Call for support for Russian physician prosecuted for helping a patient in pain

On 27 April 2009 Dr A Khorinyak wrote out two prescriptions for tramadol for Victor Sechin, a terminally-ill cancer patient. The patient was suffering from intractable pain and Dr Khorinyak provided two prescriptions for tramadol, despite the fact that the patient did not reside in the service area of Polyclininc No. 4.

In 2011, the Federal Drug Control Service discovered the prescriptions at the local pharmacy, and referred the case to the prosecutor and the court. Physician A. Khorinyak and L.N. Tabarintseva were charged with two articles of the Criminal Code of the Russian Federation:

• Article 234 of the Criminal Code: “Trafficking potent substances in large quantities by prior agreement with the intent to sell, an organized group”
• Article 327 of the Criminal Code: “Forgery of documents in order to facilitate the commission of another crime.”

Victor Sechin was suffering from congenital muscular amyotrophy and a terminal stage of malignancy.  Dr Khorinyak, as a friend of the family, had known him for over 20 years. In 2006 Dr Khorinyak diagnosed Victor Sechin with a malignant neoplasm, made referrals for other specialists, was caring for him after his operation, and helped to place the patient under the supervision of the Cancer Center.

The patient suffered from unbearable pain that did not allow him sit, lie down, or sleep. At the end of March 2009 the attending physician from Mr Sechin’s polyclinic increased the dosage of ‘Duragesik’ patches with 75 mcg / hr to 100 mcg / hr. However, Duragesik in a dosage of 100 mcg / hr was not available at the pharmacy and the patient continued to receive Durogesik in an insufficient dosage, but in combination with tramadol in tablets.

On 18 April 18 2009 Victor Sechin’s pharmacy, which he had to go to in order to get free tramadol and have his prescription paid for from his federal benefits, did not have tramadol available. The attending physician refused to write a prescription for tramadol, which was available at another pharmacy for a fee (Mr Sechin received his next prescription for tramadol only on 22 May 2009).

Day after day and night after night, the patient flailed about in bed and asked for pain relief. His relatives were unable to witness his sufferings any longer and went to Dr Khorinyak, who had observed the patient for many years. Dr Khorinyak wrote two prescriptions for tramadol to the patient suffering from intolerable pain.

L.N. Tabarintseva, another friend of Mr Sechin’s family, purchased the medication and hand delivered it to the patient.

Judge Nonna Markova found Dr Khorinyak guilty on both counts, without giving weight to the arguments of Dr Khorinyak’s attorney about inconsistencies in the case and the unlawfulness of the charges.  

The arguments were as follows:

1. The presence of medical indications for tramadol treatment for the patient Victor Sechin was confirmed by numerous documents.

2. There was a medical necessity for tramadol prescriptions for pain management for the patient. The prescription forms had been certified by a personal signature and a personal seal of physician A. Khorinyak, as well as, by the seal and the stamp of the Polyclinic No. 4.

3. The lack of attachment of the patient to Polyclinic No. 4, which employs Dr. A. Khorinyak, does not have legal value.

4. Facts presented and recorded at the trial indicated that the witnesses in the case were pressured.

Given the advanced age of the accused, the Court sentenced Dr. A. Khorinyak with a fine.

Physicians, health professionals, and concerned citizens demand that the criminal verdict for Dr. A. Khorinyak be reversed and declare:

• Dr A Khorinyak’s actions were intended to provide relief from the suffering of the patient and she acted in accordance with her professional duties.
• Criminal penalties for performing of medical debt are unjustified.
• The case of Dr A Khorinyak is an incrimination of the medical system for failing to provide health care to terminally-ill patients in Russia.
• There is an urgent need to revise the inadequate and distorted system for prescribing opioids and other potent medications for medical purposes for patients such as Victor Sechin. Special control from the Government of the Russian Federation should be in place to ensure that opioids and other potent medications from the List of Essential Drugs are available and in appropriate quantities and dosages to patients in need.

In a message of support, Trustees of the Worldwide Palliative Care Alliance said: “The Worldwide Palliative Care Alliance is seriously concerned to hear about the prosecution of Dr Alevtina Petrovna Khorinyak. Adequate access to palliative care and pain relief is a basic human right as enshrined in the Prague Charter and restrictive opioid legislation has been shown to be a barrier to the realisation of this right. We fully support Dr Khorinyak in attempting to provide  pain relief for patients coming to her for help. We stand in defence of her professional practice and her humane response to patients in pain. We add our voices to those of her colleagues in demanding that the criminal verdict against Dr. A. Khorinyak be reversed and that there is an urgent review of laws restricting access to opioid medication for pain control by the Government of the Russian Federation.” 

ehospice readers can show their support for Dr Khorinyak by signing an online petition.