Patient Ombudsman strategies in the fight for better quality healthcare. Episode 47

Monika Rachtan
Welcome to the programme 'Patient First', broadcast by the Institute for Patient Rights and Health Education. Today, I am talking to the Patient Ombudsman, Bartholomew Chmielowiec, about the differences between private care and that offered by the National Health Fund, which raise many questions on social media. I extend a warm welcome to the Minister.

Bartłomiej Chmielowiec
Good afternoon, and a very warm welcome to you.

Monika Rachtan
Minister, do you observe the disparity between private care and that guaranteed by the National Health Fund?

Bartłomiej Chmielowiec
I would rather suggest a different division - between facilities that function very well, whether they are under contract with the NHF or within the private health sector, and those that function less well and need continuous work on quality management. Indeed, most of the problems are observed in facilities contracted with the NHF, although private facilities seem to perform better in the organisation of care, including registration, empathy and patient information.

Monika Rachtan
We received an interesting question from an audience member. Can a person using private healthcare raise a problem with the Patient Ombudsman, even if they are using paid services?

Bartłomiej Chmielowiec
Absolutely yes. The Patient Ombudsman represents all patients, whether their problem is with a private or public facility. Any patient can come to us in any situation.

Monika Rachtan
It is very important that our viewers know where they can report a problem. The easiest way to contact us is via the helpline.

Bartłomiej Chmielowiec
That's right, the helpline on 800 190 590 is available 24 hours a day, seven days a week. You can also email us, visit our office at 11/13 Plocka Street in person, get in touch via social media or traditionally, send us a letter.

Monika Rachtan
I will come back to the services that facilities provide, but really the services that medics, doctors provide. How do you get doctors to present the same quality of service both in the private sector and in the one in the National Health Service? Because patients often talk about these disparities, that when they go to a doctor for money, he is suddenly nice, he has time to talk, he is more open to that patient. How do you convince doctors?

Bartłomiej Chmielowiec
Well, it is a more complex process. I don't know. I would not point here strictly to the medical staff and to these problems. Rather, I would point to the problems when it comes to the issue of the management of the facility in question. What I said in relation to the first question, if a facility is managed by a manager who knows that this quality is built from the very beginning, that is, from the moment of registration, whether we can reach the facility, through professional service when it comes to registration, through the empathy and dignity that should be shown at every stage of the process, through the interest in the facility, then it does not really matter whether the facility is public. If that is the abbreviation we use, or public or private. It is mainly the role of the manager of the facility and how he or she is involved, how motivated he or she is, that makes the facility function very well or a little less well. And, of course, it is the role of the manager to ensure that the staff who work in the facility, be they doctors, nurses or other support staff, behave in the way that you have indicated here, that is, empathetically presenting all the necessary information to the patient, showing them the due respect. I would rather not equate this with a particular staff member. What should be done to improve this situation? Obviously, one should constantly work on changing the health care system, which would move in the direction of patient-centredness.

Monika Rachtan
This is a very nice concept. How do you understand it?

Bartłomiej Chmielowiec
Firstly, education at every level, continuing education of patients and staff. Secondly, the transition of our health care system to a model in which we will pay for quality and reward quality, that is to say, those institutions that focus on quality, those institutions that have quality in their DNA. We should reward them financially and we should show them as role models.

Monika Rachtan
But this should be done by the National Health Fund.

Bartłomiej Chmielowiec
Of course, all institutions involved in the health system, including the National Health Fund, should be involved. And this is already happening. Of course, the Quality and Patient Safety Act also shows the next step of how this should be undertaken. But also everyone else who is involved. Together with the director of the Quality Monitoring Centre, we have started such a campaign, 'Choose Quality', in which we will be showing those facilities, mainly hospitals, which, in our opinion, just deserve to be rewarded in this way and to show that, yes, this is the facility. Dear patient, to which it is worth going.

Monika Rachtan
Will there be a list?

Bartłomiej Chmielowiec
There will be a list, there will be special stickers. The first such facility has already been awarded. It is the University Clinical Centre in Gdańsk, a hospital that has also been receiving awards in various types of plebiscites, including those organised by patient organisations, for many years.

Monika Rachtan
And I understand there will be first place, second place, third place, will there be a list of the best ones?

