The doctor worked 73 hours! RPO wants regulation of doctors' working hours

In 2023. The Ombudsman took careful note of the results of the Supreme Audit Office's audit "Functioning of District Hospitals," which referred in particular to irregularities involving the excessively long duration of health care services provided by doctors employed under civil law contracts.

The circumstances described include verification of working time standards and on-call staffing by medical personnel at Nowodworski Medical Center in Nowy Dwor Mazowiecki, Samodzielny Publiczny Zaklad Opieki Zdrowotnej in Wieluń and Our Lady of Perpetual Help in Wolomin. The results of the inspection indicate that the health safety of patients there, as well as of physicians, was not properly ensured by allowing doctors on civilian employment to be on duty continuously.

As a result, among other hospitals:

• In Wolomin - four doctors provided work for more than two days without rest breaks (three doctors were on duty for 52 hours and one doctor for 66 hours),
• in Wieluń - one doctor worked 73 hours continuously (from 8:00 a.m. on April 16, 2022 until 9:00 a.m. on April 19), performing duties as Head of the Neonatal Ward with Neonatal Pathology Subdivision.

The maximum daily and weekly working time standards, required rest periods and medical on-call rules arising from the Therapeutic Activities Act apply only to employees as defined in Article 2 of the Labor Code.

In the Ombudsman's opinion, the need to regulate the working time of all physicians stems from the constitutional principle of state supervision of working conditions, and, in addition, from the right of every citizen to health protection (Articles 24 and 68(1) of the Constitution). Determination of the minimum uninterrupted rest and exceptions to this principle - limited only to employees - also raises questions with regard to compliance with the right to days off and paid annual leave (Article 66(2) of the Constitution).

At present, the only recommendation remains for managers to plan for staff on-call duties in a way that ensures adequate rest time, regardless of the form of employment. However, managers of non-business health care entities are only accountable to their constituent entities.

Therefore, the NIK's request to take legislative action to determine the maximum permissible uninterrupted working time of medical personnel in the Law on Medical Activity is fully justified, in order to eliminate cases of excessively long hours of providing health services by doctors employed under civil law contracts. 

May 25, 2023. The Ombudsman asked the Minister of Health for his position on the possibility of taking appropriate legislative action. In a response dated July 4, 2023. The Ministry of Health wrote that there is currently no work on introducing legislation to regulate the

Now ZRPO writes to Minister Izabela Leszczyna that it seems that the previously presented problem is valid. In the Information on the results of the audit "Commissioning of medical services by public hospitals", the NIK audit found numerous irregularities. The organization of the provision of health services in 9 of the 12 medical entities did not ensure the health safety of patients. 134 cases were found in which 30 doctors and three paramedics were on duty for more than 40 hours without a break. In extreme cases, doctors were on duty continuously for 124 hours (five days).

According to the NIK, the overloading of medical staff was associated with the risk of physician error and a reduction in the quality of medical care. According to the Chamber, the conversion of employment based on an employment contract to a civil law contract allowed to bypass the working time restrictions imposed by labor law and thus fill the staff shortage. The conclusions of the audit again called for measures to regulate the working time standards of medical personnel employed under civil law contracts.

Source: RPO