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Patient rights violation: A theoretical and practical framework – Health and Human Rights Journal

Patient held informally in hospital had his rights violated

A man with severe learning disabilities who was held informally in a psychiatric hospital for more than four months without the safeguards applying to patients “sectioned” under the Mental Health Act won a ruling at the European Court of Human Rights in Strasbourg last week that his human rights had been violated.

The ruling has important resource implications for the NHS, which will have to provide extra safeguards for tens of thousands of patients—those who are apparently “compliant,” mainly with learning disabilities and dementia—who lack the capacity to consent or to object to treatment.

Lucy Scott-Moncrieff, solicitor for the man, named only as HL, said that the government would have to amend the Mental Capacity Bill, now going through parliament, to give patients without the capacity to consent the same safeguards as those compulsorily sectioned. This would mean a system of formal assessments and access to review tribunals to argue for their release.

The Strasbourg judges said the lack of any fixed rules in UK law governing the admission and detention of “compliant” patients who lack the capacity to consent to treatment was “striking.”

They ruled that the circumstances surrounding HL’s detention amounted to breaches of his rights to liberty and security, and that the legality of his detention should be reviewed.

HL, aged 55, from Surrey, is autistic, unable to speak, and has “limited” understanding, the court was told. He is often agitated and has a history of self harming behaviour. He had been looked after by paid carers for three years after spending the previous 30 years in an institution.

In July 1997, during a visit to a day centre, he became agitated, hitting himself and banging his head against a wall. Unable to contact his carers, staff called a doctor who sedated him.

He was admitted as an informal patient to Bournewood Community and Mental Health NHS Trust in Chertsey, Surrey. Because of his mental incapacity, he was held under common law, and not formally detained under the Mental Health Act, which would have given him the right to apply to a review tribunal for release.

His carers went to the High Court to try to secure his release, but a judge ruled that he had not been “detained” in law. The Court of Appeal overturned that decision, but the House of Lords finally ruled that he could be held under the common law doctrine of “necessity.”

The Strasbourg judges noted “the lack of any formalised admission procedures indicating who could propose admission, for what reasons and on the basis of what kind of medical and other assessment and conclusions.”

Healthcare professionals had “assumed full control of the liberty and treatment of a vulnerable incapacitated individual solely on the basis of their own clinical assessments completed as and when they considered fit.”

Without safeguards to protect against misjudgment, said the judges, HL was not protected against “arbitrary deprivations of liberty.”

Patient Rights: Confidentiality & Informed Consent

What are Patient Rights?

Patients have rights in a medical setting, including the right to care and the right to refuse treatment, among other important protections.

Patient rights are those basic rule of conduct between patients and medical caregivers as well as the institutions and people that support them. A patient is anyone who has requested to be evaluated by or who is being evaluated by any healthcare professional. Medical caregivers include hospitals, healthcare personnel, as well as insurance agencies or any payors of medical-related costs. This is a broad definition, but there are other slightly more specific definitions. For example, a legal definition is as follows; patient rights is general statement adopted by most healthcare professionals, covering such matters as access to care, patient dignity, confidentiality, and consent to treatment.

No matter what definition is used, most patients and doctors are finding that many of the details of patient rights have changed and are continuing to change over time. This article is designed to give the reader a basic introduction to patient rights.

Often, people do not realize their specific rights at the time of their care because those rights are either not clearly defined or included in a bundle of papers that patients need to sign during registration. Some basic rights are that all patients that seek care at an emergency department have the right to a screening exam and patients that cannot afford to pay are not turned away. The details of these rights are detailed in the Emergency Medical Treatment and Active Labor Act (EMTALA) laws in the U.S. In addition, many people think that patient rights are only applicable between themselves and their doctor. This is not the situation; as stated in the first definition, patient rights can be extensive and exist between many people and institutions. Most notably, they can exist between patients, any medical caregiver, hospitals, laboratories, insurers and even secretarial help and housekeepers that may have access to patients or their medical records.

It is not possible in this article to list all of patient’s rights. However, most written rights that doctors and hospital personnel have patients read (and sign) are abbreviated statements that are summaries of all or parts of the American Medical Association (AMA) Code of Medical Ethics. Many of these patient rights have been written into state or federal laws and if violated, may result in fines or even prison time.

This article will focus on the doctor patient relationship and present areas of greatest concerns. Readers should understand that in most instances, when the word “doctor” is used, the reader may substitute many other names such as nurse, caregiver, hospital, insurer, doctor’s office personnel and many others. A patient’s rights in relation to their doctors occur at many different levels, and in all specialties. As stated above, the American Medical Association (AMA) outlines fundamental elements of the doctor-patient relationship in their Code of Medical Ethics. These rights include the following in the 2012-2013 book (568 pages!) and have the various topics covered in great detail:

  • 1.00 – Introduction
  • 2.00 – Opinions on Social Policy Issues
  • 3.00 – Opinions on Interprofessional Relations
  • 4.00 – Opinions on Hospital Relations
  • 5. 00 – Opinions on Confidentiality, Advertising, and Communications Media Relations
  • 6.00 – Opinions on Fees and Charges
  • 7.00 – Opinions on Physician Records
  • 8.00 – Opinions on Practice Matters
  • 9.00 – Opinions on Professional Rights and Responsibilities
  • 10.00 – Opinions on the Patient-Physician Relationship

According to the AMA, physicians should also serve as advocates for patients and promote the basic patient rights.

Disastrous HIPAA Violation Cases | 7 Cases to Learn From

What is a HIPAA violation?

A HIPAA violation is a noncompliant disclosure of PHI that compromises the privacy and security of healthcare information. Essentially, a HIPAA violation occurs when someone learns something they shouldn’t because there weren’t enough precautions in place to protect the information.

In most instances, any unauthorized use or disclosure of PHI is considered a breach, unless the organization or employee can prove there is a low probability that the PHI was compromised. Regulation of HIPAA compliance is strict and a HIPAA violation can be expensive for covered entities (e.g. every hospital, medical center, doctor’s office, healthcare provider, and health plan) and business associates (any third parties who work on behalf of covered entities).

What are the penalties for HIPAA violations?

The Department of Health and Human Services’ Office for Civil Rights (OCR) enforces HIPAA compliance by penalizing any involved hospital, health center, or health-related service for both small and large HIPAA violations. Even if patient health information has not been compromised, HIPAA violation penalties can be severe.

The cost of HIPAA violations ranges from $100 to $50,000 based on a variety of factors, including:

  • Whether or not there was malicious intent (civil vs. criminal penalties)
  • The degree of negligence
  • If a breach occurred
  • The number of records exposed or potentially exposed
  • Future risk as a result of the breach

In HIPAA violation court cases that result in penalties issued by the Office for Civil Rights, violators may pay the following fines per violation:

CIVIL PENALTIES

  • $100 to $50,000 when a violation is attributed to ignorance
  • $1,000 to $50,000 when a violation occurs despite reasonable vigilance
  • $10,000 to $50,000 when a violation is attributed to willful neglect but is corrected within 30 days
  • $50,000 (maximum fine per violation) when a violation occurs due to willful neglect and is not corrected within 30 days

CRIMINAL PENALTIES

  • $50,000 plus up to one year of jail time if a violation occurs when someone knowingly disclosed PHI
  • $100,000 plus up to five years of jail time if a violation occurs under false pretenses
  • $250,000 plus up to 10 years of jail time if a violation is committed for personal gain (e. g. selling PHI)

Individuals can also file civil or state lawsuits for HIPAA violations against state laws that result in harm due to negligence. In some instances, these HIPAA violation lawsuit cases can result in fines over $1.5 million, which is the maximum penalty per violation that OCR can issue.

7 Examples of HIPAA violation cases

It can take months and years for the Department of Health and Human Services Office of Civil Rights to discover and resolve intentional and accidental HIPAA violation cases. And sometimes, additional HIPAA violations are found during investigations. Learn about some of the most disastrous violation of HIPAA cases below.

Illinois-based healthcare network fails to conduct a thorough risk analysis.

In 2016, the largest HIPAA settlement resulted from three data breaches affecting four million people. A healthcare network in Illinois paid $5.5 million after an unencrypted laptop was stolen from an employee’s car, and, in a separate incident, four computers were stolen. The Office for Civil Rights noted that the hospital system failed to establish a risk analysis that accounted for physical and administrative safeguards, in addition to the technical safeguards in place.

Lesson to learn: HIPAA violations are common as a result of lost or stolen organizational devices, which is why it’s so important to analyze potential risks and mitigate them with the proper safeguards.

An imaging company in Tennessee violates multiple HIPAA rules.

In 2018, a Tennessee-based medical imaging services company paid $3 million in penalties and adopted a corrective action plan (CAP) to resolve their HIPAA violations. The FBI discovered one of their servers was accessible on the Internet, allowing anyone to search and view PHI for over 300,000 individuals via search engines. Following the discovery, they initially failed to admit that the protected information had been exposed and didn’t notify affected individuals for 147 days. This resulted in additional penalties because of a delayed investigation and a violation of reporting rules. Throughout the investigation, the OCR also found instances where they did not enter into a business associate agreement for services with third-party vendors—a requirement under HIPAA.

