The reform of the medical sector is still provoking discussions among industry representatives. For example, the documents do not contain a single word about the legal protection of doctors and clinics.
As cases of lawsuits against doctors have become more frequent in recent years, the issue of legal protection becomes more and more topical.
The main fears of clinic managers
Patients by default have a lot of leverage on doctors if they are dissatisfied with the medical care provided. For example:
Complaints. Patients can file a complaint anywhere: with the Ministry of Health of Ukraine, the Consumer Protection Society, law enforcement agencies and even the Antimonopoly Committee of Ukraine. This threatens the clinic with a chain of checks, fines and possibly loss of license.
But if you make inspections and everything in your institution will be perfect – from the order of services to the registration of the consumer corner – then such an audit will play into your hands and make a model of compliance with regulations.
Claims. The complaint can be written by the patient or his lawyer. Either way, this is a great excuse for the clinic management to see their problems and shortcomings. After analyzing the claim, you will understand how justified it is, and choose the appropriate tactics for the defense.
The lawsuit. A lot of time passes between the receipt of the lawsuit and judgement. Therefore, do not immediately panic and prepare for unpleasant consequences. The chance of reaching an amicable settlement with the patient is very high.
But do not go from the start to negotiate with your lawyer – it will only increase hostility towards you. Use professional legal assistance only in two cases: if the case came to court and if you were called to the investigator as a witness.
If the patient claims financial compensation, remember that not all of the expenses can be documented. In addition, moral damages of a million or two (and other incredible amounts) are a story from a movie, and in practice such claims are usually not satisfied by the court.
Criminal liability. It is only the doctor who has provided poor medical care. But at the same time, the clinic can file a civil law claim for compensation.
In fact, it is almost always possible to resolve a conflict peacefully and with minimal financial loss. Better yet, it is possible to protect yourself in advance. It’s time to discuss options.
Contract for medical services.
It’s an optional document, but it protects against possible disputes. It is appropriate to conclude it in several cases:
- If the medical service is repeated, or a single one at a certain stage, or if the payment for the service is payment at certain intervals.
- If a refund is possible (for example, if the patient refuses further treatment at some point).
- If you want to stipulate the specifics of the service. Describe all conditions in the agreement: rights and obligations of the patient, sequence of his/her actions. This minimises the possibility of conflict.
But remember, the contract is not a panacea. You cannot include obligations that violate patient rights under applicable law.
Consent to the provision of medical services.
This document has become mandatory. This is protection of the clinic not from the patient, but from inspections by the Ministry of Health of Ukraine. The first thing that is checked by the clinical expert commission is whether there is a consent approved by the Ministry of Health of Ukraine.
It is optimal if you create an extended consent that describes in detail the treatment, possible consequences and other details. It is desirable for the patient to sign this document, rather than just read it. If the patient does not give consent, do not provide medical treatment.
Consent should not be taken only if there is a threat to the patient’s life and health. In such cases, it is not taken from relatives or from the person who brought the patient to the clinic.
Refusal to treat.
Exempts from possible negative consequences, but only if it is documented and signed by the patient. It is the doctor’s responsibility to warn of all the threats that stop treatment. If the patient still does not want to continue treatment afterwards, a written refusal must be taken from the patient. There is no form for a document, so it can be prepared at your discretion.
The easiest way is to develop a form that patients will fill in. The doctor can also make an entry on the medical record and let the patient sign it.
It may happen that the patient does not want to continue treatment or sign a waiver. In such a case, the doctor will draw up a rejection form. In the presence of three witnesses, the circumstances in which the patient refuses treatment are reproduced, an act is drawn up and the witnesses are given the opportunity to sign. It is mandatory that the witnesses are medical staff, otherwise it will be a disclosure of medical confidentiality.
Protect the doctor in the event that the patient does not perform the prescription or if complications arise, goes to another institution. This should describe the prescription in detail, the treatment instructions and indicate that in the event of negative consequences, the patient should seek your help, otherwise you are not responsible for the complications.
This will protect the doctor from situations where the patient “tolerates until the last one” and then goes to the first clinic he or she finds, where he or she is given poor quality care.
If force majeure occurs, the committee first examines the medical records and then examines the patient. It is therefore necessary to fill in the card in as much detail as possible so that the circumstances of the medical history can be understood even without the explanations of the attending physician.
If you keep an electronic card, it is advisable to periodically print out new records so that the doctor’s signature is on the records of the treatment diary.
There are situations when a patient files a complaint a year, two or more after treatment. At this point, the doctor treating him may no longer work in the clinic and it is impossible to sign his diary. In this case, it is already difficult to prove that the treatment was carried out exactly as it is written, and the entire responsibility lies with the clinic.
When you create a medical record, before starting treatment, let the patient fill in a form where he or she will state important information about himself or herself: whether he or she is taking any medication, what diseases and operations he or she has undergone, etc. In this way, you avoid situations where there are complications during treatment and the patient says, “I told you so”.
If you are asked to provide the original medical records, you have the right to refuse. The patient has the right to see his/her card, but the clinic is obliged to issue the originals only in one case: when there is an order from the investigating judge to access the originals of the medical card.
Remember the doctors’ golden rule: the medical card is written for the prosecutor. Fill in the documents in detail and in time, because without them it is impossible to prove your right.