A dentist belongs to that group of doctors that every person has to deal with sooner or later. Someone meets a dentist back in early childhood, some only in adulthood. However, sooner or later, any person’s teeth begin to need repair, and then we have only one option left - to consult a dentist.

Dental services today are provided by both public medical institutions and private clinics. But, as practice shows, in both types of medical institutions, the patient may encounter unqualified services. What to do in such cases, where to turn for assistance?

Choosing one or the other dental clinic, most citizens rely on two main criteria:

• Cost of services.
• Quality of services.

When visiting a public clinic, a person, first of all, expects to receive free medical services in accordance with the compulsory health insurance policy (CHI). As for private clinics, the majority of citizens believe that they can get dental services for more high quality than in state ones. This is partly true - privately practicing dentists value their medical reputation, since their financial well-being depends 100% on the number of clients.

But neither private dentist, nor the “state” are insured against medical errors. And sometimes both doctors simply lack medical experience and qualifications. Accordingly, patients run the risk of receiving low-quality dental services both in a public clinic and in a commercial establishment. Here's just the procedure for filing a complaint wrong actions dentist in these cases will differ, since the provision of public and commercial medical services regulated by various supervisory authorities.

A dentist in a state (municipal) clinic is obliged to perform his work in accordance with the requirements for medical employees established by the relevant federal legislation. Thus, he does not have the right to demand from a patient who has compulsory medical insurance policy, treatment fee. He also does not have the right to refuse to provide a visitor to the clinic with dental care. In case of poor-quality treatment, he is obliged to correct the mistakes made.

Accordingly, if a dentist in a clinic begins to openly extort monetary or other “gratitude” from a patient for his services, this is a direct reason to file a complaint against him. A similar case is if he obsessively offers to purchase from him certain “very good medicine"at exorbitant prices. Most often, therefore, he works part-time as a commercial agent for an affiliated pharmaceutical company, or is engaged in outright speculation in medicines.

Complaint to the head physician or department head

But the most common case that causes a patient to file a complaint is poor-quality dental repair. In all of the above cases, a clinic visitor has the right to write a complaint against such a negligent dentist. You should start filing an application with claims against the actions of the state dentist from his immediate superiors - the head dental department or the head physician of the clinic. A complaint about a doctor’s unprofessional actions can be submitted to his superiors in writing or orally.

Filing a complaint with the clinic administration is advisable only in a situation where the dentist’s actions did not cause great harm to your health, and they can be easily corrected. The fact is that the head physician has the right to apply only disciplinary measures to his subordinates: issue a reprimand or warning, deprive of bonuses, etc. But he will no longer be able to demand that the dentist pay you compensation for the damage caused to your health and nerves.

Our state has a special federal service responsible for supervision in the healthcare sector - Roszdravnadzor. Similar health departments are located in each subject of the federation. You can find out their address in your city through the information desk, or using an Internet search engine. Unlike the head of a clinic, this is a different level. Roszdravnadzor employees are obliged, in accordance with the Federal Law “On Citizens’ Appeals,” to respond to every complaint filed. But a complaint in this situation is accepted only in the prescribed manner - in writing or electronic form, drawn up in accordance with all the rules of domestic office work.

In each application you must indicate your data (anonymous federal authorities are not considered), clearly describe the essence of your claims, and also attach to the document all the information you have evidence base. This is a copy of the hospital record page, written prescriptions, names and addresses of witnesses. If a consultation or medical examination has already been conducted on your issue, the conclusions of the specialists should be attached to the complaint.

In response to formal complaint Department employees are required to conduct an inspection check of the received signal, and if it is confirmed, apply necessary measures To to this doctor or the management of the clinic. Officials are required to notify the complainant in writing about the results of the inspection ( by registered mail or by email).

Private dentist, as opposed to an employee state clinic, provides its services to on a commercial basis. That is, he has the right to refuse service to a patient who does not have money to pay for his work. But, having taken payment, he is obliged to provide the client with dental services of the appropriate level. Despite his commercial orientation, private clinics must meet the same standard requirements as other medical institutions.

