1 Legal minimum of a doctorSeminary Course of Health and medical law
2 State examinations questionsThe state's role in health care, state administration and local government in health care, Estates chambers obligations of members of ČLK (Czech Medical Association) Healthcare provider, obligations and conditions for the operation of health care services; (Accreditation of health services, system of health care providers, types and forms of health care) The system of medical professions, basic assumptions to practice medicine; specialized education of a physician, lifelong education of a doctor The rights and obligations of citizens in health care (citizens' rights, patient's rights, patient's right to information) Basic obligations of healthcare professionals Informed consent with medical performance; denial of medical care by a patient, form and essentials of the negative reverse Legal liability in health care (civil liability of healthcare providers; criminal liability of doctors; disciplinary responsibility of a doctor; offenses and administrative delicts in health care. Medical documentation, privacy of a patient and rights of a close person
3 You know from lectures The state's role in health care, state administration and local government in health care, Estates chambers obligations of members of ČLK (Czech Medical Association) Healthcare provider, obligations and conditions for the operation of health care services; (Accreditation of health services, system of health care providers, types and forms of health care) The system of medical professions, basic assumptions to practice medicine; specialized education of a physician, lifelong education of a doctor (partly) medical documentation
4 What you will know from today's seminarThe rights and obligations of citizens in health care (citizens' rights, patient's rights, patient's right to information) Basic obligations of healthcare professionals Informed consent with medical performance; denial of medical care by a patient, form and essentials of the negative reverse Legal liability in health care (civil liability of healthcare providers; criminal liability of doctors; disciplinary responsibility of a doctor; offenses and administrative delicts in health care. (part of question 8), privacy of a patient and rights of a close person
5 Before we begin… Healthcare Services Act (HCA)Generally regulates health services and conditions for their provision the rights and obligations of patients, persons close to patients, health providers and healthcare professionals Act on Specific Healthcare Services (ASHS) Everything that deviates from the "standard" A set of exceptions from the ASHS without much of consistency Assisted reproduction, Sterilization, Psychosurgical interventions, Blood Collection, Reports, occupational medicine, protective treatment Civil Code (CC) The basic framework for social relationships between people Regulates among other things Contract law and liability
6 Healthcare professionalBefore we begin… Healthcare professional According to the Healthcare Services Act Physicians and „other Healthcare professionals" Some regulations use „health professional“ in the strict sense (non-doctor professions) Other specialist Person providing activities that are directly related to the provision of health care under professional supervision or direct guidance of qualified medical staff Psychologist, social worker, occupational therapist
7 Group of issues No.1 The rights and obligations of citizens in health care (citizens' rights, patient's rights, patient's right to information)
8 Patient has rights: As a citizen to health protection.to free health care right to medical aids under conditions provided by law. As a policyholder to choose the health insurance company to time and the local accessibility and availability of paid services On medicinal product and foods for special medical purposes As a patient "Patients means a natural person, which are provided by the health services" His rights correspond with obligations of healthcare provider and medical staff
9 Rights of the patient (§28 HCA)Right on the provision of health services at the appropriate professional level according to the rules of science and accepted medical practices, while respecting the individuality of the patient, with regard to the specific conditions and objective options. to esteem, treated with dignity, to be treated with courtesy in accordance with the nature of health services, respect for privacy during the provision of healthcare services in accordance with the nature of healthcare services, Related rules for the close persons, medical documentation, etc.
10 Rights of the patient (§28 HCA)to choose a provider authorized to provide healthcare services, to seek consulting services from another provider or healthcare professional, other than that who provides health services; to be informed about the internal rules of the healthcare facility inpatient or day care
11 Rights of the patient (§28 HCA)to be informed in advance about the cost of health services not covered by public health insurance, to know the names and surnames of healthcare professionals directly involved in the provision of healthcare services providing of healthcare services to reject the presence of persons who are not directly involved in the Including those preparing for the profession of healthcare professional,
12 Rights of the patient (§28 HCA)to receive visitors in a medical facility of inpatient or day care, with regard to their health in accordance with the internal rules in a manner which does not infringe the rights of other patients, unless HCA or another law provides otherwise to receive the pastoral care and spiritual support from spiritual churches and religious communities on provision of health services in the least restrictive environment while ensuring the quality and safety of healthcare services.
