Central European Lung Cancer Patient Network NetWorkshop Baden

Central European Lung Cancer Patient Network Net-Workshop Baden, 1. April 2016 Patient Advocacy in Austria Lower Austrian Patient and Nursing Advocacy Mag. Michael Prunbauer © 2016 · NÖ Patienten- und Pflegeanwaltschaft · www. patientenanwalt. com · Mag. Michael Prunbauer

Ways of conflict management penal law in court civil law Patient advocacies arbitration boards out of court compensation funds ombudsmen in hospitals © 2016 · NÖ Patienten- und Pflegeanwaltschaft · www. patientenanwalt. com · Mag. Michael Prunbauer

Patient advocacies (legal basis) • Austria: Federal State with 9 states Burgenland, Carinthia, Lower Austria, Salzburg, Styria, Tyrol, Upper Austria, Vienna, Vorarlberg. • Patient advocacies (patient representations) are operating in each of the nine states • They are established based upon regional state acts on basis of the Federal Hospital Act © 2016 · NÖ Patienten- und Pflegeanwaltschaft · www. patientenanwalt. com · Mag. Michael Prunbauer

Organisation of Patient advocacies • 8 Patient advocacies are established as departments of the offices of the provincial governments – free from directives • 1 Patient advocacy is established as association – costs are paid by the hospitals • In most cases a jurist is head of the patient advocacies • Additional specialists are available for professional advice and assistance of the patients (jurists, physicians, nursing staff). © 2016 · NÖ Patienten- und Pflegeanwaltschaft · www. patientenanwalt. com · Mag. Michael Prunbauer

Competences of Patient Advocacies • All PAs are responsible for all the hospitals of the regional state and for all the patients treated in these hospitals • Most PAs are further responsible for all patients treated in different kinds of health care services in the regional state, e. g. : • ordinations • old people’s homes, • ambulance services, • homes for disabled persons, • …. © 2016 · NÖ Patienten- und Pflegeanwaltschaft · www. patientenanwalt. com · Mag. Michael Prunbauer

Overall concept of patient advocacies • an extrajudicial institution to enforce legal claims in an unbureaucratic manner, whereas it is ensured at the same time that none of the involved persons has to “lose his/her face” • a possibility to release emotionally strained situations, to channelize emotions and enhance the willingness to talk • an external contribution to quality-control, since they evaluate the complaints and forward the results to the decision makers © 2016 · NÖ Patienten- und Pflegeanwaltschaft · www. patientenanwalt. com · Mag. Michael Prunbauer

Main tasks of patient advocacies • Consultation and providing information • finding solutions and compensation out of court after mistakes in medical treatments • Participation in commissions and panels dealing with patient right questions (e. g. ethics committees, regional health-funds, quality-control-commissions, etc. ) • To establish of living wills © 2016 · NÖ Patienten- und Pflegeanwaltschaft · www. patientenanwalt. com · Mag. Michael Prunbauer

Patient advocacy is NO: • not a lawyer • not a trustee/guardian • not a court • not an authority • not a mediator (in the stricter sense) • not a self helping group association • not a NGO © 2016 · NÖ Patienten- und Pflegeanwaltschaft · www. patientenanwalt. com · Mag. Michael Prunbauer

Compensation Funds • Only for patients in hospitals • damage events with lack of evidence problems (“doubtful liability“) • damage events not eligible for compensation according to the provisions of the tort law, but have resulted in an uncommon and extraordinarily severe damage for the patient, however („complication“). • Funding by patients‘ fee (€ 0, 73 per hospitalization-day, max. 28 days a year). © 2016 · NÖ Patienten- und Pflegeanwaltschaft · www. patientenanwalt. com · Mag. Michael Prunbauer

Workflow PA: complaint; collecting documentation arbitration board first medical and legal check mistake in the medical treatment ? expert‘s report NO YES hospital? feedback/ qualitycontrol € YES NO doubtful liability severe complication? YES € patient compensation fund compensation proceeding with insurance © 2016 · NÖ Patienten- und Pflegeanwaltschaft · www. patientenanwalt. com · Mag. Michael Prunbauer

Statistics: trend (Austria, all cases) © 2016 · NÖ Patienten- und Pflegeanwaltschaft · www.

