ST 124 of the Criminal Code of the Russian Federation.
1. Failure to provide assistance to a patient without good reason by a person obligated to provide it in accordance with the law or with a special rule, if this resulted through negligence in causing moderate harm to the health of the patient, is punishable by a fine in the amount of up to forty thousand rubles or in the amount of wages or other income of the convicted person for a period of up to three months, or compulsory work for a period of up to three hundred and sixty hours, or correctional labor for a period of up to one year, or arrest for a period of up to four months.
2. The same act, if by negligence it entailed the death of a patient or the infliction of grievous harm to his health, is punishable by forced labor for a term of up to four years with deprivation of the right to hold certain positions or engage in certain activities for a term of up to three years or without it, or by imprisonment. for a term of up to four years with or without deprivation of the right to hold certain positions or engage in certain activities for a term of up to three years.
Commentary to Art. 124 Criminal Code
1. The objective side of the crime is characterized by an act in the form of inaction (failure to provide assistance to a patient), a special situation in which the crime was committed (lack of valid reasons for failure to provide assistance), a consequence (causing moderate harm to the health of the patient) and a causal relationship between the socially dangerous act and the consequence. The crime is considered completed from the moment of causing moderate harm to the health of the patient.
2. By valid reasons that prevent the provision of care to a patient, it is customary to understand force majeure (collapses, floods, epidemics and other natural disasters), extreme necessity, illness of the doctor himself, physical or mental coercion. Establishment of a valid reason is made on a case-by-case basis.
3. The subjective side of the crime is characterized by a careless form of guilt in relation to causing moderate harm to health. Moreover, a careless form of guilt in the form of negligence is extremely rare, since medical workers, as a rule, foresee the consequences of failure to provide assistance to a patient.
4. Special subject - a person who has reached the age of 16 years, is obliged to provide assistance in accordance with the law, agreement or special rule and has the opportunity to do this (see also Article 73 of the Federal Law of November 21, 2011 N 323-FZ “On fundamentals of protecting the health of citizens in the Russian Federation"). In addition to doctors, the subjects of the crime include leaders of tourist groups, nurses, people specially allocated to provide medical care during tours, wintering, etc.
Analysis of crime from a medical point of view.
The concept of “sick” and “patient”.
In the current legislation there is no concept of “sick”; the closest concept named in the Law “On the Provision of Medical Care” is the concept of “patient”. In accordance with the law, a patient is considered an individual who has applied to a medical institution for medical care, regardless of whether he has a certain condition or disease, or a person who is already receiving medical care .
It follows from this that, from a legal point of view, a person is recognized as a sick person (patient) if one of the conditions is present: • The individual is already receiving medical care in a medical organization. • An individual applied to a medical organization for medical care.
The concept of a “special rule”
The disposition of the article under consideration contains an indication of the so-called “special rule”, which imposes on the doctor the duties of providing assistance to the patient. What are we talking about in this case?
The Law “On Health Protection” contains an indication that health workers are obliged to provide medical care in accordance with their qualifications, service and job descriptions, and job descriptions (Article 73).
For example, the job description of a traumatologist states the following duty: “The doctor is obliged to provide medical care to all patients admitted to the emergency room.”
Another widely known informal rule, which states that a doctor is obliged to provide medical care to all patients, is the Hippocratic Oath. But in modern times, the Hippocratic Oath is not a promise to provide medical care to all patients, and certainly not a normative source or a special rule, but simply creates a positive image of the medical worker, giving him more sublimity.
Also, the Law “On Health Protection” contains the doctor’s oath, which states the promise to honestly fulfill one’s medical duty, to always be ready to provide medical care, to treat the patient with care, and to act in his interests. In essence, this oath is part of the student's rite of passage into the medical profession.
Second commentary to Art. 124 of the Criminal Code of the Russian Federation
1. The objective side of the main elements of this crime (Part 1) includes: inaction, resulting in harm to health of moderate severity. The conditions for liability for failure to provide assistance to a patient are:
1) the existence of a legal obligation to provide assistance to the patient who applies for it;
2) a real opportunity to fulfill this obligation.
