Cases where healthcare has not been properly provided to patients are not rare, and often fails to avoid media attention. Neglecting health care can have fatal consequences that can lead to the death of the patient, so there should be effective and efficacious means to prevent such situations as well as remedies that at least partially reward the families of the affected patients in the form of responsibility for neglecting the provision of healthcare.

Who in Slovakia is supervising the provision of health care?

The surveillance of the provision of health care is carried out in accordance with Act no. 581/2004 Coll. on health insurance, health care surveillance and amending certain health care authorities (hereinafter referred to as "the Office").

On what basis does the Office supervise and decide?

Generally, the basis for the decision consists of the health records under the Health Care Act and the evaluation of electronic health records in an electronic health book, by a person authorized to perform healthcare surveillance on a mandated basis. For example, medical records include data on a person's illness, data on the extent of healthcare provided, including prescribed and administered human medicines, and other similar information.

The Office's decision-making is also based on other information, which varies depending on whether the surveillance is carried out at a distance or whether it is carried out on-site.

Remote surveillance

Remote surveillance is also carried out by obtaining and evaluating information and documents about the supervised entity, which may be submitted to the Office, for example, based on its written request. Other documents may be subsumed information and documents which are stated in reports, statements or in other documents submitted to the Office based on law.

Above enumeration is quite general and the Office has access to a wide range of documents and information.

On-site surveillance

On-site surveillance, unlike remote surveillance, is far more interactive. This surveillance is carried out directly in the supervised entity and is carried out by the Office's staff and other invited persons, under the mandate from the Office. For ease of reference, they can also be referred to as supervisors.

The expertise of authorized persons to perform the surveillance is ensured by the requirement that at least one person must have professional competence in supervised work activities as well as 5 years of professional health care practice. In order to ensure the open-mindedness of these persons to the supervised matter, the law lays down the conditions to prevent the partiality, and if they are fulfilled, such persons will be excluded from surveillance.

The Office's decision-making will also be based on information obtained from the supervised entity or its employees by the persons authorized to perform the surveillance. For this purpose, persons authorized to perform surveillance are entitled, for example, to enter the premises where the supervised entity carries out its activities, to request documents, explanations, statements or other written and oral information relating to the object of surveillance or deficiencies found.

Does the Office also decide based on information received from family members of persons to whom neglected health care was to be provided?

The law does not foresee such a possibility. For this reason, the Office usually uses the information provided by the supervised entity to its decision to the extent requested by the Office.

By law, a family member does not belong to the parties to the proceedings. We can even say that the law does not mention family members in this section at all.

In light of the aforementioned, though the Office has relatively broad powers to properly ascertain the facts when performing health care supervision, its findings are based on facts from the point of view of only one party - a party that may have been mistaken in providing healthcare.

Can we expect some change?

The activity and commitment of family members of people who have been ill-treated, the activity of the media and other people interested in more equitable healthcare surveillance have resulted in a public debate aimed at adapting existing legislation and better adjustment of health care surveillance.

The Prime Minister of the Slovak Republic, Peter Pellegrini, also commented on the issue at a press conference held on April 26, 2019. He promised to adopt several measures to help resolve this situation. He stated that these measures should include (i) the possibility for the injured family to comment to the healthcare surveillance procedure; (ii) equitable punishment for those who have been neglected of proper health care; and (iii) as simple as possible to seek justice for the family members of the persons concerned.

An amendment to the Criminal Code, at the moment in the interdepartmental commenting, should establish a new crime - the crime of falsification and counterfeiting of health documentation, but this issue, as well as an amendment to the Act on the Provision of Health Care and a new institute “Clinical Audit” will be the subjects of the next article.