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The disease twisted the joints
Akvilė Maurinaitė has suffered from juvenile rheumatoid arthritis for thirteen years. The disease was diagnosed when he was only seven years old. During that time, the condition of Kaunas residents deteriorated. The disease severely twisted the joints of the arms and legs: deformities and multiple damage to the joints occurred. As a result, the girl can no longer perform basic actions on her own: washing, combing her hair, preparing to eat. She can’t even open a bottle of mineral water by herself. “My mom helps me all the time,” says Aquile.
After reading the answer, I cried. Everything goes wrong for me, and according to NDNT’s conclusions – good.
Two years ago, NDNT had determined 40% for A.Maurinaitė. level of work capacity. Knowing these documents would expire soon, Aquile asked his family doctor for a new referral to NDNT in early summer. In July, after receiving the documents, which the girl managed to collect without the girl’s direct consultations with medical specialists, Akvilė presented them to the NDNT unit in Kaunas – to determine her work capacity and issue a new disability certificate.
“I used to have to go to the NDNT for a visual inspection, but now they told me they would contact me by phone. A few days later an office worker called. I asked if I could move, walk or drive it myself. There weren’t many questions, the conversation was nice. In short, “the girl recalled.
A couple of weeks later, Akvilė received the findings and other documents signed by Rimvydas Grigaliūnas, the head of the NDNT Kaunas II territorial division. “After reading the response, I cried. I couldn’t believe the NDNT had decided that my health was improving; instead of the previous 40 percent work capacity, I now set a 50 percent higher work capacity level.” the girl recalled about the unexpected findings of the service. NDNT findings: well, I find it more difficult to move, I only walk with a walker, crutch or supported by another person, I can no longer bend down, lift a fallen object, I can serve even less than before, it is difficult for me to write I have been self-sufficient, now I need often the help of my loved ones. The disease progresses: the joints become increasingly swollen, deformed. “
Due to deformities in the joints of her arms and legs, the girl is unable to walk and do a lot of manual work, but NDNT has determined that she can work as a driver, lift loads of up to 10 kg and do other jobs. (Personal file photo)
No photos needed
A.Maurinaitė was surprised that NDNT employees drew conclusions about his health improvement without even seeing him. The girl recalled that two years ago, when she had previously determined her work capacity, she had to go to the NDNT herself, where her skills were also tested. “I don’t see how you can use a phone conversation to draw conclusions about a level of ability to work. After all, a person can deliberately lie to say that they feel worse than they actually feel to have a lower level of ability. to work. lying, I could say that I couldn’t walk at all. But I wanted to be honest, I said everything as it really is and suffered, “said the girl, who hinted that NDNT did not need any pictures of her showing deformed joints.
Furthermore, according to Ms Akvilė, the medical documents she submitted to the NDNT were incomplete. “Due to the threat of the coronavirus, not all medical specialists were able to examine me and determine how much I could do now. As a result, the family doctor did not examine me either; he relied only on previous extracts, no new tests were carried out to evaluate my health, my abilities were not assessed according to the Barthel index, “the girl pointed to the neglect test.” And my GP’s referral to the NDNT indicates that some qualifications are missing. Also, the family doctor wrote in that referral that I I had an incurable progressive disease. In fact, my health is currently deteriorating, I should go to the hospital, but due to the threat of the coronavirus, the doctors did not recommend it. After all, sometimes the coronavirus takes people’s lives healthy and it would be even more difficult for me to fight it because of my illness. “
The lack of data and medical records of progressive incurable disease did not prevent the NDNT from concluding that the girl’s level of work ability had increased. The decision of the Territorial Division of the Kaunas II Service establishes that A.Maurinaitė can perform the following jobs: working in outdoor conditions, working with ionizing radiation and mechanical equipment, working with manual feed, driving vehicles, lifting loads up to 10 kg to hand. The girl says she has no idea how she could do that job. “According to the NDNT, I can work as a driver. But I rarely drive a car with an automatic transmission. Whether I can do it depends on my health. Also, I only drive short distances. When it comes to lifting loads, I am a downed man.” bear it, and much less load of 10 kg “, the girl was surprised by the findings of the NDNT.
Personal file photo
A.Maurinaitė yesterday appealed the decision of the Territorial Division II of NDNT Kaunas.
Teacher: This is wrong
Rheumatologist Mykolas Petraitis, a doctor at the Kaunas Clinics Rheumatology Clinic, who in recent years advised A. Maurinaitė on the treatment of rheumatoid arthritis, refused to assess whether the girl’s level of work capacity was older than two years ago. He submitted a comment only on the disease itself. According to the doctor, juvenile rheumatoid arthritis is a chronic progressive disease with inflammation of the joints of the legs and arms and, as the disease progresses, deformities of the joints. “In the past, this disease caused complete disability in patients, that is, a person could no longer move independently. However, for more than 10 years in Lithuania, patients with juvenile rheumatoid arthritis have been applying biological therapy and with successful results, drugs can only temporarily stop the progression of the disease and cannot eliminate the damage to health caused by the disease “, M. Petraitis briefly described the disease and its treatment.
