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Nomenclature of medical services in healthcare. Medical service standards

1. Based on the results of the preliminary hearing, the judge makes one of the following decisions:

1) on the direction of the criminal case according to jurisdiction in the case provided for in part five of this article;

2) about returning the criminal case to the prosecutor;

3) on suspension of criminal proceedings;

4) on termination of the criminal case;

4.1) on the termination of a criminal case or criminal prosecution in accordance with Article 25.1 of this Code and the imposition of a criminal law measure on the accused in the form of a court fine provided for in Article 104.4 of the Criminal Code of the Russian Federation;

5) on the appointment of a court hearing;

6) on the postponement of a court hearing due to the presence of a sentence that has not entered into legal force, providing for the conditional condemnation of a person against whom a criminal case has been filed in court for a previously committed crime;

7) on the separation or impossibility of separating a criminal case into separate proceedings in cases provided for by this Code, and on the appointment of a court hearing;

8) on the connection or impossibility of combining criminal cases into one proceeding in cases provided for by this Code, and on the appointment of a court hearing.

2. The judge’s decision is formalized by a decree in accordance with the requirements of part two of Article 227 of this Code.

3. The resolution must reflect the results of the consideration of the submitted requests and filed complaints.

3.1. The resolution to terminate a criminal case or criminal prosecution with the imposition of a criminal law measure on the accused in the form of a judicial fine in accordance with Article 25.1 of this Code must also indicate the amount of the court fine, the period and procedure for the execution of this criminal law measure.

4. If the judge grants the request to exclude evidence and at the same time schedules a court hearing, then the decision indicates what evidence is excluded and what materials of the criminal case that justify the exclusion of this evidence cannot be examined and announced at the court hearing and used in the process of proof.

5. If during the preliminary hearing the prosecutor changes the charge, the judge also reflects this in the decision and, in cases provided for by this Code, forwards the criminal case to jurisdiction.

6. If, when resolving the accused’s request for time to familiarize himself with the materials of the criminal case, the court determines that the requirements of part five of Article 109 of this Code were violated, and the deadline for keeping the accused in custody during the preliminary investigation has expired, then the court changes the preventive measure in the form detention, grants the request of the accused and sets a deadline for him to familiarize himself with the materials of the criminal case.

7. A court decision made based on the results of a preliminary hearing may be appealed in the manner prescribed by Chapters 45.1 and 47.1 of this Code, with the exception of a court decision to schedule a court hearing regarding the resolution of issues specified in paragraphs 1, 3 - 5 of the second part of Article 231 of this Code.

Commentary to Art. 236 Code of Criminal Procedure of the Russian Federation

1. The commented article is structured in such a way that its first part contains only general list decisions made by a judge based on the results of a preliminary hearing of a criminal case. The subsequent detailed articles of the Code of Criminal Procedure (238 - 239) are devoted to a detailed presentation of the content of each type of such decisions. But in next parts This article contains a number of new and important provisions.

2. Thus, from the content of part five of the commented article, it is clear that the prosecutor has the right, at the preliminary hearing of a criminal case, to change the charge formulated in the indictment. It seems that such a change is permissible only in a direction that softens the position of the accused. In other words, the prosecutor has the right to tell the court to exclude certain charges from the indictment or to apply the law on a less serious crime, but so that the new charge, in its factual circumstances, does not differ significantly from the charge contained in the indictment. To do otherwise would mean a significant infringement of the accused's constitutional right to defense, because in the trial the defense would find itself face to face with an accusation against which it was not prepared to defend itself.

3. It is appropriate to continue the text of part five of the commented article with the following official explanation: “In this case, there is no need either to issue a resolution to terminate the criminal case, or to study all the circumstances of the crime committed...” (Definition of the Judicial Collegium for Criminal Cases Supreme Court RF dated November 25, 2008 in the case of R. // Bulletin of the Supreme Court of the Russian Federation. 2009. N 11. P. 9).

