Rus Articles Journal

We have the right! Health service of future mothers

from the moment of pregnancy establishment the woman should use services of medical institutions constantly: maternity welfare unit, medical centers, maternity hospital... Therefore future mother has to obtain information on the rights which patients of these establishments have and to learn if necessary these rights to defend.

On general laws

First of all, each woman has to know that, coming to a maternity welfare unit and coming to maternity hospital, it, in addition, acquires the special legal status of “patient“ which gives it a number of legal guarantees of safety of life and health.

the Right for high-quality medical care and health protection is established by

to Art. 41 of the Constitution of the Russian Federation. At the same time the citizens receiving medical services on a paid basis and using them it is free, have the identical volume of the rights of the patient of medical institution provided by Bases of the legislation on protection of public health of July 22, 1993 № 5487 - 1.

According to Art. 23 of Bases of the legislation each woman during pregnancy, in time is also after the delivery provided with the specialized medical care in institutions of the state or municipal health system free of charge. Thus, medical services to pregnant women are included in the list of the state guarantees of rendering to citizens of the Russian Federation of free medical care. Besides, treatment in the public and municipal authorities of the diseases caused by pathology of pregnancy and childbirth is on a grant basis carried out.

At the same time, in recent years the sector of paid medicine for pregnant women essentially increased, including public institutions render additional services to women in labor on a paid basis.

the List of the rights of the patient at the request for medical care and its receiving is established to

in Art. 30 of Bases of the legislation. Those are:

the Most important legal guarantee of any patient, including women in labor, is their prior consent to any medical intervention from doctors. Art. 32 of Bases of the legislation obliges health workers to explain in a form, available to any person, an essence of medical actions which they intend to make concerning the patient, including degree of risk of approach of negative consequences from medical intervention. And only in cases when the patient cannot independently express the will owing to a state of health, medical intervention according to the solution of a consultation of doctors, and in cases, being urgent is allowed, the question of taking measures defines treating or the doctor on duty.

the Patient who reached 15 - summer age, can refuse medical intervention taking into account that information which was obtained by it from health workers, and also in connection with other circumstances (for example, for religious and other motives). In this case alternative options of treatment can be recommended to it. In cases if refusal can lead to death of the patient, written confirmation of refusal of intervention is required. Art. 33 Bases of the legislation indicate obligation of the message to the patient of consequences of refusal of intervention of doctors about what entry in the history of an illness is made and subscribes by the citizen and the health worker of the relevant institution,

Cases of compulsory medical intervention without consent to that of the patient are possible

only in the cases which are separately specified in the law, however in practice of activity of maternity hospitals they meet extremely seldom. For example, when in accordance with the circumstances it is impossible to receive a consent of the patient or his relatives, and urgent medical care is required.

needs to tell

On a paid basis to

Besides the listed rights of the patient when rendering medical services about the rights of the pregnant women who signed contracts on paid medical care in maternity hospitals. First of all, paid medical services can be medical institutions only in the presence of special permission (license) of authorized government bodies. To the conclusion of the contract and receiving money the medical institution is obliged to inform the potential client of contents of the license which is available for it. At the same time it is necessary to pay attention to types of medical services which the relevant medical center or maternity hospital has the right to render to the woman. Duties are assigned to medical institution; to provide to the patient full information on the characteristic of the rendered services, to provide their quality according to the established standards, and also usually qualifying standards to services of this sort, to create health safety conditions for the patient.

the Contract on rendering paid medical services is signed by

in a simple written form and does not demand any additional registration or certificates of signatures.

of the Parties in the contract, as a rule, two or three. In certain cases as the customer under the contract not the patient, but other citizen (the husband, parents or other relatives) acts. It is convenient from that point of view that all formalities preceding childbirth and after them are carried out not by the woman, but the corresponding customer. The contract has to be signed by the patient or the third party ordering for it services to the room in a hospital.

the Contract on rendering medical services has to comprise a number of conditions, namely; types of service which appear to the patient, conditions of stay in maternity hospital (existence of separate chamber, food, rendering the services which are not medical), the cost of services, terms of payment, the right and an obligation of the parties of the contract, and also responsibility for non-execution of the contract.