But, since the services of a private dentist are provided on a reimbursable basis, in addition to Roszdravnadzor, Rospotrebnadzor is also involved in monitoring the activities of such institutions. This responsibility is assigned to this federal service by decree of the Government of the Russian Federation of 2012. Thus, the client of a private dentist is a consumer commercial goods, and the dentist himself is the supplier paid services. If provided poor quality services, he is obliged to return the client’s money or correct the mistake at his own expense.

Appeal to the court and prosecutor's office

The judicial authorities and the prosecutor's office are “universal” authorities to which patients and private practitioners and municipal dentists can file a complaint. This should be addressed in situations where the dentist’s actions have caused significant harm to your health, and you intend to seek administrative or criminal punishment for him, or compensation for the moral, financial and physical damage caused.

If you have enough good reasons To file a complaint, you can demand through the court or the prosecutor's office the payment of monetary compensation, the imposition of a ban on medical practice, or even the closure of a private clinic. However, domestic legal proceedings provide for the adversarial nature of the proceedings. That is, each of the litigants has the right to defend their point of view, using all the arguments they have.

Also, the current procedural legislation provides for a presumption of innocence for the defendant. That is, the complainant will need to prove to the judge the dentist’s guilt in providing poor-quality medical services. To do this, you will need to provide convincing evidence to the court:

• Medical expert's conclusion on the dentist's fault for a medical error. Such a conclusion is issued by the territorial body of Roszdravnadzor, or forensic medical examination appointed at the request of the judge.
• Video and audio recordings of your conversations with a negligent doctor.
• Testimony from which the judge can draw conclusions about the real deterioration in your health after visiting the dentist.
• When making a complaint against a private dentist, you should also attach an agreement for the provision of medical services indicating the amount of money paid for them.

To increase the chances of a successful outcome of the litigation, it is recommended to seek assistance from a professional lawyer. He will be able to provide you with the full range legal services– from filing a complaint against a dentist to presenting your case in court.

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The applicant applied to the dental center for prosthetic services. The doctor offered to undergo treatment with them, promising the applicant high-quality work and a significant discount. The applicant concluded with dental center contract for the provision dental services. Throughout the year, the applicant repeatedly contacted this center to correct rickety bridges. The applicant had acute attack pain accompanied by swelling and high temperature. She urgently went to the clinic, where they took an X-ray and discovered a serious purulent inflammatory process under the left bridge. The applicant requests termination of the contract for the provision of dental services. return the amount paid. Pay the costs to correct this situation.

OOO "__________"
Address: ____________________________
from ___________________________
Address: ___________________________