The possibility of providing assistance to a patient is determined by the physical condition of the subject, his professional training, and the availability of funds to provide medical care. A valid reason for not providing assistance to a patient may be the need to provide assistance to another patient (in this case, the issue of liability is resolved according to the rules of extreme necessity).
2. According to the Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” dated November 21, 2011 No. 323-FZ, everyone has the right to medical care in a guaranteed volume without charging a fee in accordance with the state guarantee program, as well as to receive paid medical services in accordance with the agreement, including in accordance with the voluntary health insurance agreement (Article 19).
According to Article 21 of this law, emergency medical care is provided by a medical organization and a medical worker to a citizen immediately and free of charge. Refusal to provide it is not allowed. Thus, the failure to provide assistance to a patient means, in addition to the refusal to provide assistance to the person who applied for it, the provision of assistance not in full, in violation of the requirements, as well as the provision of medical assistance in violation of the deadlines.
3. A mandatory sign of the objective side is the consequence - causing moderate harm to the health of the patient. With its onset the crime is over.
4. The subjective side of the crime is characterized by frivolity. If there is direct or indirect intent, failure to provide assistance to a patient is considered as intentional infliction of harm to health.
5. The subject of this crime is a medical worker - a person who has reached the age of 16, who has the right to engage in medical and pharmaceutical activities (doctor, paramedic, nurse), who is responsible for providing first aid to the patient (Articles 38 and 39 Basics).
6. The qualifying signs of failure to provide assistance to a patient (Part 2) are derivative consequences - the death of the patient or serious harm to health.
Behavior rules
Organization of first aid in the Russian Federation
Today, the first aid system in the Russian Federation consists of three main components:
1. Regulatory support (federal laws and other regulations and documents defining the responsibilities and rights of participants in the provision of first aid, their equipment, the scope of first aid, etc.).
2. Training participants in first aid in the rules and skills of providing it.
3. Equipping participants in providing first aid with means to provide it (first aid kits and packs).
Participants in first aid may have different training and equipment. They may also be required to provide first aid, or have the right to provide it.
In the event of any incident, as a rule, first aid can be provided by eyewitnesses to the incident - ordinary people who have the right to provide it. In most cases, they have minimal training and do not have the necessary equipment. However, witnesses to the incident can take simple steps to eliminate the immediate danger to the victims' lives.
Then they can be joined by vehicle drivers or employees of organizations and enterprises who have studied first aid techniques during appropriate training. They have a first aid kit (vehicle) or a first aid kit for workers, which can be used for more effective actions.
Employees of internal affairs bodies and fire and rescue units are required to provide first aid and have the appropriate equipment. Upon arrival at the scene of the incident, they must begin providing first aid, replacing other first aid participants.
In most cases, first aid should end with the transfer of victims to the arriving ambulance team, which, continuing to provide assistance along the way, delivers the victim to a medical facility.
Thus, providing first aid in most cases takes a short period of time (sometimes only a few minutes) before a more qualified employee arrives at the scene. But without providing first aid in this short period of time, the victim may lose the chance to survive in an emergency situation, or he will develop severe disorders in the body, which will negatively affect the process of further treatment.
Legal framework defining rights, duties and responsibilities when providing first aid
1. Federal Law No. 323-FZ of November 21, 2011 “On the fundamentals of protecting the health of citizens in the Russian Federation” defines first aid as a special type of assistance (different from medical care) provided by persons without medical education in case of injuries and emergency conditions until medical personnel arrive.
2. According to Part 4 of Art. 31 of the Federal Law of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation,” every citizen has the right to provide first aid if he has the appropriate training and (or) skills.
3. Legislation at various levels establishes the obligation to provide first aid for persons who, due to their professional duties, are the first to be at the scene of an accident with victims:
— employees of the internal affairs bodies of the Russian Federation;
— employees, military personnel and workers of all types of fire protection;
— rescuers of emergency rescue services and emergency rescue units;
— military personnel (employees) of the National Guard troops;
— departmental security workers, private security guards, customs officials;
- military personnel of the federal security service, bailiffs, employees of the penal system, freelance police officers and people's vigilantes and other persons.
