Lecture 8: HDCA: Consumer Rights Legislation & Policy Flashcards
How was the legislation enacted?
Aug 1988 dept of health release discussion paper developing thr concept of health commissioner and patient advocates
Oct 88 DoH working party convene to develop concept of a health commissioner to report in march 1989
Nov 88 David Cagill announces appointment of health commissioner and establishment of patient advocates
June 89 NZ health council working party on informed consent releases discussion paper and draft standard
Welcomed by consumers but generally condemned by medical groups due to prescriptive and impractical
Second working party develops watered down guidelines
Sept 90 health commissioner bill introduced by labour govt
……
Which case study recommended statutory recognition of patients rights?
The unfortunate experiment at National Women’s
Where some women were treated for cervical cancer while answers were merely observed, without bring told they were part of an experiment.
Some of these women even died.
It stirred a lot of public attitudes and demanded a legal recognition of patient rights
What happened regarding the legislation in aug1992?
Assoc. professor Margaret Vennells review recommends
Need for din dependent commissioner with investigatory function
Single entry point for all complaints
Independent advocacy services
Single tribunal for hearing complaints against health professionals
Code of rights to be integral part of process of standard-setting for health professionals
What happened in may 1993 in enacting the legislation?
National govt. social services select committe consider HCB, seeks submissions on proposed changes to the complaints process outlined in the bill.
i) to separate patient advocates from the office of the commissioner
ii) require the commissioner to refer complaints to the relevant disciplinary body rather than pursue them through an independent tribunal as originally proposed
What happened in aug 1993 in enacting the legislation?
Govt introduces changes to the bill via supplementary order paper on what is currently health and disability services commissioner bill.
Changes reflect doctors interests and bill no longer reflects patient - centred model as recommended by Cartwright
Advocacy services to be independent of commissioner but within ministry of health and code to be approved by the minister of health
What happened in oct 1994 in enacting the legislation?
Health and disability commissioner act passed, and commissioner appointed
What happened in aug 1995 in enacting the legislation
Proposed draft code put out by commissioner for submissions
(Code relates to HOW services are provided not WHETHER services are provided)
Robyn Stent acknowledges code posed a fiscal risk to govt and as the govt had the right of veto over the cod, she worked with govt to make sure this didn’t happen. So access to health care is not covered.
What happened in 1995 in enacting the legislation?
Report of the draft code delivered to the minister
When did the code come into effect?
July 1996:
Retains reference to resource constraints as a reason for providers not meeting their responsibilities under the code.
Allows providers to have a reasonable defence
What is the purpose of the legislation?
To promote and protect the rights of health consumers and disability services consumers, and, to that ends to facilitate the fairy simple, speedy, and efficient resolution of complaints relating to infringements of those rights”
What are the provisions for the HDC act?
Office of the commissioner for education and complaints resolution
Network of independent advocates
Independent prosecutor
Development of code of rights
What does the code of health and disability services consumers’ rights 1996 consist of?
10 code rights:
Regulates quality of care
Applies to all providers
Employers can be vicariously liable for breaches of the code if they do not take steps to ensure employees comply with it
What could be a defence for providers if sued with breach of HDC act?
any reasonable actions in the circumstances commissioner considers conjunctival factors and resource constraints
What are the two main roles of the health and disability commissioner?
Education: to promote the rights and responsibilities of consumers and providers
Complaints resolution: resolve complaints in a fair, simple, speedy and efficient manner
What was the case study of the first major test of the HDC act? And why was this significant?
Tipping J in Nicholls & Brown vs HDC 1997
Commissioners powers clarified:
- can undertake investigations on own initiative
- can look at events prior to 1 July 1996
- can investigate systems issues, including policy and practice issues
- can report publicly on an investigation in the interests of fairness and public info
What other legislation does the HDC act have an interface with?
ACC, which is an insurance scheme which compensates for inability to work
Funds rehabilitation and care
Accident insurance act 1988 prohibits civil action unless for exemplary damages.
Since July 1 2005 there has been no fault provision
What are exemplary damages?
To punish offender and not compensate
Circumstances of outrageous conduct
Difficult to get, expensive, low money
Proceedings through human rights review tribunal ( cheaper than courts)
Access through HDC process but currently limired
What other legislations does the HDC act have an interface with?
HPCA act:
Complaints procedures streamlined
Referral to persons and/ or agencies:
E.g. Medsafe, privacy commissioner
Provider
Registration authority ( competence, professional conduct committee)
What are the “umbrella rights” in the code of rights
Patients have the right to be
Treated with respect
Freedom from discrimination, coercion, harassment and exploitation
Dignity and independence
What are the rights involved with standard of care?
Pharmacists and technicians have a duty to provide services with reasonable care and skill
Comply with legal, ethical, professional and other standards
Cooperate with other providers
What are the three components of informed consent?
The right to effective communication
The right it sufficient information
The right to make an informed choice and give informed consent
What are the rights associated with support and complaints?
Patients have the right to have a support person present
Complain to the provider, an advocate, or the health and disability commissioner
What are the options for resolution?
HDC supports low level resolution
No action
Advocacy and mediation often successful
May refer to other agencies e.g. Pharmacy Council
What happens if a provider is found in breach of the code?
Recommended that practitioner apologise and review practice in light of HDC report
Refer to registration authority for confidential, rehabilitative competence review
Refer to director of proceedings for consideration of disciplinary proceedings