Care Provision Obligation of Healthcare Workers
In emergencies, irrespective of time and place, the healthcare worker shall provide first aid to any person in need, to the extent that said healthcare worker can provide such aid under given conditions with the implements available, and/or shall immediately take necessary measures. In cases of doubt, the existence of an emergency shall be presumed.
(1) When mandated to provide in-area care, the healthcare worker shall take the
measures during his working hours, as set forth in Subsections (2) and (5) and in keeping
with the professional competencies and expertise of the healthcare worker, to provide care
for a patient requesting it.
(2) A physician, assuming that he is authorized to do so on the basis of professional competence and expertise, shall examine all patients requesting to be seen. Depending on the findings of the examination, he shall treat the patient or, in the absence of proper objective and personnel conditions, shall refer the patient to a physician or healthcare provider with the proper conditions.
(3) Examination of the patient shall include investigating all complaints of which the attending physician is aware, ascertaining patientís medical his tory and discovery of individual circumstances that influence patient recovery.
(4) The measures set forth in Subsections (2) - (3) shall be circumvented only in cases when life-saving interventions of pressing necessity are required.
(5) A healthcare worker who does not have medical qualifications shall provide such examinations for patients requesting them that are within his competency, or when they exceed the healthcare workerís scope of competency, he shall notify a physician with the authority to conduct said examinations. In this latter case, however, if made necessary by patientís condition, until arrival of the physician, he shall complete all interventions for which he is authorized on the basis of professional competency and experience.
(1) For the duration of the time a physician is absent or otherwise prevented from
a) the employer of the attending physician
b) in lieu of an employer, the attending physician himself
c) or if the attending physician is prevented from providing care, the regionally responsible health authority, at the expense of the healthcare provider,
shall have to arrange for the examination and treatment of the patient through another physician, which shall not include the situation when there is an on-duty physician handling the work of the attending physician.
(2) The physician requested to attend to the patient as a substitute, or the on-duty physician, shall have to brief the regular attending physician on events related to the patientís health within an appropriate time frame and in an appropriate manner.
(1) To ensure that continuous care is available a healthcare worker obliged to provide
in-area care shall, in keeping with employer rules and the provisions of separate
statutes, beyond regular working hours
a) be within reach, or in stand-by in a specific place, or
b) provide on-duty services.
(2) With respect to Subsection (1)
a) stand-by is defined as being prepared and ready to conduct work during out-of-the-ordinary working times, at a specific place accessible or designated by the healthcare provider,
b) on-duty shall mean, if it is not necessary or possible to organize a regular work shift, availability to work at a work site during out-of-the-ordinary working time in return for an on-duty fee, as well as to conduct both on-duty tasks and tasks falling within the healthcare workerís job description.
Choice of Methods of Examination and Therapy
(1) It shall be the right of the attending physician to choose freely among the
scientifically accepted methods of examination and therapy [as set forth in Paragraph b)
of Subsection (3) of Section 119], within the framework of valid statutes, that are to be
applied, are known to and practiced by him or the persons participating in the care and
that can be carried out under available objective and personnel conditions.
(2) The prerequisite for applying the method of examination and therapy chosen shall be that
a) the patient has consented to it within the rules of this Act, and
b) the risk of the intervention is lower than the risk of non-completion of the intervention, or that there be a well-founded reason for taking the risk.
(3) When performing /his tasks, the attending physician shall be authorized to
a) request the participation of another physician or healthcare worker with other qualifications in the examination or treatment of the patient,
b) recommend or convene a consultation.
(1) The attending physician, in his area of responsibility, shall be authorized to issue instructions to healthcare workers participating in patient care. The instructions shall include a clear specification of the task to be completed, the place and time of completion, and, if necessary, the names and sphere of activity of additional healthcare workers to be requested to participate.
(2) The healthcare worker participating in the care shall
a) execute the instructions in accordance with the conditions set forth in them and in keeping with the code of practice of the profession,
b) immediately notify the attending physician, or if this is impossible, another physician participating in the care of the patient, if an unforeseeable event or event leading to a deterioration in patient condition occurs during implementation,
c) immediately make it known to the attending physician, or if this is impossible, to another physician participating in the care of the patient, if in his opinion, execution of the instructions would have an unfavorable influence on the condition of the patient, or if he has some other concern,
d) refuse to execute the instructions, simultaneously notifying the attending physician, if, according to knowledge he is expected to possess, compliance would threaten the life of the patient or lead to permanent impairment to patientís health that would otherwise not be a necessary outcome of treatment.
(3) The participating healthcare worker, if instructed to execute the instruction despite the provisions set forth in Paragraph c) of Subsection (2), shall be authorized to request that said instructions be communicated in writing.
(4) Within the framework of the instructions, the healthcare worker, in keeping with his own professional competency and experience, shall make his own decisions on the manner and order of executing the tasks he is to complete.
The Right to Deny Care
(1) A physician directly involved in patient care may refuse to examine a patient
a) if prevented from doing so because of the immediate need to care for another patient or
b) because of a personal relationship with the patient
on condition that he refers the patient to another physician.
(2) A physician may refuse to examine and provide further treatment for a patient if his own health or some other obstacle renders him physically unfit to do so.
(3) A physician may refuse to provide care for a patient only following an examination,
if in the course of the examination he determines that
a) the patientís health status does not require medical care,
b) the treatment requested by the referring physician or the patient is not justified professionally,
c) the healthcare provider does not have the personnel or objective conditions needed to provide the care and he refers the patient to a professionally responsible healthcare provider, or
d) the condition of the patient does not require immediate intervention and the physician completing the examination can order the patient to return at a later time, or the physician acts in accordance with Paragraph b).