4. Part seven of the commented article in its current wording significantly expands the list of court decisions adopted based on the results of a preliminary hearing in a criminal case, which can be appealed in cassation. Now it includes all decisions of the judge on the issues listed in paragraphs 1 - 4 of the first commented article, as well as on issues of: 1) consideration of a criminal case by a single judge or a collegial court (clause 2 of part two of Article 231 of the Code of Criminal Procedure) and 2) preventive measures in relation to the defendant (clause 6 of part two of Article 231 of the Code of Criminal Procedure). Decisions regarding: the place, date and time of the scheduled court hearing are not subject to cassation appeal; appointment of a defense attorney in cases of his mandatory participation in court proceedings; on summoning participants in the trial to a court hearing based on lists submitted by the parties; as well as the consideration of a criminal case in a closed meeting.

5. Regarding the new paragraph 7 of the first part of the commented article: the judge’s decision to separate the criminal case into separate proceedings inevitably entails the return of the entire investigative proceeding to the prosecutor, since the court itself cannot “cut” the indictment and all the investigative materials into two parts.

Eugene de Blaas, Flirtation at the Well, 1902

A preliminary hearing is a special court hearing. It is characterized by the fact that:

2. The preliminary hearing is held:

1) if there is a request from a party to exclude evidence declared in accordance with part three of this article;

2) if there are grounds for returning the criminal case to the prosecutor in the cases provided for in Article 237 of this Code;

3) if there are grounds for suspension or termination of the criminal case;

4.1) if there is a request from a party to conduct a trial in the manner prescribed by part five of Article 247 of this Code;

5) to resolve the issue of considering a criminal case by a court with the participation of a jury;

6) in the presence of a sentence that has not entered into legal force, providing for the conditional condemnation of a person against whom a criminal case has been filed in court for a crime previously committed by him;

7) if there are grounds for separating a criminal case.

3. A request for a preliminary hearing may be filed by a party after familiarization with the materials of the criminal case or after the criminal case with the indictment or indictment has been sent to the court within 3 days from the date the accused receives a copy of the indictment or indictment.

Part two of Article 229 was recognized as not contradicting the Constitution of the Russian Federation, since the provisions contained therein, in their constitutional and legal meaning in the system of current criminal procedural regulation, do not allow the possibility of holding the accused in custody without a court decision after the prosecutor or a higher court has sent a criminal case to the court for consideration. Resolution of the Constitutional Court of the Russian Federation dated March 22, 2005 N 4-P.

Order

7. The defense’s request for additional evidence or items is subject to satisfaction if the data proof and the items are relevant to the criminal case.

8. At the request of the parties, as witnesses Any persons who know anything about the circumstances of investigative actions or the seizure and inclusion of documents in a criminal case may be questioned, with the exception of persons who have witness immunity.

9. During the preliminary hearing, a record is kept.

3) on suspension of criminal proceedings;

4) on termination of the criminal case;

5) on the appointment of a court hearing;

7) on the separation or impossibility of separating a criminal case into separate proceedings in cases provided for by this Code, and on the appointment of a court hearing.

2. The judge’s decision is formalized by a decree in accordance with the requirements of part two of Article 227 of this Code.

3. The resolution must reflect the results of the consideration of the submitted requests and filed complaints.

A preliminary hearing in a criminal trial is a closed court session, which is the preparatory stage of the trial on the merits. The judge conducts this review alone with the participation of the parties and in accordance with Chapter. Ch. 33-36 of the Criminal Procedure Code of the Russian Federation. At this stage, only those issues that served as the basis for its implementation are resolved.

Reasons for carrying out

This event is possible if there is one of the following reasons:

Application to exclude evidence.
There are grounds for the prosecutor to return the case materials.
There are grounds to suspend or terminate the case.
A request by a party to conduct the trial without the accused, who is abroad and/or is avoiding appearing in court and has not been held accountable for a crime.
The accused filed a request to have a trial in front of a jury.
There is a sentence that has not become effective and provides for the suspended sentence of the accused for another act.
There is a reason to highlight the case.
Request by a party to join cases.

