In response to numerous requests to the authors of the series, we are separately posting the entire text and presentation on the Medical Event Compensation Fund. Together part 4 - 6.
Medical Event Compensation Fund - what you need to know
Published Jan. 9, 2024 10:29
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Medical Event Compensation Fund
It must be clearly emphasized that the Medical Event Compensation Fund, is an important component of the system that affects the quality of health care.
The impact on healthcare quality stems from several circumstances:
1) First, because of the introduction, through the regulation of the Medical Event Compensation Fund, of the so-called "no fault" system;
2) Second, because of the simplification of the claims process for patients;
3) Third, because of the reduction in the time it takes for patients to pursue claims;
4) Fourth, due to the introduction of the principle of applying analyses of the irregularities found and preparing corrective measures for patient safety in entities where medical incidents have occurred.
Important date
Patients can apply to the Fund starting September 6, 2023.
What is a "non fault" system?
The no-fault system was introduced in Sweden as early as the 1970s. All medical facilities in the country take out mandatory no-fault patient insurance.
When an adverse medical event occurs, it is not necessary to rule on whose fault it occurred. It is enough to prove that it occurred and that the patient suffered a loss for which compensation is due.
Instead of asking: "who was at fault ?", the most important question is: "did the patient suffer harm ?".
Separately, analyses of events causing damage are conducted and answers are sought to the question "why did something go wrong ?"
Treatment in hospital
The provisions on compensation benefits from the Medical Event Fund shall apply to medical events occurring in the course of providing or as a result of providing or failing to provide publicly funded health care services under the terms of the Act of August 27, 2004 on publicly funded health care services in a hospital within the meaning of Article 2(1)(9) of the Act of April 15, 2011.
What is a hospital?
A hospital is a medical establishment in which a medical entity performs therapeutic activity in the type of hospital services - Article 2 (1) (9) of the Law on Medical Activity of April 15, 2011.
Hospital benefits
Inpatient service - comprehensive health care services performed around the clock, consisting of diagnosis, treatment, care and rehabilitation, which cannot be provided under other inpatient and round-the-clock health care services or outpatient health care services; inpatient services are also services provided with the intention of completing them within a period not exceeding 24 hours.
In order for a patient to claim a compensation benefit, he or she must be provided with:(i) a hospital benefit (ii) funded by the National Health Service (iii) in a hospital.
What is a medical event?
Medical event - occurring in the course of providing or as a result of providing or omitting to provide a health care service:
(a) infection of the patient with a biological pathogen,
(b) bodily injury or disorder of the patient,
(c) death of the patient,
which, with a high probability, could have been avoided if the health service had been provided in accordance with current medical knowledge or if another available diagnostic or therapeutic method had been used, unless there were foreseeable normal consequences of the method to which the patient gave informed consent.
Thus, a medical event is an occurrence:
- In the course of providing health care services;
- As a result of providing health care services;
- failure to provide health care services.
Note that this is only about inpatient hospital services provided in a hospital.
Failure to provide a service does not include a delay in providing the service due to the patient's wait in the waiting queue.
We will deal with a medical event when a patient is unreasonably denied admission to a hospital - a failure to provide a service.
The term "as a result of the provision of health care" means that a medical event may occur later than "during the provision of health care" if the medical event is a result of the provision of health care.
The condition for an event to be considered a medical event within the meaning of the regulations is that "with a high probability, the event could have been avoided if the health service had been provided in accordance with current medical knowledge using another available diagnostic or treatment method."
What is not a medical event?
A medical event is not an occurrence if it is "the foreseeable normal consequences of the application of a therapeutic method to which the patient gave informed consent."
What, despite the patient's consent, is a medical event?
Even if the event is a foreseeable normal consequence of a treatment method to which the patient did not give informed consent.
In order for informed consent to be considered to have been given, the following conditions must be met:
- information to the patient is given in a clear and accessible manner;
- as part of this information, there is an indication of all possible normal consequences of treatment
- as part of this information, there is an indication of other possible treatments
- The patient is free to decide on treatment - no coercion.
Thus, if there are normal consequences of treatment, if the patient did not consent to these consequences (did not give informed consent to treatment) we will have a medical event - the medical event will be the normal consequences of treatment not covered by the patient's informed consent.
Summary:
A medical event is any bodily injury, disorder of health, infection, or death of a patient, which, with a high probability, could have been avoided, with management in accordance with current medical knowledge or with the use of another therapeutic method.
A medical event is any bodily injury, disorder of health, infection, or death of a patient that is a normal consequence of a method of treatment if the patient did not give informed consent to the method of treatment.
How much time is there to submit an application?
An application to the Patient Ombudsman must be submitted within one year from the date the applicant learned of the medical event.
Patients can apply to the Fund starting September 6, 2023.
An application for compensation benefits may also be filed when the medical event occurred before the date of entry into force of the Law (before September 6, 2023), if the applicant learned of the medical event after the date of entry into force of this Law.
The maximum period within which a claim can be filed is 3 years from the date the medical event occurred, even if the patient learned of the event after September 6, 2023.
The earliest date when a medical event could have occurred is September 6, 2020.
If the patient learns of the medical event in the last period of 3 years then he or she has one more year to file a claim.
Who to apply to?
The application is submitted to the Patient Ombudsman.
Who can submit an application?
In the case of:
(a) infection of the patient with a biological pathogen,
(b) bodily injury,
(c) disruption of the patient's health,
application can be made by the patient
In the event of a patient's death, an application may be filed:
- first-degree relative,
- The non-separated spouse,
- a person in an adoption relationship,
- A person in common life with the patient.
Key elements of the application
The most important elements of the proposal are:
- indication of a medical event,
- Justification, including an indication of the facts on which the application is based,
- A copy of the medical records in your possession and other documents confirming the described facts, or detailed information on the absence of such documents.
Other compensation or damages
Obtaining compensation from the Compensation Fund cannot be combined with other compensation or damages.
Proceedings for compensation benefit, shall not be initiated, and initiated shall be discontinued, in the event that in connection with the medical event:
- final judgment on compensation, pension or damages,
- civil proceedings for compensation, pension or damages are pending,
- the applicant has obtained compensation, pension or damages from the person responsible for the damage, including liability insurance,
- The court ordered the applicant to make reparation for the damage caused by the crime or to compensate for the harm suffered, or to pay a surcharge.
How long does the procedure take?
The entire proceedings can take up to 4 1/2 months at most. This is the period during which the court may not yet have served a lawsuit for damages on the other party in a civil trial.
The decision on compensation, is issued within 3 months from the date of receipt of a complete and properly paid application.
The applicant shall submit to the Ombudsman a statement of acceptance of the compensation benefit or
Failure to submit a statement shall be treated as a statement of resignation from the compensation benefit.
Payment of the compensation benefit shall be made within 14 days from the date of submission of the statement of acceptance of the compensation benefit.
The amount of compensation from the Fund
Infection of a patient with a biological pathogen from PLN 2,000 to PLN 200,000.
Patient injury from 2,000 zlotys to 200,000 zlotys.
Patient disorder from 2,000 zlotys to 200,000 zlotys.
Death of a patient from PLN 20,000 to PLN 100,000.
Prof. Dorota Karkowska, Dr. Tomasz Karkowski, Dr. Iga Lipska, counselor legal counsel Michal Modro.
