Rozhovor Mgr. Radek Halouzka, „Zásadní změny zdravotnického práva, které přinesl zákon o zdravotních službách " | Medicínske právo
              

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Rozhovor Mgr. Radek Halouzka, „Zásadní změny zdravotnického práva, které přinesl zákon o zdravotních službách "


 | 11.4.2012 | komentárov: 388

Na tému zmien zdravotníckeho práva, ktoré priniesol zákon o zdravotních službách v Českej republike sme sa porozprávali s pánom magistrom Radkom Halouzkom, vedúcim právneho oddelenia Masarykovho onkologického ústavu v Brne.

Obrazok 1.    Dobrý deň. Mohli by ste priblížiť, kde momentálne pôsobíte? Čo tvorí hlavnú náplň Vašej práce?

Již delší dobu pracuji v Masarykově onkologickém ústavu, což je zdravotnické zařízení zřízené Ministerstvem zdravotnictví specializující se na léčbu onkologicky nemocných pacientů. Jedná se o takový „národní onkologický ústav České republiky“. V oblasti svého působení dosahuje velmi dobrých výsledků jak v oblasti kvality poskytované péče (včetně mezinárodně uznávané akreditace Joint Commission International), spokojenosti pacientů (vyhráváme v různých průzkumech), tak i v oblasti výuky či výzkumu.
Jako vedoucí právního oddělení koordinuji a přímo vykonávám řadu činností, jejichž cílem je, aby náš ústav fungoval tak, jak právo požaduje. Odpovídám zejména za sjednávání smluv, realizaci složitějších nákupů (zadávání veřejných zakázek / „verejné obstarávanie“) či řešení právních problémů spojených s poskytováním zdravotní péče, a to od těch jednodušších, vznikajících např. v souvislosti s realizací práva pacientů a dalších osob na informace o zdravotním stavu, až po ty složitější, které třeba již vyústily v soudní spor a které se týkají uplatňování nároků pacientů na náhradu škody způsobené při poskytování zdravotní péče. Tyto jsou však vzhledem k řadě „preventivních opatření“, která se snažíme v praxi zavádět, pouze ojedinělé.


2.    S akými právnymi problémami sa na oddelení potýkate najčastejšie?

Vzhledem k tomu, že se v rámci své činnosti věnuji například sjednávání smluv na provádění klinických hodnocení humánních léčivých přípravků, kdy zadavatelé těchto hodnocení jsou často zahraničními společnostmi, bývá občas dosti problematické dohodnout se s nimi na úpravě těchto smluv tak, aby tyto korespondovaly s českým právním řádem a zájmy našeho ústavu. Taková jednání pak někdy trvají i několik týdnů, neboť zvláště zadavatelé z USA chtějí zarputile dosáhnout maximum s argumentem, že jsou to oni, kdo to celé platí. Tato jednání jsou typickou ukázkou toho, že právní život není jen o právních argumentech, ale také i o umění vyjednávání.


3.    Stáva sa, že právny problém vyvstane z nedostatočných právnych znalostí lekárov?

Někdy samozřejmě ano, poslední dobou ale spíše výjimečně. Dlouhodobě je u nás trendem pravidelně seznamovat lékaře a další zdravotnické pracovníky s jejich právy a povinnostmi při poskytování zdravotní péče. Navíc se snažíme, aby byl v ústavu neustále přítomen (v běžné pracovní době) alespoň jeden právník, aby mohl operativně řešit problémy, se kterými se zdravotničtí pracovníci při své práci setkávají. Ti jsou tak zvyklí, že v případě problému či nejistoty v oblasti práva se s námi mohou spojit a my jim garantujeme, že buď okamžitě či v řádu minut od nás dostanou jasné instrukce. Samozřejmě právně obtížné situace se dějí i mimo běžnou pracovní dobu, pak na nás mají telefonní kontakt a zatím se nestalo, že by se nás nedovolali.
Naší cestou k minimalizaci problémů spojených s neznalostí práva zdravotnických pracovníků tak je průběžné a pravidelné vzdělávání zaměstnanců spojené s tím, že právník je vždy po ruce!


4.    Novoprijatý zákon o zdravotných službách si kladie za cieľ posilnenie práv pacienta. Aké  najzásadnejšie zmeny prinesie?

Změn, které nový zákon, nebo lépe řečeno nové zákony, protože vedle zákona o zdravotních službách byly přijaty rovněž zákon o specifických zdravotních službách a zákon o zdravotnické záchranné službě, přinesly, je celá řada. Z těch nejvýznamnějších můžu zmínit explicitní zakotvení některých práv pacienta, které sice zpravidla již vyplývala z Úmluvy o lidských právech a biomedicíně, ale chyběla jinak bližší úprava českými zákony. Zejména se jedná o právo vzdát se podání informace o svém zdravotním stavu, právo určit osobu, která bude oprávněna vyslovit za pacienta v případě jeho indispozice souhlas nebo nesouhlas s poskytnutím zdravotních služeb, rozvedení institutu dříve vyslovených přání nebo práva pacienta na „druhý názor“, tj. práva vyžádat si konzultační služby od jiného lékaře či zdravotnického zařízení.


