In Ukraine Legal Dying is Easier Than Living

One June 7 seven surgeries were canceled at the Spinal and Cerebrospinal Neurosurgery Center of the Kyiv Emergency Hospital. Almost all were complex, and neurosurgeon Ihor Kurylets, head of the center, had invited British consulting neurosurgeons Henry Marsh and Richard Gotfield, with whom he has cooperated for the past seven years. Yet, says Dr. Kurylets, when they arrived KEH Chief Physician Valery Zboromyrsky forbade the British experts to consult patients or take part in any surgeries.

Dr. Kurylets believes that the actual reason behind the conflict is that the clinic, set up jointly with British neurosurgeons according to Western standards, with equipment worth at least a million dollars, impedes the monopolistic interests of other neurosurgery wards in the city, including the Institute of Neurosurgery.

"We have not only exposed the general backwardness of domestic neurosurgery, but have also created severe competition, for most patients want to be treated here. Every year the center renders medical assistance practically free of charge to over a thousand patients and we have introduced some thirty new surgical techniques. Regrettably, the bureaucrats in charge of medicine in this country hate the very notion of progress. Our opponents claim that cooperation with British colleagues visiting Ukraine for the eighth time or more has to be legalized. I think that matters such as this must be resolved by the administration, not by surgeons. A year ago, the British side tried to negotiate a large-scale cooperation contract between KEH and the London Central London, but found no understanding on the Ukrainian side," says Mr. Kurylets.

"I love your country and its people," Henry Marsh told The Day, "and consider it an honor to take part in reforming Ukrainian medicine. It is unfortunate that the process involves certain complications, for they are directed not at Dr. Kurylets but at the patients."

A 41-year-old woman, mother of two, was signed in with a cerebrospinal tumor. She says she came to Kyiv from Bila Tserkva. She was examined at Central Hospital No. 1 and then at the Regional Hospital where she was told to go to KEH at 3 Bratislavska St. Now she is on the surgery waiting list. In the West an operation like hers costs at least $20,000. Here she will have to pay only for medications, but still...

What is to be done with hard cases like hers? Ihor Kurylets counted on his British colleagues for help. Now he is uncertain. If such cooperation is considered illegal the patients should be refused help under the law, but for many surgery is their only chance. Death "under the law" cannot be a justification for a physician whose duty it is save his patient's life.

"The problem is maintaining proper conduct, observing established ethics, as well as the legal aspect," The Day was told by KEH Deputy Chief Physician Volodymyr Nikishayev. "No one prevented Ihor Kurylets from setting up a joint venture, but he needed to register it and sign all the required papers. He has done nothing of the kind. Why? I don't know."

Henry Marsh was posed a straight question. Could a Ukrainian physician come to Britain and perform surgery? He answered no. No country will allow a foreign physician practice medicine without taking exams and getting that country's license. Ukraine is no exception. In Dr. Nikishayev's words, "They [the British neurosurgeons - Ed.] arrived and would not even visit the Chief Physician's office to introduce themselves."

The Deputy Chief Physician refused to comment on Dr. Kurylets's professional level but stressed that he is no good as head of the ward. In addition, all his surgeries are scheduled, yet he works for an emergency hospital.

Valery Bidny, Deputy Head of Kyiv City State Administration (in charge of health care), informed The Day that what happened at KEH is not a conflict but merely a misunderstanding. Ihor Kurylets's methods and the center's program "have the right to live" and no one is going to ban them. As for friction, it has occurred now and then over the past four or five years. After all, our British partners, who invested in the center, have their own business interests in Ukraine.

Ukraine strives to adopt civilized approaches, and joint ventures in medicine, as in any other country, must be officially registered. In accordance with a recent Cabinet resolution, any medical institution has to be licensed and accredited by the Ministry of Health.

PS: Dr. Ihor Kurylets announced on June 9 that the conflict is getting worse. The British neurosurgeons are still barred access to the operating room.

"Western consultants were invited to attend the surgery on Boris Yeltsin. Why is a similar procedure is impossible in Ukraine?" Mr. Kurylets asks. "Who is going to invest in a country with such unfavorable investment climate?"

Medical friction, confrontation between rights and ambitions - all this Mr. Bidny aptly described as provincialism. Yet investment in the medical sphere is badly needed and this is big politics, for such help is needed by Ukraine and above all by the patients for whom it is a matter of life and death.

COMMENTARY

"I worked for eight years in the medical administrative system and was witness to constant friction between the executive authorities, bureaucracy, doctors, and patients throughout that period," states Valery Ivasiuk, health care expert with the Ukrainian Human Rights Center. "This KEH conflict, which became public knowledge thanks to Ihor Kurylets' uncompromising stand, is one of many, and the apple of discord is always money and ambition. This particular conflict reflects the utter chaos in Ukrainian medicine. A neurosurgical center is offered foreign aid, which is rejected on some bureaucratic pretext or another. Is it not a case study in the inhuman nature of the current health care system in which human health is anything but the main priority?"

Mr. Ivasiuk also believes that the reason for such conflicts is not so much inadequate legislation as the absence of a national policy in health care. Over the years of Leonid Kuchma's presidency the human element has been withdrawn from the medical sphere - and this element existed during Soviet times in the form of doctor-patient-state relationships. In fact, both the patient and his physician are now left one on one, so that the patient's health and life depend on that physician's personal and professional qualities. Today, doctors and patients depend on how close a given medical institution is to the bureaucratic machine and how well it is financed. Meanwhile the Constitution reads that every person has the right to received medical help under any circumstances, stresses Mr. Ivasiuk.