Bartłomiej Chmielowiec
There will be no rankings, first, second, third, but we will indicate in our opinion, in the opinion of the Patient Ombudsman, in the opinion of Ms Agnieszka Makieta, director of the Quality Monitoring Centre, based on objective criteria, those facilities are the best. And you, dear patient, colloquially speaking, vote with your feet. That is, choose the best ones so that the weaker ones can also see that it pays off, that you need to constantly improve your procedures, that patients keep coming back. And it pays off, because the more patients, the more contracts from the National Health Fund, the more revenue and, in the end, income for the facility.

Monika Rachtan
In other words, it is very important for this consistency to appear on the part of the Ministry of Health, the National Health Fund, but also on the part of the medical institutions, so that it really starts to work, because here I think two sides have to get to work.

Bartłomiej Chmielowiec
All of us, of course, have to work. This is also my appeal from the Patient Ombudsman to patients. I repeat this appeal every time, dear patient, do not hesitate to inform us of irregularities. It is also up to you, in the main, to decide how this health care system looks. If you see that you are being treated as an object, if you see that your intimacy and dignity are being violated, if you see that your rights are not being respected, call us, report us, write to us. That is what we are here to help you, because it is with such actions that we also enforce quality in these establishments. It is with such actions that we make these medical staff respect your rights, that the medical facility respects your rights, and consequently the health care system also changes for the better.

Monika Rachtan
I am thinking about the fact that we in Poland very much like to complain about health care, about the way institutions function, but we just do not take any steps, we do not report it, we do not make any phone calls, and I wonder why this is so. Is it still so entrenched in us that, let's say I live in a small town, I complain about a doctor, he finds out about it, he tells others and they don't treat me well. What's not working here that Poles aren't reaching for that phone? They write comments on social media, on Twitter, on Facebook, on groups everywhere, that it doesn't work in Poland, that health is not the priority, that doctors don't take good care of them, and on the other hand they have a tool they could use.

Bartłomiej Chmielowiec
This situation is changing and is getting better. I think this is also a measure of the maturation of our society, of civil society. I think we have also seen this measure of maturation in the elections, and this measure of maturation is also, of course, translated into our involvement in various areas of everyday life. This is changing for the better. Of course, there are still many things to improve. These are the signals we receive, especially in small towns, there is this concern about this issue. In that case, if I report, I could be harassed in any way, or treated worse. If this were to happen, it would obviously be a scandalous situation. I can assure you that we would certainly take action immediately, but I can also assure you that a patient can report a complaint or a concern to us anonymously, or they can report under their name, but stipulate that their data, their details, should not be disclosed anywhere, anywhere. We as a society must also learn that we should react. I am not just talking about the health care system, that we should react, because a great deal depends on our reaction, on paying attention.

Bartłomiej Chmielowiec
But at the same time, I will also refer to the fact that choosing those facilities that focus on quality, that consistently, step by step, will also cause, regardless of the actions of those in power, that this health care system will change for the better.

Monika Rachtan
And is it possible to falsify medical records in Poland?

Bartłomiej Chmielowiec
Falsification of medical records is of course punishable and there is criminal liability for this. Legislation has now been introduced stipulating that these records should be electronic. However, there are exceptions whereby it can still be done on paper and some institutions are also switching from the paper to the electronic form. In theory, this is possible. Occasionally, we have encountered situations where we had very justified doubts that medical records were completed post factum, i.e. after a medical event was completed. And I can only say, and warn all medical staff, that this type of situation is punishable and we file a notice to the public prosecutor's office every time, and there is criminal liability for this. I firmly believe that these are isolated situations and there will probably never be a situation where we can say that this will definitely not be the case. But I firmly believe that this is changing, and in fact we are also seeing that it is changing, that we have fewer and fewer of these situations.

Monika Rachtan
It seems to me that doctors today guard these medical records very strongly. This is what I have observed, because they are also aware of the criminal responsibility that comes with failing to comply with this obligation. In this case, I would still like to convince patients that it is worth using the tools that allow them to contact the Patient Ombudsman. And I think it will be much easier for patients if we tell them, in points, what the procedure is like, so let's say I call the hotline and report my problem, what happens in the next step?

Bartłomiej Chmielowiec
First of all, it depends what kind of problem we have. At the helpline we can get legal information, professional legal assistance, if we want to know what rights we have, whether we can refer such rights or others in this particular situation.

