Is the health care provider liable for the injury without fault?

Neišspręsti teisinio reguliavimo klausimai Lietuvoje dėl žalos atlyginimo pacientui, bei specifiniai šio delikto sistemos proceso bruožai lėmė neefektyvią jo teisių gynybą. Dėl šių priežasčių buvo pasiūlytas ikiteisminis žalos atlyginimo modelis, kurį sėkmingai naudoja dauguma Skandinavijos šalių. Atsižvelgiant į tai darbe keliamas tikslas – nustatyti, ar siūlomas modelis, kuriame nereikalaujama iš paciento įrodyti gydytojo (sveikatos priežiūros įstaigos) kaltės, gali žalos atlyginimą reglamentuoti geriau nei šiandieną sveikatos priežiūros sistemoje egzistuojantis žalos atlyginimo modelis. Darbe analizuojami esminiai siūlomo modelio ypatumai ir lyginami su dabartiniu šalyje egzistuojančiu modeliu. Lietuvos ir užsienio valstybių praktikos ir dokumentų analizė, parodė, kad taikant skandinaviškąjį žalos atlyginimo modelį, galima išspręsti šiuo metu egzistuojančius delikto sistemos žalos atlyginimo klausimus. Žalos atlyginimo modelyje be kaltės yra formuojamas pacientų draudimo fondas, iš kurio lėšų standartizuotomis išmokomis yra kompensuojama žala. Modelis įgalina labiau praplėsti pacientų kurie gali tikėtis kompensacijos ratą ir tuo pačiu mažina bylų teisme skaičių. Kompensuotina žala savo ruožtu yra įstatymo įvardinama, skirstoma į atitinkamas kategorijas ir atlyginama įvertinant paciento patirtos žalos atitikimą definicijai. Tai, darytina išvada, daro procedūrą paprastesnę, o įstatymo nustatytas terminas skundo nagrinėjimui analizuojamame modelyje yra šeši mėnesiai, todėl reikalauja mažiau išlaidų ir lengvesnis emociškai. Vienas iš modelio be kaltės tikslų – sumažinti visuomenėje įsišaknijusią bendravimo įtampą tarp pacientų ir medicinos darbuotojų. Švedų, kurie taiko tokį žalos atlyginimo būdą, nuomone, sistemoje, kurioje neprivaloma ieškoti kokių nors nerūpestingumo faktų siekiant patvirtinti žalos atsiradimo aplinkybes, t.y. neįrodinėjant gydytojo kaltės dėl atsiradusios žalos, galima geriau tarpusavyje bendradarbiauti. Todėl jų naudojamos nepalankių įvykių medicinoje raportavimo ir registravimo sistemos pagrindinis tikslas – sudaryti galimybę medicinos darbuotojams mokytis iš kolegų patirties, siekiant išvengti nesėkmių pasikartojimo ateityje. Modelis be kaltės yra modeliavimo modelis, nes žalos atlyginimo variantų gali būti įvairių ir neapsiribojama vienu standartu. Atsižvelgiant į tai, darbe siūloma nustatyti tokį teisinį reguliavimą, kad modelio pasirinkimas priklausytų nuo nacionalinės sveikatos priežiūros kokybės koncepcijos (pasirinktų prioritetų) bei pacientų saugumo koncepcijos (saugumo kultūros, bendravimo tarp pacientų ir gydytojų, nepalankių atvejų prevencijos sistemos).The number of cases of the physicians’ professional liability is growing and, it is assumed, to be the reason of such growth is that the patients are becoming more and more active as the receivers of the health care facility, also, susceptible to apply to the physician, the director of the health care center, the lawyer, if the patient thinks that he got inappropriate health care. The expectations by the patients nowadays are bigger than some time ago, as the material of sociological researches shows, while from the health care providers there are expected sort of knowledge and skills of psychology, management, and health law. The opinion of the patient is usually orientated to the perfect presentation of the health care services, not considering the fact that the real condition of the sponsorship system or its working possibility differs from the perfect ones. The right to health care is regulated in the Constitution of our country as well as the right to the compensation of for the injury made by the health care providers. This right is more concretized in the country’s law, where is said that the patient has the right to the compensation for the injury which was caused by violating patient’s rights while providing health care facilities. The pretrial complaint investigation was only legitimized in 1996 even though the institution responsible for the investigation began its work in 2005. The procedure there is excluded into two parts: (1) first, patient has to make complaint in writing to the director of the health care center and in the case if he disagrees to compensate for the injury, (2) patient makes a complaint to the special Commission that is responsible for the patient’s claim investigation. While having an opportunity to make a claim for two instances one can say that it is better protection of patients’ right to compensation but as statistics shows the pretrial complaint investigation is not working properly. Unresolved questions also in the trial complaint investigation raise quite a lot of discussions. For example, by the law, the compulsory insurance of the civil responsibility had to be applied in all the health care centers in the country, but because of the particular reasons, not all the hospitals have made the contract with the insurance company and the reasons are: the insurance method was prepared to late, the rules of compulsory insurance did not mach the classic rules of the insurance of the medicine practice and that the buildup of the process of the standards of quality, norms, algorithm are still in progress. As a result, if the injury occurred to the patient, the hospital does not have enough money to compensate for the accident. Another problem occurring while compensating for the patient injury is that there is no law determining the limit of the compensation for the material injury in the precise way in the country. According to the common principles of law, who regulate the compensation for the injury, there appears a right for the patient to require unlimited size of the compensation, where these requests demand quite a lot of attempts from the patient in the trial. That is, while requiring unlimited size of the compensation, patient has not only to prove the causes of the injury, but also the consequences of it. Also, this unlimited size of the compensation requires from the physician, as a perfect specialist, the consent of the patient in writing for even simple procedures. According to those, there was suggested another method in compensating the injury for the patient - no fault system. The basic points of this method are that the decision weather to compensate the injury for the patient or not make the commission of the experts, and not the court, that is this compensation for the injury method is pretrial. Other basic points of this method are that the injured patient has no need to prove physician’s fault; the decision weather to compensate the injury for the patient or not is the basis of the patient eligibility; there are more patients who get the compensation without the help of the lawyer or other expenses; there is established a system where the precedents of compensations for the injuries are registered and in that way the compensation for another patient is paid in more expeditious way. The aim of this work is to evaluate weather this compensation for the injury method without fault can solve the problems of the method of the compensation that exist nowadays in our country.Vytauto Didžiojo universiteta