Lesson to learn: When suspected or known security breaches arise, covered entities must follow reporting guidelines to notify affected individuals within 60 days.

Member data stolen by cybercriminals using phishing.

A large health insurer in the U.S. was the victim of a targeted cyberattack in 2015. The investigation, which concluded in 2018 with a $16 million settlement, revealed a data breach of over 78 million member records as cybercriminals used phishing to enter the network and access plan members’ data. The OCR identified multiple HIPAA violations, including failure to prevent unauthorized access to ePHI as a result of insufficient technical policies and procedures to maintain ePHI privacy. As the largest HIPAA settlement ever, they also paid damages to members whose privacy was compromised.

Lesson to learn: Large health organizations are specific targets for hackers, which is why large healthcare entities must establish strong password policies and regularly monitor information system activity to mitigate potential risks.

A Texas health system discloses unauthorized identifiable information in a press release.

In 2015, Texas-based health system responded to an incident involving the use of a fraudulent ID card by a patient with a memo to the press. In the press release, the hospital system violated the privacy of the involved patient by including their name in the title, which the OCR determined to be an intentional failure to protect the patient’s rights to privacy. Although releasing the patient’s name to police was permissible, the issued public statement by the hospital system should have protected the patient’s privacy. Failure to do so cost them $2.4 million.

Lesson to learn: While most HIPAA violation settlements affect a large number of medical records, the OCR takes serious measures to uphold HIPAA laws, even when just one individual’s medical data is involved. HIPAA’s Privacy Rule requires that unauthorized PHI must not be disclosed.

 

Patients’ Rights in New York State

  • FAQs for Facilities Reproducing and Posting Patient Rights Publications.

  • Deciding About Health Care – A Guide for Patients and Families. Also available in the following languages: Spanish, Russian, Haitian Creole, Korean, Chinese


  • Your Rights as a Hospital Patient in New York State. Also available in the following languages: Spanish, Russian, Haitian Creole, Korean, Chinese

  • New York State Hospital Patients’ Bill of Rights Also available in the following languages: Spanish, Russian, Chinese, Haitian Creole, Korean, Italian, Yiddish, Polish, Arabic

  • Patients’ Bill of Rights for Diagnostic & Treatment Centers (Clinics) Also available in the following languages: Spanish, Russian, Haitian Creole, Korean, Chinese

  • Parents’ Bill of Rights (PDF) Also available in the following languages: Spanish, Russian, Creole, Korean, Chinese



  • New York State Sexual Assault Victim Bill of Rights (PDF)
    Also available in the following languages: Arabic, Bengali,
    Haitian Creole, Italian, Korean, Russian, Simplified Chinese, Spanish, Yiddish





  • Breastfeeding Mothers’ Bill of Rights is available in Portable Document Format (PDF). Also available in the following languages: Spanish, French, Chinese, Italian, Russian, Haitian Creole

  • Do I have the right to see my medical records?
  • Your Rights as a Nursing Home Resident in New York State and Nursing Home Responsibilities
  • When Your Home Is Inspected
  • Discharge Planning
  • Managed Care Bill of Rights
  • Amendments to 10 NYCRR Part 405 Concerning General Hospitals Including Pediatric Minimum Standards

Advance Directives

Funeral Rights

Related Links

Requests for any of the above documents in an alternate format can be made by sending an e-mail to: [email protected]

Remedies for Violation of HIPAA Privacy Rights and Medical Confidentiality

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

I receive many questions and e-mails about possible violations of the Health Insurance Portability and Accountability Act’s (HIPAA) Privacy Regulations and Security Regulations, and breaches of confidentiality of medical records and medical information.   I will attempt to explain and clarify this issue a little in this short blog.

More detailed information on HIPAA Privacy Regulations and Security Regulations, can be found at: http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html

There is no private cause of action allowed to an individual to sue for a violation of the federal HIPAA or any of its regulations.  This means you do not have a right to sue based on a violation of HIPAA by itself.  However, you may have a right to sue based on state law.  See below.

1.  File a HIPAA Privacy Complaint with the Office of Civil Rights (OCR).

As a first step, you may desire to file a HIPAA Privacy Complaint with the federal government.  These are usually required to be filed within 180 days of the event (there are limited exceptions).  They are usually all taken and fully investigated.  If it is an egregious or a repeat violation, it may even result in an investigation by the Federal Bureau of Investigation (FBI) and criminal charges being filed against those responsible.   However, in most cases if there is a valid complaint, the federal government will assess administrative fines against those responsible.  In almost all cases, a report will be made back to you of what is found and what actions have been taken.

If you decide to file a HIPAA Privacy Complaint, this is done with the Office of Civil Rights (OCR) of the U.S. Department of Health and Human Services (DHHS).  You may do this online.  The Complaint form is found at: http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html

If you follow this process and receive a finding that verifies the violation, you may find it easier to retain an attorney to take your case.  Please note, there is only a very short period of time in which you are allowed to file such a complaint after you have discovered it.  So be sure to do this right away.

2.  File a Complaint Against the Physician Involved with the Florida Department of Health (DOH).

The Florida Department of Health (DOH) licenses all physicians, nurses and health professionals in the state of Florida.   It is also responsible for investigating complaints against them.  The various professional boards (Board of Medicine, Board of Nursing, etc.) are under the DOH.

If there was a violation or breach of patient confidentiality or medical records confidentiality, this may also be a violation of the state’s laws on patient or medical records confidentiality. This is true in most states, not just Florida.

If there was a violation or breach of patient confidentiality by a licensed health care professional, you may also file a complaint with the appropriate state licensing board or agency about this, as well.  In Florida, for example, if a licensed health professional did this, you may decide to report this to the Florida DOH.  If they are licensed in a different state, you may have to follow that state’s procedure for filing a complaint.

For Florida, you may call the Florida DOH at (888) 419-3456 or (850) 245-4339, or you may use the online complaint form found at: http://www. doh.state.fl.us/mqa/enforcement/enforce_csu.html

The Florida DOH will investigate the complaint and will usually have an expert witness review it.  If there is a finding against the physician (or other licensed health professional) you can ask for a copy of the DOH expert’s report.  This may result in your obtaining a free expert witness review of the case.  The expert witness might even agree later to testify as an expert witness if there is a civil lawsuit filed (however, this is something your attorney would have to work out with the expert witness).

3.  File Grievance or Report to Third Party Payer (Medicare, Tricare, VA, Insurance Co.).

If you are a Medicare patient, TRICARE/CHAMPUS patient, Veterans Administration (VA) patient, Public Health Service patient, or military patient, you may also report this to the Office of the Inspector General (OIG) of that specific agency.

If you are a member of a managed care plan or have health insurance, you may desire to file a member grievance or complaint with the insurance company.   Every physician who accepts Medicare is subject to the Medicare Program’s peer review system.  You may file a complaint directly with Medicare and ask for it to be reviewed by the Medicare peer review program.

4.  State Laws and Law Suits (Civil Recovery).

If there was a violation or breach of patient confidentiality or medical records confidentiality, this may also be a violation of the state’s laws on patient or medical records confidentiality.  In most states this would give you a legal cause of action for invasion of privacy or for negligence.

The biggest problem usually encountered in this type of case and the reason most attorneys will not even consider taking one is the lack of documented  provable damages (again, I emphasize the words “documented” and “provable”).

5.  Documented, Provable Damages is Key.

Unless you have actual bills and receipts, you don’t have this.  In most cases, unless you can prove that you have suffered actual damages by proof such as:

a.  Doctors’ bills you have paid
b.  Mental health counseling fees you have paid
c.  The purchase of credit protection insurance
d.  The purchase of identification theft insurance
e.  The costs you have paid because your identity was stolen
f.  Lost pay from time off (with the pay stubs, W-2 forms, etc., to prove the amount)
g.  Lost pay from a lost job (with the pay stubs, W-2 forms, etc., to prove the pay lost)
h.  Attorney’s fees paid as a direct result of the breach of privacy (key word being “direct result”)
i.  Other actual out-of-pocket expenses, you may have a difficult time in proving a case in a court of law

If you have these, keep good, detailed documentation.  Obtain good, legible receipts for everything.

Unless you have these, you will have great difficulty in finding a plaintiff’s attorney to take such a case.  It is doubtful that you would have a provable case, as well.  There are exceptions to every case, however.

If you do feel that you have a valid case with documented damages, we urge you to contact and retain a plaintiff’s attorney to file suit on your behalf as soon as possible.  You have only a short period of time to bring such a case, after which your rights to do so will be extinguished forever.

We would urge you to consider carrying out the actions in #1, #2 and #3 above first.  If these organizations do not find in your favor, then it is even less likely that a judge or jury would find in your favor.

Hourly Attorney vs. Contingency Fee Attorney.

