THE ABILITY OF A HEALTH CARE PROVIDER TO TERMINATE PATIENT CARE: WHAT ABOUT VULGAR PATIENTS?

The law allows health service providers to refuse to admit a patient for care in certain cases, as well as to terminate the care of a patient already admitted. However, can a healthcare provider refuse to readmit a patient whose care has been terminated due to uncooperative or inappropriate behaviour? Can an outpatient provider even terminate care for noncompliance with internal regulations? These questions were addressed by the Supreme Administrative Court (hereinafter referred to as the "SAC") in a recent decision, so let's look at the answers to these questions together in this article.

The decision in question dealt with two fundamental issues, namely the refusal to provide care to patients for reasons attributable to them and the issue of the internal rules of a health service provider. In general, the most common problems in practice are the consistent failure of patients to comply with the proposed individual plan and the failure to comply with the internal rules of the healthcare establishment.

Legal grounds for refusing a patient

Section 48 of Act No 372/2011 Coll., on Health Services and Conditions of their Provision (hereinafter referred to as the “HCA”), allows a provider to refuse to admit a patient to care, as well as to terminate the care of a patient, for the reasons stated.

The reasons that would entitle a health service provider to refuse to admit a patient to care include exceeding the provider's reasonable workload as a result of admitting such a patient; operational or staffing reasons; the inability of the GP to visit the patient at the patient's home due to the excessive distance of the patient's place of residence; or if the patient is not insured by an insurance company with which the provider has a contract (the exception being insured persons from the EU, EEA, Switzerland and countries with a social security agreement with the Czech Republic).

A health service provider mayterminate the care of a patient if he or she transfers the patient to the care of another provider with the patient's consent; if the reasons for providing health services (except for a registering provider such as a GP, etc.) cease to exist. ); if the patient does not consent to the provision of all health services; if the patient severely restricts the rights of other patients, does not comply with the treatment procedure, although he/she has consented to the provision of health services, or the internal rules of the provider, and his/her behaviour is not due to a medical condition, or does not provide the necessary cooperation. The termination of care must not, of course, result in an imminent threat to life or serious damage to the patient's health.

The reasons that lead a provider to refuse to admit a patient to care or to terminate care should always be properly communicated with the patient and recorded in the patient's medical record.

What about a patient whose care has been terminated by a provider due to consistent noncompliance with physician orders and established treatment? The HCA does not explicitly state that the provider does not have to readmit the patient to care in such a case. The language thus creates a rather absurd situation where a patient could repeatedly claim admission to care that the provider would repeatedly terminate, locking the parties into the process.

In the decision in question, the SAC expressly rejected such a simplistic interpretation, arguing that it would lead to precisely that kind of deadlock in the process of terminating care. Thus, a provider who has terminated a patient's care for reasons stated in the law does not have to readmit the patient.

Internal rules for all providers

In the decision in question, the SAC also emphasised that, although the HCA uses the legislative abbreviation internal regulations only in the context of inpatient and day care, the meaning and purpose of the law is that outpatient care providers should also have the right to terminate care for breach of internal regulations.

This conclusion is mainly based on the fact that the wording of Section 28(3) of the HCA imposes an obligation on facilities providing inpatient and overnight care to establish internal regulations, but does not prohibit outpatient health care providers from voluntarily establishing internal regulations. The possibility for outpatient providers to create internal rules is also recognised in the commentary literature, which refers to the obligation to provide information to the patient regarding the provider's internal rules in relation to both inpatient and outpatient care.

Thus, if an outpatient care provider has internal rules beyond the scope of the law, the patient in whose care it is is obliged to comply with them. Failure to do so may provide a statutory basis for terminating the care of that patient.

Conclusion

The SAC further recalls that, according to the provisions of Section 2636 of Act No. 89/2012 Coll., Civil Code (hereinafter referred to as the “CC”), the provision of healthcare is based on a contractual basis, even if the care is fully reimbursed by a health insurance company. This contractual basis of the relationship between the patient and the healthcare provider applies to all providers (whether outpatient or inpatient care). In order to preserve the principles of private law, where both contracting parties are on an equal footing, the provider must be given the option to terminate the contractual relationship, even if this option is limited by law in view of the nature of the services provided, as a counterbalance to the patient's freedom to choose the provider.

In conclusion, it is worth mentioning that the reasons for termination of patient care still do not include the loss of trust between the doctor and the patient, despite repeated efforts by the Czech Medical Chamber. Thus, if a provider does not want to care for a patient who, although complying with the treatment procedure, is, for example, aggressive, abusive or makes unjustified complaints against the doctor, etc., the provider must prohibit such behaviour with sufficient certainty and clarity in its internal rules.

If you have any questions in connection with health law or related issues, please do not hesitate to contact us. We will be happy to learn more about your case and provide you with appropriate legal assistance.

Responsible lawyer: Mgr. Mgr. Barbora Dlabolová, Kateřina Chaloupková contributed to this article.