First responders in Abinsk (Krasnodar Region) demand payment for work during the epidemic. The hospital administration insists that additional funds are available only for special infectious disease teams. But medical workers argue that everyone, without exception, must respond to potentially dangerous calls.
In an attempt to get “Putin’s” bonuses, nine health workers from one of Abinsky district’s ambulance brigades recorded a video message and posted it online on May 18. “The management of the Abinsk Central District Hospital is trying to convince us that there are no payments for us,” the paramedics claimed. According to the paramedics of the brigade Roman and Sergey (names changed at the request of the heroes), they were encouraged by the example of their colleagues from Armavir, who, after recording a video appeal, obtained a decision on the payment of federal allowances.
According to the medical workers’ union “Action”, all emergency medical workers in Armavir should receive the money, regardless of whether they had contact with patients with confirmed coronavirus infection. “We can’t get through to anyone. Earlier, we had a meeting with the management of the [Abinsk] Central Regional Hospital, and the management tried to explain the government’s decisions on bonus payments. According to them, we were not entitled to anything because the money was allocated only to the infectious disease brigade and only to those who had contact with patients with a confirmed diagnosis of Covid-19. Although we also went on calls where there was a suspicion of coronavirus – respiratory viral infection, pneumonia,” says Roman. “At that moment, we knew nothing and believed that management was hiding information from us, so we decided to make a video statement,” Sergey explains.
According to the paramedic, in April no one from the hospital management explained to them how the incentive payments mentioned by Vladimir Putin are calculated. The salary of Roman and his colleagues in the ambulance is 22,000 rubles, while drivers earn 18,000 rubles. Paramedics respond to an average of 17-19 calls per shift (24 hours). Taking into account the bonuses promised by Vladimir Putin, paramedics could receive an additional 40% (8,000 rubles) on top of their salary for the “COVID” month of April, which is about 30,000 rubles.
However, a few days after the video appeal was published, the card of one of the paramedics of the brigade decreased by 760 rubles, that of another paramedic by 3700 rubles, and that of the driver by 300 rubles. According to Roman, the hospital’s accounting department was unable to provide an accurate answer to the question of why these amounts were transferred to them. Why have the paramedics not received the money promised by the president?
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The payments promised by Vladimir Putin are legally formalized in two government resolutions – 484 and 415. The first one is about incentive payments to employees of “COVID” hospitals and specialized “COVID” emergency medical teams. Thus, this regulation does not apply to Roman and Sergey – they work in a general-purpose team that is not designated to work with “COVID” patients.
Resolution No. 415 states that “payments of an incentive nature for special working conditions and additional workload shall be made to medical personnel providing medical assistance to persons diagnosed with new coronavirus infection and persons at risk of infection with new coronavirus infection. “In general, if you read this resolution, you can understand that the title itself and the first paragraphs of Resolution 415 are worded in such a way that it is impossible to determine unambiguously what concept the phrase ‘and persons from the risk group’ is referring to,” says Andrey Konoval, co-chair of the medical workers’ union Action. “Either it refers to patients from the risk group, or it refers to medical workers who are exposed to risk.”
“But it is more logical to consider that we are talking about patients from the risk group – because it is in this sense that this concept is used in section 10 of the same resolution and other documents of the Ministry of Health. For example, in the Order of the Ministry of Health of the Russian Federation # 198н of March 19, 2020 (On the work of medical organizations in conditions of the spread of Covid-19 infection). It is also mentioned in the recommendations of Rospotrebnadzor. These documents talk about people over the age of 60-65, patients with chronic diseases and pregnant women,” says Andrey Konoval.
As the co-chair of the “Action” union points out, every paramedic, every community clinic encounters people at risk of infection – people over 65 and patients with chronic illnesses. “This means that Resolution 415 should theoretically apply to all health care workers,” he concludes.
Roman and Sergey, like many of their colleagues, believed that the term “risk group” referred to health care workers who work in conditions of coronavirus infection spread. This opinion was shared by the deputies and public figures who took part in the meeting of doctors and the management of the Abinsk central district hospital on May 17. However, as the hospital’s chief economist Irina Ilyina explained at the meeting with the medical staff, medical workers who “work with biological material” are considered a risk group and are entitled to payments. “Why were we not told this before? Why not in April? Why now?” – asked one of the doctors. “The resolution is new to us. We also sent questions to the regional ministry and the ministry, which in turn sent questions to the Russian government,” Isaeva replied.
On May 21, the Ministry of Health issued a clarification to Resolution 415, stating that only medical personnel who work with biological material are eligible for compensation. According to Konoval, this means replacing the concept of “risk groups” and unjustifiably narrowing the circle of healthcare workers who can expect compensation for working in conditions of Covid-19 spread. According to the new clarification from the Ministry of Health, it is also indicated that employees of general-purpose emergency brigades cannot count on presidential payments unless they have had contact with a patient with laboratory-confirmed coronavirus.
Paramedics Roman and Sergey work in a universal brigade at a substation in the village of Kholmskaya. Their brigade responds to calls in other settlements, including remote ones, located 40-50 km from the substation. This is the only emergency medical team for Kholmskaya and neighboring settlements. Since the beginning of the epidemic, one emergency team has been assigned to work with patients suspected of having a coronavirus infection, while others have had to work with patients where there is no suspicion of Covid-19, Larisa Kovalenko, head of the Abinsk hospital union, told the BBC Russian service. “In each shift, a team is assigned to work with patients with coronavirus infection,” confirmed the chief physician of the Abinsk Central District Hospital.
