Adri Nieuwhof, Human Rights Advocate, Switzerland
On 29 May, I received information from a Russian physician calling for support to Dr Alevtina Petrovna Khorinyak who was sentenced in court for performing her professional duties by providing care to a terminally ill cancer patient. Dr Khorinyak has 50 years’ experience as a general practitioner. She worked in the Polyclinic No. 4’s group practice in the Siberian town of Krasnoyarsk, Russian Federation.
On 27 April 2009, Dr Khorinyak wrote two tramadol prescriptions to relieve the intolerable pain of Victor Sechin, a terminally ill cancer patient who did not reside in the service area of Khorinyak’s polyclinic. She decided to help Sechin because she had known him for more than 20 years as a friend of the family. Moreover, she was the physician who had diagnosed Sechin with a malignant neoplasm in 2006.
By the end of March 2009, Sechin was suffering unbearable pain that prevented him from sitting, lying down, or sleeping. The attending physician from ‘his’ polyclinic prescribed stronger fentanyl patches of 100 mcg/h (instead of 75 mcg/h) to relieve the pain. However, the pharmacy had no 100 mcg/h patches in stock. Sechin continued to receive the old dosage fentanyl patches but now in combination with tramadol tablets.
Problems arose on 18 April 2009 when Sechin’s pharmacy had no tramadol in stock. Only this pharmacy could deliver free tramadol to Sechin and have his prescription paid for from his federal benefits. Although tramadol tablets could be bought in another pharmacy, the attending physician of Sechin’s polyclinic refused to write the required prescription. More than one month later, on 22 May 2009, Sechin’s physician wrote a new prescription for tramadol.
In the days following 18 April, Sechin suffered severe pain while asking for relief. His relatives were unable to witness his suffering and asked Dr Khorinyak for help. In response, on 27 April 2009 Dr Khorinyak wrote two prescriptions for tramadol to relieve the patient’s unbearable pain. Another friend of the family bought the tramadol in the pharmacy and brought the tablets to the patient.
In 2011, the Russian Federal Drug Control Service noticed the prescriptions in the local pharmacy and referred the case to the state prosecutor who brought the case to court. On 20 May 2013, the Court found Dr Khorinyak guilty of “forgery of documents in order to facilitate the commission of another crime” (Article 327 of the Criminal Code of the Russian Federation), and “trafficking potent substances in large quantities by prior agreement with the intent to sell as an organized group” (Article 234). The judge did not send Dr Khorinyak to prison because of her advanced age. Instead, she was sentenced to a fine of 15,000 Rubles (Euros 363).
In her verdict, Judge Nonna Markova gave no weight to the arguments of the defence that medical indications for tramadol treatment were confirmed by numerous documents; there was a medical necessity for tramadol prescriptions for pain management; the prescription forms had been certified by a personal signature and a personal seal of Dr Khorinyak and by the seal and the stamp of the Polyclinic No. 4, and that the lack of attachment of Sechin to Polyclinic No. 4 had no legal value. She did not commit a crime, but conscientiously performed her professional duties by providing the requested and needed assistance to manage the pain of a terminally ill cancer patient.
Moreover, the World Health Organization does not recommend controlling tramadol as a drug, and neither is it included in the international drug control conventions.
On June 4, I heard that Khorniyak’s attorney had now appealed against the Court’s ruling.
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