislation for a long time.

We cannot side-step an issue of the state of the

sanitary and epidemiological service in many

countries, including the Republic of Tajikistan. The

COVID-19 coronavirus pandemic identified many of

the problems, accumulated in society over the post-

war years, including in health service. Unfortunately,

this direction of medicine has fallen into complete

decay. But sanitation and hygiene are the fields, that

are directly responsible for national safety. In medical

universities, the faculties "Sanitary and Hygienic" are

closed, instead they train general practitioners (GPs),

they do not train forensic doctors. Over time, there

will be no one to replace the older generation, even

the middle one. The existing morgues do not meet

sanitary requirements, they are in critical condition,

new buildings, equipped with new equipment and

preparations, are required, waste must be disinfected

and disposed of, and not drained into the general

sewer system. Forensic medical examiners should

receive wage supplements, as they directly work with

coronavirus.

When considering various kinds of medical

interventions in the human body, the medical risk

should always be minimal, "that is, this should mean

the main thing: the danger and severity of medical

intervention should not exceed the danger and

severity of the disease or injury itself, for which they

Causal Complex of Medical Crimes in the Republic of Tajikistan

are performed" (Savoshchikova, Voronina, Sabrin,

2018).

During the pandemic, "the existing social

contradictions have become aggravated, exposed

shortcomings in managerial activity, and influenced

the state of crime" (Ovchinsky). The number of

crimes related to encroachment on the property of

citizens has increased: robberies, attacks on grocery

stores.

Violations of isolation during quarantine, as

practice has shown, are associated with selfish ideas

about own rights, with a carefree attitude towards the

risk of being infected and infecting others, with

misinterpreted interests of own professional duty,

with an ignorant idea of possible negative

consequences, etc. (Kazakova, 2020).

A hasty change in legislation cannot be

considered successful, since it not only represents a

derogation from the principle of systemic lawmaking,

but also contains direct contradictions to the current

criminal legislation. For example, a comparative

analysis of the newly introduced Art. 207.1 and 207.2

of the Criminal Code of the Russian Federation

revealed a number of illogical and random decisions.

This also applies to the updated version of Art. 236,

additions to Art. 238.1 of the Criminal Code of the

Russian Federation.

The few doctors, who have followed proceeding

in court are only a small part of the picture (Sebastian

Peruz).

American forensic medicine is less than a hundred

years old as an organized field. Overall, this relatively

young field has almost certainly had a positive impact

on the precise definition of de facto guilt and de facto

innocence in the criminal justice system (Risinger, D.

Michael, 2010).

The emergence of new articles in the Criminal

Code of the Russian Federation is associated with

such a negative phenomenon of public life during the

coronavirus period as "infodemia", defined as "the

production of fictional "conspiracy theories" about

the origin of the virus, the dissemination of

information about fake treatment methods, the spread

of cases with the level of the disease, unreliable

information on methods of prevention, giving an

extreme emotional coloring to existing reliable

information” (Ishchenko, 2012).

Human rights include formulation of the need for

fair, dignified and humane treatment of people,

regardless of their ethnicity, religion or race (Ekpa,

2016). The medical field is one of the social

institutions that should be implemented humanely.

Medical activity is based not only on the

principles of medical ethics, but also apply the

principles of the United Nations. International

humanitarian law is another important source of

professional regulations, by which doctors can

calibrate legislation or other obligations to the state

(Faunce, 2008).

In general, summarizing, it would be nice to note,

that this is the first attempt to study the determinants

of medical crime in the Republic of Tajikistan. Thus,

the general and specific reasons for the commission

of crimes by health and pharmaceutical workers

should be considered from both objective and

subjective factors. Medical and pharmaceutical

activity should be transparent, available and open.

The transition to digitalization of health service will

address these problems to some extent. It is necessary

to separately post an electronic database of all

medical errors on the website of the Ministry of

Health and Social Protection of the Population of the

Republic of Tatarstan, which will help health workers

quickly and efficiently make the right decisions on

the patient's illness (injury).

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