Medical Services Amendment Bill H.B. 6, 2024

This is a Bill — H.B. 6 of 2024 — not law. It would amend the Medical Services Act [Chapter 15:13] to align it with the health rights in the Constitution: access to basic and reproductive health care (section 76(1)), care for chronic illness (76(2)), emergency treatment at any health institution (76(3)), children's health care rights (81(1)) and their paramountcy over parents' religious choices (60(3)), care for people over seventy (82(b)), access to treatment for persons with disabilities (83(b)) and basic health care for war veterans (84(1)(d)). The memorandum notes the amendments are deliberately drafted subject to the resources available to the State.

Definitions would be added or rewritten for basic health care, chronic illness, emergency medical treatment, health care provider, health service, patients' health record, reproductive health care and health institution — the last widened to cover any public or private institution or facility, for profit or not, providing inpatient or outpatient treatment, diagnosis, nursing, rehabilitative, palliative, convalescent or preventive care. References to the repealed Medical, Dental and Allied Professions Act would be updated to the Health Professions Act [Chapter 27:19].

A new Part on general standards in health care delivery would create a patients' charter with teeth. Providers would have to tell patients their health status (unless disclosure would be contrary to the patient's best interests), the diagnostic and treatment options available, the benefits, risks, costs and consequences of each, and the right to refuse treatment and what refusal means — where possible in a language the patient understands and pitched to their literacy. Informed consent would be required, with a listed order of substitute decision-makers (a written mandate, then a court or statutory authorisation, then spouse or partner, parent, guardian, adult child, grandparent, adult sibling) and exceptions where the law or a court authorises it, where failure to treat is a serious public health risk, or where delay risks death or irreversible harm. Patients would have a right to participate in decisions about their treatment.

It would become a criminal offence, punishable by a fine up to level 8 or up to a year's imprisonment or both, for a parent or guardian to prevent a child receiving health care in the child's best interests, or to withhold consent contrary to section 60(3) of the Constitution.

Other patient protections would include a discharge report at the time of discharge; strict rules on experimental or research treatment requiring prior written authorisation from the patient, the treating provider, the head of the institution and the relevant research ethics authority, with written consent for any extraction of bodily tissue; and confidentiality of all patient information, breachable only with written consent, under court order or law, or where non-disclosure is a serious threat to public health. Falsifying, destroying, unlawfully copying or gaining unauthorised access to a patient's record — including hacking or tampering with the systems on which records are kept — would carry a fine up to level 8 or a year's imprisonment or both. Every health institution would have to run a visible complaints procedure. Health workers would get corresponding rights: institutions must take measures to minimise injury and disease transmission, and a provider may refuse to treat a patient who is physically or verbally abusive or who sexually harasses them, with the refusal recorded and reported through the head of the institution to the Permanent Secretary, who may issue binding guidance.

The non-discrimination provision would be replaced with a general prohibition tied to section 56(3) of the Constitution. Fees at government and State-aided institutions would have to be fixed after consultation with health care providers, and as maximum fees. A new section would prohibit a private health institution from refusing emergency treatment, requiring it to admit a patient in immediate danger to life for a period of not less than 48 hours. People under arrest, detention or imprisonment would have a right to treatment on the same terms as other patients, at State expense or their own if they elect. The Minister would be able to offer incentives, with the Finance Minister, to those establishing health institutions in marginalised areas, and to make regulations on care for people with chronic illnesses, those over seventy, war veterans, persons with disabilities and children; on health care packages at each level of hospital; and on a national consultative health forum.

Caveats. The text available here is truncated partway through clause 7, so the emergency treatment provision is only partly reproduced and clauses 8 to 10 are described from the memorandum rather than the operative text. There is also a mismatch between the memorandum and the Bill body — the memorandum refers to sections 8I, 8J, 8K and 8L including "duties of patients", while the body numbers the same material differently and contains no duties-of-patients section. Anyone relying on specific clause numbers should work from the Bill as printed.