PNRL's comments to the draft amendments to the act on health care services

First of all, PNRL points to the extremely short - only 3-day - deadline for submitting comments on the extensive and complicated, because it relates to many issues, regulated in many different legal acts of the draft. In the opinion of the local government, such a procedure is in contradiction with the essence of public consultation, which is one of the most important processes in the field of lawmaking and guaranteeing its high quality.

The Presidium of the Supreme Medical Council, having read the draft act amending the act on health care services financed from public funds and certain other acts, submits the following comments to this draft:

The Presidium of the Supreme Medical Council positively assesses the direction of the proposed amendments to the Act on the Professions of Physicians and Dentists relating to the simplified procedure for granting the conditional license to practice. Adding new requirements for granting a conditional right to practice a profession: presenting a promise of employment from a future employer who is the so-called covid hospital and knowledge of the Polish language. Already during the legislative work in 2020, the medical self-government raised how important it is from the point of view of patient safety to ensure that the doctor providing health services in Poland, even in times of a pandemic and in entities dedicated to the care of covid patients, knows the Polish language to the extent necessary to practice the profession.

The following assumption, which is necessary and consistent with the assumption adopted in the project, about the need for the knowledge of the Polish language by persons who are to obtain the license to practice as a doctor or dentist under the simplified procedures is:

and the granting of Art. 7 sec. 2a point 1 of the new wording: "1) shows knowledge of the Polish language sufficient to perform the scope of professional activities entrusted to her - the condition is deemed to be fulfilled on the basis of a submitted declaration, subject to the provisions of para. 20a; " and

b adding in Art. 7 of the Act on the Professions of Physicians and Dentists, the provisions of para. 20a reading as follows: “20a. The competent minister of health, before issuing the decision referred to in paragraph 1. 2b or sec. 9, and the district medical council prior to adopting the resolution referred to in para. 2e or paragraph 13, as well as after granting the right to practice a profession on the basis of these provisions:

1 can check the knowledge of the Polish language of the person referred to in sec. 2a or sec. 9, if there is reasonable doubt as to the knowledge of the Polish language to the extent necessary to practice the profession of a doctor or dentist;

2 checks the knowledge of the Polish language at the request of the person referred to in sec. 2a or sec. 9. "
Knowledge of the Polish language by a practitioner or dentist under the provisions of Art. 7 sec. 2a-22 is a prerequisite for patient safety. The justification of the bill is a confirmation of this view, also expressed by the Minister of Health. For the above reasons, the authorities issuing the decisions which are to enable the practice of the profession of a doctor or dentist in Poland should be provided with the possibility of verifying the truthfulness of the statement made in terms of knowledge of the Polish language. It is obvious that the condition for issuing the decision of the minister responsible for health and the resolution of the district medical council is knowledge of the Polish language, and not submission of a declaration in this regard. Provided for in art. 7 sec. 2a (1), the requirement to submit a language proficiency declaration is only a means of proof indicated by the legislator to confirm the knowledge of the Polish language. For the above reasons, the wording of Art. 7 sec. 2a, point 1, clearly specifying what, with regard to the knowledge of the Polish language, is a requirement for granting the right to practice a profession, and what is merely a proof of meeting this requirement. However, in the event that this evidence raises doubts as to its truthfulness, the authority, before issuing an administrative decision, should have the possibility, expressed directly in the provisions of the Act, to verify the fulfillment of the condition of knowledge of the Polish language. It should be noted that the provision proposed above is modeled on the solution adopted in the government draft act amending the act on the principles of recognition of professional qualifications acquired in the Member States of the European Union, where the possibility of verifying the knowledge of the Polish language is provided for other professions, in particular for medical professions.

With regard to the provided for in Art. 4 amendment No. 11 to include contributions to the Solidarity Fund in the amount of funds transferred to finance residencies of the Presidium of the Supreme Medical Council indicates that the amount of these funds should also include the costs of:

1 monthly HR and payroll and administrative service of the resident and the service of the specialization program by the administrator, entity manager, as well as monthly administrative service of the training process, in a flat rate of 5% of gross remuneration

o for a resident;

2 the entity's fulfillment of Occupational Health and Safety requirements and documented with an invoice, initial and periodic medical examinations, as well as the costs of OHS training, protective clothing and personal protective equipment

3 an increase in the premium for insurance of medical activity;

4 increase in material expenses resulting from the provision of services by doctors undergoing training;

5 contributions that the entity is obliged to pay to the State Fund for Disabled Persons, if applicable;

6 training leaves; business trips related to training, accommodation, diets;

7 to cover the obligations of the entity conducting the specialization training to transfer funds for the remuneration of doctors participating in a specialization internship outside this entity,

8 of the labor fund transferred to the Social Insurance Institution (from the rate of 2.45%, the Ministry reimburses only 1%);

9 participation of residents in the Employee Capital Plans

10 equivalents for annual leave resulting from the employment relationship when the resident is on maternity and parental leave.
Detailed comments on other changes provided for in the project:

1 ad art. 2 - changes to the act on the state sanitary inspection: provided for in art. 2, amendment 6 of the draft, the possibility of refusing to provide the sanitary inspection authorities with information covered by statutorily protected secrecy other than professional secrecy, when this information cannot be provided in accordance with the provisions on the protection of classified information, should also be extended to the obligations of making available for inspection and providing documents about which mentioned in the proposed art. 25 sec. 1 points 2 and 3 of the Act on the State Sanitary Inspection;

2 ad art. 7 - changes to the Pharmaceutical Law: doubts are raised as provided for in Art. 7 point 2 change of the provision of Art. 96a paragraph. 1d of the Pharmaceutical Law, preventing the issuance of a prescription with an annotation that it is impossible to change the drug indicated in the prescription;

3 ad art. 13 - changes to the act on the information system in health care: in connection with the proposed amendment to sentence 2 par. 3 Art. 11 of the Act, the first sentence of this paragraph should also be amended. The current wording of Art. 11 sec. 3, first sentence of this act indicates that the subject of exchange are not only electronic medical records, but basically all documentation prepared in accordance with the provisions issued on the basis of the Act on Patient Rights and the Patient's Rights Ombudsman. It is not clear who is to assess which documents are "necessary to conduct diagnostics or ensure continuity of treatment". Meanwhile, with Art. 11 sec. 1b of the Act shows that the obligation to exchange between service providers only applies to electronic medical documentation specified in the regulations issued on the basis of art. 13a of the Act. The provision of art. 11 sec. 3 should therefore refer to the data for which the law provides for the obligation to exchange them via SIM;

4 ad art. 8 - changes to the act on combating and preventing infectious diseases in humans: the proposed changes should be positively assessed to the extent that they will enable better control over the implementation of compulsory preventive vaccinations, will enable a greater number of people to carry out preventive vaccinations during a pandemic and will enable doctors undergoing postgraduate internship qualifying for vaccination against COVID-19 also outside the entity where they are undergoing postgraduate internship - the medical self-government indicated the need for such a change many months ago;

5 ad art. 23 of the draft - the amendment to the Act of March 2, 2020 on special solutions related to the prevention, prevention and combating of COVID-19, other infectious diseases and crisis situations caused by them should be assessed negatively, providing for the waiver of the requirement to submit a report on the implementation to the Sejm of the Republic of Poland by the Council of Ministers of this act every 6 months.

Source: NIL