(4) If, during the course of examining the patient, it is concluded that the treatment recommended by the referring physician or the patient is in conflict with the statutes or with professional rules, the physician may deny care.
(5) A physician also may refuse to treat a patient if
a) said treatment is in conflict with the physicianís moral outlook, conscience, or religious convictions,
b) the patient seriously violates his obligation to cooperate [Subsection (2) of Section 26],
c) patient behaves in a manner that insults or threatens the physician, unless this behavior can be attributed to the disorder,
d) patient behavior puts the life or physical well-being of the physician at risk.
(6) In the cases set forth under Paragraphs a) and c) of Subsection (5), the physician
only may refuse care if
a) said refusal will not damage patient health, and
b) he refers patient to another physician, or recommends that the patient see another physician in his own interests.
(1) A healthcare worker who is not a qualified physician must deny care requested by a
a) provision of said care conflicts with statutes or professional rules,
b) physically unfit to provide it because of his own state or health or other obstacle.
(2) A healthcare worker who is not a qualified physician may refuse care within his sphere of competence for causes set forth in Subsection (5) of Section 131, when simultaneously notifying the attending physician.
When a healthcare worker is employed by a healthcare provider with obligation to provide in-area care, the condition for exercising the right of refusal set forth in Paragraph a) of Subsection (5) of Section 131 shall be the notification of the employer in writing of this circumstance prior to commencing employment or immediately following the occurrence of the circumstance during the course of employment.
Obligation to Provide Information
(1) With the exception of cases set forth in Subsections (1) - (2) of Section 14, the
attending physician shall brief the patient on his medical condition to the best of his
knowledge, with the regularity justified by the condition, in keeping with the level of
knowledge expected of the physician, and in accordance with the provisions set forth in
(2) If the patientís disposing capacity is severely impaired or limited, the attending physician also shall inform the persons set forth in Subsection (2) of Section 14 or Section 16.
(3) Receipt of general informative leaflets prepared in bulk shall not substitute for a provision of oral information.
(4) In appropriate cases the information shall include the circumstances set forth in Subsections (1) and (5) of Section 209, Paragraph e) of Subsection (1) of Section 210, and Paragraph e) of Subsection (2) of Section 219.
(1) The attending physician shall be circumspect in informing the patient, and shall do
so gradually when necessary, considering the patientís condition and circumstances.
(2) When informing the patient, special attention shall be given to the generally known, significant side effects of treatment, to possible consequences, and to possible outcomes of interventions including the frequency with which they occur. The physician shall ascertain that the patient has understood the information, and when necessary the physician shall see to it that the patient so informed shall have psychological care.
Obligation to Document
(1) The healthcare documentation shall contain data related to patientís examination and treatment. Clinical charting shall be conducted in a manner that reflects the true course of the healthcare process.
(2) Healthcare documentation shall include
a) patient identification data,
b) if a patient is in possession of full disposing capacities, a person to be notified in case of emergency, or in the case of a minor or a person with a guardian, the name, address, and manner of accessing said patientís legal guardian,
c) patientís history, and the etiology of the disease,
d) the results of the initial examination,
e) the results of examinations/test serving as a basis for diagnosis and therapy, and the dates on which said examinations/tests took place,
f) the name of the disease justifying care, the underlying diseases, comorbidities, and complications,
g) the names of other illnesses not directly requiring care, and of the risk factors,
h) the time and results of interventions,
i) pharmaceutical and other therapies, and the results,
j) patient data on over-sensitivity (allergies) to medications,
k) the name of the healthcare worker recording the information on the chart, and the date on which it was charted,
l) a statement of the information provided to the patient and/or to other persons authorized to receive said information,
m) the fact of patient consent [Subsection (3) of Section 15] or denial of consent (Sections 20-23), and the date(s) on which it (they) occurred,
n) all other data and facts that can influence treatment outcome.
(3) The following shall be maintained as a part of healthcare documentation:
a) findings from all laboratory tests,
b) documents written during the course of treatment and during consultations,
c) nursing care documents,
d) copies of images taken during imaging diagnostic procedures, and
e) findings of tests on tissue samples taken from the patientís body.
At the conclusion of a therapeutic procedure consisting of several parts or following care in an inpatient facility, a written summary report (discharge summary) shall be prepared and, excepting the case as set forth in Subsection (1) of Section 14, this report shall be given to the patient.
Obligation to Maintain Confidentiality
(1) All healthcare workers and all persons employed by a healthcare provider shall be
obliged to maintain unlimited duration confidentiality regarding the health of a patient,
as well as regarding all data learned while providing healthcare services, irrespectively
of whether said data was provided directly by the patient, or learned through an
examination/test or through treatment, or learned indirectly through medical documentation
or in any other manner.
(2) The requirement for confidentiality shall not cover cases in which the patient has given a release, or for which statutes specify an obligation to provide said data.
Protection of Healthcare Workers
A healthcare worker and all other workers employed by a healthcare provider qualify as
persons performing a public service when performing any of the following:
a) issuing medicolegal expert report,
b) judging fitness or unfitness to work or the degree to which working ability has been impaired,
c) judging fitness to perform a job or work in a given occupation,
d) conducting examinations as part of a procedure to grant a permit linked to physical fitness,
e) conducting examinations to determine eligibility for other healthcare, health insurance or welfare services,
f) performing mandatory public health measures,
g) performing an examination or intervention at the request or on the orders of the authority,
h) providing on-duty or emergency services.
The Right and Obligation to Develop Professionally
A healthcare worker and other person employed by a healthcare provider has both the right and the obligation to continuously develop and advance his professional knowledge, in keeping with the current state of science and its advances.