5.    Myslíte si, že zákon kladie na lekárov primerané a realizovateľné povinnosti? Naozaj posilní práva pacienta? Myslím tým predovšetkým problém s ochranou osobných údajov pacientov v národných registroch.

Kdyby na tuto otázku odpovídal lékař zastávající názor, že lékař má pouze léčit a nikoli „řešit administrativní záležitosti“, pravděpodobně by odpověděl, že povinnosti plynoucí z tohoto zákona jsou nepřiměřené a jen stěží realizovatelné. Já si však myslím, že posilování práv pacientů je celoevropským trendem, kterému se nelze vyhnout a je tedy nutné se smířit s tím, že pacient je partnerem lékaře, přičemž tomuto vztahu lékaře a pacienta musí odpovídat i povinnosti kladené na lékaře a další zdravotnické pracovníky. Co se týče Vaší druhé otázky týkající se posílení práv pacientů, mám za to, že i přes četné nedokonalosti, je zákon pro pacienty přínosný. Jak jste již ovšem naznačila, jednou z těch méně povedených částí je i úprava Národního zdravotnického informačního systému určeného mj. i k vedení Národních zdravotních registrů. Je pravdou, že právní úpravu registrů kritizoval vedle odborníků z řad medicínských právníků i Úřad pro ochranu osobních údajů. Nejčastějšími výtkami je zbytečný rozsah informací, které se o pacientech budou v registrech shromažďovat, otázka zabezpečení těchto údajů či diskutabilní délky lhůt, po které mají být tyto údaje v registrech shromažďovány.


6.    Zákon o zdravotných službách sa nevyhol kritike. Skupina poslancov a neskôr 20 senátorov na podnet Českej lekárskej komory podali ústavnú sťažnosť. Kde by ste Vy videli najväčšie nedostatky zákona o zdravotných službách?

Ano, ústavní stížnost směřovala právě k problematické úpravě zdravotnických registrů a rovněž také k vysokým sankcím směřujícím vůči poskytovatelům zdravotních služeb a tzv. přeregistracím (tj. novým registracím poskytovatelů zdravotních služeb). Já zásadní problém vidím vedle úpravy zdravotnických registrů např. v požadavku souhlasu obou rodičů se zákroky u dětí, v nedomyšlené úpravě rozsahu subjektů, které mohou nahlížet do zdravotnické dokumentace bez souhlasu pacienta či v širokém vymezení osob, které za pacienta mohou vyslovit souhlas se zákrokem, nemůže-li jej pacient vyslovit sám.


7.    Bývalý minister zdravotníctva David Rath vidí ako problémovú požiadavku informovaného súhlasu oboch rodičov pri liečbe neplnoletých pacientov. Aký je Váš názor? Vyhovuje takáto úprava praxi? Neskomplikuje poskytovanie zdravotnej starostlivosti detským pacientom?

Pro úplnost je nutné zmínit, že zákon o zdravotních službách umožňuje i vyslovení souhlasu jedním z rodičů, ovšem pouze u takových zdravotních služeb, které nemohou podstatným způsobem negativně ovlivnit další zdravotní stav dítěte nebo kvalitu jeho života. Problémem, na který poukazují zejména pediatři ovšem je, že téměř všechny zákroky prováděné u dětí, např. i běžné očkování, mohou zdravotní stav dítěte negativně ovlivnit. Z toho pak plyne, že u téměř všech zákroků budou lékaři vyžadovat souhlas obou rodičů. To je však samozřejmě po praktické stránce zcela nevyhovující. Jsem zvědavý, jakým způsobem budou tuto situaci řešit rodiče, z nichž jeden pracuje po delší dobu v zahraničí, rodiče dětí žijící odděleně apod. Myslím si, že tato úprava je nedomyšlená a způsobuje více problémů, než jich řeší.


8.    Akým aspektom témy sa hodláte venovať vo svojich príspevkoch?

Jeden z příspěvků hodlám věnovat právě problematickému požadavku zákona ohledně nutnosti souhlasu obou rodičů s poskytování zdravotních služeb a možnostem jeho řešení. V dalším z příspěvků se pak zaměřím na druhý již zmíněný problém, který je ochrana či spíše „neochrana“ soukromí pacienta v důsledku řady norem zavedených zákonem o zdravotních službách.

Ďakujem za rozhovor.




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