Corina Ciobanu – Lawyer
Luca Mihai Cătălin Law Office
In this issue of the magazine we aim to make a brief general presentation of the patient’s rights, as provided by the provisions of the Patient Rights Law no. 46/2003 and continued by the 2016 Norms for the application of the Patient Rights Law no. 46/2003 approved by Order no. 1410/2016.
As a preliminary point, we mention that Law no. 46/2003, in the first article, offers a series of definitions for certain notions, including the notion of “patient” which means any healthy or sick person using health services or the notion of “legal representative” of the patient by which means the spouse, children, parents or other relatives up to the fourth degree of the patient, the guardian, as well as any person at least 18 years of age who the patient designates for this purpose by a statement concluded in authentic form which will include the rights provided by law that can be exercised by the representative.
Patient rights in Romanian legislation
The main rights of the patient stipulated by the provisions of Law no. 46/2003 are, in the order of their regulation by the Romanian legislator, the following:
I. General rights of the patient (art. 2-3 of Law no. 46/2003)
1. The patient has the right to the highest quality medical care available to society, in accordance with human, financial and material resources.
2. The patient insured through the National Health Insurance House has the right to free screening investigations at his / her own request from the moment he / she is included in the risk group or on the basis of a referral from the specialist doctor. The notion of screening means the initial examination of the presumption or the establishment of the actual existence of diseases or other biological or behavioral characteristics in a population, which consists in applying a set of investigative procedures and techniques in order to detect early and highlight them in a early stage.
3. The patient has the right to be respected as a human person, without any discrimination. In this regard, health facilities should ensure equal access of patients to medical care, without discrimination based on race, sex, age, ethnicity, national origin, religion, political choice or personal dislike.
II.The patient’s right to medical information (art. 4-12 of Law no. 46/2003)
1. The patient has the right to be informed according to art. 4, art. 5 and art. 6 of Law no. 46/2003: on the medical services available and on how to use them, on the identity and professional status of health care providers, on the rules and habits that they must follow during hospitalization, on their state of health, of the proposed medical interventions, of the potential risks of each procedure, of the existing alternatives to the proposed procedures, as well as of the data on diagnosis and prognosis.
The information is made known to the patient in a respectful, clear language, with the minimization of specialized terminology. If the patient does not know the Romanian language, the information will be made known to him in his mother tongue or in a language he knows or, as the case may be, another form of communication will be sought.
2. The patient has the right to decide if he still wants to be informed if the information presented by the doctor would cause him suffering. At the same time, the patient has the right to expressly request not to be informed and to choose another person to be informed in his place. Relatives and friends of the patient can be informed about the evolution of investigations, diagnosis and treatment, with the patient’s consent.
3. The patient or expressly designated person is entitled to receive, upon discharge, a written summary of the investigations, diagnosis, treatment, care provided during hospitalization and, upon request, a copy of the records of the high performance investigations, once.
Patient rights in Romanian legislation
III. Consent regarding medical intervention (art. 13-20 of Law no. 46/2003)
1. The patient has the right to refuse or stop a medical intervention assuming, in writing, the responsibility for his decision. According to art. 4 of the Implementing Rules, in the event that medical interventions are refused by patients, they must be explained the consequences of refusing or stopping medical acts. As an exception, when the patient cannot express his will, but an emergency medical intervention is necessary, the medical staff has the right to deduce the patient’s consent from a previous expression of his will. In this case, the consent of the legal representative is no longer required.
If the consent of the legal representative is required, the patient must be involved in the decision-making process as far as his capacity for understanding allows. If it is considered that the intervention is in the interest of the patient, and the legal representative refuses to give his consent, the decision is declined to a specialized arbitration commission consisting of 3 doctors for hospitalized patients and 2 doctors for outpatients.
2. The patient’s consent is required: for the collection, storage, use of all biological products taken from his body, in order to establish the diagnosis or treatment with which he agrees, in the case of his participation in clinical medical education and scientific research, and to could be photographed or filmed in a medical facility, unless the images are necessary for diagnosis or treatment and to avoid suspicion of medical malpractice.
IV. The patient’s right to confidentiality of information and privacy (art. 21-25 of Law no. 46/2003)
1. The patient has the right to confidentiality of information, so that all information on the patient’s condition, results of investigations, diagnosis, prognosis, treatment, personal data are confidential even after his death and can be provided only if the patient gives his explicit consent or if the law he expressly requests it. Exceptionally, if the information is required by other accredited healthcare providers involved in the treatment of the patient, consent is no longer required.
2. The patient has the right of access to personal medical data and to designate, by agreement in the annex to the general clinical observation sheet, a person who has full access, both during the patient’s life and after the patient’s death, to the information confidential from the observation sheet.
3. Any interference in the patient’s private, family life is prohibited, unless this interference positively influences the diagnosis, treatment or care provided and only with the patient’s consent. Exceptions are cases in which the patient is a danger to himself or to public health.
V. Patient’s rights in the field of reproduction (art. 26-28 of Law no. 46/2003)
1. The woman’s challenge to decide whether or not to have children is guaranteed. As an exception, a woman’s right to life prevails if pregnancy is a major and immediate risk factor for the mother’s life.
2. The patient has the right to information, education and services necessary for the development of a normal sex life and reproductive health, without any discrimination. Also, every patient has the right to effective and risk-free family planning methods.
Patient rights in Romanian legislation
VI. Patient’s rights to treatment and medical care (art. 29-36¹ of Law no. 46/2003)
1. If providers are required to select patients for certain types of treatment that are available in limited numbers, the selection is made only on the basis of medical criteria developed by the Ministry of Health and Family within 30 days from the date of entry into force of law.
2. The patient has the right to terminal care in order to die with dignity. Terminal care means the care provided to a patient with the available means of treatment, when it is no longer possible to improve the fatal prognosis of the disease, as well as the care provided near death.
3. The hospitalized patient has the right to medical services provided by an accredited doctor from outside the hospital. According to art. 16 of the Implementing Rules, at the request of inpatients, bedside health facilities must ensure the necessary conditions for them to obtain other medical opinions, as well as for the provision of medical services by accredited doctors from outside the unit.
4. The patient has the right to continuous medical care until his / her health improves or until he/she is cured, and after discharge the patient has the right to the available community services. The patient also has the right to benefit from emergency medical care, emergency dental care and pharmaceutical services, in a continuous program.
In conclusion, we would like to emphasize that the patient has the right to report to the medical and administrative staff of public or private health units any deficiency in connection with the violation of his rights, at any time during the use of health services, community or medical act, and violation by the medical-sanitary staff of the patient’s rights provided in the Romanian legislation, may attract, as the case may be, the disciplinary, contraventional or criminal liability of the guilty persons, according to the legal provisions.
