Fundamental rights of the patient. Patient protection

Any of us has ever come across medicine, whether it’s consulting a doctor, staying in a hospital, or simply passing tests. In fact, as soon as you cross the threshold of a medical institution, you acquire the status of a patient. What is hidden behind this concept, what can you count on? We will talk about the rights of patients today.

Patient Status

Usually people wish each other health. For example, when they greet, congratulate on holidays, say toasts, etc. The law defines health as the state of the human body, when all its physical, mental and social aspects are normal, there are no diseases and any disorders.

A set of measures called medical care is aimed at maintaining this condition and the necessary restoration of functions. It is provided through the provision of appropriate services.

The law refers to a patient as an individual who has sought medical help, or who is already receiving it, regardless of the presence of a disease. That is, this status can be "awarded" to a completely healthy person who came to the clinic just to consult, perform diagnostics or take tests.

Only the relevant medical organization (legal entity or individual entrepreneur) that has a license is entitled to provide services to him.

It should be noted that help should be provided to the patient with high quality. This is an important and necessary condition. The law defines quality as a set of characteristics that indicate the timeliness of assistance, the correct choice of methods of prevention, research, treatment, recovery during its provision. In addition, they pay attention to whether the goals were achieved, whether there is a positive effect.

This concept is important for people who conduct an examination of the quality of medical care. Often, even with the right tactics and methods of operations, they are ineffective, as a result, the patient remains unhappy, sometimes even with damaged health. In such cases, the patient’s rights are protected by himself (by filing a statement of claim, by contacting public organizations), law enforcement agencies, Rospotrebnadzor, and the courts. The main thing in this matter is to get papers and opinions of professional independent experts.

Normative regulation

The basic concepts in the medical field, the rights and obligations of the patient, medical organizations and their employees are enshrined in the Federal Law “On the Basics of Protecting the Health of Citizens in the Russian Federation” (No. 323-FZ of 2011)

Until this year, the 1993 Basics of Legislation were in force. Of course, legal relations have stepped far forward and the regulatory act is outdated. The new 323-FZ adds a massive conceptual block that defines health, medical care, intervention, service, organization, patient, health, prevention, diagnosis, treatment, etc. An expanded concept is given to some terms, for example, the moment of birth of a child is defined.

The following principles have been added to the assistance principles:

• quality,
• inadmissibility of failure,
• protection of medical confidentiality,
• in the first place are the interests of the patient, that is, the patient is always right;
• Priority child health.

In addition, the rights of citizens in the medical field are regulated by:

• The Constitution of the Russian Federation (Art. 41);
• legislation on compulsory health insurance;
• normative acts on state social assistance;
• The Law of the Russian Federation “On transplantation of organs and (or) human tissues”;
• The law of the Russian Federation “On psychiatric care and guarantees of the rights of citizens in its provision”;
• “European Social Charter” (Article 13) and others.

Basic rights

So, all citizens can count on:

• health care;
• medical assistance;
• refusal / consent to intervention;
• choice of doctor and institution;
• obtaining information about his health;
• reporting on factors that affect it.

In this case, the patient has the right to:

• choice of a doctor and medical institution;
• treatment, prevention, diagnosis, restoration of health in medical organizations;
• advising relevant specialists;
• pain relief as a consequence of a disease or honey. interventions with appropriate methods and drugs;
• informing about his rights, duties, his health situation, has the right to choose those to whom this information can be communicated;
• clinical nutrition in a hospital;
• preservation of medical confidentiality;
• refusal of medical manipulations;
• Compensation for health damage resulting from the provision of assistance;
• the requirement to let a lawyer (legal representative) go to him to protect his rights;
• admission of the clergyman, conducting religious rites in appropriate conditions, if this does not violate the routine of the medical institution.

Paragraphs 10 and 11 of this list more relate to the rights of patients in the hospital, that is, persons who live in medical institutions under conditions of "long-term" treatment.

Choosing a doctor and institution

The realization of these rights is possible only when providing services under the state guarantees program for the free provision of medical care.

These include institutions operating under the compulsory medical insurance system, departmental and others subordinate to the FMBA of the Russian Federation.

It follows that the indicated rights of the patient in the system of providing paid medical services will not apply.

Let's take a closer look at what is meant by these powers.

To provide primary medical care, a citizen has the right to choose an organization or a doctor at his place of residence or other address of residence annually no more than 1 time, except for cases of changing permanent residence.

Primary specialized medical care is carried out both in the direction of the local doctor, and on the basis of independent treatment of the person.

When a patient chooses a doctor, the main condition is the consent of the latter.

The law also provides that a citizen must have access to information about a medical organization, its work, specialists, their qualifications and education, including on the Internet.

The procedure for choosing a doctor and institution is defined in the relevant order of the Ministry of Health and Social Development. Such a right is granted only to persons who have reached the age of majority. When applying to the organization, it is also necessary to provide a list of documents defined in this normative act (including mandatory mandatory medical insurance policy).