Monika Rachtan
I may give an example. The nurse at the registration desk did not want to give me the results of my lab tests. She said that the documentation would be waiting for me in the doctor's office, but that I wouldn't get that result today, and I wanted to go get a second opinion.

Bartłomiej Chmielowiec
And now, when you call our helpline, first of all, depending on what you want, you can get professional information saying that your test results are part of your medical records. The Patients' Rights and Ombudsman Act therefore states that you have the right to access your medical records, to obtain a copy, to obtain an extract or to inspect your medical records. You can therefore go to the registration desk, speak to a member of staff, indicate which legal basis you wish to consult and request your medical records. You can also ask us on the telephone to intervene. One of our measures is to act here and now, i.e. by calling 800, 190 590 in situations that require the intervention of the Patient Ombudsman, we intervene immediately. Sometimes we call the medical facility straight away. Sometimes we immediately send an e-mail, sometimes we write a letter. In what we might call extreme situations that pose a threat to patient safety, we also sometimes go in person to the facility the next day or the same day to react, as well as calling the helpline to report a problem that has already arisen or a situation that has already occurred. You can make a complaint and we will then also take appropriate action.

Monika Rachtan
So it's not as if this email of ours, this complaint of ours, this phone call of ours is put together in some kind of pile and then Mr Ombudsman comes, Mr Minister sits down, let's just say on Wednesdays and says today I'll recognise 5 applications and another 5 for the next week. This is happening here and now.

Bartłomiej Chmielowiec
Here and now. It would be impossible, by the way, if there was not enough time to go through all this documentation from a given day, a day. Two days, I think. So no, it is happening here and now. Of course, the staff, the committed staff take action. And as I said, you can get professional legal help, you can get advice. The second stage depending on what the expectations are and what the situation is we intervene. Especially when there is a threat to life, especially when it concerns pregnant women, especially when it concerns underage children, especially when it concerns people with disabilities or the elderly, or if a certain thing has already happened and the incident has already taken place, you can make a complaint and then, of course, we will take action to clarify the matter to the very end. And if it turns out that the patient was right, which is not always the case, this must also be borne in mind. If it turns out that the patient was right, take action to ensure that such situations do not arise again in the future.

Monika Rachtan
Now perhaps we will do a bit of a glossary of terms. Minister, I've tried to look at all these terms that are used on the Patient Ombudsman's website regarding medical errors, medical events, with the eye of a man who doesn't quite know what it's all about, and I'm sure he's not able to figure it out, because it's very difficult and convoluted. So in human words, if the Minister could explain to us what a medical event is.

Bartłomiej Chmielowiec
Perhaps I will try as simply as I can, although these are indeed legal terms, to talk about these two avenues of redress. The term 'medical error' and the term 'medical event', and these are the terms we use, are related to a situation where something went wrong during our treatment. The fact that something abnormal happened caused the injury. And now the patient has two possible pathways. The first pathway, where we suffered an injury in a medical facility. Wrong diagnosis, wrong operation, wrong treatment, wrong medication, which resulted in damage to health, then the patient in this situation can take their claims to court, that is, they can file a lawsuit, previously calling the institution in question to pay damages or its insurer. And here, in this area, we are dealing with a medical error, and this is how we define it in this legal issue, where there is an event. And now there is a second pathway, which opened from the sixth of September 2023. A simplified pathway, which is very beneficial for the patient, where you can also claim compensation for damages, but by addressing a request to the Patient Ombudsman, not to the court, not to the facility, but to the Ombudsman. The Ombudsman, when considering this application, investigates whether there has been a medical event. A medical incident is a situation where there has been an inadequacy of treatment that could in all probability have been avoided if the correct method of treatment had been used, or another method of treatment that might have proved effective.

Monika Rachtan
I think we finally have that exact explanation and one for the people. So I would recommend, if you don't distinguish between the two terms, to focus on what the Minister has said here, I think it will already be clearer.

Bartłomiej Chmielowiec
There is one more thing I can say. We can provide clarification. 800 190 590 is the number for the Patient Ombudsman. If someone has doubts, they can always write, call, ask. We will explain everything. And I am also aware of the complexities, sometimes legal, but that is what we are here to explain too.


Monika Rachtan
This is another difficult concept: compensation funds. What is it?