Our statements above hold true mainly because most attorneys who would take such a case are plaintiff’s attorneys who take cases for a contingency fee (a percentage of the amount they win).  In such a case, if an attorney spends 100 hours preparing for trial (actually a low number), wins your case, and you only have $500 worth of provable damages (if the contingency fee agreement is for 40%, a fairly standard amount) then that attorney only gets $200, or $2.00 per hour.  I don’t know any attorney who works that cheaply.  (This is a very simplistic illustration to make the point; it does not even take into account the legal costs involved, which the client is usually responsible for paying.)

An attorney who charges by the hour may be more likely to take the case (but he/she may also be hard to find for this type of case), but may require a retainer fee of $5,000 to $15,000 paid up front just to get started.

If you have a civil case for liability, you only have a short, limited time to file it.  You must do so within the applicable time period or you will lose the right to do so forever.

Remember, there is only a short time in which to take any action that may be necessary and if you fail to do so, your rights may be lost forever.

Again, this is not legal advice, just general information.

Contact a Health Law Attorney Experienced in Defending HIPAA Complaints and Violations.
 
The attorneys of The Health Law Firm represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in investigating and defending alleged HIPAA complaints and violations and in preparing Corrective Action Plans (CAPs).
 
For more information about HIPAA violations, electronic health records or corrective action plans (CAPs) please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

Tag Words: Health Insurance Portability and Accountability Act, HIPAA, HIPAA audits, HIPAA audit protocol, HIPAA compliance, medical records, medical practice audit, records request, defense attorneys, lawyers, legal representation, audit attorneys, health care audits, breach of patient confidentiality

Patient Rights and Responsibilities – Lakewood ASC

Patient Rights

Florida law requires that your health care provider or health care facility recognize your rights while you are receiving medical care and that you respect the health care facility’s right to expect certain behavior on the part of patients. You may request a copy of the full text of this law from your health care provider or health care facility. A summary of your rights and responsibilities follows:

  • A patient has the right to be treated with courtesy and respect, with appreciation of his or her individual dignity, and with protection of his or her need for privacy.
  • A patient has the right to a prompt and reasonable response to questions and requests.
  • A patient has the right to know who is providing medical services and who is responsible for his or her care.
  • A patient has the right to know what patient support services are available, including whether an interpreter is available if he or she does not speak English.
  • A patient has the right to know what rules and regulations apply to his or her conduct.
  • A patient has the right to be given, by the health care provider, information concerning diagnosis, planned course of treatment, alternative, risks, and prognosis.
  • A patient has the right to refuse any treatment, except as otherwise provided by law.
  • A patient has the right to be given, upon request, full information and necessary counseling on the availability of known financial resources for his or her care.
  • A patient who is eligible for Medicare has the right to know, upon request and in advance of treatment; whether the health care provider or health care facility accepts the Medicare assignment rate.
  • A patient has the right to receive, upon request, prior to treatment, a reasonable estimate of charges for medical care.
  • A patient has the right to receive a copy of reasonably clear and understandable, itemized bill and, upon request, to have the charges explained.
  • A patient has the right to impartial access to medical treatment or accommodations, regardless of race, national origin, religion, physical handicap, or source of payment.
  • A patient has the right to treatment for any emergency medical condition that will deteriorate from failure to provide treatment.
  • A patient has the right to know if medical treatment is for purposes of experimental research and to give his or her consent or refusal to participate in such experimental research.
  • A patient has the right to express grievances regarding any violation of his or her rights, as stated in Florida law, through the grievance procedure of the health care provider or health care facility which served him or her and to the appropriate state licensing agency.
  • A patient is responsible for providing to the health care provider, to the best of his or her knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to his or her health.
  • A patient is responsible for reporting unexpected changes in his or her condition to the health care provider.
  • A patient is responsible for reporting to the health care provider whether he or she comprehends a contemplated course of action and what is expected of him or her.
  • A patient is responsible for following the treatment plan recommended by the health care provider.
  • A patient is responsible for keeping appointments and, when he or she is unable to do so for any reason, for notifying the health care provider or health care facility.
  • A patient is responsible for his or her actions if he or she refuses treatment or does not follow the health care provider’s instructions.
  • A patient is responsible for assuring that the financial obligations of his or her health care are fulfilled as promptly as possible.
  • A patient is responsible for following health care facility rules and regulations affecting patient care and conduct.

Patient Responsibilites

The care a patient receives depends partially on the patient himself. Therefore, in addition to these rights, a patient has certain responsibilities as well. These responsibilities shall be presented to the patient in the spirit of mutual trust and respect. The patient/family/representative shall be responsible for:

  • Providing accurate and complete information concerning his/her present complaints, past illnesses, hospitalizations, medications, including over-the-counter medications and herbal supplements, allergies and any sensitivities.
  • Following the treatment plan established by his/her physician, including the instructions of nurses and other health professionals as they carry out the physician’s orders.
  • Reporting perceived risks in his/her care and unexpected changes in his/her condition to the responsible practitioner.
  • Asking questions about the patient’s condition, treatments, procedures, diagnostic test results.
  • Asking questions when they do not understand what they have been told about the patient’s care or what they are expected to do.
  • Immediately reporting any concerns or errors they may observe.
  • Keeping appointments and for notifying the ASC or physician when he/she is unable to do so.
  • Providing a responsible adult to transport him/her from the ASC to home and to remain with the patient for at least 24 hours if required by the patient’s physician.
  • His/her actions should he/she refuse to follow his/her physician’s orders.
  • Assuring that the financial obligations of his/her ASC care are fulfilled as promptly as possible.
  • Being considerate of the rights of other patients and ASC staff.
  • Providing accurate and complete information concerning his/her present complaints, past illnesses, hospitalizations, medications, including over-the-counter medications and herbal supplements, allergies and any sensitivities.
  • Following the treatment plan established by his/her physician, including the instructions of nurses and other health professionals as they carry out the physician’s orders.
  • Reporting perceived risks in his/her care and unexpected changes in his/her condition to the responsible practitioner.
  • Asking questions about the patient’s condition, treatments, procedures, diagnostic test results.
  • Asking questions when they do not understand what they have been told about the patient’s care or what they are expected to do.
  • Immediately reporting any concerns or errors they may observe.
  • Keeping appointments and for notifying the ASC or physician when he/she is unable to do so.
  • Providing a responsible adult to transport him/her from the ASC to home and to remain with the patient for at least 24 hours if required by the patient’s physician.
  • His/her actions should he/she refuse to follow his/her physician’s orders.
  • Assuring that the financial obligations of his/her ASC care are fulfilled as promptly as possible.
  • Being considerate of the rights of other patients and ASC staff.

Please feel free to read online or print to review our policies and procedures as well as your rights and responsibilities. If you have any questions, feel free to contact us.

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Patient Rights and Responsibilities – Arnold Palmer Hospital for Children

SUMMARY OF THE FLORIDA PATIENT’S BILL OF RIGHTS AND RESPONSIBILITIES

Florida law requires that your healthcare provider or healthcare facility recognize your rights while you are receiving medical care and that you respect the healthcare provider’s or healthcare facility’s right to expect certain behavior on the part of patients. You may request a copy of the full text of this law from your healthcare provider or healthcare facility. A summary of your rights and responsibilities follows:

  • A patient has the right to be treated with courtesy and respect, with appreciation of his or her individual dignity, and with protection of his or her need for privacy.
  • A patient has the right to a prompt and reasonable response to questions and requests.
  • A patient has the right to know who is providing medical services and who is responsible for his or her care.
  • A patient has the right to know what patient support services are available, including whether an interpreter is available if he or she does not speak English.
  • A patient has the right to know what rules and regulations apply to his or her conduct.
  • A patient has the right to be given by the healthcare provider information concerning diagnosis, planned course of treatment, alternatives, risks, and prognosis.
  • A patient has the right to refuse any treatment, except as otherwise provided by law.
  • A patient has the right to be given, upon request, full information, and necessary counseling on the availability of known financial resources for his or her care.
  • A patient who is eligible for Medicare has the right to know, upon request and in advance of treatment, whether the health care provider or health care facility accepts the Medicare assignment rate.
  • A patient has the right to receive, upon request, prior to treatment, a reasonable estimate of charges for medical care.
  • A patient has the right to receive a copy of a reasonably clear and understandable, itemized bill and, upon request, to have the charges explained.
  • A patient has the right to impartial access to medical treatment or accommodations, regardless of race, national origin, religion, handicap, or source of payment.
  • A patient has the right to treatment for any emergency medical condition that will deteriorate from failure to provide treatment.
  • A patient has the right to know if medical treatment is for purposes of experimental research and to give his or her consent or refusal to participate in such experimental research.
  • A patient has the right to express grievances regarding any violation of his or her rights, as stated in Florida law, through the grievance procedure of the health care provider or health care facility which served him or her and to the appropriate state licensing agency.
  • A patient is responsible for providing to the healthcare provider, to the best of his or her knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to his or her health.
  • A patient is responsible for reporting unexpected changes in his or her condition to the healthcare provider.
  • A patient is responsible for reporting to the health care provider whether he or she comprehends a contemplated course of action and what is expected of him or her.
  • A patient is responsible for following the treatment plan recommended by the healthcare provider.
  • A patient is responsible for keeping appointments and, when he or she is unable to do so for any reason, for notifying the healthcare provider or health care facility.
  • A patient is responsible for his or her actions if he or she refuses treatment or does not follow the health care provider’s instructions.
  • A patient is responsible for assuring that the financial obligations of his or her healthcare are fulfilled as promptly as possible.
  • A patient is responsible for following healthcare facility rules and regulations affecting patient care and conduct.