According to the authors of the video message, as it is mentioned, such division of teams into infectious and others does not always work. “We had two cases of suspected COVID. In the first case, the dispatcher reported that the patient complained of discomfort and sore throat and that she had come from Moscow. According to the epidemiologic history, a person coming from another region, especially from Moscow, is assumed to be possibly infected. My team was sent, we went and checked. The symptoms were those of a common cold, we have no tests. And I do not know what will happen to her,” says Sergey. Roman’s colleague says that even a call that does not seem suspicious to 911 dispatchers could potentially be related to COVID-19. “And the second case – they asked the dispatcher if there was any contact [with a potentially sick person] with the patient. There didn’t seem to be, they said. But when we arrived, it turned out that her son had visited her from Moscow, stayed for two weeks, left, and she had a fever for the third day,” Sergey says. “According to the instructions, if we suspected a coronavirus infection, we were supposed to call an infectious disease brigade. We learned of the situation and reported it to our supervisor – the senior paramedic – who told us to put on protective gear and transport the patient to the hospital. At the time, we did not have hazmat suits, but we did have surgical gowns, gloves, caps, and regular medical masks. We put them on, returned to the patient, and began to prepare her for transport. We took her to the Covid-19 Specialized Hospital in Krymsk. Roman reports.
According to Andrey Konoval, the division of ambulance teams into “COVID” and “non-infectious” is a beautiful but abstract plan that is doomed to failure in Russia, especially in the conditions of a pandemic. He claims that even before the pandemic began, ambulance teams across the country were facing a severe shortage of personnel. According to a union representative, the number of teams across the country is one and a half to two times less than recommended by federal regulations. In addition, he says, general-purpose teams often lack a second paramedic, and specialized teams are converted to general-purpose status to avoid having three paramedics. Konoval says that even with this understaffing, employees are working at 1.5-2 rates. “If we only send specialized [brigades], no one will come. Since the end of March, there have been so many SARS and pneumonia calls in the regions where the coronavirus has spread that 99% of the [brigades] must be specialized and fully equipped with personal protective equipment. At the same time, we have to somehow provide for other calls. And in rural areas – there may be only one or two brigades for an entire district, with long distances and bad roads. In other words, the situation is such that strict division is an unrealistic plan,” emphasizes the co-chairman of the union “Action”.
The chief doctor of the Abinsk Central District Hospital, when asked by the Russian service of the BBC about the effectiveness of separating teams into infectious and non-infectious, replied: “This is done to ensure the safety of our medics. We have not had any infected staff during this whole period. Does that mean we are doing everything right?”
Employees of the Kholmsk regional hospital say that in late April, an elderly man waited about four hours for an infectious disease team to arrive – during which time he walked around the hospital and went outside to pass the time. “If he really had COVID, can you imagine how many people in the hospital he could have infected during that time? We could have taken him to the hospital in Crimea ourselves,” says Roman. If Roman’s team had been assigned to transport this patient to the hospital at the time, the team members would have received additional compensation only if the patient’s Covid-19 diagnosis was confirmed.
The very term “detected coronavirus infection” implies the possibility of different interpretations. At the moment, the official authorities understand it as a laboratory-confirmed case of COVID. In addition, the antibody test that is currently being performed is not considered to be a confirmation of past COVID-19 infection,” says Andrey Konoval.
In early April, at the “Man and Medicine” congress, Sergey Avdeyev, chief external pulmonologist of the Ministry of Health, stated that the sensitivity of the polymerase chain reaction method (recommended by the WHO for testing for Covid-19) is about 70-80%. In late April, Moscow Mayor Sergei Sobyanin told Russia 24 that up to 50% of severely ill COVID-19 patients in the capital have received two negative test results. “Many patients are not tested at all. For a variety of reasons. The healthcare system itself is currently unable to provide widespread testing for patients with symptoms of coronavirus. At the same time, we know that about 40% of people with Covid-19 are asymptomatic,” says Konoval.
Immediately after the doctors posted a video message on social networks, they were summoned by law enforcement. “They asked who organized it, what it was for. They said that such things should not be filmed,” says Roman. The police then issued him with a warning about the inadmissibility of engaging in extremist activities “during meetings, rallies, demonstrations, processions and pickets” (a copy of the document has been obtained by the BBC). “You, as the organizer, are responsible for complying with the established requirements of the legislation of the Russian Federation on the procedure for conducting mass actions, preventing the commission of extremist activities, as well as their timely suppression,” the document says. According to the paramedic, the police considered the video call a mass action.
So far, only one team, working at the substation in the village of Kholmskaya, has publicly decided to speak out. The rest of the non-infectious teams at the Abinskaya Central Hospital initially planned to support their colleagues, but then changed their minds and decided not to express their discontent. Now, according to the authors of the video, they are being pressured – they are being asked to write statements that they have no claims against the hospital administration regarding payments. Almost simultaneously with the video message from the brigade of Sergey and Roman, employees of the Krasnoarmeysk Central City Hospital released a similar video. They, too, were inspired by the example of their colleagues from Armavir. Among the participants of the video message were ambulance workers who were in quarantine after contact with a Covid-19 patient, as well as those who were in the hospital with confirmed Covid-19. After this video appeal by the paramedic of the ambulance service in Krasnoarmeysk, she was interrogated by the Investigative Committee, and the investigator drew up a protocol on the confiscation of her phone.