According to the Supreme Medical Chamber, the local government will introduce a bill on the debt-free system within a few months. The pillar should include: creating a register of side effects. It was discussed today at NIL headquarters, but only among doctors, patients and lawyers – none of the representatives of the Ministry of Health, despite being invited to the interview, did not appear at the conference.
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On August 3, an expert conference was held at the headquarters of the Supreme Medical Chamber, where the president of the NRL, Łukasz Jankowski, together with the invited experts, presented the details of the memorandum. The document is intended as an introduction to the discussion on the no-fault system law. Its introduction is a flagship project, the implementation of which was aimed at the new authorities of the Supreme Medical Council. The primary goal is to improve the safety of both the patient and the physician.
Medical mistakes happen, but you have to learn from them
According to representatives of the Supreme Medical Chamber, the lack of a properly functioning error-free system has at least a number of negative consequences. They include discouraging physicians from working in surgical specialties and having physicians opt for less risky treatment approaches with potentially lower effectiveness. The development of the memorandum by experts of the Supreme Medical Chamber should be an attempt to diagnose the effects of the lack of blame on patients, doctors and the system, and the first step in the discussion about the ultimate shape of this solution, which to be completed by the draft decision. As NIL spokeswoman Renata Jeziółkowska noted at the conference, the act will be created in the coming months.
– The discussion about the need to introduce the no-fult system has been going on for a long time. Therefore, we must ask ourselves: why is it necessary to introduce it and where does the memorandum come from? Our primary goal is patient health. (…) Given the fate of subsequent laws seeking to improve the quality and safety of treatment, we in the NRL came to the conclusion that we should take matters into our own hands and first diagnose the current situation and ideas on how to improve this system, and then come up with a proposal for the law. The memorandum should be a prelude to the discussion about the premise of the law – said Dr. Lukasz Jankowski, President of the Supreme Medical Council.
A major problem in this area, he says, is the lack of trust between doctors and patients, which also strengthens the system.
– The system ensures that in the event of an undesirable event, a confrontation also arises between the patient and the doctor. (…) One of the fundamental shortcomings of the current system is the lack of a register of updates. (…) We need to find solutions that allow the system and doctors to learn from their mistakes. We are not perfect, mistakes happen. The main reason to draw conclusions from it is to serve this purpose register of side effects. (…) Today, the atmosphere is conducive to punishing doctors, but also to sweeping mistakes and adverse events under the carpet – President Jankowski noted.
As he noted, the second pillar of the guiltless system should be the introduction of compensation instruments for patients in the event of an adverse event or medical error. A patient left in such a situation turns against the medical entity in which the event took place.
– At the moment there are as many as seven different institutions in the system that deal with this type of business. Each of them, given a particular case, can come to different conclusions, and the patient is left alone anyway. (…) For the doctor it ends with the fact that he cannot calmly return to the treatment of patients, and must appear in different institutions to give the same explanations. (…) I want to emphasize that the community and local government do not want to completely abolish the criminal liability of doctors. This is a myth that is being duplicated by government officials and some media. If there is gross negligence, for example if a doctor is under the influence of alcohol, criminal liability must remain – stressed President Jankowski.
As he noted, the result of the lack of an error-free system is also the so-called defensive medicine, ie a situation in which a doctor, more than the patient’s well-being, is guided by the desire to avoid the interests of the prosecutor . Moreover, only a few percent of the cases investigated by the public prosecutors end with a motion to punish a doctor.
Patients wait many years for compensation
Przemysław Rosati, president of the Supreme Bar Association, also pointed out the inefficiency of the current system.
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– I lead a dozen cases in which I defend doctors or members of the medical staff. There is no such procedure that would lead to a quick fix from the patient’s perspective. (…) To develop drugs and improve procedures from the patient’s perspective, we should develop a system that would shorten patient reimbursement, President Rosati said.
He also admitted that these procedures are difficult for prosecutors because of the complexity of medical knowledge and the need to find a suitable expert.
– The current system is absolutely not patient-oriented. It is based on the fact that you have to blame someone, often look for a scapegoat, because mistakes often arise as a result of many events. As a result, the patient is left without what is crucial for him for months, ie without repairing the damage that has occurred – said Ewelina Nazarko-Ludwiczak of the MY PATIENCI Foundation.
She also recalled that already in 2017 the Foundation postulated, among other things: o the creation of a register of side effects.
One of the principles of the no-fault system is to separate the responsibility for an unwanted event from the error.
– If we don’t have legal comfort and good working conditions, we can’t talk about patient safety. (…) Criminalization, criminalization of events and some degree of inadequate legal liability are associated with the deterioration of patient safety. (…) Today, most adverse events are related to errors in the design of health care systems – added Stanisław Iwańczak, deputy director for patient safety at Katowice Cancer Center.
The three pillars of the new error-free system
From the patient’s perspective, what would be the ideal solutions for compensation funds?
– Above all, the compensation fund must work quickly. If the patient has experienced an adverse reaction, he or she is traumatized, as is his or her family. (…) This situation also has economic consequences, as it prevents the patient from engaging in professional activity, among other things – said Robert Moldova, the president and co-founder of the Institute of Health and Democracy, adding that it is also important that the patient and his family understand how the side effect happened.
In the relevant memorandum, the Supreme Medical Chamber proposed to base the error-free system on three related pillars:
- introduction of a compensation fund for medical events
- creating a registry of side effects
- changing the liability rules of medical personnel
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