CLAIM

«___»____________ _________

I, _________________, applied to the dental center “____________” for prosthetic services. I was received by doctor ___________ She offered to undergo treatment with them, promising me high-quality work and a significant discount. ____________ I entered into an agreement with a dental center for the provision of dental services. I followed all the doctor’s orders and went through all the recommended procedures. At the beginning of ________, bridges were installed for me. In total, I paid _________ rubles for all services. Throughout the year, I repeatedly contacted this center to correct rickety bridges.
_____________ year I had an acute attack of pain, accompanied by swelling and high fever. I urgently went to the clinic, where they took an X-ray and discovered a serious purulent inflammatory process under the left bridge. On the same day, I had 3 teeth urgently removed. I was prescribed a long course of treatment and was deprived of my ability to work. I had to pay for these services in the amount of __________ rubles. As a result of this whole situation, my pancreas has worsened (as a result chronic pancreatitis and cholecystitis)
According to clause 5 of this contract for the provision of dental services, the PROVIDER is responsible for the services provided as provided for by current legislation.
The customer's payment obligations cash performed properly for the services.
There is a relationship between the Seller and the Buyer arising from the purchase and sale agreement, which is regulated by Chapter 30 of the Civil Code of the Russian Federation.
In accordance with Article 454 of the Civil Code of the Russian Federation, under a sales contract, one party (seller) undertakes to transfer the thing (product) into ownership of the other party (buyer), and the buyer undertakes to accept this product and pay a certain amount of money (price) for it.
In accordance with paragraphs 1 and 2 of Article 469 of the Civil Code of the Russian Federation, the seller is obliged to transfer to the buyer goods whose quality corresponds to the purchase and sale agreement. If there are no conditions in the purchase and sale agreement regarding the quality of the goods, the seller is obliged to transfer to the buyer goods suitable for the purposes for which goods of this kind are usually used. If the seller, at the conclusion of the contract, was informed by the buyer about specific purposes acquisition of goods, the seller is obliged to transfer to the buyer goods suitable for use in accordance with these purposes.
Under the terms of the Agreement, there is no warranty period for these services.
According to Article 5 of the Federal Law “On the Protection of Consumer Rights” for goods (work) intended for long-term use, the manufacturer (performer) has the right to establish a service life - the period during which the manufacturer (performer) undertakes to provide the consumer with the opportunity to use the product (work) for its intended purpose and bear responsibility for significant deficiencies.
The manufacturer (executor) is obliged to establish the service life of durable goods (work), including components, which after a certain period may pose a danger to the life and health of the consumer, cause damage to his property or environment.
The service life of a product (work) can be calculated in units of time, as well as other units of measurement (kilometers, meters and other units of measurement based on functional purpose product (result of work)).
The sale of goods (performance of work) after the expiration of the established expiration date, as well as goods (performance of work) for which an expiration date should be established, but is not established, is prohibited.
The seller has the right to establish a warranty period for the product if it is not established by the manufacturer.
The seller has the right to accept an obligation regarding defects in the goods discovered after the expiration of the warranty period established by the manufacturer (additional obligation).
The content of the seller's additional obligation, the validity period of such an obligation and the procedure for the consumer to exercise rights under such an obligation are determined by the agreement between the consumer and the seller.
The warranty period for the product is calculated from the moment of signing the Transfer and Acceptance Certificate. I didn't sign anything like that.
Due to the current situation, I was left without money and without teeth. I am forced to go to another clinic for quality treatment. In another clinic this service costs _________ rubles.
According to clause 1 of Article 18 of the Law “On the Protection of Consumer Rights”, in relation to a technically complex product, the consumer, if defects are discovered in it, has the right to refuse to execute the sales contract and demand a refund of the amount paid for such a product or make a demand for its replacement with the product of the same brand (model, article) with a corresponding recalculation of the purchase price within 15 (fifteen) days from the date of transfer of such goods to the consumer. After this period, these requirements are subject to satisfaction in one of the following cases: detection of a significant defect in the goods; violation of the deadlines established by this Law for eliminating product defects.
According to clause 1 of Article 19 of the Law “On Protection of Consumer Rights”, the consumer has the right to make demands against the seller (manufacturer, authorized organization or authorized individual entrepreneur, importer) regarding defects in the goods if they are discovered during the warranty period or expiration date.
In accordance with paragraph 2 of Article 450 of the Civil Code of the Russian Federation, significant defects are understood as defects that cannot be eliminated or the elimination of which requires disproportionate expenses or time, or that reappear after their elimination, as well as other defects due to which the buyer is deprived of what he had the right to count on when concluding the contract, including the possibility of using the goods for their intended purpose.
Consequently, the Seller duly significantly violated the quality requirements for the goods transferred to the Buyer.
According to Article 309 of the Civil Code of the Russian Federation, obligations must be fulfilled properly in accordance with the conditions and requirements of the law, other legal acts, and in the absence of such conditions and requirements - in accordance with business customs or other usually imposed requirements.
In accordance with clause 2 of Article 475 of the Civil Code of the Russian Federation, in the event of a significant violation of the requirements for the quality of goods (detection of fatal deficiencies, deficiencies that cannot be eliminated without disproportionate costs or time, or are identified repeatedly, or appear again after their elimination, and other similar defects), the buyer has the right, at his own discretion:
- refuse to fulfill the contract and demand a refund of the amount of money paid for the goods;
- demand replacement of goods of inadequate quality that comply with the contract.
Based on the above, guided by Articles 5, 18, 19 of the Law “On Protection of Consumer Rights”, Articles 309, 314, paragraph 2. Article 450, Article 454, paragraph 1, 2 Article 469, paragraph 2 Article 475 of the Civil Code of the Russian Federation

1. Terminate the contract for the provision of dental services concluded between LLC “___________” and me, __________________.
2.Refund the paid amount in the amount of ___________ rubles.
3. Pay the costs of correcting this situation in the amount of ____________ rubles
4. Refund legal expenses in the amount of ______ rubles.
In case of non-transfer of funds within 7 days from the receipt of this claim to LLC "_________", complaints will be sent to Rospotrebnadzor of ________, and statement of claim to court.