Also, the obligation to “...take measures to provide first aid...” arises for drivers involved in an accident (clause 2.6 of the Road Traffic Rules of the Russian Federation). In the event that the driver is not involved in the accident, but became a witness to it, in accordance with Part 4 of Art. 31 of Federal Law No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation”, the driver has the right to voluntarily provide first aid.
Due to the high degree of potential risk of injury at work, Art. 228 of the Labor Code of the Russian Federation provides for the employer’s obligation in the event of an accident at work to “immediately organize first aid for the victim and, if necessary, transport him to a medical organization.” To organize the provision of first aid in the event of an accident at work by employees, the employer is obliged to organize first aid training for all persons entering work, as well as for employees transferred to another job (Articles 212, 225 of the Labor Code of the Russian Federation). For an employee, the Labor Code of the Russian Federation provides for the obligation to “be trained in safe methods and techniques for performing work and providing first aid to victims at work” (Article 214 of the Labor Code of the Russian Federation).
In relation to teaching staff, the above norms of the Labor Code of the Russian Federation are supplemented by the provisions of Art. 41 of the Federal Law of December 29, 2012 No. 273-FZ “On Education in the Russian Federation.” According to this article, protecting the health of students includes, among other things, training teaching staff in first aid skills.
The corresponding responsibilities for providing first aid are prescribed in the job descriptions of employees (including teaching staff).
4. Persons obliged to provide first aid are subject to liability for failure to provide first aid, up to and including criminal liability. For eyewitnesses of the incident who provide first aid voluntarily, no liability for failure to provide first aid can be applied. Special standards have been established for drivers involved in road accidents. Taking measures to provide first aid is one of the driver’s responsibilities in connection with an accident, for failure to comply with which the driver faces administrative liability and punishment in the form of an administrative fine (Part 1 of Article 12.27 of the Code of Administrative Offenses of the Russian Federation). In the event that a citizen knowingly left a victim in a helpless state without the possibility of receiving help, he may be prosecuted (Article 125 “Leaving in danger” of the Criminal Code of the Russian Federation).
5. Due to the fact that human life is declared to be the highest value, the very attempt to protect this value is placed above a possible error during first aid, since it gives the injured person a chance to survive. Criminal and administrative legislation does not recognize as an offense causing harm to legally protected interests in a state of extreme necessity, that is, to eliminate a danger that directly threatens the person or rights of a given person, if this danger could not be eliminated by other means (Article 39 “Extreme necessity” of the Criminal Code Russian Federation; Article 2.7 “Extreme necessity” of the Code of the Russian Federation on Administrative Offenses). There is a similar norm in the Civil Code of the Russian Federation (“Civil Code of the Russian Federation (Part Two)” dated January 26, 1996 N 14-FZ (as amended on March 28, 2017), Article 1067 “Causing harm in a state of extreme necessity.” Interpretation This article does not exclude the possibility of compensation for the harm caused, however, “...Taking into account the circumstances under which such harm was caused, the court may impose the obligation to compensate for it on a third party in whose interests the person who caused the harm acted, or exempt this third party from compensation in whole or in part.” person who caused the harm." Currently in the Russian Federation there are no judicial precedents for bringing to legal liability for unintentional harm during the provision of first aid.
6. If the court decides on the issue of bringing a person to justice for causing harm to life or health, providing first aid to the victim is taken into account as a circumstance mitigating the punishment (clause 2, part 1, article 4.2 of the Code of the Russian Federation on Administrative Offences; clause “ to" Part 1 of Article 61 of the Criminal Code of the Russian Federation). For example, for causing minor or moderate harm to health as a result of an accident in accordance with Art. 12.24 of the Code of the Russian Federation on Administrative Offenses provides for an alternative punishment. At the discretion of the court, the offender may be sentenced to a fine or deprivation of the right to drive a vehicle. The fact of providing first aid to the victim may contribute to the imposition of a more lenient punishment, that is, a fine. In addition, providing first aid can reduce the medical consequences of the injury; accordingly, the victim will be classified as harm of lesser severity.