Today, in connection with the active development of the field of electronic public services, such a procedure is available to everyone. For example, you can sign up to the necessary specialist at the other end of the city or region without leaving your home on the site.

Separately, it is worth mentioning the provision of medical care in the presence of medical practitioners. The patient has the right to inform him of this, as well as to refuse the participation of students in assisting him.

Certain categories of the population have special rights to choose a medical institution. These include military personnel, conscripts, contract employees, detainees who are in MLS, living in ZATO.

Medical care - what happens?

This inalienable right belongs not only to the sick, but also to every citizen. This is enshrined primarily in the Constitution.

So this authority includes:

1. Primary health care: examinations, diagnostics, prevention, pregnancy monitoring, obstetric care, promotion of healthy lifestyle.
2. Specialized assistance. It can be obtained at a medical organization only with a doctor’s referral for a specific disease. As an example, doctors can be cited in narrow areas: a gastroenterologist, a surgeon, an orthopedist, a cardiologist, etc.
3. Emergency medical care. In this situation, the speed of providing a minimum of emergency actions is important. Such measures are taken in cases that threaten the patient's life. Assistance may be provided by the appointment of the head of any employee with qualifications.

Pain relief

This is one of the most pressing medical rights of the patient. Agree, when something hurts you, you don’t think about anything else. In medicine, there is also such a thing as “pain shock”, when a person loses consciousness from any extensive injuries and intolerable sensations.

Most of the citizens, when they go to hospitals, do not suspect that such a right exists, but it is often not implemented in practice.

Some diseases (gout, rheumatoid arthritis, etc.) are accompanied by an impressive pain syndrome, but doctors are in no hurry to prescribe potent drugs, limiting themselves to conventional painkillers.

The doctor acts as a judge in deciding whether to prescribe any drugs to the patient or not. At the same time, patients suffer, which is a violation of the rights of the patient.

Since this authority is separately prescribed in the law, it follows that a citizen should decide whether anesthesia is necessary in a particular situation, since everyone has a different sensitivity. The doctor’s task is to eliminate the syndrome by any available means, including the appointment of opioid analgesics.

Information Rights

The patient may know information about:

• survey results;
• existing diseases;
• diagnosed;
• disease prognosis;
• methods of assistance;
• risks;
• probable types of medical intervention;
• the consequences of such manipulations;
• assistance outcomes.

Information about the state of health is communicated to the citizen by the attending physician or other employee authorized to do so, in person or through legal representatives - in cases where the patient is underage or incompetent. Against the will of the patient, such information cannot be provided to him. If the disease suggests a disappointing prognosis of development, then the patient, his marital half, or one of his close relatives should be informed about this in a tactful form, unless he himself forbade this and did not choose another person.

Some often wonder if the patient has the right to study medical documents that directly reflect his health, receive certificates, and test results. Yes, the law grants such a right to the patient himself or his representative by law. In addition, he can, on the basis of these papers, consult other specialists.

Usually, in order to receive any extracts from medical records, you need to write a statement in duplicate.

There is also the concept of medical secrecy - this is information that cannot be disclosed to third parties, i.e. which are known only to medical assistants and the patient.

These include information about the fact of applying for medical services, the patient’s health status, diagnosis, other, obtained during the examination.

It is not only doctors who should disclose this information, but also other persons to whom they became known in the performance of their professional duties.

This information may be published only with the written consent of the patient for the purpose of scientific research, use in the educational process, etc.

There are exceptions to any rule, and with medical secrets.

The disclosure of this information is allowed in the following cases:

• for the purpose of medical examination and treatment of a citizen who is not able to express his will if the intervention is necessary according to urgent indications to eliminate the threat to life and if his condition does not allow him to express his will or if there are no legal representatives;
• with the danger of the spread of infectious diseases, mass poisoning;
• at the request of the relevant authorities (investigation, court, execution of punishment);
• in connection with the provision of assistance to a person under the age of 18 for reporting to one of his parents (a representative by law);
• informing the internal affairs bodies about the patient’s admission if harm to his health is caused as a result of an offense;
• military medical examination;
• industrial accident and occupational disease;
• the exchange of information by medical organizations in order to provide assistance, taking into account the requirements for the protection of personal data;
• accounting and control in the system of compulsory social insurance;
• supervision of the quality and safety of medical activities.

This list is exhaustive.

Refusal of intervention

323-FZ in common people is also called the law on the rights of the patient. Indeed, he describes in sufficient detail the credentials of clients of medical institutions. This list also includes the right to refuse any kind of intervention (surgical, therapeutic, etc.)

Usually, before the doctor conducts an examination or writes out a prescription, a subscription is taken from a citizen about consent to treatment, about informing about possible consequences.

The list of persons authorized to express refusal of medical intervention includes the patient himself or the representative by law. The last person can decide on behalf of minors up to 15 years old or drug addicts - up to 16, who need transplantation of organs and tissues, incompetent patients with drug addiction (including at the time of their examination).