Bartłomiej Chmielowiec
The Compensation Fund is precisely linked to what I was talking about, the medical event. We suffered an injury in hospital, we suffered an injury, a misdiagnosis was made. Patients, as I said, have two ways to go. One is the long, expensive court case, which requires hiring a lawyer, because these are very complicated processes and, in the end, the outcome is quite uncertain. And the other path. The easy way, costing 300 PLN. An application fee, where this amount is refunded when it turns out that the decision will be positive. This second way is precisely the issue related to the medical event and the medical event compensation fund. From the sixth of September 2023, patients who have suffered an injury in hospital can refer a claim for compensation. Patients or their families in a situation where a patient has died in a medical facility can submit a request to the Patient Ombudsman. The application is on a simplified form. The amount, as I said, for the application fee is PLN 300. It is not necessary to use a professional representative. When submitting an application, the staff of the Office of the Patient Ombudsman will review the application. This is a panel of experts who will assess, on the basis of the medical records provided, possibly records that the Patient Ombudsman will obtain, whether a medical event, i.e. an unacceptable situation, has actually occurred.


This is a situation where the treatment was not in accordance with current medical knowledge with due diligence, where it could have been avoided with a high degree of probability. If the Ombudsman is satisfied that there has been a medical malpractice situation in the hospital, the Ombudsman will propose to the patient or the patient's family the amount of compensation due. This amount of compensation for the patient may be up to a maximum of PLN 200 000, or for the family up to PLN 100 000 for each member of the family. In other words, if the father has died, any of the children can apply, the parents of the deceased can apply and his wife can also apply. And this amount is up to PLN 100 000 for each person. We will consider this application within three months. The patient or his family will decide at the end whether to accept this amount. This is a very viable alternative to the lengthy, multi-year court proceedings. It is very expensive, because I cannot imagine a trial without a professional lawyer, who also has to be paid.


Monika Rachtan
This is usually big money.


Bartłomiej Chmielowiec
And these are usually big money. A viable alternative? An application to the Ombudsman. Above all, also for the patient and the family, a fairly quick answer as to whether the treatment was correct.


Monika Rachtan
But was a mistake made? And if the treatment was correct, we will also explain why we believe the treatment was correct based on the knowledge of the most eminent experts. Now, in the Office of the Patient Ombudsman, there are more than 80 experts on the team, nearly 30 presidential professors, very many post-doctoral fellows. Such experts who deal with the most difficult cases on a daily basis and know them very well. These are very well-known names of people, valued, respected throughout the health care system.


Monika Rachtan
And by using this payment, from the compensation fund, am I closing the way to going to court, or still after this compensation, if I receive it. I already know that the doctor was wrong, I know that a mistake was made, can I then go to court?


Bartłomiej Chmielowiec
And now by accepting the amount of compensation, we are de facto giving up. So, to recap, we make a proposal, we say this is how the incident occurred. This is the amount resulting from the law and the regulation. If the patient accepts this amount, he or she may not claim a higher amount, unless some new damage occurs after this time, e.g. epilepsy, which may manifest itself several years later. On the other hand, if the patient accepts this amount, he can no longer pursue his claim in court.


Monika Rachtan
That is, a responsible decision. The important thing is to do it sensibly.


Bartłomiej Chmielowiec
Responsible, I will just add these amounts, which are proposed 200 thousand zloty for the patient and 100 thousand for each family member when the next of kin died in hospital. These amounts correspond to the amounts that can potentially be obtained in court. I know that the public is receiving such information about multimillion-dollar compensation amounts.


Monika Rachtan
But I guess it's the US companies that do it to us that we think such compensation can be obtained.


Bartłomiej Chmielowiec
In Poland, there are also sums, only firstly these are sums in very extreme situations, that is, failure in terms of childbirth, where the child has 4 limbs, new paralysis and will de facto be in a virtually vegetative state for the rest of its life. This is aggregate compensation for that child and for its parents. On top of this, there is interest, because these trials take many years and these sums can in fact sometimes amount to 600, 700, 800 thousand. Again, these processes are very complicated, very difficult and, according to the data we have, the patient only wins 30% cases in court.


Monika Rachtan
And here, what is the percentage of these positive responses for patients?


