Lecture 8: HDCA: Consumer Rights Legislation & Policy

Question 0

How was the legislation enacted?

Answer 0

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

……

Question 1

Which case study recommended statutory recognition of patients rights?

Answer 1

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

Question 2

What happened regarding the legislation in aug1992?

Answer 2

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

Question 3

What happened in may 1993 in enacting the legislation?

Answer 3

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

Question 4

What happened in aug 1993 in enacting the legislation?

Answer 4

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

Question 5

What happened in oct 1994 in enacting the legislation?

Answer 5

Health and disability commissioner act passed, and commissioner appointed

Question 6

What happened in aug 1995 in enacting the legislation

Answer 6

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.

Question 7

What happened in 1995 in enacting the legislation?

Answer 7

Report of the draft code delivered to the minister

Question 8

When did the code come into effect?

Answer 8

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

Question 9

What is the purpose of the legislation?

Answer 9

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”

Question 10

What are the provisions for the HDC act?

Answer 10

Office of the commissioner for education and complaints resolution

Network of independent advocates

Independent prosecutor

Development of code of rights

Question 11

What does the code of health and disability services consumers’ rights 1996 consist of?

Answer 11

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

Question 12

What could be a defence for providers if sued with breach of HDC act?

Answer 12

any reasonable actions in the circumstances commissioner considers conjunctival factors and resource constraints

Question 13

What are the two main roles of the health and disability commissioner?

Answer 13

Education: to promote the rights and responsibilities of consumers and providers

Complaints resolution: resolve complaints in a fair, simple, speedy and efficient manner

Question 14

What was the case study of the first major test of the HDC act? And why was this significant?

Answer 14

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

Question 15

What other legislation does the HDC act have an interface with?

Answer 15

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

Question 16

What are exemplary damages?

Answer 16

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

Question 17

What other legislations does the HDC act have an interface with?

Answer 17

HPCA act:

Complaints procedures streamlined

Referral to persons and/ or agencies:
E.g. Medsafe, privacy commissioner
Provider
Registration authority ( competence, professional conduct committee)

Question 18

What are the “umbrella rights” in the code of rights

Answer 18

Patients have the right to be

Treated with respect
Freedom from discrimination, coercion, harassment and exploitation

Dignity and independence

Question 19

What are the rights involved with standard of care?

Answer 19

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

Question 20

What are the three components of informed consent?

Answer 20

The right to effective communication

The right it sufficient information

The right to make an informed choice and give informed consent

Question 21

What are the rights associated with support and complaints?

Answer 21

Patients have the right to have a support person present

Complain to the provider, an advocate, or the health and disability commissioner

Question 22

What are the options for resolution?

Answer 22

HDC supports low level resolution

No action

Advocacy and mediation often successful

May refer to other agencies e.g. Pharmacy Council

Question 23

What happens if a provider is found in breach of the code?

Answer 23

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

Question 24

What are the implications of the HDC act for pharmacy?

Answer 24

Pharmacists need to operate with a reasonable care an skill

We must be compliant with legal, ethical and professional standards.

Our services need to be consistent with and respectful of consumer needs

We need to provide adequate and appropriate info and explanations

We need to have honest and effective communication

We need to display a coordination of services

Question 25

What does this mean for pharmacists?

Answer 25

Ensuring prescriptions are adequate and appropriate

Ensuring dispensing is accurate

Ensuring medication reaches the correct person

Ensuring the person is fully informed.

Question 26

What are some professional responsibilities pharmacists need to adhere to?

Answer 26

Document all interventions, especially clinical matters about drug, strength, dose, frequency

Question 27

What should happen if prescribing errors occur?

Answer 27

The code of ethics requires evaluation for appropriateness

E,g, antidepressant/ antibiotic
E,g, drug interactions

Question 28

What do dispensing errors include? What right does it breech?

Answer 28

Incorrectly labelled container, incorrect name, form, strength, dose, frequency, quantity

Breaches right 4(2)

• medicines act (not pursuant to prescription)
• code of ethics
• professional standards (quality in pharmacy)
• standard operating procedure

Question 29

What were the lessons learned from the Maxolon for a child case?

Answer 29

• Dispensing was not accurate or adequate
• Lack of frequency info on label

Case highlighted responsibilities of pharmacists beyond accurate dispensing- to utilise their knowledge and skills to ensure optimal outcomes for patients.

Question 30

What was the code of ethics in relation to the Maxolon for a child case?

Answer 30

Pharmacists have a professional responsibility to assess the suitability of a prescription.

Question 31

What are a pharmacists’ responsibilities regarding doctors prescriptions?

Answer 31

Pharmacists are independent health professionals well placed to consider the suitability of prescibing common, powerful medications to children.

It is expected that we specifically query unusual prescriptions of common medications known to have serious side effects.

It is not sufficient just to query the dosage

We have a responsibility to raise concerns about a doctors practice, whether a specific prescription, or recurrent inappropriate prescribing.

Question 32

What were the lessons learnt from the mistaken identity case?

Answer 32

The incident report was not accurate, it needed to include

• analysis of reasons for incidents
• recommendations for improvements
• changes mad to systems and procedures designed to eliminate the possibility of the same thin happening again