Article 30. Rights of the patient / ConsultantPlus

When applying for medical care and receiving it, the patient has the right to:

1) respectful and humane treatment from the medical and service personnel;

2) the choice of a doctor, including a general practitioner (family doctor) and an attending physician, subject to his consent, as well as the choice of a medical and prophylactic institution in accordance with compulsory and voluntary medical insurance contracts;

(as amended byFederal Law of 22.08.2004 N 122-FZ)

(see the text in the previous edition )

3) examination, treatment and maintenance in conditions that meet sanitary and hygienic requirements;

4) holding, at his request, a consultation and consultations of other specialists;

5) relief of pain associated with the disease and (or) medical intervention, using available methods and means;

6) keeping secret information about the fact of seeking medical help, about the state of health, diagnosis and other information obtained during his examination and treatment, in accordance with Article 61 of these Fundamentals;

7) informed voluntary consent to medical intervention in accordance with Article 32 of these Fundamentals;

8) refusal of medical intervention in accordance with Article 33 of these Fundamentals;

9) obtaining information about their rights and obligations and the state of their health in accordance with Article 31 of these Fundamentals, as well as the choice of persons to whom information about the patient’s health can be transferred in the interests of the patient;

10) receiving medical and other services within the framework of voluntary medical insurance programs;

11) compensation for damage in accordance with Article 68 of these Fundamentals in the event of harm to his health during the provision of medical assistance;

12) admission of a lawyer or other legal representative to him to protect his rights;

13) admission of a clergyman to him, and in a hospital institution for the provision of conditions for the performance of religious rites, including the provision of a separate room, if this does not violate the internal regulations of the hospital institution.

In the event of a violation of the patient’s rights, he can file a complaint directly with the head or other official of the medical and prophylactic institution in which he receives medical assistance, with the relevant professional medical associations or with the court.

(as amended by Federal Law of 10.01.2003 N 15-FZ)

(see the text in the previous edition)


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On the rights of patients

“On the rights of patients”

Patient – a person in need of and / or seeking medical care, receiving medical care, or participating as a subject in biomedical research, under medical supervision, as well as acting as a consumer of medical and related services, regardless of whether he is healthy or sick.

Medical information – information about the patient’s state of health and medical care provided to him, including data on the presence of a disease, its diagnosis, prognosis, methods of diagnosis, treatment and prevention, risk associated with medical intervention, other medical information – rights exercised at the individual, collective and group levels in the field of health, including in connection with any medical intervention.

Guarantee of patient’s rights is a system of obligations established by a legal act or contract, ensuring the implementation of the patient’s rights.

Standards of medical care are norms, rules and recommendations approved at the level of the federal executive body and determining the procedure for the provision of medical care.

Medical aid – treatment, prophylactic and rehabilitation measures carried out during pregnancy, childbirth, diseases, injuries.

Necessary medical care – medical care provided in accordance with approved standards.Participants in the provision of medical care – medical institutions, private practitioners, pharmacies, federal executive authorities and executive authorities of the constituent entities of the Russian Federation, medical insurance organizations, compulsory medical insurance funds and other individuals or legal entities licensed to engage in a certain type of activity, providing caring for a patient in an inpatient facility or at home, as well as persons and organizations involved in the financing and use of funds allocated for the resource and organizational provision of the necessary medical care.Medical intervention – any examination, treatment and other action that has a prophylactic, diagnostic, therapeutic, rehabilitation or research focus, performed by a doctor or other medical professional in relation to a specific patient. Medical service is the direct implementation of examinations, consultations, operations, manipulations, procedures, research and patient care. Service – providing additional comfortable living conditions for the patient’s stay in a medical institution.Informed voluntary consent – voluntary consent of the patient or his legal representative to medical intervention, given by him on the basis of complete and comprehensive information received from the attending physician or physician conducting the biomedical research in an accessible form for the patient about the purpose, nature, methods of this intervention, related with it the probable risk and possible medical-social, psychological, economic and other consequences, as well as possible alternative types of medical care and the associated consequences and risks.

Biomedical research – scientific research aimed at studying specific physiological, psychological and other states of the human body under the influence of factors, as well as approbation of new diagnostic, therapeutic and prophylactic, rehabilitation methods, medicines and other means, carried out in the form of a clinical trial with the participation of a person as a test subject.

Alternative hospitalization conditions for the provision of medical care – the organization of medical care for the population without interrupting the usual social environment, including help at home, in an outpatient clinic or in a semi-inpatient department (institution).

Professional medical secret – not subject to disclosure about the patient, the fact of seeking medical help, diagnosis and other information about the state of health and private life obtained as a result of treatment and examination. The legislation of the Russian Federation on the rights of the patient consists of the relevant provisions of the Constitution of the Russian Federation, the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens, this Federal Law, other legislative and other regulatory legal acts of the Russian Federation, legislative and other regulatory legal acts of the constituent entities of the Russian Federation regulating relations in the area of ​​ensuring and protecting the rights of the patient.Patients’ right to social services is exercised in accordance with the legislation of the Russian Federation on social protection of the population, including the Federal Law on Social Services for Elderly and Disabled Citizens. Laws and other regulatory legal acts adopted in the Russian Federation and the constituent entities of the Russian Federation cannot restrict the patient’s rights provided for by this Federal Law. If an international treaty of the Russian Federation establishes rules other than those provided for by this Federal Law, then the rules of the international treaty shall apply.This Federal Law establishes the legal basis for state policy and regulates relations in the field of ensuring and protecting the rights of the patient.
The main objectives of this law are: to consolidate the rights and obligations of the patient; establishment of basic guarantees for ensuring the rights of the patient;
determination of the grounds for liability for violation of the patient’s rights and methods of their protection; establishing the procedure for limiting the patient’s rights; determination of responsibility for violation of the requirements of this law.This Federal Law applies to citizens of the Russian Federation, state authorities, local governments, organizations of state, municipal and private health systems, foreign citizens temporarily or permanently residing in the Russian Federation, unless international treaties provide otherwise, stateless persons temporarily or refugees and displaced persons permanently residing in the Russian Federation.

Article 4.Principles of approach to patients’ rights and implementation of these rights

The fundamental value of life. Close relationship of physical and mental health. Ensuring the safety of life and health. Mental and physical integrity of a person. Respect for dignity. Inviolability of a person and his personal life. Individuality and choice. Recognition of the patient as an equal participant in decision-making about medical intervention. Regulation of the rights and obligations of the patient, the conditions for limiting his rights for the health and interests of the patient himself and others.Regulation of the patient’s rights by mechanisms of their provision and protection. Approval of the principle of mutual trust in the relationship between the patient and the medical worker. Prompt and objective consideration of the facts of violation of patients’ rights and responsibility for violation of rights. Control and independent examination of the quality of medical and pharmaceutical care.

Article 5. Conditions for the implementation of patients’ rights.

The rights of patients enshrined in this federal law are exercised by the patients themselves, and in relation to persons under 15 years of age or persons recognized as legally incompetent, by their parents or other legal representatives.The patient can entrust any competent person with the exercise of his rights in connection with the medical intervention. In this case, the representation of the patient’s interests is confirmed by a power of attorney drawn up in accordance with the legislation of the Russian Federation. In urgent cases, when the patient’s health condition does not allow him to exercise his rights and requires urgent medical intervention, as well as in the absence of the persons specified in parts one and two of this article, and (or) if it is impossible to establish contact with them, responsibility for organizing the provision The necessary medical care and the life of the patient are undertaken by a commission of doctors, and if it is impossible to assemble a commission, the attending (duty) doctor who is obliged to notify the administration of the health care institution about the measures taken at the earliest opportunity.The administration during the first day of the patient’s stay in a medical diagnostic institution is obliged to notify the patient’s relatives or his legal representatives about the case, and if it is impossible, to notify the territorial bodies of internal affairs. Responsibility for the realization of the rights of patients under the age of 15 or recognized as legally incompetent and without legal representatives rests with the administration of the health care or social service institution where they are located, or which provides them with home-based services and assistance.If the legal representatives of the patients referred to in the first part of this Article refuse to exercise the rights provided for the patients, and this refusal creates a danger to their life and health or contradicts the interests of the patients, the administration of the healthcare institution providing them with medical care shall assume responsibility for the exercise of these rights. Refusal in these cases is made in writing, confirmed by the signature of the patient or his legal representative and attached to the patient’s medical records.