Bartłomiej Chmielowiec
We are ahead of the first decisions, we are already practically at the finishing line. I can say based on the experience of western countries, it more or less looks like between 20 and 40%. The only difference is, here the patient pays a fee of 300 PLN and no more. And de facto he doesn't have to do anything else, because all the work is done for him by the Office of the Patient Ombudsman. He is taken care of, for a shorter time he does not have to appear in the courtroom. Here there are no hearings, no witnesses, no questioning of the patient. None of these things. Here there are no examinations of the patient, here are the medical records and the actions of the experts of the Office of the Patient Ombudsman. In the courtroom many years of a very expensive process. Testimony also in court, because it is always this element inherent, if the patient himself comes to. So this is an alternative where after three months we know how the incident happened. Is there such an amount proposed? I'll think about it, I'll accept it or I won't accept it, maybe I won't accept it and I'll nevertheless pursue my claim in court. So I think this is a very viable alternative, modelled on solutions that work in Western European countries, those that are presented as a model, which are mainly Scandinavian countries.


Monika Rachtan
Nobody likes going to court, so I think this is a very good alternative and we appeal that if indeed something has happened that raises your concerns, it is worth approaching the Ombudsman's office. The staff are waiting, they are looking after them.


Bartłomiej Chmielowiec
It is worth turning to. Of course, I do not wish this on anyone, because it is an extreme situation where some damage is done. Hence, I encourage you once again. 800 190 590. Do you have a question? Give us a call. Want to report a problem? Call, email. See something going wrong at a medical facility? Can't get through to your GP facility? Report the situation to us. I assure you that we analyse every situation. We will take action in every situation. Of course. It's not that immediately, already, now, immediately, but in those situations where people's lives are at risk, when it involves pregnant women, children of elderly people with disabilities Yes, this is our priority. We act already, now, immediately. Prevention is better, hence, if you see a violation of a patient's rights, that's what we are for and report to us. We will help.


Monika Rachtan
A great deal of work has now been done by the Ministry of Health related to women's health. Today we are after Minister Izabela Leszczyna's briefing, where she talked about in vitro, how it will work. But in vitro is a little bit related to another topic I would like to ask the Minister about, which is perinatal care. This is a project that the Patient Ombudsman is very much involved in. And what do we have the biggest problem with in our country today? What are the Minister's observations?


Bartłomiej Chmielowiec
Yes, maternity care is our priority, and we will place particular emphasis on that as well. We have a problem with the proper implementation of standards of perinatal care, because these standards function on paper, but unfortunately they do not actually function in every medical facility. These standards say that a birth plan should, for example, be prepared. These standards say that every patient has the right to pain treatment, especially epidural pain treatment. These standards say that every patient is to be a person whose dignity and intimacy is respected at all times, especially and especially in such intimate situations as childbirth. These standards say that we have the right to have someone close to us or someone we feel should accompany us. This could be a friend. These standards say that at every stage of this special situation, because it is a very special situation when a new life is created, a new life is born. When a new baby arrives, it is in a special way that this family should be cared for by all the staff, by all the medical staff, and this is not necessarily the case. We see situations where this birth plan is not made. We see situations where there is no anaesthesia at all. There are medical facilities where these anaesthetics do not exist. The very high-profile data presented by the National Health Fund show that in the Mazowieckie Voivodship more or less 40% births are performed with epidurals, while in the Wielkopolskie Voivodship, which does not seem to differ, not far off, not far off either, in terms of cultural or financial issues, epidurals are practically not provided.


Monika Rachtan
Doctors say there is a shortage of anaesthetists, that they themselves cannot anaesthetise, gynaecologists that this is where doctors would need to be trained, specialisations would need to be encouraged so that young doctors would come to study in this direction. What is the idea behind this? Well, because we are not printing these doctors tomorrow, the day after tomorrow.


Bartłomiej Chmielowiec
Editor, it is very easy for some outlets to look for such excuses. It is very easy to find excuses and say it is not me, it is the health system. Preferably it is the Minister of Health, still maybe the Patient Ombudsman. Mazovian province during 40% natural deliveries are used. This is the average. Epidural anaesthetics are used. I do not see any differences between the Wielkopolska and Mazovia Voivodeships, and there less than one per cent. This means that this explanation regarding the lack of doctors is, in my opinion, very, very questionable. It is more, in my opinion, about the willingness of the managers of medical institutions to organise the work of gynaecological-obstetric wards in such a way as to actually ensure that women really benefit from the right to pain treatment. Minister Izabela Leszczyna has announced, together with President Filip Nowak, that there will be bonuses for facilities where the number of anaesthetics in relation to natural births is at least 10%. So these announcements are also already in place to strengthen this financial aspect. However, I come back to what I said. I do not see any differences between the Mazowieckie Voivodeship and the Wielkopolskie Voivodeship. And the question is: why are anaesthetics used in one and not in the other? In my opinion, this question should be addressed to the managers of these facilities and they should not look for easy excuses and blame everything on the health care system.