13 Obligations of the patient (!)to follow a designed individualized treatment procedure to follow the internal rules, to pay the provider cost of health services provided to him with his consent truthfully inform healthcare professional about the development of health condition, including information on infectious diseases not to drink alcohol or use other addictive substances during hospitalization and undergo in justified cases examination in order to establish whether or not is the patient under the influence of alcohol or other addictive substances at the discretion of the attending physician
14 Refusal to provide healthcare services
15 It is necessary to distinguishRejecting by a Healthcare Professional Retention of conscience refusal to provide healthcare services to the patient if the disclosure would be contrary to conscience or religious beliefs of a healthcare professional Rejecting by a Healthcare Provider rejection of proof of identity exceeding the workload operational reasons not insured Foreigners from the EU have a special regulation
16 transfer the patient to another healthcare provider Termination of the healthcare (provider) transfer the patient to another healthcare provider There are no longer reasons for the provision of healthcare services; does not apply in the case of the registering provider patient refuse the provision of all healthcare services, patient severely restricts the rights of other patients deliberately and systematically fails to comply with the proposed individual medical procedure, if he gave his consent to the provision of health services, Does not follow internal rulles does not cooperate;
17 Informed consent with medical performance; denial of medical careGroup of issues No.2
18 Distinguish Free of will InformedInformed consent Information about health condition Free of will Informed notified upon admission to healthcare Always if it is purposeful The patient may waive
19 Information about health conditionabout the disease, the purpose, nature, expected benefits, potential consequences and risks of the proposed health services other possibilities, their suitability and risks another needed treatment, restrictions and recommendations in the way of life with regard to health conditions options To waive the right to be informed about health condition identify the persons to whom the information may be given or to impose a ban on reporting on health condition according to § 33.
20 Retention of health information,The information would cause serious injury to the patient. Does not apply if: a) there is a need for early treatment, b) risk for the surroundings, c) patient specifically asks for accurate and truthful information.
21 Written form of a consentConsent with hospitalization must be in writing. Written form of a consent must be where it is required by law or a provider. Remember HCA, transplantation Act,
22 Previously expressed wishesDisagreement Revers Withdrawal of consent Previously expressed wishes
23 REVERS Withdrawal of consent Recordthe patient is informed about his health condition and still refuses treatment makes a written declaration of refusal Withdrawal of consent Patient may withdraw his consent to the provision of healthcare services unless the medical procedure has allready started and its termination may cause a serious injury to the patient. Record Written consent and written withdrawal of a consent or its record is a part of medical documentation It is signed by a patient and healthcare professional Patient may refuse to sign - healthcare professional and witness
24 Previously expressed wishesPatient may express agreement / disagreement in advance in certain cases Provider takes into account the previously expressed wishes if it is available there was a predictable situation which previously expressed wish covers patient is unable to pronounce a new agreement or disagreement Previously Expressed wishes will be respected If it was based on a written notice about the consequences of his decision. It must be in writing and shall bear an officially verified signature of the patient. If a written notice of the attending physician is a part of previously expressed wishes.
25 When it is not necessary to respect the previously expressed wishes?From the expression occurred such developments on which basis it can be reasonably assumed that the patient would give his consent; Patient encourages to cause his death, Its fulfillment could threaten others, If the provider started a healthcare procedures at the time he did not know previously expressed wishes and interruption of such procedures would lead to an active cause of death.
26 Underage patient it is necessary to know his opinion on the planned provision of health services if it is appropriate to his age and maturity. the importance of his opinion increases in proportion to age and degree of maturity. The intended health services can be provided to an underage patient on the basis of his consent if the execution of such procedure is appropriate to his mental and moral maturity and corresponds with his age.