The patient has the right to refuse intervention at any stage of treatment, while objections can be partial.

An exception to this rule is medical manipulation without the consent of the appropriate person in the following cases:

• as an emergency to eliminate the threat to life if he cannot express his will or if there are no representatives under the law;
• concerning persons having diseases dangerous to others;
• with severe mental disorder;
• against criminals;
• during the examination (forensic or psychiatric).

In special cases, the attending physician, despite the decision of the legal representatives, can go to court to protect the health of patients and save his life.

Indemnification

Among all the rights of a patient of the Russian Federation, the final is the claim for compensation for harm caused to his health in the provision of medical care.

These relations are regulated not only by 323-, but also by the Civil Code of the Russian Federation, legislation on the protection of consumer rights.

This authority is restorative in nature, since it is aimed at protecting the rights of patients who have already been harmed in the provision of medical services, for example, a poorly performed operation, the result of the analysis was incorrectly determined, infection occurred, etc.

It is not the medical worker himself who will be responsible for these obligations to the patient, but his employer, the institution that, after compensation for the harm to the patient, will be able to recourse to his employee.

Such cases often go to court, since only in this instance can an independent examination be appointed. At the same time, it is important to stock up on papers about treatment and strong nerves.

Before making a decision on assignment of responsibility, the court assesses the presence of the following circumstances:

• patient care event;
• consequences in the form of harm to health;
• unlawful actions / omissions of medical workers;
• causal connection between the manipulations of a medical professional and the consequences that have arisen;
• the fault of the performer of medical services.

Since the judge does not have special knowledge in the field of medicine, an examination is appointed to clarify these facts. It should be noted that in practice there have been cases when, as a whole, independent specialists recognized the correct tactics and methods of medical manipulations, while the quality did not meet the requirements, i.e., a positive result for the operated person was not achieved. This is also a violation of the rights of the patient.

Lost earnings, other additional expenses (for treatment, special nutrition, medicines, etc.) are subject to compensation.

At the same time, the Civil Code of the Russian Federation obliges the contractor to compensate moral damage as well.

A medical institution may be exempted from liability if it provides evidence that the harm arose as a result of force majeure or a patient's non-compliance with rules (for example, postoperative care).

How to defend your rights?

Knowing your authority is good, but not enough. One must still be able to protect oneself. When you act as a patient, this is especially important because, for example, when deciding on such a step as an operation, you always feel like a little victim. You don’t know what result awaits you.

If it happened that your patient’s rights were violated (did not provide the service or did it poorly, did not inform on time, refused to compensate for the harm, etc.), then all efforts must be made to restore them and hold the perpetrators accountable. Consider what methods this can be done:

1. Negotiations with the leadership of a medical institution. They should be conducted delicately, in writing, you can attract a lawyer or lawyer. This method is effective, because usually the institution does not want to spoil its reputation, and only if the rights are violated slightly, there are no serious consequences for health.
2. Local health committees. They resort to this method when the clinic’s management does not want to negotiate, or refuses to restore rights, or compensate for harm.
3. Patient Rights League. This is a public organization on the territory of the Russian Federation, the main purpose of which is to restore them. Employees provide advice in this area, draw up documents, conduct business in courts. It was created in 2000, today it has its own website on the Internet, positions itself as an organization that provides services for free (with the exception of doing some business), the main motto is: “The patient is always right.”
4. The police, prosecutors. Consider messages, statements of citizens about the commission of offenses, including crimes. Usually, in the presence of serious consequences arising from unlawful acts or omissions of medical workers, a case is initiated immediately. If this does not happen, you as a victim have the right to apply yourself. You can contact the prosecutor's office in case of any violation of your rights as a patient, since this body oversees the implementation of laws.
5. Court. The last resort, where the patient can count on the protection of their rights. However, in practice, it is often the first and only stage, since medicine is a specific area, everything here depends on the documentary support of one’s position, and addressing the hospital management or local authorities simply does not make sense. Need an independent expert point of view.

Initiation of a case in court begins with the submission of a statement of claim. At this stage, do not neglect the help of professional lawyers, preferably specializing in this particular field. 90% of the success of the case depends on the competent preparation of the claim.

As you can see, the methods for solving the problem are quite diverse. It’s worth choosing, based on the essence of the violation of rights and the consequences that have arisen. If the question is about compensation for harm to health, then it is advisable to immediately go to the court. You can also write an appeal to the Patient Rights League. The most extraordinary cases can be covered in the media, thereby attracting the public.

To date, the rights of the patient are quite clearly regulated at the legislative level. However, there remain problems with their implementation in life. Medical workers do not always strive to comply with them, to admit their mistakes. The rights of patients and doctors are opposed to each other, but it is always worth remembering that when a person comes to a clinic, he becomes dependent on the servants of Hippocrates, his life and fragile health are entirely in their hands.