“There were too many paid services”: for which Nizhny Novgorod surgeons were sent to arrest

Investigators believe that vascular surgeons from the Nizhny Novgorod region, Andrei Vasyagin and Maxim Kudykin, engaged in fraud - forcing the patient to pay for consumables, which were legally supposed to be free. After spending almost two months in jail, doctors wrote an open letter in their defense. Surgeons explained that their operations with the arteries of the legs are not included in the free list of compulsory health insurance. According to them, patients need to pay consumables from their own pockets, since the leg can only be amputated at public expense. Shortly after the publication of the open letter, both doctors from the cell were transferred to house arrest. To try to understand the situation, RT correspondent went to Nizhny Novgorod.

“Patients who came to us themselves searched for the salvation of their limbs, seeking any opportunity to avoid their crippling amputation, which, according to the standards of medical care, was guaranteed to them by the state for free,” said a letter from vascular surgeons Andrei Vasyagin and Maxim Kudykin from the pre-trial detention center.

It turns out that the doctors did not deceive the patients, but only offered them a chance to save the limb. Just medicine stepped forward, and state guarantees remained somewhere in the past. True, there is a slippery moment: the doctors called the patients themselves the cost of consumables, and there is a suspicion that patients could greatly overpay. Hundreds of operations were performed on the arteries of the legs, so the total margin for mediation - if it was, of course, was - it can turn out to be very solid. And is it true that the operation could not be done according to the compulsory medical insurance policy?

Let's try to find out who Vasyagin and Kudykin are: ascetic doctors or skillful businessmen?

“Two weeks left to save a leg”

The story began in the winter of 2016. The head of the third surgical department of the Dzerzhinsk Emergency Hospital (Nizhny Novgorod Region) Andrey Vasyagin, patient Konstantin Shilkin, had pain in his right leg. The year before, in 2015, Vasyagin removed a blood clot in Shilkin’s leg, so the patient and the doctor knew each other.

“Leg pains started after even short walks. As soon as 500 meters pass, a tingling appeared, and then everything hurt so much that at least stand, at least fall, ”Shilkin told RT.

Konstantin Shilkin worked as a driver, but due to complications after the operation, he lost his leg, and then his job
© Oleg Adamovich / RT

Doctors found that the patient suffers from a narrowing of the peripheral arteries in the leg (atherosclerosis of the arteries of the limbs). With age, the small arteries of the limbs lose their elasticity, become clogged, blood circulation worsens. In severe cases, gangrene can begin.

“Vasyagin explained to me that the position of the leg is dangerous. He said that I had literally two weeks left to save my leg, otherwise I would face amputation. You can do an operation to expand the arteries, it can help. The operation itself was supposed to be free, but consumables for expanding the arteries must be bought on their own, because they are not in the hospital, ”recalls Shilkin.

The patient was given a payment in the amount of 125 thousand rubles. The doctor explained that these are the details of the supplier of supplies. As soon as the organization receives funds, it will bring the necessary equipment to the hospital, then it will be possible to operate.

“When there was a need for the operation, an application was sent to the email address of the representative (supplier of consumables. - RT ) for a set of tools. A company representative prepared it in the name of the patient, and the interested patient, who gave written consent to perform the operation using the new technology and who was aware of the free alternative treatment method in the form of amputation, independently paid for the consumables for the operation, ”explained Maxim Kudykin in an open letter.

Andrei Vasyagin only received Shilkin’s patient, and also assisted in operations. The main surgeon during the expansion of the patient's arteries was precisely Kudykin.

Maxim Kudykin - Doctor of Sciences and Professor, one of the most experienced vascular surgeons in the Nizhny Novgorod region.

“I had to get a bank loan for the operation. I worked as a driver with a salary of 40 thousand rubles - I did not have 125 thousand free, ”says Shilkin.

The operation to expand the peripheral arteries was unsuccessful. Leg pains returned just one day later. Shilkin was sent for a consultation with specialists in Nizhny Novgorod.