Application:
1.Copy of the Dental Services Agreement.
2.Copies of receipts

"___"____________ year _______________

A dentist is a doctor whom no one can avoid meeting. Teeth will sooner or later need “repair”.

But what if the new filling falls out after a month or the wrong tooth is pulled out? According to experts, patients are very often dissatisfied with the work of dentists. But, as a rule, things don’t go further than complaints to friends and acquaintances. But you can protect your rights! How to do this correctly? Tells Dmitry Lesnyak, Lawyer of the Society for the Protection of Consumer Rights.

Most Russians go to state clinics. If treatment is free, then complaining about poor quality is pointless, many patients think. But that's not true. There are several rules that will help ensure the provision of quality services.

Require a plan

Elena turned to the state dental clinic: she wanted to get fillings, remove tartar, and treat her gums. I expected to finish it in a month, but the treatment lasted for six months. At the same time, the doctor could not really explain why all the procedures could not be carried out faster.

Your actions. When you first see your doctor, ask them to create a treatment plan and walk you through it. This is the responsibility (!) of every doctor. Then you will know what, when and how you will be treated. If the doctor refuses to fulfill his duties, go to another one or complain to the administration of the medical institution.

If you feel that the treatment period is being delayed, ask your doctor to explain why this is happening. Perhaps you will agree with his arguments. If there are no reasonable arguments, verbally set a deadline by which you would like to complete all manipulations. If the doctor does not meet this requirement, submit a written complaint to the head of the medical institution.

The same goes for paid clinic. Request the development of a treatment plan. Remember: it is done for free. Having drawn up a plan, doctors will not be able to deliberately delay the process in order to extract as much money from you as possible. Of course, there are unforeseen cases: for example, you need to additionally delete. But general scheme treatment you should know from the beginning. And if the contract specifies a clear treatment period, you have the right to demand a penalty for delay.

Irina Mikhailovna had dental prosthetics done as usual dental clinic. When the work was finished, it turned out that the teeth and gums hurt unbearably. During a consultation with another doctor, it turned out that serious mistakes were made during treatment.

Your actions. This will require an expert evaluation of the treatment. However, the problem is that, in fact, in our country there is no independent medical examination. There are government bureaus that are overloaded with work, and the queues there stretch for years. You can, at your own expense, contact expert institutions created by dental associations, or a specialized dental educational medical institution (for example, medical school) and persuade them to conduct an examination. In Moscow, you can contact the city commission on the quality of dentures. Please contact the court with the results of the examination.

Another option is to write a complaint to the territorial department of Roszdravnadzor. This is the basis for an unscheduled inspection of a medical institution, therefore, having learned about your intentions, the clinic’s management will most likely prefer to correct the mistakes. In any case, Roszdravnadzor is obliged to respond to your complaint within a month, and if this does not help resolve the conflict, you need to go to court.

If we are talking about private clinic, contact the management, which must itself conduct an examination of the services provided and resolve the complaints. Are they refusing? Then go to court.

The main thing is the contract

Nikolai visited a private dentist. Each time he was given a cash receipt order, and he paid for the services. But in the end, the condition of the teeth only worsened. However, it was not possible to prove the fact of visiting a doctor - the documents were drawn up incorrectly.

Your actions. When you first contact a doctor, even for a consultation, insist on concluding a written agreement describing the already mentioned treatment plan, as well as the specific amount that you will be required to pay. If the scope of work during the treatment process needs to be increased, all manipulations are carried out only with your written consent, which is formalized in an additional agreement to the contract. This is a guarantee that you will be able to prove the fact of treatment in this clinic.

As for confirmation of payment, you should be given exactly cash receipt, and not a receipt or cash receipt order. Pick up the check on the day of payment, and not “sometime later.” Make sure that it indicates the organization you applied to, and not a shell company with an unclear name. Otherwise, if something happens, you will not be able to prove that they took money from you.