The concept of "first aid"
Currently, first aid is defined as a set of measures aimed at maintaining life and health, provided before the provision of medical assistance to victims of accidents, injuries, poisoning and other conditions and diseases that threaten their life and health, by first aid participants. Its purpose is to eliminate life-threatening phenomena, as well as to prevent further damage and possible complications.
List of conditions for which first aid is provided, list of measures to provide it
In accordance with the order of the Ministry of Health and Social Development of the Russian Federation dated May 4, 2012 No. 477n “On approval of the list of conditions for which first aid is provided and the list of measures for providing first aid,” first aid is provided for the following conditions:
1. Lack of consciousness.
2. Stopping breathing and blood circulation.
3. External bleeding.
4. Foreign bodies of the upper respiratory tract.
5. Injuries to various areas of the body.
6. Burns, effects of exposure to high temperatures, thermal radiation.
7. Frostbite and other effects of exposure to low temperatures.
8. Poisoning.
In these conditions, the following measures are taken:
1. Measures to assess the situation and ensure safe conditions for providing first aid:
— identification of threatening factors for one’s own life and health;
— identification of threatening factors for the life and health of the victim;
— elimination of threatening factors for life and health;
— termination of the action of damaging factors on the victim;
— assessment of the number of victims;
— removing the victim from the vehicle or other hard-to-reach places;
- moving the victim.
2. Calling an ambulance or other special services, whose employees are required to provide first aid in accordance with federal law or a special rule.
3. Determining whether the victim has consciousness.
4. Measures to restore airway patency and determine signs of life in the victim:
- throwing back the head with lifting the chin;
- extension of the lower jaw;
- determining the presence of breathing using hearing, vision and touch;
— determining the presence of blood circulation, checking the pulse in the main arteries.
5. Measures to carry out cardiopulmonary resuscitation until signs of life appear:
- hand pressure on the victim’s sternum;
— artificial respiration “Mouth to mouth”;
— artificial respiration “Mouth to nose”;
— artificial respiration using a device for artificial respiration (in accordance with the approved requirements for equipping first aid kits (packs, sets, kits) with medical products for first aid).
6. Measures to maintain airway patency:
— giving a stable lateral position;
- throwing back the head with lifting the chin;
- protraction of the lower jaw.
7. Measures for a general examination of the victim and temporary stop of external bleeding:
— general examination of the victim for the presence of bleeding;
- finger pressure of the artery;
— application of a tourniquet;
- maximum flexion of the limb at the joint;
- direct pressure on the wound;
- applying a pressure bandage.
8. Measures for a detailed examination of the victim in order to identify signs of injuries, poisoning and other conditions that threaten his life and health, and to provide first aid if these conditions are identified:
- conducting a head examination;
- performing a neck examination;
- performing a breast examination;
- performing a back examination;
- examination of the abdomen and pelvis;
— conducting an examination of the limbs;
— application of bandages for injuries to various areas of the body, including occlusive (sealing) for injuries to the chest;
— carrying out immobilization (using improvised means, autoimmobilization, using medical products (in accordance with the approved requirements for equipping first aid kits (packs, kits, kits) with medical products for first aid);
— fixation of the cervical spine (manually, with improvised means, using medical products (in accordance with the approved requirements for equipping first aid kits (packs, kits, kits) with medical products for first aid);
- stopping the victim’s exposure to hazardous chemicals (gastric lavage by drinking water and inducing vomiting, removing from the damaged surface and washing the damaged surface with running water);
— local cooling for injuries, thermal burns and other effects of high temperatures or thermal radiation;
— thermal insulation against frostbite and other effects of low temperatures.
9. Giving the victim an optimal body position.
10. Monitoring the victim’s condition (consciousness, breathing, blood circulation) and providing psychological support.
11. Transfer of the victim to an ambulance team and other special services, whose employees are required to provide first aid in accordance with federal law or a special rule.