“All the doctors took me for money - a thousand rubles for a consultation. 10 thousand had to be paid for computed tomography of the legs, ”complained Shilkin.

After many analyzes and studies, the patient was admitted to Kudykin in April 2016. The surgeon said that Shilkin needs another leg operation.

“This time I was told to pay 59 thousand rubles. The operation was not the same as the first time, ”Shilkin explains.

Unfortunately, the second operation also failed. The patient began suppuration, which could not be stopped.

“I went for examination to Moscow, to the Central Clinical Hospital of the Presidential Administration. For the examination they took another 90 thousand rubles from me. Doctors said that the last operation was unsuccessful, infection began, I can’t save my leg. On June 22 in Nizhny Novgorod, she was amputated to me. The operation itself was done for free, but for the subsequent rehabilitation I gave another 100 thousand rubles, ”concludes Shilkin.

A professional driver lost his leg and was left without work. On the man hangs another 300 thousand rubles of debt. Shilkin does not know how to return them from an eight thousand disability pension.

Surgeons accused of fraud

The criminal case began with the fact that Konstantin Shilkin tried to get a tax deduction for purchased consumables for the first operation.

“At the tax office, they told me that I could not get a deduction. The company indicated in the payment from Vasyagin (LLC Antey), to which I transferred 125 thousand rubles, is not officially engaged in the supply of medical equipment. It turned out that its main activity: trade in motor vehicles. Then I filed a lawsuit against the organization, demanding that I return the amount equal to the tax deduction. As a result, I did not receive money, because the office suddenly went bankrupt. After that, I wrote a statement to the police on Antey LLC with a request to understand the situation, ”Shilkin recalls.

For several years, the criminal case was either suspended or resumed until it fell into the hands of the staff of the Main Investigation Department of the Main Directorate of the Ministry of Internal Affairs of Russia for the Nizhny Novgorod Region. Law enforcement officers from the headquarters, unlike their colleagues in the region, quickly sorted out the situation and decided that the doctors were engaged in fraud. The doctors were arrested.

We received the following response to RT’s request to the Ministry of Internal Affairs in the Nizhny Novgorod Region:

“The chief physician of one of the regional central hospitals (meaning Maxim Kudykin. - RT ) in 2015-2016, while working as the department head, stole money from him on the pretext of the need for the patient to purchase medical equipment. At the same time, the doctor reliably knew that the medical equipment for the operation was provided free of charge within the framework of the MHI Program and hid this circumstance from the patient. On suspicion of involvement in this criminal activity, the surgeon of a medical institution was also detained (Andrey Vasyagin. - RT ). A criminal case has been instituted on the basis of the elements of a crime under Part 3 of Art. 159 of the Criminal Code (fraud committed by a person using his official position or on a large scale). ”

Investigators found a photo of Kudykin with piles of money in his personal computer. The surgeon's wife claims that the photos are comic, taken after the sale of the car.
© Photo from the personal archive

However, there are many inconsistencies and contradictions in the matter. And the doctors, it seems, are not saying something, and the investigators probably did not fully understand the circumstances of the case.

Was it possible to do operations for free?

The press service of the regional Ministry of Health RT said that it was possible to save Shilkin’s leg at state expense:

"According to the Ministry of Health of the Nizhny Novgorod Region, the provision of medical care to patients with obliterating diseases of limb arteries (the very narrowing. - RT ) included in the group of the International Classification of Diseases I70.2 is provided for by the state guarantee program - which means it can be provided free of charge."

Strange, but the response of the press service clearly contradicts the Program of State Guarantees for the free provision of medical care to the population of the Nizhny Novgorod Region for 2016. Appendix 6 on 242 pages lists all types of guaranteed high-tech medical care, plus treatment methods and sources of funding. There is everything that patients can count on. There is nothing said about the treatment of disease I70.2. On page 203, operations to expand arteries are mentioned, but the document separately states that the state pays for various types, except for operations on the arteries of limbs.

In addition, the official response of the Dzerzhinsk Emergency Hospital to the lawyer defending Kudykin said that the clinic did not buy supplies for vasodilation operations in 2014-2016.