As you can see, a preliminary hearing in a criminal case is possible at the request of a party, or at the initiative of the court, if there are grounds.

The petition is submitted upon completion of familiarization with the case or after transfer to the court, within a three-day period from the moment when a copy of the indictment document is received by the accused. The case material can be voluminous, consisting of a dozen volumes, each of which is 5-7 centimeters. Accordingly, familiarization with the case can take a long time. Also, when presenting the indictment document, a note must be made on what date and time it happened.

Resolution of the Constitutional Court of the Russian Federation dated March 22, 2005 No. 4-P states that the above circumstances do not contradict the Constitution of the Russian Federation, because Having sent the case to court, it is not allowed to keep the accused in custody without an appropriate decision.

Order of conduct

Information that a judicial procedure will take place is sent to the parties at least three days before it takes place.

At the meeting, the judge rules alone. It takes place behind closed doors and is carried out with the participation of the parties.

In this case, the accused may be absent from the hearing if he filed a petition for this or the petition was filed by one of the parties, and this accused is abroad and/or avoids appearing at the hearing and is not held accountable in this case. The absence of other participants in the process does not prevent the consideration of the case.

Thus, accused D. did not appear at the preliminary hearing in case No. 1-42/18 at the Nogai District Court, but asked the court to hold the hearing without her participation. Due to the fact that Art. 234 of the Code of Criminal Procedure of the Russian Federation provides for such a right, the proceedings were carried out in the absence of D.

It should be noted that the court has the right to leave a civil claim without consideration if the civil plaintiff or his representative is absent from the hearing. However, a civil plaintiff can file a claim under the civil procedure law.

During the proceedings, the secretary of the meeting keeps minutes. You can obtain permission to photograph, video and/or audio record, film, broadcast on television, radio, or the Internet, as noted in the protocol.

If a party has declared the exclusion of evidence, then a copy of the petition is sent to the opposite party on the day it was received in court.

The application must indicate:

argument to be excluded;
what basis excludes the evidence;
confirming circumstances.

So, the applicant must justify his request. If the application asks to question a witness and attach documents to the case, the court may satisfy it. Art. 234 of the Code of Criminal Procedure of the Russian Federation indicates that interrogation of witnesses is allowed at the request of a party. This requirement does not apply to citizens who have witness immunity. However, the possibility of interrogating these persons with their consent cannot be ruled out, which does not contradict the Constitution of the Russian Federation.

During the trial, the judge learns from the opposing party about the existing disagreement to exclude the evidence. If there are no objections or other reasons for preparatory consideration, then the application is granted and a meeting is scheduled.

When a party has objections to exclude arguments, the court may read documents present in the materials and/or filed by the parties. If the defense asks to exclude evidence obtained in violation of the Code of Criminal Procedure of the Russian Federation, then this argument is refuted by the prosecutor. In other cases, the responsibility for justification rests with the declaring party.

If evidence is excluded, it no longer has legal force, is not taken into account in the court decision, is not examined and is not used in the case. Also, court assessors should not be aware of this argument. When considering the case on the merits, a party may ask to recognize this evidence as admissible. This position is given importance by the Plenum of the Supreme Court of the Russian Federation in Resolution No. 1 of 03/05/2004.

For example, the Borisoglebsk City Court, in its ruling following a preliminary hearing, satisfied the lawyer’s request to declare it inadmissible and exclude the expert’s opinion from the list of prosecution evidence. The prosecutor, disagreeing with this decision, filed an appeal with the Voronezh Regional Court. The latter, in his decision, returned the case materials for a new trial, and explained to the prosecutor the right to file a motion to recognize the previously excluded argument as admissible.

Types of solutions

The preparatory consideration of the case ends when a decision is made:

Transfer materials to another jurisdiction.
Return the materials to the prosecutor.
Suspend the judicial procedure.
Stop the criminal process.
Schedule a meeting.
Postpone the hearing if a sentence was passed against the defendant for another act, providing for a suspended sentence and which has not entered into legal force.
Separate the case into separate proceedings or if such is impossible, schedule a meeting.
To combine cases into a single proceeding or if this is not possible, schedule a meeting.