A.Maurinaitė said that he has been using biological medicines since 2009. However, even they did not always help to curb the disease. “In the last year, two biologics changed me because they still did not help, there was no effect. I am using the third now, but I feel a strong side effect. I will have to ask my doctor to change them,” said the interviewee.
Professor Julius Kalibatas, President of the Lithuanian Association of General Practitioners, was surprised that the NDNT’s work capacity level was determined on the basis of a telephone survey and incomplete medical documents lacking an evaluation of the Barthel index of the capabilities of a person. “In my opinion, it is incorrect to determine the level of work capacity only by listening to the phone and having incomplete medical records. The level of work capacity should be determined by the Medical Advisory Commission (CCG), which normally employs the best specialists. determines the work capacity, consult a specialist specialist. All documents must be presented and reviewed, and the person is directly evaluated “, said the professor.
Determining the level of work ability solely by listening to the phone and having incomplete medical records is, in my opinion, incorrect.
According to the interlocutor, now that the quarantine has been lifted and the Health Minister has long asked doctors to provide direct advice, the NDNT should respond.
Service feels good
Rimvydas Grigaliūnas, the head of the NDNT Kaunas II territorial division, who signed the response to A.Maurinaitė, declined to comment on the situation, stating that the comments were provided by employees of the service in Vilnius.
Viktorija Vasiljeva-Gringienė, Deputy Director of NDNT, stated that the change in the level of work ability of A. Maurinaitė was not determined by a telephone survey, but by the conclusions presented by doctors: “The level of work ability is determined by the This year, as the doctors had indicated second-degree disease activity, a higher level of work capacity was established (…) in this case ”.
According to the interlocutor, GKK has not been involved in NDNT for a long time, for several years. “The law establishes the responsibility of the patient’s treating physician to prepare a referral to the NDNT. This could be a family physician or a physician who treats an illness that results in a person being recognized as disabled,” said the NDNT deputy director. .
Photo by Justina Lasauskaitė
When asked how the service representatives themselves assess the possibility of objectively determining the level of work ability without seeing a person without visually assessing them, V. Vasiljeva-Gringienė replied: “Currently, special conditions apply. As for determining the level of work capacity, were established by two ministers: Exceptions were made to interview people remotely during quarantine and, in an emergency, when we first determined a person’s capacity to work, we interviewed them in alive and, in repeated cases, remotely, meaning that we have seen the person once, we know their functional disorders.
This procedure will remain in effect for the duration of the emergency. “
V. Vasiljeva-Gringienė stated that a fairly comprehensive questionnaire is used when interviewing a person remotely.
Asked why the service specialists did not miss A.Maurinaitė’s skills assessment according to the Barthel index, the NDNT representative replied: “Now the Barthel index is no longer used to determine disability, it is not considered a tool suitable for assessing human abilities. This is a medical criterion. However, in the case of the human disease in question, the Barthel index had no effect on the determination of work capacity.
If, in the current circumstances, the NDNT no longer accepts the population for re-disability and if their medical records are incomplete due to limited access to doctors, they do not reflect the actual state of health, why extend the disability for two years instead of several months until the COVID-19 pandemic ends? To this question, V. Vasiljeva-Gringienė replied: “The deadlines are regulated by law. However, if the health status changes, a person can apply to the NDNT with a new referral before the deadline to determine their capacity. If the girl thinks her condition is more serious than the doctor If her illness has worsened, she can request a new referral before the deadline. There will be no obstacles to a reevaluation. “
According to the NDNT deputy director, there are no time frames to reapply for this service, and this can be done immediately after the level of work capacity has been determined.
The number of complaints is the same
Total since March 16. (when the quarantine was announced) before July 31. NDNT employees remotely completed a questionnaire from which the level of work ability was determined. 651 person. This figure also includes cases where the level of work capacity was determined for the first time and repeatedly during quarantine, as well as cases where the level of work capacity was determined again during an emergency.
From March 16. until July 31. in total, NDNT made 19,822 thousand. evaluations of the level of work capacity.
According to V. Vasiljeva-Gringienė, the number of complaints submitted to the service during quarantine and in case of emergency did not increase, remained the same and reached 3%. of the total number of cases of determination of the level of work capacity. According to her, this percentage has not changed for twelve years.
During the first seven months of this year, the NDNT determined the level of disability, work capacity and special needs at 38,102 thousand. people, of which 1,239 thousand filed complaints. In the same period last year, NDNT served 51,719 thousand. people, received 1,656 thousand. complaints.
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