Article 8. Patients’ right to freedom of choice

The right to freedom of choice implies the right to consent to hospitalization and the right to refuse it, as well as to receive medical care outside the hospital, in the patient’s area of ​​residence in his usual social environment, unless otherwise required by the patient’s health condition.
The right to receive medical care outside the hospital provides for freedom from using physical restraints on patients in isolation, except in cases where patients may harm their health or the health of others, and when out-of-hospital care is ineffective.The conditions and procedure for applying physical restraint and isolation devices to patients are determined by the health authorities of the Russian Federation. Violation of these conditions and procedures entails liability in accordance with the legislation of the Russian Federation.
Hospitalization is carried out only on the basis of the patient’s voluntary consent, except for the cases provided for in Articles 27 and 31 of this Federal Law and in other circumstances established by the legislation of the Russian Federation.The patient has the right to refuse hospitalization or interrupt his stay in an inpatient healthcare institution, except for the cases provided for in Articles 27 and 31 of this federal law and in other circumstances established by the legislation of the Russian Federation. In case of refusal of hospitalization or discharge on the initiative of the patient, the consequences of the decision should be explained to him. In special cases associated with the threat of a serious deterioration in the patient’s health, his refusal to hospitalize is made in writing, confirmed by the patient’s signature and included in his medical documentation.
In the absence of medical contraindications, the patient has the right to interrupt inpatient treatment in order to resolve personal issues. The days free from hospital stay are provided to the patient in the manner prescribed by the regulatory legal acts of the health authorities, without issuing an discharge from the hospital.

Article 9. Patient’s right to health safety

Patients have the right to safety, excluding the possibility of risk to life or harm to their health during medical intervention.
The use of methods of prevention, diagnosis, treatment, rehabilitation, as well as medicines, medical devices, medical equipment and software is allowed only with a permit issued after registration by the federal health authority in the manner prescribed by the legislation of the Russian Federation. In order to ensure the safety of life and health of patients, any medical intervention, production, purchase or sale of medical products is carried out in accordance with the established federal standards in compliance with sanitary norms and rules.It is not allowed to use methods of influence on the human body that are not amenable to standardization, qualitative assessment and, as a result, subsequent control of the application. Responsibility for ensuring the safety of patients in health care institutions, regardless of ownership, is borne by the administration of this institution, or a doctor engaged in the provision of paid services or private practice. Ionizing and radioactive exposure is used in the provision of medical care to patients within the limits excluding the possibility of exceeding the permissible radiation doses, only for diagnostic and therapeutic purposes and taking into account the patient’s state of health.Allowable levels of such exposure and the procedure for performing the appropriate medical procedures are established by the federal health authority.

Article 11. Patients’ right to freedom of religion in healthcare institutions

The patient has the right to perform religious rituals and invite a clergyman in a specially designated place. Proselytism is prohibited in health care institutions. The admission of a clergyman to health care institutions is carried out only at the invitation of the patient or his representative at any daytime with the consent of all patients in this room.In the event of a threat of death of the patient, the admission of a clergyman is allowed at night in a separate room.

Article 12. Right to pain relief

The patient is entitled to pain relief. Treatment of terminally ill patients with chronic pain should be directed towards alleviating their suffering. Treatment for severe chronic pain should be individualized and tailored to the needs of the patient. Patients suffering from acute pain, as well as terminally ill patients suffering from chronic pain, are guaranteed the availability of pain relievers that provide quantitative and qualitative pain management.

Article 13. Prohibition of any measures of influence on the patient for behavioral reasons

Drugs, physical restraint and isolation devices may not be used against a patient to punish or provide convenience to staff in healthcare facilities.

Article 14. Right to participate in planning and carrying out treatment

The patient, with the assistance of a doctor, has the right to participate in the planning and implementation of the treatment of his disease.If the patient has a chronic disease, the doctor is obliged to teach the patient self-help methods, including prevention and pre-medical diagnostics and ways to overcome the painful symptoms that arise, in order to preserve the independence of patients and maximize the ability to function both at home and in the community. The patient’s request to provide him with additional medical and service services that are not included in the compulsory treatment plan provided by the doctor can be satisfied taking into account the patient’s health condition and for an additional fee paid by him in the manner prescribed by the legislation of the Russian Federation, constituent entities of the Russian Federation.The doctor has the right to refuse the patient’s request to provide additional medical services that do not correspond to the treatment plan at this stage and time of medical care.

Article 15. Right to receive medical information

The patient enjoys the right to receive information about his state of health, diagnosis, prognosis, treatment of his disease, methods of prevention, possible risk associated with medical intervention. The patient is also given the right to receive information about the advantages of the proposed and alternative methods and forms of providing him with medical care.
The right to information is not subject to any restrictions, except in cases where the information may cause serious harm to the patient’s state of health. The information is communicated by a doctor, other medical professional who provides assistance to the patient in a form accessible to him, orally or in writing. If the patient does not speak Russian, an interpreter must be provided.
The patient has the right to refuse to receive information, which is made in writing and included in the patient’s medical records.
The patient may designate a person to whom information about the patient’s health should be provided. Upon admission to an inpatient healthcare facility, the patient must be informed about the professional status, the names and surnames of the medical personnel who will provide him with medical assistance, as well as the rules that the patient must follow during his stay in the healthcare facility. The patient has the right to receive information about his rights and obligations as a patient, about the services provided, their cost (provided that the services are paid), as well as about the procedure for their provision.Patient rights information should be posted or publicly available at the healthcare facility. Patients over the age of 15 are entitled to access to their health information. The doctor of the institution, at the request of the patient, is obliged to provide the necessary explanations related to the content of the medical information.
Medical information (documentation) may not be provided to the patient for review, not issued in the form of extracts and copies if this information: may cause serious harm to the patient’s health or the health of a member of his family and, thus, entail a violation of the right to safety ;
concerns other persons, the circumstances of their life and may lead to a violation of the rights of these persons to privacy;
deals exclusively with the administrative issues of the health care institution; In case of refusal to provide the patient with medical information on the grounds that this may cause serious harm to his health, the patient has the right to instruct any person to get acquainted with the requested data or go to court.
After the end of treatment, the patient has the right to receive a written certificate issued by the attending physician or an extract from the medical history about the diagnosis, treatment performed and relevant recommendations.

Article 17. Observance of the principle of inviolability of the person in the provision of medical care

Interference with the patient’s private life is not allowed, except in cases when he himself consents to this, or when such interference can be justified by the need to establish a diagnosis, treat the patient and care for him.The patient’s right to privacy is realized through: the right to confidentiality of information, the right to anonymity of the examination, the right to confidentiality of correspondence, telephone conversations and other messages in case of being in an inpatient healthcare institution. The exercise of these rights is not subject to any restrictions other than those established by law and necessary to protect public health and protect the rights of others. At the request of the patient, his examination can be carried out anonymously.The list of diseases that preclude the anonymity of the patient’s examination is established by the health authorities of the Russian Federation and the constituent entities of the Russian Federation. Patients’ right to privacy implies that medical intervention can be carried out in the presence of those who provide medical care and patient care, unless the patient decides otherwise regarding the presence of others and if the technology of providing medical care in this particular case allows this is.

Article 18. Professional medical secrets

Professional medical secrets (hereinafter referred to as professional secrets) apply not only to information that the patient entrusted to a doctor or other person when receiving medical care, or which became known to them in connection with the performance of professional duties, but also to any information about the patient identified in the process medical intervention.Violation of professional secrecy entails liability in accordance with the legislation of the Russian Federation. Information constituting a professional secret cannot be provided to persons who do not have access to it. The patient’s permission to access his medical information is not required: for medical workers who directly provide medical assistance to him, or a doctor who is invited to the patient as a consultant; in cases where it is limited only to data on the patient’s presence in the health care institution and information on his general condition; in the performance of official duties by employees of health authorities who are responsible for the confidentiality of information; for the bodies of inquiry, investigation, prosecutor’s office and the court in the presence of a written request; in other cases established by the legislation of the Russian Federation.The healthcare facility administration is responsible for maintaining the confidentiality and protection of patient medical information. It is not allowed to include and use in automated databases without the patient’s permission information of a personalized nature concerning his private life. It is not allowed to connect automated databases of a personalized nature to networks connecting them with other databases. Disclosure without the patient’s permission orally or in writing of information about his state of health and other data about him that became known to other persons in the course of providing him with medical care is an infringement on the patient’s privacy, regardless of whether the information disclosed was true or false.

Article 19. Consent to medical intervention

A prerequisite for any medical intervention is the informed informed consent of the patient or his legal representative. If medical intervention is required for health reasons, and the patient is unable to express his will or if it is impossible to obtain the consent of his legal representative, the intervention may be carried out without obtaining consent under the conditions specified in Article 5 of this Federal Law.
For certain types of medical intervention, the list of which is approved by the health authority of the Russian Federation, the patient must give his written voluntary consent, which is certified by his signature and included in the patient’s medical documentation.
In the process of deciding on consent, the patient has the right to seek advice from any specialist of his choice.
The consent given by the patient may be revoked before the start of the medical intervention. It is imperative to obtain the patient’s informed consent for his participation in the clinical education process and in scientific research.Experiments on people unable to express their will and consent cannot be carried out. In exceptional cases, such studies are carried out in accordance with the legislation of the Russian Federation, when the consent of the legal representative of the patient is obtained and the study is carried out in the interests of the patient.

