Medical Services Amendment

This Act rewrites large parts of the Medical Services Act [Chapter 15:13], and most of what it adds is a set of patient rights that can now be enforced against health care providers.

The provision with the sharpest edge is the ban on refusing emergency treatment. A private health institution must admit any patient whose condition puts their life in immediate danger and keep them for at least 48 hours to stabilise them, before transferring them to a government institution with the capacity to treat them — and it must do so on the same terms as any other patient if the person cannot afford treatment. The head of the institution, or the practitioner who acted without the head's knowledge, commits an offence punishable by a fine up to level 8, imprisonment up to a year, or both. The Minister may also require a private institution to make specialist facilities available to a patient or public-emergency victim who was first admitted to a government hospital, and may agree with the institution on recovering costs from the patient or the State.

A new Part IIA sets out general standards for everyone providing health care. Providers must tell a patient their health status, the diagnostic and treatment options available, the benefits, risks, costs and consequences of each, and their right to refuse — in a language the patient understands and pitched to their literacy. No health service may be given without informed consent, except where the patient cannot consent and a mandated person, family member in a listed order, or court order supplies it, or where delay risks death or irreversible damage, or where failure to treat is a serious public health risk. Patients must get a discharge report, and every institution must run a visible, documented complaints procedure.

Records and confidentiality are tightened considerably. All information about a patient is confidential and may only be disclosed with written consent, under a court order or law, or where non-disclosure is a serious threat to public health. Providers must set up storage and control measures against unauthorised access, and a long list of record offences — falsifying, destroying, copying without authority, gaining unauthorised access, linking a record system to another computer without authority — carries a level 8 fine or up to a year's imprisonment.

Several other changes matter in practice. People under arrest, detention or imprisonment must be treated by any health institution on the same terms as other patients, at State expense or their own if they elect. Fees at government and state-aided institutions are now a maximum fixed after consultation with health care providers, rather than simply fixed by the Minister, and the proviso to section 13(1) on private institution fees is repealed. A parent or guardian who blocks a child's treatment contrary to section 60(3) of the Constitution commits an offence. Providers may refuse to treat a patient who is physically or verbally abusive or who sexually harasses them, provided the refusal is recorded in writing and sent to the Permanent Secretary, who may issue binding guidance. The Permanent Secretary can refer breaches to disciplinary authorities or start deregistration proceedings. New regulation-making powers cover basic health care for the chronically ill, war veterans, people over 70 and people with disabilities, emergency and reproductive health care, and the basic health care packages to be available at each level of government facility.

Two drafting points the reader should know about, because the Act does not resolve them. "Basic health care" is defined as the care referred to in section 3B, but this Act does not insert a section 3B, so the definition points at a provision not found in the text. And the heading to section 9 says a new section is inserted after section 15 of "Cap 20:30", while the body of that section amends the principal Act — Chapter 15:13 — which appears to be an error in the citation.