Your actions. The guarantee for treatment must be specified in the contract by law. However, the law does not regulate the length of the warranty period. The clinic itself can specify this period - 1 hour. Or 0 days. This will not be a violation. It’s bad if the contract says “quality guarantee” or “treatment guarantee.” We need an exact figure - say, “1 year warranty”.

- Egor Olegovich, on what principle is the commission created, who is included in it?

The commission is created under the health care committee and the composition, accordingly, is approved by it. Moreover, the committee is guided by the recommendations of the St. Petersburg Dental Association within the framework of the agreement signed in 1999.

The main criterion for selecting members of the commission is the professionalism of specialists in various fields in almost all areas of dentistry. They are proposed and evaluated by the association. On the one hand, she does this on formal grounds (in accordance with necessary list specialists, academic degrees and experience practical work). Mostly the commission members are representatives educational organizations, scientists, there are also employees of clinics, but more are representatives of universities, although they can also work part-time in private clinics. An informal criterion is that the committee member must be a respected specialist in the professional dental community.

-Are you conducting a real examination?

Yes, we will explore everything that can be explored. First this medical documents- the main object of research before examining the patient. Almost always except medical card the patient provides many other materials - conclusions based on the results of consultations, consultations with doctors different clinics, data additional research(radiological, allergological, histological...).

Often the case contains the results of previously conducted examinations, as well as various memos, written explanations, and protocols. There is also physical evidence. For example, one patient carried a tooth with her in a jar - pierced in the middle of the root, like a spear, with an endodontic instrument. Some patients bring several sets of dentures at once.

At the commission meeting, we always listen to the applicant and the clinic representative, conduct an examination of the patient, we have all the conditions for this.

Every year from 40 to 50 St. Petersburg residents turn to the commission with complaints about poor quality treatment or causing harm to health. Surely the number of victims dental patients in a city of 5 million there are much more. How can they get on your committee?

People search for the truth in different ways: some first turn to the clinic administration, and others go straight to the Kremlin. As a rule, such a request still comes to us. Until 2008, GorKEK received a flow of applications from everywhere. We considered not only requests from patients; we had to work with requests from courts, prosecutors, insurance companies, and licensing authorities. Moreover, the number of these requests grew so much that it was necessary to change the procedure for receiving requests and make sure that they were received by GorKEC only through the Health Committee. Around the same time, we ensured that our colleagues conducting the preliminary examination of documents were paid for their work from the city budget. Well, members of GorKEK, as before and now, work as volunteers - on a voluntary basis.

Now, before contacting us, the patient should contact the medical commission of the clinic where he was treated. Usually, when it is not possible to solve the problem there, only then do they write a statement to the health committee with a request to schedule an examination at the City Health Commission.

- What are the most common complaints?

By type of assistance provided, more than half of the complaints are related to dental prosthetics, almost a quarter are therapy, every tenth case is surgical interventions. Rarely - less than 5% - complaints about the quality of orthodontic care. Approximately 8% of cases are combinations different types assistance, for example: therapy and orthopedics (treatment followed by prosthetics), surgery and orthopedics (prosthetics on implants), orthodontics and surgery (treatment of malocclusion with tooth extraction), other combinations.

Complaints may be related to both violations of medical technologies and non-compliance by clinic staff with ethical standards.

It happens that the patient’s claim is caused not so much real defect, how many unrealized inflated expectations. In such situations, the doctor also bears a certain responsibility if he has not informed the patient in an accessible form about his state of health, the results of the examination, diagnosis and prognosis, treatment methods, and the risk of possible complications.

There are also real iatrogenies (causing harm to health as a result of treatment). For example, we examined a case where one girl had her jaw broken during tooth extraction. This possible complication, but the doctor then behaved incorrectly: the patient was not conflicted at all, she simply asked for help, and the doctor did nothing and even denied the very fact of the fracture. As a result, more severe complication- post-traumatic osteomyelitis. The man had to undergo difficult and long treatment.

What explains that dear help- prosthetics - often turns out to be of poor quality, and equally expensive - orthodontic - rarely causes complaints?

There really aren’t that many complaints about orthodontic treatment, apparently because its share in the structure of all dental care is significantly less than the share of prosthetics.

