Adri Nieuwhof, Human Rights Advocate, Switzerland
On 4 September, the Russian Court of Appeals overturned the conviction of Dr Alevtina Petrovna Khorinyak, a physician with more than 50 years’ experience who was sentenced for prescribing tramadol as pain relief to a terminally ill patient. The Court found a “technical irregularity” in the trial at the Oktyabrsky District Court of Krasnoyarsk and ordered a re-trial with a new panel of judges, according to a statement by the Court’s press officer. The technical irregularity meant that the lawyer had violated Khorinyak’s rights by defending both her and Lydia T. (who bought the tramadol) in court.
A re-trial means a continuation of the ordeal of Dr Khorinyak. The new panel of judges at the District Court is not bound to the first ruling. The verdict may be acquittal, a fine or up to nine years in prison.
In 2009, Dr Khorinyak wrote two tramadol prescriptions to relieve the intolerable pain of a terminally ill cancer patient, Victor Sechin, (as I reported in my post on 9 June). Although Sechin did not reside in the area of Khorinyak’s polyclinic, she decided to help him because he had been a family friend for over 20 years. Problems started when Sechin’s pharmacy could not provide the stronger fentanyl patches (100 mcg/h instead of 75 mcg/h) prescribed by his own general practitioner from the polyclinic. Sechin therefore continued to receive the original dosage fentanyl patches but now in combination with tramadol tablets.
The situation became worse when a few weeks later Sechin’s pharmacy ran out of tramadol. It was only at this pharmacy that Sechin could get free tramadol, which was state-subsidised. Sechin’s general practitioner refused to write the required prescription to buy the tramadol tablets in another pharmacy, which had them in stock; subsequently Sechin suffered unbearable pain because of inadequate pain control. A social worker testified during a hearing on 23 July 2012 that Mr Sechin “experienced severe pain; he just lay there slowly dying [from it]. It was difficult to watch.”1
As a medical doctor bound by the Hippocratic Oath, Khorinyak wrote Sechin two prescriptions for tramadol to relieve his pain. Another friend of the family bought the tramadol in the pharmacy and took the tablets to the patient which lasted him until late May. Then Sechin’s own physician renewed the prescription for the free tramadol.
Control hampers access
After noticing Dr Khorinyak’s prescriptions in the local pharmacy, the Russian Federal Drug Control Service informed the state prosecutor who brought the case to court. It is remarkable that tramadol is a controlled drug in the Russian Federation, yet neither the World Health Organization nor the international drug control conventions recommends controlling it as a drug.
Dr Khorinyak was found guilty of “forgery of documents in order to facilitate the commission of another crime” and “trafficking potent substances in large quantities by prior agreement with the intent to sell as an organized group.”
In a letter to the Prosecutor General of the Russian Federation, Human Rights Watch writes that regulations on medical use of controlled substances in Russia are “overly bureaucratic and excessively onerous”, interfering with proper prescribing and with the ability of patients to access these medicines.
The right to the “enjoyment of the highest attainable standard of physical and mental health” is enshrined in the International Covenant on Economic, Social and Cultural Rights.
Palliative care is an essential part of health care.
In February 2013, Juan Méndez, Special Rapporteur on torture and other cruel inhuman or degrading treatment or punishment classified the denial of pain treatment as an example of abusive practices in healthcare settings.2 Méndez warned that certain abusive practices violate the prohibition on torture and ill-treatment reminding States of their obligation to regulate, control and supervise health care.
Instead of prosecuting Dr Khorinyak, the Russian Federation should invest in designing new regulations that ensure that controlled medicines are made available for patients with severe pain.
1. Quote from a Human Rights Watch letter to the Prosecutor General of the Russian Federation.
2. See also a previous post on the EAPC blog.
Support the Prague Charter
Read more about the Prague Charter.
Please support the Prague Charter by signing the petition urging governments to relieve suffering and recognise palliative care as a human right.