27 Hospitalization and provision of health services without consentcondition of the patient requires the provision of urgent care and he is unable to give his consent at the same time Urgent care case of health services essential to saving lives or preventing serious damage to health.
28 The patient can not give his consentconsent of other legally competent close person parents spouse or registered partner consent of the person designated by the patient
29 Basic rights and obligations of healthcare professionals
30 Rights and obligations …..Provider Healthcare professional
31 Rights and obligations of healthcare professional
32 Healthcare proffesional is…a person performing the medical profession
33 Obligations of healthcare professional according to HCAand to act in accordance with ethical principles, on appropriate professional level to the extent corresponding to their competence, patient's medical condition (a) provide healthcare services to which they have a professional or specialist qualification,, b) immediately provide first aid to everyone c) fulfill other obligations imposed by HCA or other legislation.
34 Rights and obligations under the Labour CodeThe employee is required: Follow the instructions of the employer held work personally according to a employment contract in apportioned working time and to comply with obligations that arise from the employment relationship.
35 Rights of a healthcare professionalHealthcare worker has the right a) to obtain information from the patient that the patient is the carrier of infectious diseases and on other relevant matters relating to the patient's health status, b) do not provide healthcare services in the case that there would be a direct threat to life of healthcare worker or a serious threat to his health during their provision. c) do not provide healthcare services in a case of retention of conscience (there are some restrictions on this right)
36 Medical documentation and the confidentiality obligationGroup of issues No.4
37 Patient privacy Medical documentation
38 Medical documentation HCAThe provider is obliged to keep and store medical records Medical documentation is a collection of information related to a specific patient.
39 Form Physical Electronic Parallel
40 Access to a medical documentation
41 Healthcare professionalpersons with competence for the medical profession in direct connection with the provision of health services to the extent necessary for the profession due to completion of tasks under HCA or any other legislation when evaluating the correct procedure for the provision of health services
42 Patient in the presence of personnel authorized by a providerThe right to make copies or extracts
43 legal representative or custodian of the patient Family, relatives, mourners legal representative or custodian of the patient the person designated by the patient, legal representative or custodian of the patient people close to the deceased patient information about the health condition of a patient who died, information on the outcome of the autopsy, including the right to inspect medical documentation and take extracts from it or make copies. The deceased could prohibit such access in advance
44 Students Persons studying towards qualifications for the profession of a healthcare professional may inspect medical documentation to the extent necessary to ensure the teaching, this does not apply if the patient clearly forbade it NO ! extracts or copies
45 Making copies Provider A person entitled by lawMake a record about every copy ( excluding healthcare professional)
46 The provider is obliged to maintain confidentiality about all facts of which he learned in connection with the provision of health services
47 Breach of confidentiality is nottransmission of information necessary to ensure the continuity of health services, transferring the data or other evidence if the provider is relieved of confidentiality by a patient for the purpose of criminal proceedings to the extent necessary to protect own rights
48 the right to protection of life and health Civil code (apply in parallel HCA) the right to protection of life and health No person shall interfere with the privacy of another, unless lawful reasons. It is forbidden to disrupt private space of a man, pursue his private life or make an audio or video recording and distribute this record without a permission
49 Criminal liability Who even negligently breached the duty of confidentiality in connection with the exercise of his profession by unlawfully disclosure or by giving access to personal data to a third party will be punished Up to three years or prohibition of activities
50 Protection of personal dataSpecific regulations It also applies to databases outside medical documentation It also applies to samples and biometric data
51 Detour: Definition of Close persons
52 Close persons a direct relative, sibling
53 Close persons spouse / partner
54 Close persons another person in a family or similar connection are considered as close persons, if the harm suffered by one of them, other considers as his own injury persons who permanently live together.* brother-in-law / sister-in-law* * rebuttable presumption
55 Close persons
56 Close persons The world's biggest family: The man with 39 wives, 94 children, 14-daughters-in-law and 33 grandchildren. The Ziona family in its entirety with all 181 members.