Not all patients who apply for a GorKEC opinion receive unambiguous answers to their questions. Although those who made it to the commission clearly did this not out of love for art, but because the doctor made a mistake in the treatment or treated it incorrectly. Therefore, the commission is often accused of protecting corporate interests rather than the interests of the patient.

Incorrect treatment is a medical error. But they never gave it a legislative definition. We proceed from the fact that errors are preventable, objectively incorrect actions (or inaction) of a doctor that contributed or could contribute to a violation medical technologies, increasing the risk of progression of an existing disease or the emergence of a new one pathological process or patient dissatisfaction.

As for the unambiguous answer, whether the treatment was “right” or “wrong,” simple assessments such as “yes” or “no” are very rare. We most often have to work with complex cases, in conditions of conflict. And it practically never happens that everyone is 100% satisfied with the result of the examination. Neither patients nor representatives usually have complete satisfaction medical organizations. This depresses experts, but no longer surprises them.

To understand the degree of satisfaction of the parties with our expertise, it is necessary to conduct sociological research— study the opinions of the parties involved in these discussions. But no one did this. We have other statistics - if we take everyone who applies to GorKEK, more than half are either already at the stage of trial or are actively preparing for it. And after the GorKEK examination, only 5% of patients go to court.

The Commission has an important psychological significance- in a sense, it disciplines both sides: it is a platform on which they, sometimes for the first time, truly begin to listen and understand each other, and re-evaluate their actions.

Does it happen that clinic representatives do not attend committee meetings? Like because she just disappeared?

There have been situations when claims were brought against a clinic that had already been liquidated, or one that had not yet received a license and claimed that it had not yet treated anyone. But we are not authorized to deal with such clinics - this is the competence of law enforcement agencies. Our task in such a situation is to form our own judgment about the quality of the treatment provided, and operational investigative measures and sanctions against clinics are not our business. GorKEK is a consultative and advisory body on issues of quality management of dental care; the decisions of the commission are advisory in nature.

Theoretically, yes.

- Has this ever happened?

No. In our country, licenses to practice medicine are revoked very rarely, and mechanisms for disqualifying a doctor practically do not exist. There are other mechanisms, such as civil damages or criminal prosecution.

But it’s precisely the deprivation of a clinic—a license or a doctor—of the right to practice medical activities can insure patients against poor quality treatment...

Therefore, in other countries, a doctor, even if he is not the one receiving the sentence, may be disqualified. And it is still unknown what he is more afraid of - imprisonment or deprivation of his profession. And in our country, even if a doctor is found guilty of committing a crime against health and sent to prison, his professional status is still preserved.

- Why do dentists protect the honor of their uniform so much - if a doctor at one clinic treated a patient incorrectly, another clinic will never give him a conclusion about the incorrect treatment, they say - corporate (professional) ethics does not allow it?

This is false ethics. True professional ethics the doctor is that he serves not a corporation or even medicine as an idea, but a person - a patient.

And the corporate ethics that you are talking about does not always work and does not work everywhere. On the contrary, another extreme is often encountered when the doctor, trying to attract the sympathy of the patient, begins to criticize the work of other clinics and specialists without sufficient grounds, accompanying this with very incorrect characteristics addressed to them... There is also such “corporatism”. In general, ethical problems in our medicine are a separate issue.

- But what about the hope that in the future it will be medical public organizations will they evaluate the work of colleagues and issue licenses for the right to engage in the same dentistry or other medical activities?

I'm convinced that decisive role in quality management medical care the professional community must play. But we do not yet have a full-fledged effective system for managing the quality of medical care.

Today, associations can participate in the development of rules and regulations, as well as in resolving issues related to their violation. They develop standards, approve recommendations for the provision of medical care, treatment protocols, and participate in the certification of health workers to obtain qualification categories.

These are already certain elements of quality management, but only elements. Because the decisive factor in quality management is not the creation different systems, and the status of a doctor. If a doctor becomes an independent professional - a representative of a free profession with a high degree of responsibility, this is the basis on which the corresponding settings arise. And if he continues to remain an employee with a permanently disadvantaged status, this is a different coordinate system.

Irina Dontsova

Doctor Peter