Obviously, Konstantin Shilkin could not count on free consumables, operating in a clinic in Dzerzhinsk. Their purchase is not provided for by the State Guarantee Program. Physicians did not physically have these materials. Therefore, the primary version of investigators raises big questions.

At the same time, the press service of the regional Ministry of Health added that in order to keep the leg free, it was necessary to conduct another operation.

“There are two alternative treatments for lower limb ischemia: open surgery and endovascular intervention, balloon angioplasty (exactly what Shilkin did. - RT ). According to the draft national recommendations for the diagnosis and treatment of diseases of the lower limb arteries in 2018, the advantages of one method over another with respect to long-term results have not been proven, although the endovascular method has an advantage in terms of the length of hospital stay. The choice of treatment should be determined according to the preference of the surgeon in consultation with the patient. For the endovascular treatment method, disposable supplies are required, ”the RT department said.

Die in line

Suppose that the press service of the Ministry of Health of the Nizhny Novgorod Region was not mistaken, and Shilkin really had a free alternative. How could he use it?

“All medical institutions are divided into three levels: the first is the municipal hospital, the second is the larger inter-municipal clinics, the third is the regional specialized hospitals. Usually, high-tech medical care is provided in third-level organizations. But you can’t just turn to a specialist with a policy. First you need to get a referral from a primary care doctor. Each region has its own patient routing for high-tech medical care. Every doctor at the municipal level knows which regional clinic to send a patient with a difficult case to, ”explained RT Larisa Gabueva, Head of the Department of Economics and Management in the Social Sphere of the Institute of Industry Management (IOM), RANEPA.

In the Nizhny Novgorod region, there is also a document on patient routing. All adult patients who need specialized high-tech medical care are sent to the N.A. Nizhny Novgorod Regional Clinical Hospital Semashko.

Now let's imagine if Konstantin Shilkin could actually use the free operation? According to doctors, the man had about two weeks to save his leg. During this time, the patient had to get all the certificates and tests confirming the diagnosis from the doctors, get a referral for an initial specialist appointment at the Semashko hospital.

Since there is only one hospital in the region, Shilkin would have had to wait a long time for his turn. According to the Federal State Statistics Service, 3.2 million people live in the region. And everyone who needs special treatment for the vessels or arteries of the legs is sent to Nizhny Novgorod. Shilkin cannot be taken earlier than other patients who also need help. After a doctor’s appointment, if the diagnosis were confirmed, Konstantin Shilkin would be put in line for surgery. After some time, he would have been operated on under the compulsory medical insurance policy. But what is the likelihood that gangrene would not have begun during this time? Nobody knows that.

Unfortunately, there is a lot of news from the regions about patients who died before waiting for their treatment. In fact, people die in line. You can recall the story of a resident of Apatity, Daria Starikova, who began to be treated for cancer only after a complaint during the “Direct Line” by Vladimir Putin. Even the president’s intervention did not save the girl.

Many, like Shilkin, agree to the operation without waiting, albeit with the need to pay for consumables. According to the Dzerzhinsk Emergency Hospital, from 2014 to 2016, the clinic performed 176 operations on the arteries of the legs, similar to the ones that Shilkin did. All patients bought supplies themselves. And this is only in one clinic of one provincial city. Perhaps a bit too much, given that there is supposedly a free alternative in the region.

Consumables sold at inflated prices?

The Federal Service for Health Supervision in the Nizhny Novgorod Region checked how Shilkina was treated. The agency’s conclusion says that “the surgical interventions performed by Shilkin were carried out according to indications, technically correct.” Moreover, "there is no federal standard for the provision of medical care for atherosclerosis obliterans of the lower extremities."

Thus, an inspection of the department confirmed that Kudykin and Vasyagin correctly prescribed treatment to Konstantin Shilkin. The operation to expand the arteries is consistent with the recommendations of specialists, even though the press service of the regional Ministry of Health does not quite agree with this.

