MÉNARD, MARTIN, AVOCATS
THE RIGHT TO
SAFE CARE
LEGAL ISSUES
By: Mtre. Jean-Pierre Ménard, Ad. E.
1
PATIENT SAFETY
DEFINITION
SAFETY:
FREE FROM ACCIDENTAL INJURY
ADVERSE EVENT:
INJURY CAUSED BY MEDICAL
MANAGEMENT RATHER THAN BY
THE PATIENT’S UNDERLYING CONDITION
FAULT:
BREACH OF DUTY, BREACH OF STANDARD OF
CARE
2
RECENT AWARENESS REGARDING PATIENT
SAFETY
AN IMPORTANT NUMBER OF PATIENTS SUFFER FROM
ADVERSE EVENTS
AN IMPORTANT PART OF THOSE ADVERSE EVENTS CAN BE
PREVENTED
DETRIMENTAL ASSOCIATED EFFECTS TO ADVERSE EVENTS
ARE :
INDIVIDUAL
FINANCIAL IMPACT
SOCIETAL IMPACT
IT IS POSSIBLE TO REDUCE ADVERSE EVENTS AND THEIR
CONSEQUENCES
WE MUST LEARN FROM EXPERIENCE AND/OR ERRORS
3
PATIENT SAFETY
EMERGING ISSUES IN HEALTH CARE SERVICES
DEVELOPMENT OF PATIENT SAFETY GROUPS
INTERNATIONAL TREND
INVOLVES LEGAL DEVELOPMENT
4
BASIS OF A SAFETY PROCESS TO INCREASE
PATIENT SAFETY
-
REPORTING ADVERSE EVENTS
-
PROTECTING THE PATIENT
-
ANALYSING ADVERSE EVENTS
-
RECOMMENDATION
-
IMPLEMENTATION
5
BILL 113 – NOW INCLUDED IN THE ACT
RESPECTING HEALTH SERVICES AND
SOCIAL SERVICES (RSQ c. S-42.2)
• PATIENT’S RIGHT TO SAFETY OF CARE
•SAFETY OF CARE AS A MANAGEMENT AND CLINICAL FACTOR
•OBLIGATION TO REPORT INCIDENTS AND ACCIDENTS
• OBLIGATION TO DISCLOSE
• ACCIDENTS
• MEASURES TO BE TAKEN TO AVOID RECURANCE
• SUPPORT TO VICTIMS AND THEIR RELATIVES
• CREATE A RISK AND QUALITY MANAGEMENT COMMITTEE
• CREATE A:
- LOCAL REGISTER
- NATIONAL REGISTER FOR
ACCIDENTS
6
SAFETY OF SERVICES
RIGHT TO SAFETY
Section 5 HSSS
(Health services and social services, An Act respecting, R.S.Q. c.
S-4.2)
EVERY PERSON IS ENTITLED TO RECEIVE, WITH
CONTINUITY AND IN A PERSONALIZED AND SAFE
MANNER, HEALTH SERVICES AND SOCIAL SERVICES
WHICH ARE SCIENTIFICALLY, HUMANLY AND SOCIALLY
APPROPRIATE.
7
SAFETY OF SERVICES
INTERPRETATION GUIDELINES
Section 3 HSSS
For the application of this Act, the following guidelines shall
guide the management and provision of health services and
social services:
1) the person requiring services is the reason for the very
existence of those services;
2) respect for the user and recognition of his rights and
freedoms must inspire every act performed in his regard;
8
SAFETY OF SERVICES
INTERPRETATION GUIDELINES
(CONTINUED)
Section 3 HSSS
3) the user must be treated, in every intervention, with
courtesy, fairness and understanding, and with respect for
his dignity, autonomy, needs and safety;
4) the user must, as far as possible, play an active role
in the care and services which concern him;
5) the user must be encouraged, through the provision
of adequate information, to use services in a judicious
manner.