As you can see, the outcome depends on the basis for holding a preliminary hearing in criminal proceedings.

A decision is drawn up in the form of a resolution, which reflects the results of all appeals.

When the case is terminated due to the imposition of a court fine on the accused, the decision shall indicate its size, duration, and procedure for execution. In case of exclusion of evidence, it is indicated which particular argument is excluded, which particular materials of the case are not examined, not disclosed and not used in the case. When the prosecutor changes the charge, this is reflected in the decision and, if necessary, the case is sent to the jurisdiction. If it turns out that the materials of the completed investigation were not presented to the accused within the prescribed period, and his period of detention has expired, the court makes a decision to change the measure of restraint and determines the period for familiarization with the documents.

The judge's ruling can be appealed.

Return of the case to the prosecutor

The case is returned to the prosecutor under the following circumstances:

the indictment document was drawn up in violation of criminal procedural law;
the accused was not given a copy of the indictment unless it was found lawful to do so;
it is necessary to draw up a resolution on medical measures;
possible connection of cases;
the rights of the accused are not explained;
the need to change the classification of the act to a more serious act. In this case, the judge indicates only the basis for qualifying the actions as a more serious offense without commenting on the articles of the Special Part of the Criminal Code of the Russian Federation;
the presence of circumstances precluding the conduct of a criminal case in an abbreviated form;
availability of new dangerous consequences acts for which there were grounds to bring charges of a more serious assault;
the presence of a canceled court order, the basis of which was the circumstances that led to the accusation of a more serious act.

Thus, obstacles to further consideration of the case are removed. It is possible to take measures against the accused, including increasing the period of detention.

The case is suspended if:

The defendant is hiding, his whereabouts are unknown.
The defendant is seriously ill, which confirms medical report.
An appeal has been sent to the Constitutional Court of the Russian Federation or a complaint has been received regarding compliance with constitutional legislation.
It is impossible to ensure the participation of the accused in the court case, although his location is known.
The accused, who is in custody, absconded from court.

The trial does not continue unless there is a reason for it.

The grounds for termination of the case or prosecution are specified in Part 1, Part 2 of Art. 239 Code of Criminal Procedure of the Russian Federation. These include the expiration of the statute of limitations for prosecution, the existence of an act of amnesty, repentance of the defendant, reconciliation of both parties, refusal of the prosecutor to charge, and more. The court decides to terminate the criminal case, sending a copy of the document to the prosecutor and the parties within a five-day period from the moment it was issued.

Difficulties in practice

As you know, legislation is not perfect; there are gaps and contradictions. This also applies to the preliminary hearing, enshrined in the Code of Criminal Procedure of the Russian Federation.

Some issues need to be briefly considered:

Despite the fact that you can find a sample document on the Internet, the request for preliminary consideration of the case must be competent and reasoned. As a rule, such a statement can be drawn up by the defendant's defense attorney. But there are circumstances when he gets involved much later. For example, if the defense attorney did not take part in the investigation and the preparatory trial was not scheduled, then he will not be able to declare this procedure;
the inability to challenge evidence in the proceedings that is not in the indictment. In accordance with the Code of Criminal Procedure of the Russian Federation, during the preliminary hearing in a criminal case, the parties are given the right to declare the exclusion of case materials. This is not entirely true. It is possible to file an application in relation to those arguments that are listed in the indictment. At the same time, the investigator is not prohibited from presenting evidence during the judicial procedure that is not included in the indictment document. That is, the defense cannot challenge arguments at the stage of preparation for a trial procedure, which does not exist in the first place;
refusal to exclude evidence. Despite the fact that the Code of Criminal Procedure of the Russian Federation sets out in detail the procedure for considering an application to exclude materials during the preparatory consideration of the case, in practice the court often refuses to satisfy it. In this case, the judges refer to the following: during the consideration of the case on the merits, it will be possible to file this petition. But in the future they reject it, claiming that they will give a legal assessment of the arguments when passing a verdict. Such actions involve a violation of the Code of Criminal Procedure of the Russian Federation.