Article 20. Refusal of medical intervention

The patient has the right to refuse medical intervention or stop its implementation, except for the cases specified in Articles 27, 30, 31 of this Federal Law.Refusal of medical intervention must be voluntary, made out in writing signed by the patient after he receives information about the possible consequences of his decision and is included in the patient’s medical documentation. In cases where the patient’s legal representative refuses medical intervention that is not of an emergency nature, but is necessary in the interests of the patient, the decision on such intervention is made by the relevant health authority or court on the proposal of the attending physician or the administration of the health care institution where the patient was recommended the specified medical intervention.

Article 21. Right to accessible and necessary medical care

Ensuring the availability of necessary medical care is one of the main priorities of state policy, an indicator of its effectiveness and moral orientation. The patient has the right to receive affordable and necessary medical care. Local authorities, and in exceptional cases, executive authorities of the constituent entity of the Russian Federation, are obliged to ensure the transportation to healthcare institutions (medical centers) of those patients who need emergency (specialized) medical care.Patients have the right to the necessary medical care, which is provided in accordance with federal medical standards, which include ethical, technological and economic components. With the organizational and methodological assistance of the federal health authority, the health authorities of the constituent entities of the Russian Federation, by combining efforts and funds, plan and ensure the optimal placement of rare and (or) expensive medical technologies in order to simplify access to them by the population.

Article 26. Obligations of patients

The patient is obliged: to show respect and tact in communication with medical workers;
provide the doctor with all the information necessary for the diagnosis and treatment of the disease; after giving consent to medical intervention, strictly follow all the prescriptions of the attending physician; comply with the internal regulations of the health care institution where he is located; cooperate with a doctor when receiving medical care; immediately inform the doctor about the change in his health status in the process of diagnosis and treatment; immediately consult a doctor if you suspect or have a disease that poses a danger of mass spread; not take actions that could violate the rights of other patients.

Article 32. Guarantees for the protection of patients’ rights

Protection of patients ‘rights is carried out by the administration of health care institutions, commissions for the protection of patients’ rights under health authorities, public organizations, including associations of patients and (or) their families, ethical committees (commissions), which operate within the limits established by their statutes. In case of violation of their rights, the patient or his legal representative may apply to the health authorities, to the court, to the Ombudsman for human rights in a constituent entity of the Russian Federation, and the Ombudsman for human rights in the Russian Federation.The procedure for appealing against illegal actions in relation to patients is established by the legislation of the Russian Federation.

Article 34. Responsibility for violation of patient’s rights

Persons guilty of violating the patient’s rights defined by this Federal Law shall be held liable in the cases and in the manner provided for by the civil, administrative or criminal legislation of the Russian Federation.
The harm caused to the health of patients as a result of violation of their rights is subject to compensation in the manner prescribed by the civil legislation of the Russian Federation.The fact of committing unlawful actions against patients that resulted in harm to their health may be recognized as a result of pre-trial proceedings with the participation of the Commissions for the Protection of Patients ‘Rights, representatives of public organizations for the protection of patients’ rights and professional medical associations, insurance organizations and (or) in court. … The conditions and procedure for insurance of civil liability for harm caused to the patient’s health, as well as the procedure for payment of compensation are determined by the legislation of the Russian Federation.

Article 35. State and public control over the observance of the patient’s rights and ensuring his safety

State and public control over the observance of the patient’s rights and ensuring his safety is carried out by health authorities, commissions operating under them to protect the rights of patients, as well as other ministries and departments within their competence in accordance with the legislation of the Russian Federation. Public control over the observance of patients’ rights may be exercised by associations of medical (pharmaceutical) workers, associations of patients or their family members, other public associations within the limits established by the legislation of the Russian Federation.The supervision of compliance with the rule of law while ensuring the rights and safety of patients is carried out by the Prosecutor General of the Russian Federation, prosecutors of the constituent entities of the Russian Federation and prosecutors subordinate to them.

General rules for preparing for ultrasound examination.

Modern ultrasound scanners have high resolution and many methods of processing and analysis of signals returned from the scanned organ. However, the limitation of the method is the acoustic accessibility of organs and tissues, that is, the presence of acoustic windows. As you know from the physics course, ultrasonic signals propagate poorly in air, giving maximum dispersion even at short distances.The optimal media for the propagation of ultrasonic radiation is water and dense moist tissues, for example, liver, kidney parenchyma, etc. and to improve diagnostic capabilities, it is necessary to get rid of the presence of air and gases in the study region, if possible, or create homogeneous acoustic windows. For example: to examine the bladder, it is necessary that it be filled. For this, there are certain rules for preparing for an ultrasound examination.

Preparation for ultrasound of the abdominal organs and liver elastometry

3 days before the study, it is necessary to exclude black bread, whole milk, raw fruits and vegetables from the diet, take 2-4 tablets of activated carbon or Espumisan, Filtrum, etc. during these days. according to the scheme attached to the packaging of the drug. In case of digestive problems, you can take mezim-forte, or festal, 1 tablet with a meal, but it is better to consult your doctor.Two days before the study, make a cleansing enema / not the day before !!! /. The last meal at 19.00 the previous day – if the study is in the morning, the study is carried out strictly on an empty stomach. If the study is carried out in the afternoon, it is recommended not to eat 6 hours before the study

Preparation for ultrasound of the abdominal organs with the determination of the function of the gallbladder

3 days before the study, exclude black bread, whole milk, raw fruits and vegetables from the diet, take 2-4 tablets of activated carbon or Espumisan, Filtrum, etc. during these days.according to the scheme attached to the package of the drug. In case of digestive disorders, you can take either mezim-forte, or festal, 1 tablet per meal 30 minutes after a meal, but it is better to consult your doctor. Two days before the study, make a cleansing enema / not the day before !!! /. The last meal at 19.00 the previous day – if the study is in the morning, the study is carried out strictly on an empty stomach.
If the study is carried out in the afternoon, it is recommended not to eat 6 hours before the study.Take with you two raw yolks or 0.5 liters of kefir 3.2% or cream of at least 10% -100-200 ml.

Preparation for ultrasound examination of the kidneys.

If the patient is overweight and has increased gas production
in the intestine, 3 days before the study, exclude black bread, whole milk, raw fruits and vegetables from the diet, take 2-4 tablets of activated charcoal or Espumisan during these
days “,” Filtrum “, etc.according to the scheme attached to the package of the drug.
In case of digestive disorders, you can take either mezim-forte or festal, 1 tablet at a time, 30 minutes after a meal, but it is better to consult your doctor. Two days before the study, make a cleansing enema / not the day before !!! /.
On the day of the study, you can eat and drink, the study is not carried out on an empty stomach.

Preparation for ultrasound examination of the bladder.

1.5 hours before the study, gradually drink 1-1.5 liters of any liquid tea, water, fruit drink, and with a full bladder arrive at the appointed time of the study. If it is impossible to endure and there is a strong urge, it is permissible to empty the bladder a little to relieve tension and re-drink a little liquid to achieve full bladder filling by the time of the study.

Types of patient rights violations

Types of patient rights violations

Where to go?

In the event of a violation of his rights, the patient can file a complaint directly with the head or other official of the medical and preventive institution where he is provided with medical assistance, with the relevant professional medical associations or with the court.

Attention: bad faith !!!

The following violations of patients’ rights are possible:

– unjustified refusal to provide medical care;

– a low level of quality or defects in the provision of medical care that did not harm the patient’s health, the inconsistency of its quality and volume with established standards;

– a low level of quality or defects in the provision of medical care that caused harm to health or caused the death of the patient, the non-compliance of its quality and volume with established standards;

– the use of merciless (painful) methods of treatment, if it is possible to exclude them or use other, sparing methods;

– unjustified collection or demand for payment for treatment;

– abuse by medical professionals;

– violation of the conditions and treatment regimen;

– violation of rights in terms of awareness of the diagnosis, possible risk, consequences and results of treatment, as well as preservation of medical secrecy;

– absence, design defects, provision of unreliable medical, statistical and financial documentation.

Unjustified refusal to provide medical care

Upon receipt of a complaint about an unjustified refusal to refer to hospitalization, hospitalization, provision of emergency, outpatient, specialized medical care, the examination of the quality of medical care should find out:

– whether the reasons for the refusal were unreasonable;

– whether the refusal has caused harm to the patient’s health;

– is there a causal relationship between the refusal of assistance and the harm caused to the patient’s health.

The presence or absence of registration at the place of residence (stay) cannot serve as a basis for refusing to receive services in medical institutions (even if the citizen is not registered anywhere at the place of residence).

If no harm is caused to the patient’s health by the refusal, the expert opinion must be submitted to the administration of the medical facility with the necessary recommendation (to provide medical care, hospitalize or issue a referral for hospitalization). The administration, if it agrees with the recommendation, must inform the TFOMS or the CMO about the measures it has taken, and in case of disagreement, raise the issue of re-examination.Along with the result of the examination, a recommendation may be sent to the administration of the healthcare facility to bring its specific employees to disciplinary responsibility.

If an unjustified refusal of medical care entailed causing harm to health (a deterioration in health condition, etc.), the expert opinion is transferred to the legal service of the TFOMS (SMO) to consider the issue of filing a claim for compensation for harm caused to health by a health facility.