9
DUTY TO REPORT INCIDENTS
AND ACCIDENTS
DEFINITIONS
INCIDENT: An action or situation that does not have
consequences for the state of health or welfare of a user, a
personnel member, a professional involved or a third
person, but the outcome of which is unusual and could have
had consequences under different circumstances (183.2 (4)
HSSS)
10
DUTY TO REPORT INCIDENTS
AND ACCIDENTS
DEFINITIONS (CONTINUED)
ACCIDENT: An action or situation where a risk
event occurs which has or could have consequences
for the state of health or welfare of the user, a
personnel member, a professional involved or a third
person. (8 (3) HSSS)
11
DUTY TO REPORT INCIDENTS AND
ACCIDENTS
Who must report:
(233.1 HSSS)
Any employee of an institution
Any professionnal practicing in the institution
Any person undergoing training
Any person under a service contract
12
DUTY TO REPORT INCIDENTS AND
ACCIDENTS
(CONTINUED)
TO WHOM:
Executive director
Person designated by the executive director
(Practically: to the risk and quality management
committee)
13
DUTY TO REPORT INCIDENTS AND
ACCIDENTS
(CONTINUED)
WHAT:
Any accident or incident
WHEN:
As soon as possible
14
OBLIGATION TO REPORT INCIDENTS AND
ACCIDENTS
(CONTINUED)
HOW:
In the form provided for such purposes, which shall be filed
in the users’s record
15
DUTY TO DISCLOSE
HOLDER OF THE RIGHT
USER (8 (2) HSSS)
Representative of an incapable user of full age (tutor,
curator, person mandated by the incapable, spouse, close
relative, person proving that he has a special interest in the
user of full age, holder of parental authority)
(235.1 HSSS)
Heirs, legatees by particular title and legal representatives
of a deceased user (235.1HSSS)
16
OBLIGATION TO DISCLOSE
CONTENT
(8 (2) HSSS)
Any accident having occurred during the provision of
services that has actual or potential consequences for the
user's state of health or welfare
Measures taken to correct the consequences suffered
Measures taken to prevent such an accident from
recurring
17
SUPPORT MEASURES
(235.1 HSSS)
HOW:
BY BY-LAW
USER
FOR WHOM:
USER’S REPRESENTATIVE
RELATIVES
CONTENT:
SUPPORT MEASURES
INCLUDING THE
APPROPRIATE CARE
18
RISK AND QUALITY MANAGEMENT
COMMITTEE
COMPOSITION
(183. 1 (3) HSSS)
Balanced representation:
- Employee
- User
- Professionnal
- Contractual
- Executive director or person designated by the executive
director (ex officio)
19
RISK AND QUALITY MANAGEMENT
COMMITTEE
TRAINING (183.1 (1) AND (2) HSSS)
- DESCRIBED IN THE ORGANIZATION PLAN
- REGULATION :
NUMBER OF MEMBERS
MANAGEMENT
REGULATIONS
20
RISK AND QUALITY MANAGEMENT
COMMITTEE
FUNCTIONS
(183.2 HSSS)
Seeking, developping and promoting ways to:
Identify and analyse the risk of incidents or accidents in
order to ensure the safety of users and, in particular in the
case of nosocomial infections, prevent such risks and reduce
their occurrence.
21
RISK AND QUALITY MANAGEMENT
COMMITTEE
FUNCTIONS
Make sure that support is provided to the victim and his
relatives.
Establish a monitoring system of incidents and accidents.
22
RISK AND QUALITY MANAGEMENT COMMITTEE
FUNCTIONS (CONTINUED)
Create a local register of incidents and accidents for the
purpose of analyzing the causes of incidents and accidents
Recommend to the board of directors of the institution
measures to prevent such incidents and accidents from
recurring and any appropriate control measures.
23
RISK AND QUALITY MANAGEMENT COMMITTEE
PROTECTION OF INFORMATION
(183.3 HSSS)
Answers, informations or documents cannot be used or
be admitted as evidence
A risk manager or a member of a risk management
committee cannot be compelled
Nothing contained in a risk management record can
be construed as an admission
Records and minutes are confidential (183.4 HSSS)
24
HEALTHCARE SECURITY
ESTABLISHMENT OF A REGISTER
1. Local register of incidents and accidents (183.2 (3)
HSSS)
2. National register of incidents and accidents (431 (6.2)
HSSS)
25
HEALTHCARE SECURITY
ESTABLISHMENT OF A REGISTER
(CONTINUED)
GOAL OF THESE REGISTERS
•MONITORING AND ANALYZING THE CAUSES OF
INCIDENTS AND ACCIDENTS
•ENSURING THAT MEASURES ARE TAKEN TO
PREVENT SUCH INCIDENTS AND ACCIDENTS
FROM RECURRING
•ENSURING THAT CONTROL MEASURES ARE
IMPLEMENTED, WHERE APPROPRIATE
26
CONCLUSION
- SAFETY OF CARE INVOLVE INDIVIDUAL AND
COLLECTIVE RESPONSABILITY
- SAFETY OF CARE IS A PATIENT’S RIGHT
- SAFETY OF CARE IS EQUALLY IMPORTANT
FOR ALL THE CARE’S PROVIDERS
- SAFETY OF CARE PROCESS INVOLVES AN
INVESTIGATION INTO THE ROOTS CAUSES OF
INCIDENT OR ACCIDENT TO PREVENT THE
RECURRENCE
27