At the same time, raising money is a big doubt. Patients transferred funds to some organizations, and then consumables in an obscure way ended up in the operating room. The doctor Vasyagin gave the patient Shilkin a payment of 125 thousand rubles. RT has at its disposal a list of consumables purchased for this amount - there are 11 items. For comparison, the company Cardiosystem LLC is now ready to deliver the same materials to the Dzerzhinsk clinic for 62 thousand 600 rubles. And this is an organization that is officially engaged in medical components, and not the ruined Antey LLC (officially, we recall, was selling vehicles), to which Vasyagin sent Shilkina.

62 thousand 400 rubles - the difference between the real price of consumables and what was asked of the patient. This is one and a half monthly salaries of the driver, which Shilkin had to take on credit.

You can roughly calculate how much 176 operations performed in three years could bring, if each patient overpays no less than 60 thousand. It turns out more than 10 million rubles.

“Operations on the peripheral arteries of the legs clearly went on stream. In this case, the hospital had to centrally purchase the necessary consumables. They would be stored in the clinic and debited for each operation. Patients would still pay for materials from their pocket. This is called extrabudgetary funding, such a scheme is provided for by federal law No. 223-FZ “On the procurement of goods, works, services by certain types of legal entities”. Then there would be no questions about the price of consumables and their quality. Now the story looks strange: it is not clear who supplied the materials, who was responsible for their quality, ”said Larisa Gabueva from RANEPA.

The current head physician of the Dzerzhinsk Emergency Hospital, Mikhail Gutkin (the doctor headed the clinic after the story with Shilkin), agrees with the opinion that consumables were paid doubtfully.

“Unfortunately, under the old management, the hospital had too many paid services. I'm not even talking about vascular surgery right now. In traumatology, all patients were offered to put metal pins for money, which are supplied by the company of the deputy of the City Council of Dzerzhinsk. Free government pins lay idle in the warehouse. Now I have stopped this vicious practice. In place of Vasyagin and Kudykin, I would send patients to other specialists - there are hospitals in the region that specialize in vessels. Probably there could help for free. As soon as the doctor in the state hospital starts telling the patient what must be paid, the situation immediately becomes doubtful, ”RT Gutkin said.

What will happen to the doctors next

Most likely, law enforcement officers will now find out the connection between physicians and suppliers.

The police are actively looking for possible victims. For a long time, the only victim was Konstantin Shilkin. Now there are already 67 statements from former patients in the case.

“The police seized from the Dzerzhinsk hospital all medical records of people who underwent operations to expand the arteries of the legs. Further, the investigators began to offer everyone to write applications for doctors in order to get the money spent back, ”said Kudykina lawyer Alexander Ageev to RT.

Two former patients Kudykina and Vasyagina confirmed RT the words of the lawyer. According to the men, police officers turned to them several times to write a statement. Law enforcement officers came home and to work.

It is completely incomprehensible how this story can end. If doctors go to jail, then for what? They really tried to save patients, a check showed that the treatment was prescribed correctly. Unfortunately, Konstantin Shilkin still lost his leg, but the operation does not give an absolute guarantee.

Consumables sold at inflated prices? But the intent of the doctors remains to be proved. Perhaps the surgeons did not earn anything from operations. So far, these are just suspicions and conjectures.

By the way, the story of the operation might not have reached arrest. Shilkin’s lawyer Maxim Rybalkin suggested that doctor Kudykin pay 3.5 million rubles to the injured patient for revoking the lawsuit. Then the matter could fall apart. But the surgeon did not make a deal, hoping for justice.

Shilkin himself claims that the lawyer acted without his knowledge. But the Kudykin family doubts this.

Doctor Maxim Kudykin is interested in basketball

“My husband’s former patient called us and wrote on the Internet, demanding money. In the summer of 2019, my husband even wrote a statement to the police because of Shilkin’s threats - he always claims that they will put us all in jail. It's just awful, ”complained RT to Kudykina’s wife, Svetlana Tishkova, chief freelance specialist in plastic surgery at the Ministry of Health of the Nizhny Novgorod Region.