the Majority of the medical institutions specializing in rendering paid services have own standard forms of contracts which are offered by them for patients. However, in any of such contracts, when signing the transaction, it is possible to demand introduction of changes necessary to the client. If the contract was signed without looking, it is necessary to know that it can be applied only in case of compliance to the Act of the Russian Federation “About consumer protection“. That is in this case the client has the right to demand performance of the conditions stipulated in this law even if the contract conflicts to it. Patients of medical institutions always act in relation to establishment as consumers and possess all additional guarantees which are established by the law irrespective of, they pay own services from the means or due to obligatory or voluntary medical insurance. The customer of services is obliged to pay in due time them, and directly the patient also also to provide to physicians the full information necessary for ensuring quality and safety of medical activity.

of the Measure of responsibility of medical institution to the consumer for quality of rendering its services it are specified by p in the Act of the Russian Federation “About consumer protection“, and also Rules of rendering the medical services approved by the Resolution of the Government of the Russian Federation № 27 of January 13, 1996

the Law calls
four conditions at which simultaneous existence responsibility of health workers is possible.

If the medical institution does not fulfill the duties under the contract properly, the client has several options for protection of the interests.

In - the first, to it is given the chance to demand reduction of cost of the rendered services (for example if not were are created conditions of stay in maternity hospital, provided by the contract, it is possible to demand partial return of the paid means).

These shortcomings (for example, the idle refrigerator or lack of a bathroom in chamber) can be proved in any lawful way. For example, testimony of those who saw the real conditions created in maternity hospital or the written addresses to the address of the management of medical institution.

In - the second, the consumer has the right to dissolve the contract ahead of schedule and to demand return of the paid means in full, and also indemnification (for example if by the time of arrival to maternity hospital the conditions for the woman in labor specified in the contract are not created). The legislation did not provide the special list of the rights of women in labor, but there are universal rights of the consumer when rendering paid services, including medical. Naturally, all of them can be used depending on a real situation.

Any violation of the rights of the consumer gives to

an opportunity of collecting by the client from medical institution of compensation of moral harm in a judicial proceeding. Taking into account that childbirth it is the special situation accompanied with danger to life and health of mother and the child, the amount of compensations in similar cases can be rather high.

the Contract on rendering paid medical services consists in a simple written form.

in practice quite often situations when the customer of medical services in acceptance of childbirth on own initiative ahead of schedule refuses service of the relevant institution though from the last all obligations were fulfilled arise. For example, you decided not to use services of one maternity hospital and decided to give birth in other place, but already paid money under the contract.

In similar situations medical institutions often prove to clients impossibility of return of already paid means. It not absolutely corresponds to the law. The right of the consumer of service to refuse at any time its receiving is established to Art. 782 of the Civil code of the Russian Federation. At the same time he is obliged to pay the costs of rendering services which are only actually incurred by establishment to it by the time of refusal. If childbirth did not take place, and the advance payment was made completely, then it is possible to claim that the most part of the sum was not spent by establishment and has to be respectively returned to the client. This rule works irrespective of contents of the signed contract.

If the doctor made a mistake...

Especially would like to note the legal problems connected with presentation of claims to medical institutions in connection with the mistakes of doctors which entailed negative consequences for health.

the Law calls

four conditions at which simultaneous existence responsibility of health workers is possible. Let`s consider each of them.

  1. of Existence of harm of life or to health of the citizen. Under harm to health, according to the order of the Russian Ministry of Health of December 10, 1996 № 407 “About introduction to practice of rules of production it is judicial - medical examinations“, it is necessary to understand:
    • injuries, t. e, violation of anatomic integrity of bodies and fabrics or their physiological functions;
    • of a disease or pathological states, the resulted influences of various factors of external environment: mechanical, physical, chemical, biological, mental.
    at the same time should note that emergence of damages of health can be as result of the direct damaging impact of medical manipulations (for example, in one of lawsuits the case of damage of a mochetochnik at uterus operation was considered), and to consist in deterioration in already being available disease as a result of inadequate or untimely medical care (for example, progressing of a tumoral disease owing to the wrong diagnostics and untimely operation).