Statistics: categories (Austria 2014) others 1, 415 living will 1, 151 compensation fonds 995 public health insurance 472 ambulancservices 96 old people's homes 439 ordinations 1, 265 hospitals 4, 948 © 2016 · NÖ Patienten- und Pflegeanwaltschaft · www. patientenanwalt. com · Mag. Michael Prunbauer

Statistics – insurance-compensations (Austria, 2014) total: € 7. 482. 532, 00 © 2016 ·

Statistics – Compensation Funds Results: © 2016 · NÖ Patienten- und Pflegeanwaltschaft · www.

Living will • Legal living will definition: Declaration of will by which a patient denies a medical treatment and which shall become effective if the patient is unable to understand, judge or express himself at the moment of the treatment. • legal basis: Living Will Act - 55 th Federal Act, Volume 2006. • Binding living will / Non-binding living will even non-binding will must be taken into account when establishing the patient‘s will © 2016 · NÖ Patienten- und Pflegeanwaltschaft · www. patientenanwalt. com · Mag. Michael Prunbauer

General preconditions • A living will can only be established personally • the patient must posses the capacity of insight and judgement when making a living will • No legally unacceptable content (prohibition of euthanasia) • free and well-considered declaration, which is not initiated by error, fraud, deception or on physical or mental pressure © 2016 · NÖ Patienten- und Pflegeanwaltschaft · www. patientenanwalt. com · Mag. Michael Prunbauer

Binding living will • Concrete description of the medical treatments which are the object of the refusal • Comprehensive medical consulting • living will must be drafted in writing in the presence of an lawyer, a notary or a legally trained associate of the patient advocacies. The patient has to be informed concerning the consequences of the living will and about the possibility of revocation at any time. • validity: 5 years (afterwards renewal or: non-binding living will) © 2016 · NÖ Patienten- und Pflegeanwaltschaft · www. patientenanwalt. com · Mag. Michael Prunbauer

Experiences – motives © 2016 · NÖ Patienten- und Pflegeanwaltschaft · www. patientenanwalt. com

Patient Empowerment • • Information and support of patients Member of Federal Health Commission Member of local Health Commission Member of Patient-Safety Advisory Board Member of Health Telematics Advisory Board Member of Medical Service Council Member of local Ethics Commission Patient Advocacies are represented in different task forces (e. g. : Ministry of Health - PHC, Federal Electronic Medical Record) • … © 2016 · NÖ Patienten- und Pflegeanwaltschaft · www. patientenanwalt. com · Mag. Michael Prunbauer

Patient Advocacies – a good practice model for Europe? • Good experience in Austria since more than 20 years – Most complaints are processed by the Patient Advocacies (most patients do not go to court) – fast and unbureaucratic solutions – PAs are respected as serious partners in public health politics • European Network of Patient‘s Rights Organisations – Lower Austrian Patient and Nursing Advocacy is already partner of Active Citizenship Network (ACN) © 2016 · NÖ Patienten- und Pflegeanwaltschaft · www. patientenanwalt. com · Mag. Michael Prunbauer

Many thanks for your attention NÖ Patienten- und Pflegeanwaltschaft / Lower Austrian Patient and Nursing Advocacy 3109 St. Pölten, AUSTRIA Rennbahnstraße 29 www. patientenanwalt. com post. ppa@noel. gv. at Phone: +43 (0)2742 / 9005 15575 Fax: +43 (0)2742 / 9005 15660 © 2016 · NÖ Patienten- und Pflegeanwaltschaft · www. patientenanwalt. com · Mag. Michael Prunbauer