Monika Rachtan
We look forward to this change. All women. Minister, we are educating ourselves when it comes to maternity care. We go to birthing school, we browse the internet and I firmly believe that we use sources that are reliable. We ask our female colleagues about what this care looked like in their case, what we should prepare for. And now, again, it seems to me that we have done this education lesson. We did our homework, we girls. But the system doesn't necessarily, that nobody tells us just like that, top-down, systemically, what it should look like. There is midwifery care, but it's just a moment before this important moment in life. Any ideas on how to modernise this?


Bartłomiej Chmielowiec
As in all changes, it is important to have a strong leader, and that strong leader is now Minister Izabela Leszczyna, who has announced very fundamental changes to improve the situation of pregnant women and gynaecological and obstetric care in general. And these changes are happening. For example, the Minister's conference on in vitro fertilisation and fertility. Plans are also being presented on this subject today. Of course, this is a complex situation, because on the one hand, we should educate, and medical staff should also strive to reward, as I have said, those facilities which focus on quality, while at the same time verifying how these standards of perinatal care are implemented in all other facilities. On the other hand, it is also important to educate us as a society from an early age. For some years now, I have been working to ensure that the subject of health literacy is introduced from an early age, and it has been. It has been such a subject throughout our lives from primary school through to secondary school and perhaps university. Why not? A much-needed health knowledge where we would learn about all the extremely important aspects, about a healthy lifestyle. Obviously about the nutrition issue, but also about mental health prevention. A very important issue about the issue of self-control, about the issue of how important vaccination is. Well, for young girls, for example. HPV vaccination an extremely important, extremely important issue. We know that HPV vaccination has virtually eliminated the problem of cervical cancer in some countries. Obviously, at a certain stage of development, at this appropriate stage of development, adapted to the young person, the question of sexual life, the question of contraception, but also those questions concerning, for example, how a young mother, what she should be prepared for, how she should prepare herself for this role. So yes, education is very important. Yes, issues relating to the promotion of those facilities which place an emphasis on quality, education of medical staff as well, but also what I was talking about, reporting all those situations, those situations which should not occur, that is, verbal aggression, for example, in gynaecological and obstetric wards, such subjective treatment of women, failure to administer anaesthesia - all these issues so that institutions such as the Patient Ombudsman will have a chance to react, because if we do not have this signal, if we do not have this information, we cannot, after all, know what it is. There is no way. We have to have the signal from the patients, from the patients. We, of course, monitor social media and I can assure you that if we are flagged, we see that flagging.


Monika Rachtan
Confirmation.


Bartłomiej Chmielowiec
Nevertheless, you know, if certain things happen and we have some specific information and it comes to us directly, we have a chance to react. I guarantee that every time there is such a reaction. And the situation is changing for the better. If we compare respect for patients' rights 10 years ago and now, the situation has improved dramatically. Of course, there is still a lot of room for improvement. This is the case, but we are all aware of it.


Monika Rachtan
But this situation is improving.


Bartłomiej Chmielowiec
The situation is improving, and there will probably never be such a perfect state that we say to ourselves: yes, patient rights are always respected in every facility. There is no such state anywhere in the world. But we are striving for the ideal. Let us continue to do everything we can to make this health care system as friendly as possible for all of us, because we all benefit from it.


Monika Rachtan
Pregnant women obviously expect and need this healthcare, but I think they need one very important thing - dignity. That's the kind of word that says more than a thousand words. And I think each of us, when we look at doctors, we see people in aprons who are supposed to provide health, to take care of her and her baby. But on the other hand, she also has a human being on the other side. And I think it's looking at each other precisely as human beings, that is, the patient as a human being and the doctor as a human being. And to think of this dignity is something we should strive for today in these wards where new life is emerging.