If the medical institution does not agree to compensate for the harm caused to life and health (as well as moral harm) on a voluntary basis, it is reimbursed in court.In the cases stipulated by the agreement, TFOMS may apply financial sanctions to health care facilities.

A guilty medical worker may be prosecuted for failure to provide assistance to a patient on the basis of a patient’s complaint received by the prosecutor’s office or preliminary investigation, information from the Health Insurance Organization or TFOMS.

Low level of quality of medical care that did not cause harm to the patient’s health

If the examination of the quality of medical care revealed a low level of quality of medical care or defects in its provision that did not cause harm to the patient’s health, the inconsistency of the quality and volume of services with established standards, then there are no grounds for compensation for harm caused to life and health.In the presence of moral damage, the issue of its compensation may be decided in court.

If the shortcomings of the medical service included in the territorial CHI program can be eliminated upon receiving paid medical care, the patient has the right to demand:

– gratuitous elimination of deficiencies in the provided medical service;

– repeated provision of the service;

– reimbursement of expenses for the elimination of deficiencies in the rendered service on their own or by third parties;

– compensation for moral damage.

The administration of the healthcare facility can bring the guilty workers to disciplinary responsibility.

In the cases stipulated by the contract, the medical institution may apply financial sanctions to the medical institution: full or partial refusal to pay for treatment, repeated treatment is free of charge (if the treatment has already been paid for).

Low level of quality of medical care, causing harm to the patient’s health

At the complaint of the patient (in the event of his death – his relatives) about the low level of quality of medical care or defects in its provision that caused harm to health or caused the death of the patient, the inconsistency of the quality and volume of services with the established standards, an examination of the quality of medical care is carried out.She must answer the following questions:

– is there any harm to the life and health of the patient;

– what is the nature of the harm caused;

– are the actions of medical personnel illegal;

– Is there a causal relationship between the illegal actions of medical workers and the harm caused to the patient.

If the examination confirms the infliction of harm to life and health, the healthcare facility may be brought to civil liability. The patient himself has the right to compensation for damage, and in case of death, his relatives.

The specific guilty medical worker can be brought to disciplinary liability (if the harm caused to him is minor bodily injury) or to criminal liability (causing death by negligence or serious injury to health due to improper performance of his professional duties). In the second case, the CMO (TFOMS) is obliged to inform the prosecutor’s office and the preliminary investigation about the incident.

Disciplinary liability also occurs in the case of nosocomial infection, criminal liability – in case of HIV infection.

The patient has the right to file a claim for compensation for moral damage.

The financing authority, in accordance with the agreement, may impose penalties on the healthcare facility or refuse to pay for the service.

The use of merciless (painful) methods of treatment, if they can be excluded or the use of other, sparing methods

A patient’s complaint about unreasonably inflicted moral and physical suffering may become the subject of a claim for compensation for moral damage.

The specific perpetrator of a medical institution may be subject to disciplinary action.

Unjustified collection or demand of payment for treatment

The patient has the right to apply to the Medical Insurance Organization (TFOMS) with a request on the legality of charging fees for the treatment provided to him in a medical and preventive institution. The lawyers of CMO (TFOMS) are obliged to give him the necessary explanations.

If the explanations do not satisfy the patient, he or she has the right to bring a claim or claim against the healthcare facility for the return of unreasonable payment for treatment and recover moral damage in court.

CMO (TFOMS) has the right to present the administration of a medical institution with a demand to stop unreasonable collection of fees for medical services. If the administration of a healthcare facility does not agree with such a requirement, the conclusion of the CMO (TFOMS) should be sent to the healthcare management body.

Abuse by health workers

Specific medical professionals in respect of whom abuses have been identified (extortion and bribe-taking, abuse of power and official authority, negligence, official forgery, etc.)must be disciplined or criminally liable.

The patient has the right to file a claim against the healthcare facility for compensation for moral damage.

Violation of conditions and treatment regimen

An expert opinion on violations of the conditions and treatment regimen of CMO (TFOMS) should be sent to the administration of the healthcare facility or to the healthcare management body. On the basis of such a conclusion, administrative penalties are applied to the guilty employees of the medical institution.

According to the conclusion of the CMO (TFOSM), the head of the health care facility may be held administratively liable for violation of the sanitary legislation.

Violation of the patient’s rights in terms of his awareness of the diagnosis, possible risk, consequences and results of treatment and preservation of medical confidentiality

Medical professionals responsible for such violations must be disciplined. For the disclosure of information constituting a medical secret, specific medical workers may be prosecuted.The patient has the right to go to court with a claim for compensation for moral damage.

Absence or defects in design, provision of unreliable medical, statistical and financial documentation

According to the conclusion of the CMO (TFOMS), the administration of the medical and prophylactic institution should apply disciplinary sanctions to employees guilty of such violations.

90,000 Violation of patient’s rights – types of violations of rights and responsibility

Sometimes people simply do not know their rights and responsibilities, so it turns out that their rights are violated.This also happens when visiting various medical institutions, then we are talking about the fact that there is a violation of the patient’s rights. This can be done simply inadvertently, through carelessness or an annoying misunderstanding – but this does not negate the fact that the problem has occurred – therefore it is necessary to protect your rights and ensure that the people or organizations responsible for such violations bear appropriate responsibility.

Main types of violations of rights

Rights can be violated in various ways, situations can vary, but most often the following happens:

  • A person is denied medical assistance without any objective reason.This can be either a denial of outpatient care, or a denial of hospitalization, and other
  • When caring for a person, violations of the treatment regime occurred
  • Incorrect information about the disease was provided, which could cause negative consequences
  • The medical care provided to the person was of inadequate quality
  • Data were disclosed that were confidential and in which the person had the right to non-disclosure
  • In assisting the patient’s health or life, harm was done
  • A fee was demanded for the treatment, although there was no objective reason for this
  • Medical staff abused their rights and capabilities for their own benefit
  • The documentation regarding the patient’s treatment process was incorrectly drawn up

These are just some examples, rights can be violated for other reasons, including indirect and ambiguous.Therefore, for any problem, you need to immediately contact organizations that will help protect the patient’s rights.

Who protects patients?

If rights are violated, you need to take care of their protection. There are several organizations at once whose responsibilities include protecting the patient. These include:

  • Regional Ministry of Health
  • Administration of the medical institution responsible for treatment
  • The insurance company in which the injured patient is insured
  • Prosecutor’s Office and Court

A person can independently defend his rights if he is 18 or more and he is legally capable.The consumer protection society or similar types of institutions may also act for him. If a person is a minor or incapacitated, then his rights are protected by his legal representatives. But, whoever is involved in the protection of rights, the presence of the victim himself during the proceedings is mandatory.

It is important to remember that although individuals who have reached the age of 15 and may independently decide whether to provide or refuse medical care – and may even restrict the provision of medical information about their health status to parents and other legal representatives – they cannot to independently protect their rights in court, this can only be done by their legal representatives.

Also, a citizen can, when drawing up a power of attorney, seek help from various individuals and legal entities, including units at regional HIOs. They can sue for the person if they don’t want to do it on their own.

If the truth is on the victim’s side, then the guilty party will incur a punishment that is comparable to the level of violation of rights and the damage that was caused to the client of the medical institution for this reason. This can be disciplinary liability or, in more complicated cases, civil liability.

Read also: Patient Rights Act

90,000 Patient rights and how to protect them, basic legislation on patient rights

Consent to the processing of personal data

I hereby, hereinafter referred to as the “Personal Data Subject”, in pursuance of the requirements of Federal Law No. 152-FZ “O” dated 27.07.2006 (with amendments and additions) freely, of my own free will and in my own interest, give my consent to ROOP “Society Patient Protection “(hereinafter -” Society “, legal address: St.Moscow, st. Dolgorukovskaya, 33, building 6) to process your personal data specified when filling out web forms for sending a message through feedback forms on the website of the company and its subdomains (hereinafter referred to as the Site), sent (filled in) using the Site.

By personal data, I mean any information relating to me as a Personal Data Subject, including my last name, first name, patronymic, address, education, profession, contact information (phone, fax, e-mail, postal address), photos , other other information.

By the processing of personal data, I mean the collection, systematization, accumulation, clarification, update, change, use, distribution, transfer, including cross-border, depersonalization, blocking, destruction, indefinite storage), and any other actions (operations) with personal data. The processing of personal data of the Personal Data Subject is carried out solely for the purpose of registering the Personal Data Subject in the Company’s database with the subsequent sending to the Personal Data Subject of telephone calls, mail messages and SMS notifications from the Company, its affiliates and / or subcontractors.The date of issue of consent to the processing of personal data of the Personal Data Subject is the date of sending the registration or other web form indicating the user’s personal data from the Company’s Website. The processing of personal data of the Personal Data Subject can be carried out using automation tools and / or without using automation tools in accordance with the current legislation of the Russian Federation and the internal regulations of the Company. The Company takes the necessary legal, organizational and technical measures or ensures their adoption to protect personal data from unauthorized or accidental access to them, destruction, alteration, blocking, copying, provision, dissemination of personal data, as well as from other illegal actions in relation to personal data, and also undertakes the obligation to maintain the confidentiality of the personal data of the Personal Data Subject.