  2. of Action of the causer of harm have to be illegal. Literally it means that the responsible person has to violate any established rules and the instructions obligatory for observance. There is a speech about violation of technologies of delivery of health care to the patient, Quality check has to be carried out according to the petition from the citizen of office of Federal Compulsory Health Insurance Fund in the place of his residence. It does not depend on that, help on VHI or not as quality of services has to be identical was given. Let`s emphasize that this check is carried out free of charge. As a rule, in offices of compulsory health insurance fund there are special departments of quality control of delivery of health care. The solution of a question in each case is entrusted to medical scientific or educational institutions. First of all documentation is provided to experts: the clinical record, epikriz (for example, the conclusion or an extract from the clinical record) etc. Besides, they can conduct additional examinations of patients. The conclusion about violation of medical technologies by doctors or, on the contrary, about observance of the existing standards by them has to become result of check. Here approximate list of possible violations:
    • non-performance, untimely or low-quality performance of diagnostic, medical, preventive, rehabilitation actions necessary for the patient (researches, consultations, operations, procedures, manipulations, transfusions, medicamentous appointments etc.) ;
    • unreasonable (without sufficient indications or in the presence of contraindications) the carrying out diagnostic, medical, preventive, rehabilitation actions which led to a diagnostic error, the choice of wrong tactics of treatment, deterioration in a condition of the patient, complication of a course of diseases or lengthening of terms of treatment;
    • of a disease (injuries, burns) and the complications which arose during stay of the patient in medical institution because of health workers and demanded rendering additional medical services including:
      • the intrahospital infection connected with the wrong actions of medical personnel;
      • of complication after medical manipulations, procedures, operations, tool interventions, infusions etc., connected with defects of their performance or underestimation of contraindications.
    Unfortunately, in practice quite often it turns out so that expert opinions have indistinct character; in them it is told about possible wrong treatment only with a certain share of probability. Anyway, the patient should know that the result of check can be reconsidered by court by consideration of the claim. Therefore even at not absolutely concrete judgment it is necessary to appeal to court with requirements about compensation of damage.

  3. Existence of a causal relationship between actions of the doctor and damage of health. Actions of the physician even if they violate rules of rendering medical services, have to be the cause or one of the reasons which caused infliction of harm to health of the citizen. Otherwise to talk about indemnification to the patient it is impossible, admissible to achieve only disciplinary responsibility of the doctor no more.

    is also provided In Art. 1079 of the Civil code responsibility for harm, is innocent caused by a source of the increased danger, i.e. responsibility is born also in the absence of fault of the causer of harm. As such source different mechanisms used in medicine and also strong substances (poisons, chemicals, drugs etc.) can be considered . The owner of a source of the increased danger is exempted from liability only if proves that harm arose in connection with action of force majeure circumstances or on intention of the victim. Thus, for example, if at the patient deterioration in a state is caused by the wrong dosage of medicine, then irrespective of on whose fault it occurred (for example, information inappropriate to reality on packing or unreasonable appointment as the doctor), responsibility is born by either the producer of a preparation, or the person, it is wrong using it, i.e. the doctor who made the wrong appointment. If the patient himself is guilty of causing to himself damage, then, in the presence of intention, about responsibility of the doctor there cannot be a speech if imprudence took place, then the amount of compensation decreases by the part determined by court in each case.

  4. Existence of fault of the doctor in the actions made by it. the Law provides two forms of fault: intention (if it really took place, then to speak just right about criminal prosecution of the doctor) and imprudence (in the majority a case at trial of claims to medical institutions it is about it). Imprudence also happens two types: negligence when the doctor owing to absence of knowledge which has to possess does harm to the patient, and levity at which the perpetrator is groundless counts that it will not do harm to health though on all facts of the case has to understand that its actions are unsafe. In practice negligence and levity differ proceeding from all circumstances of incident, depending on the fact that all - took decisive place at infliction of harm to the patient. Medical examination which defines existence and a form of fault is in most cases appointed.

    Many victims of low-quality medical care citizens try to achieve also criminal prosecution of the doctors guilty of damage of their health or death of close people. Here it is necessary to know that responsible according to Art. 293 of the criminal code of Russian Federation only the physician of the public or municipal authority can be made for negligence. Concerning doctors of other establishments initiation of legal proceedings according to Art. 118 of the criminal code of Russian Federation - causing heavy or harm of average weight on imprudence is possible. It is explained by the criminal legislation which establishes more strict liability for officials of government institutions. Anyway in practice it is rather difficult to law enforcement agencies to personify responsibility of physicians as, as a rule, a large number of doctors is engaged in health of one patient and to prove that fact who exactly and at what stage made a fatal flaw, in most cases very difficult, and at times it is impossible. Therefore we advise, first of all, to try to achieve indemnification in grazhdansko - a legal order, and already then, depending on circumstances, to demand initiation of legal proceedings.

    the Employee of medical institution personally guilty of violation of the existing rules of rendering the medical services which entailed infliction of harm to the patient can be also brought to a disciplinary responsibility, up to dismissal. However, only the administration of the relevant institution can make the decision on the matter.

    of the Claim of patients to the state and commercial healthcare institutions about indemnification are shown by identical rules, i.e. both that and others bear equal grazhdansko - legal responsibility, including liabilities for damage and moral harm.