The existence of problems in the preliminary hearing process suggests that work should be done to improve criminal procedural legislation.

Complex- a set of simple medical services, which requires for its implementation a certain composition of personnel, complex technical equipment, special premises, etc., corresponding to the formula (Diagram 4)

Comprehensive- a set of complex and (or) simple medical services ending with either prevention, or diagnosis, or the end of a certain stage of treatment (inpatient, rehabilitation, etc.) according to the formula:

“Patient” + “simple + complex services” = “Carrying out prevention, establishing a diagnosis or completing a certain stage of treatment.”

Medical services, in essence, are based on manipulation.

Manipulation- a separate medical event, research aimed at providing medical procedure(assistance), described by the requirements for the technologies for their implementation, but not having an independent complete preventive, diagnostic, therapeutic or rehabilitation value, which is an auxiliary element of the medical service.

Classification of medical services according to functional criteria(Scheme 5).

Treatment and diagnostic- aimed at establishing a diagnosis or treating a disease, including providing assistance during physiological childbirth and in neonatology in the absence of pathology on the part of the newborn;

Preventive- clinical examination, vaccination, physical education and health activities, sanitary and educational work;

Recovery and rehabilitation– related to social and medical rehabilitation of patients;

Transport- transportation of patients using ambulance and air ambulance services, provision of emergency medical care during transportation.

Classification of medical services according to conditions of provision(diagram 6) .

Industry classifier of simple medical services provides for a three-stage hierarchical classification of medical services, carried out at each level of classification according to significant classification criteria.

At the first stage of the classification there are types of simple medical services, at the second - classes of simple medical services, at the third - types of simple medical services. Thus, each simple medical service has a seven-digit digital code of the following structure (Scheme 7).

Characteristics of the type of service (X). Currently, 25 codes for standard service sections have been introduced. Sections are a list of various research methods used medical workers in professional activities.

For example.

Section 01 concerns methods of functional examination without the use of devices or instruments. In class sections of this type, services for collecting anamnesis, conducting a visual examination, palpation, percussion, and auscultation are recorded.

Section 02 is a list of the simplest diagnostic services, which use elementary instruments: tonometry, pulse rate counting (watch), thermometry (thermometer), etc. A significant difference from the previous section is the impossibility of performing techniques classified as this type, without the use of instruments and devices.

Characteristics of class divisions (XX). In each typical section, simple medical services are divided into classes. The division is based on an anatomical and functional principle. The classifier provides 31 class sections. The following class sections are distinguished:

01. Skin, subcutaneous - fatty tissue, skin appendages;

02. Muscular system;

03. Skeletal system etc.

Characteristics of species sections (XXX). Each class section lists specific simple medical services. The main principle of identifying and including a simple medical service in the OK PMU was to satisfy the definition of a simple medical service and the ability to describe the technology for performing the service.

Since, for example, there is no description of the technology for performing the service “Appointment with a local therapist, medical and diagnostic, primary outpatient.” This appointment is broken down into a number of specific simple medical services (history taking, physical examination, tonometry, heart rate measurement, etc.). As a result of completing each element, a primary diagnostic hypothesis can be formulated.

Each of the listed simple medical services may have a complete diagnostic or medicinal value, which fully corresponds to the formula of a simple medical service. Each simple medical service has a clear description of the technology for performing it, and several methods (techniques) for performing the service are allowed.

The study of hemoglobin levels, the phenomenon of erythrocyte sedimentation, the number and composition of leukocytes is summarized in general analysis blood, which cannot be classified as a simple medical service, since it is no longer an indivisible procedure with an independent, complete meaning.