The Company has the right to involve subcontractors for the processing of personal data of the Personal Data Subject, and also has the right to transfer personal data for processing to its affiliates, while ensuring that such subcontractors and affiliates take appropriate obligations in terms of confidentiality of personal data.

I am aware that: this consent to the processing of my personal data specified when filling out the feedback forms and any services on the Company’s Website sent (filled out) using the Website is valid for 20 (twenty) years from the date of the initial sending on the Company’s Website;

Consent can be revoked by me on the basis of a written statement in any form sent to the e-mail address mos @ mosmedicina.ru; the provision of personal data of third parties without their consent entails liability in accordance with the current legislation of the Russian Federation.

90,000 How can a patient defend his interests

3.2. Criminal liability for violation of patients’ rights

3.2.1. Grounds and limits of the onset of criminal liability

A clear definition of the grounds and limits of criminal liability is, first of all, a necessary guarantee against unfounded accusations of medical workers in cases where the harm was caused not due to their dishonesty or negligence, but in view of, for example, the particular difficulty of diagnosing a disease, the lack of scientifically substantiated methods of treatment at the moment. or other objective reasons.

The basis for bringing a particular medical worker to criminal liability is his commission of an offense – a crime by which is meant a guilty socially dangerous act prohibited by the Criminal Code under the threat of punishment (Article 14 of the Criminal Code of the Russian Federation).

Before proceeding to the analysis of specific offenses that may occur in the provision of medical care, it seems necessary to recall the content of some concepts used in the Criminal Code of the Russian Federation.

A deed is a person’s behavior in the form of action or inaction, and action is an active volitional behavior, and inaction is a passive volitional behavior, which is expressed in the failure to fulfill the obligation to act on the person.

Mandatory signs of a crime are unlawfulness; public danger; guilt; punishability.

Wrongfulness means the commission of an act provided for by the current Criminal Code of the Russian Federation.

Public danger is considered as the ability of an act provided for by the criminal law to cause significant harm to objects (interests) protected by criminal law – life, health, human and civil rights and freedoms, property, public order and public safety, the environment, the constitutional order of the Russian Federation.

It should be borne in mind that an act that formally falls under the signs specified in the Criminal Code of the Russian Federation, but due to its insignificance does not pose a public danger, that is, did not cause harm and did not pose a threat of harm to an individual, society or the state, is not a crime (Art . 14 of the Criminal Code of the Russian Federation).

Punishment means that for the commission of one or another act prohibited by criminal law, the current Criminal Code of the Russian Federation provides for a certain punishment.

Guilt – a certain mental attitude to an act and its consequences on the part of the person who committed this act.If a person’s actions innocently caused socially dangerous consequences, then his behavior is not a crime. There are two main forms of guilt: intent and negligence.

Reckless acts in themselves are not criminal, but administrative, disciplinary, production, technological and other violations of established rules or elementary caution . Reckless acts acquire the character of criminal acts when they become the cause of socially dangerous consequences .Careless guilt is possible only when committing crimes with a material composition, that is, when the Criminal Code of the Russian Federation provides for socially dangerous consequences that are the result of certain actions of the perpetrator.

In case of frivolous guilt, the subject foresees the possibility of the onset of socially dangerous consequences, but without sufficient reason, arrogantly counts on their prevention. In case of negligent fault, a person, performing an action, does not foresee the possibility of socially dangerous consequences, although with appropriate care and foresight, he should and could, according to his subjective capabilities, foresee these consequences .The subjective criterion, that is, what is included in the concept “could”, is the main, determining one. It takes into account the individual characteristics of the subject – age, life experience, education, qualifications, emotional state.

There are cases when a crime is committed with two forms of guilt: deliberately and carelessly. The subject’s attitude to the actions performed is characterized by intent, and to the serious consequences that have occurred – by negligence (for example, the deliberate production of an abortion by a person who does not have a higher medical education of the relevant profile, which inadvertently entailed the death of the victim or causing grievous harm to her health; failure to provide assistance to the patient (deliberate inaction) , entailing by negligence the death of the patient or harm to health).

Actions that are socially dangerous by the nature of the committed actions (inaction) and the resulting consequences, committed innocently, are not considered crimes and do not entail criminal liability (innocent harm, Art. 28 of the Criminal Code of the Russian Federation).

Part 1 st. 28 of the Criminal Code of the Russian Federation, the act is recognized as committed innocent if the person who committed it did not realize and, due to the circumstances of the case, could not realize the social danger of his actions, or did not foresee the possibility of socially dangerous consequences and, due to the circumstances of the case, should not or could not have foreseen them ( an unfavorable outcome of treatment called an “accident”).The totality of subjective and objective impossibilities of awareness and foresight gives grounds to recognize the actions of a person, which entailed socially dangerous consequences, as innocent.

Part 2 st. 28 of the Criminal Code of the Russian Federation, an act is recognized as committed innocent if the person who committed it, although he foresaw the possibility of the onset of socially dangerous consequences of his actions, could not prevent these consequences due to the discrepancy of his psychophysiological qualities to the requirements of extreme conditions or neuropsychic overload .In this case, the intellectual moment in the mental attitude of a person to possible consequences is that he foresees their occurrence. At the same time, his will is aimed not at achieving the predicted consequences, but at preventing them.

Extreme conditions mean extreme circumstances, unusual in terms of difficulty and complexity. Inconsistency of the psychophysiological qualities of a person with the requirements of extreme conditions or neuropsychic overload means that a person who has the necessary professional skills, knowledge, experience, health status, admission to such types of work, and so on, with all the tension of his subjective capabilities and professional literacy of actions does not could prevent the onset of consequences.

This text is an introductory fragment.

Continuation for liters

GBUZ MO “Volokolamsk CRH” – Corruption situations in the healthcare system and violation of patients ‘rights

Corruption situations in the healthcare system and violation of patients’ rights

Today we hear more and more often about the fight against corruption in the medical field.As a rule, we are talking about everyday corruption. However, the attitude of patients towards her is ambiguous, some of the patients believe that today it is impossible to receive high-quality medical care without material reward, and in fact “thank” medical workers for the proper performance of their duties. Nevertheless, corruption in healthcare undermines the confidence of citizens in representatives of the medical community, because in the minds of people, doctors are people who are called to help, save lives.It is important to counteract everyday corruption situations in healthcare!

Most common corruption situations:

  1. Consent to receive remuneration for services. Earnings by prior arrangement are often regarded as an acceptable form of informal payment. He also finds support from patients.

  2. Artificial creation of deficits in medical services .Patients have to wait for months and pay for medical care. For a fee, these studies are carried out more quickly. At the same time, forced payment for medical services does not always guarantee their quality.

  3. Request to pay for free medical services, communication of quality and personal attention. For doctors and patients, the unambiguous criterion for getting into the corruption zone is the situation when the offer comes from the doctor himself.

  4. Unjustified medical intervention, imposition of unnecessary services

  5. Refusal to provide free medical services and demand to pay for them

  6. Subscriptions for compulsory medical insurance – inclusion of services that were not actually provided.

Most common corrupt medical services:

Hospitalization. The most common type of informal payment is payment for hospitalization services, namely: payment for services to simplify the procedure for getting into an institution, getting out of line in the event of a planned operation. The ambulance service occupies a special place in the “shadow” market of hospitalization services.

Payment for consumables. A widespread type of informal earnings in residential institutions. As a rule, the patient is offered a choice of standard consumables that are included in the programs of state guarantees or higher quality and modern ones.

Surgery. Payment for the operations themselves is a direct “shadow” earnings in hospitals. The subject for calculations can be the purchase of a queue for an operation already in the medical organization itself, as well as payment for the work of medical workers who perform operations.

Payment for diagnostic procedures. The patient is offered for an informal calculation to conduct expensive research before the operation, which is allegedly not included in the program of state guarantees.

Consultations. Informal earnings of narrow specialists are due to the restriction of patients’ access to their consultations.

Earnings from medicines. It is common for outpatient doctors and hospitals to earn money by selling drugs directly to patients. Frauds with the purchase of drugs according to the list for socially unprotected segments of the population are possible.

Registration of certificates, directions. The subject of informal sale is medical certificates, sick leaves.

For early discharge of a patient from the hospital or, conversely, for extending the patient’s stay in the hospital.

For confirmation or concealment of certain medical facts (most often – beatings and other bodily injuries.

Most of the anti-corruption measures can undoubtedly be implemented at a level as close as possible to the doctor-patient level.

Where to contact patients in case of corruption or suspicion of it:

  • “Helpline” for the prevention of corruption and other offenses of the Ministry of Health of the Russian Federation: 8 (495) 789-45-24

  • Stop Corruption telephone line of the Investigative Committee of the Russian Federation: 8 (800) 100-12-60

  • Oral communications and written statements to the bodies of the Ministry of Internal Affairs

  • Your insurance company

  • Regional Ministry of Health hotline

Management of the medical organization

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