57 (some) The rights of close personsPatient's right to a permanent presence of CP The right to information about the current state of health The right to give a consent to the provision of health care Lodge a complaint
58 Group of issues No.5 Liability
59 Právní odpovědnost ve zdravotnictví
60 Assumptions of LiabilityBreach of legal obligations Causality Damage/violation of a legally protected interest
61 Breach of legal obligationsThe obligation given: By the Agreement By the law Types of culpability Intention Negligence
62 Lex artis Procedure according to "normal" levelsCompliance with professional standards The patient has the right to health services on appropriate professional level. Lex artis is a concept that applies to providers as well as healthcare professional
63 Parts of lege artis Professional qualifications healthcare professional Providing medical care to the best and at the moment the available options Providing medical care without negligence
64 List of procedures lege artisDoes not exist Recommendation of Czech medical societies … Ultimately, the choice is on doctors
65 Problems Retention of conscience Rejection of healthcare by a patientLack of resources for treatment lege artis
66 Obligation of preventionObligation to prevent unjustified harm to freedom, life, health or property of another. The duty of everyone who has control over dangerous situations to take action to protect the rights of another.
67 Types of liability Civil Labor Administrative Penal Disciplinary
68 Liability under civil law
69 Damages Harm Property damage Non-material damage
70 Coincidence The obligation to pay compensation has the one who caused the circumstances leading to coincidence.
71 Exclusion of unlawfulnessNecessary defense Before the attack Extreme distress Before the threat of injury Excusable excitement The excitement of the mind is taken into account when assessing whether someone acted in self-defense, or in extreme distress
72 Waiver of compensationIf the fulfillment of obligations under the contract was temporarily or permanently prevented by: exceptional unpredictable unsurpassable obstacle arising independently of the will.
73 Damage caused by information or adviceWho reports himself as a member of a particular state or profession to professional performance or otherwise act as an expert, Is responsible for Damages, if the harm is caused by an incomplete or incorrect information or harmful advice if he received the reward for this counsel
74 The extent of compensation
75 General provisions (1) Damage should be replaced by indicating to the previous status. If it is not possible, or is asked by the damaged, the damage is payable in cash. (2) Non-pecuniary damage is redresses by adequate satisfaction.
76 Range Actual damage Loss of profits
77 Reimbursement of harm of healthHarm is replaced by a financial compensation pain suffered and other non-pecuniary damage; social impairment arose if the harm of health caused a setback of better future of a victim.
78 The killing In case of death or extremely serious injury, the one whou caused it is responsible to compensate for damage caused by mental suffering of a spouse, parents, childs or other close persons. Funeral expenses Costs for maintenance of the residuars
79 The costs associated with health care reasonably incurred costs associated with health care of the damaged, with the care of his person or his household to anyone who's spent them Compensation for loss of earnings Compensation for loss of a pension
80 A crime
81 A crime A criminal offense is an unlawful act that criminal law identifies as a crime, and that has the characteristics specified therein. The criminal liability for the offense is intentional culpability unless the Criminal Code expressly states that culpable negligence suffices. Intentionally committed crime Negligence
82 The principle of subsidiarityCriminal liability and criminal consequences associated with it can be applied only in socially harmful cases in which it is not sufficient to establish the liability under other legislation.
83 Disciplinary liabilityMedical Authority Disciplinary liability
84 Each member of the Chamber has the obligationa) exercise their profession in accordance with its ethics and manner specified by law, b) observe the organization, rules, election and Disciplinary Rules of the chamber, c) properly fulfill defined contributions d) notify the competent authorities of the chamber changes related to the exercise of medical or pharmaceutical profession, e) conclude liability insurancein cases specified by the Chamber
85 Disciplinary liability- Every citizen has the opportunity to submit complaints free of charge to authorities of CLK about the conduct of doctors, if he considers that the doctor acted unprofessionally or behaved unethically. - fine up to Kč - Exclusion from Czech Medical Chamber de facto prohibition of activities for up to 5 years