The operative benefit, despite its complexity, is a simple medical service. Each element of the operation - anesthesia, extracorporeal blood flow, vascular coagulation, etc. - has no independent meaning. Only together do they satisfy the patient’s consumer expectations for medical care. It should be taken into account that the operation is performed by one surgeon, regardless of the auxiliary and assisting personnel involved in it, which also satisfies the definition of a simple medical service. The technology for performing each operation can be described, although several technology options - methods for performing the operation - can exist simultaneously.

In addition to simple medical services, during the provision of medical care to the patient, medical personnel provide complex and complex medical services.

Complex medical service- a set of simple medical services that require for their implementation a certain composition of personnel, complex technical equipment, special premises, etc., corresponding to the formula “patient” + “complex of simple services” = “stage of prevention, diagnosis or treatment.”

Comprehensive medical service- a set of complex and (or) simple medical services that end with either prevention, diagnosis, or the end of a certain stage of treatment according to the formula “patient” + “simple + complex services” = “prevention, diagnosis or end of a certain stage treatment."

The classifier of complex or complex medical services contains 5 standard sections:

I - medical and diagnostic services of a doctor(the section contains a list of treatment and diagnostic services that form the stages of the process of providing medical care);

II - services nursing care (section contains a list of medical services performed medical personnel with a high school diploma in patient care);

III - complex diagnostic services (research methods: laboratory, functional instrumental, X-ray radiological, etc.). This section contains a list diagnostic complexes, including laboratory (study of biological fluids, morphological study of tissues, etc.), functional instrumental (ultrasound studies, electrocardiography, phonocardiography, use of fiber optics, etc.), X-ray radiological, performed at the stage of diagnostic search.

IV - preventive medical services(the section contains a list of preventive services, such as dispensary observation, vaccination, medical sports and recreational activities);

V - medical rehabilitation services(this section contains a list of services related to social and medical rehabilitation sick).

In each model section, complex and complex medical services are divided into classes. The division occurs in accordance with the established list of medical specialties. The OK SKMU has 69 class sections. The following class sections are distinguished:

001 - obstetrics and gynecology;

002 - allergology and immunology;

003 - anesthesiology and resuscitation, etc.

Each complex and complex health services class section lists specific complex and complex health care services. The main principle for identifying and including a complex or complex medical service in an industry classifier is the ability to describe the composition of the service.

Each of the listed complex and complex medical services can have a complete diagnostic or therapeutic value, which fully complies with the definition of a complex and complex medical service.

So, for example, a simple medical service “palpation for diseases of the liver and biliary tract” is important only in conjunction with simple medical services “collection of anamnesis and complaints for diseases of the liver and biliary tract”, “visual examination for diseases of the liver and biliary tract”, “ percussion for diseases of the liver and biliary tract”, etc. This approach forms a complex medical service “primary appointment (examination, consultation). In the future, to form a diagnostic stage of medical care, it is necessary to connect complex medical services “general (clinical) blood test”, “general therapeutic biochemical blood test”, “ ultrasonography organs abdominal cavity”, simple medical services “radiography of the gallbladder”, “radiography of the liver”, etc., which leads to the emergence of a complex medical service “complex of studies for the diagnosis of liver failure”.

The use of medical services in practical healthcare requires compliance with certain legal, organizational, methodological and other requirements for their quality. In this regard, before introducing various preventive, diagnostic and therapeutic procedures into the work of health care institutions, they all must undergo standardization. The standardization system in healthcare provides for the development and adoption of standards and protocols for the implementation of medical care.

Medical service standards

In the process of standardization of medical services, it is envisaged to formulate requirements for the conditions for their implementation, medical technologies(protocols for patient management) and results (outcomes) that make it possible to objectify the assessment of the quality of medical care. At the same time, regulatory documents may contain both the minimum necessary and recommended level of requirements.

Standard- normative document, developed by consensus and approved by a recognized body, in which rules are established for universal and repeated use, general principles or characteristics concerning various types activities or their results, and which is aimed at achieving the optimal degree of order in a certain area.