Bartłomiej Chmielowiec
Of course that is the way it is, also we ourselves, as patients, if we demand and rightly demand to be treated with dignity and empathy, then let us behave in the same way towards medical personnel. On the other side is the human being, there is the specialist, there is the professional, the doctor, the nurse, the midwife, the laboratory diagnostician. All these professions, the paramedic, and they want to help us. They want to help us and they want to give us the best possible medical service. So let's also remember that all these people should be treated with dignity, that we should also dignify them. To speak up, to present our case.


Monika Rachtan
This is very important. Let's be human to each other.


Bartłomiej Chmielowiec
Exactly right. Let us be human to each other. Let us think to ourselves that, after all, there is a human being on the other side. There is a human being who wants to help us. Let us not treat someone down, let us not treat someone haughtily. Let us not treat someone in such a way that we have a claim. We have rights, we have rights and those rights should be exercised. But let's remember exactly that there is a human being on the other side and this relationship really can, be built in the way we would all like it to be.


Monika Rachtan
More and more private births are occurring in Poland, but in some, and I think in most of them, in a situation where there is a threat to the life of either the mother or the baby, the patient is transported to a public hospital and this medical care, often emergency care, is continued there. Is this in line with patient rights?


Bartłomiej Chmielowiec
In general, I would say that, of course, everything depends on the clinical condition and the case in question. If a particular institution has no specialists and no experience in dealing with a difficult situation, then, of course, the correct model is to transfer the patient and her child as quickly as possible to a hospital of a higher reference level, where she will be properly looked after.


Monika Rachtan
The minister in general accepts that the patient is paying money to be cared for, and the moment something bad happens, this transport comes on top of that. This is an even greater risk. Should there even be such a thing in Poland that a facility which is not able to 100% this patient's safety can provide such services as delivery?


Bartłomiej Chmielowiec
I am talking here about two different situations. Obviously, in a situation where you go to a hospital where there is a gynaecology and obstetrics unit, all these basic elements, including the caesarean section, should be done in that unit, in that particular medical facility. If this is not the case, then this is an irregularity and should not be the case. Of course, apart from making a signal and a complaint, the patients themselves, what I keep coming back to and saying, there is no such division between public and private. It all depends on how a particular facility functions and how it puts a premium on quality. If facilities see that these types of private hospitals function in this way, then they should probably make a different choice. However, what I am talking about here is a situation where, regardless of whether it is a public or private facility and we are dealing with a very difficult case, a case which can only be dealt with by a hospital with a higher level of reference, I am talking about a situation where the patient should be looked after as quickly as possible and transported to a hospital with a higher level of reference. On the other hand, of course, if we have a public hospital and we have a private hospital, then both are obliged to carry out in full the procedures to which they are committed. I am talking about such special situations, where it is necessary to transport a given patient to a hospital where there is more experience, where there is better care, where the staff will take proper care of the patient. So I am talking about such cases.


To sum up, it is not the way an organisation is financed that determines how it functions, although, of course, in terms of service, we can probably see some elements that speak for private establishments, but the issue is how the management of an organisation manages the organisation and how it focuses on quality. It is the management of a facility that decides how the facility functions. If the manager is a professional, if he or she has built up a team of people who support him or her and is committed to quality, he or she reacts to any situation in which quality is not at the highest level and introduces various types of solutions, such as applying for an accreditation certificate or having an accreditation certificate. As far as the hospital is concerned, here we have greater certainty that the facility is actually functioning properly.


Monika Rachtan
What are the three most important things from our conversation today that viewers should remember?


Bartłomiej Chmielowiec
Firstly, that the Patient Ombudsman is for the patient. He is the Ombudsman for all patients, both those who use the private health system and those who use the public health system. Secondly, not to be passive, , not to be afraid to report all kinds of problems and irregularities to us. The telephone number is 800 190 590, because only then will we, as an institution, have the chance to react, and our reaction will result in such a situation not occurring again in the future, and that these patients' rights will consistently be respected one hundred per cent by all institutions. And the third important thing is that if a situation arises, which I do not wish to wish on anyone, but if a situation arises where a hospital error results in a patient's injury, disorder or death, the patient or his or her next of kin will consider. Instead of taking the matter to court, they should consider making an application to us. An application to the Patient Ombudsman, the Medical Injuries Compensation Fund, a 300zł fee, a decision within 3 months, and the amounts of compensation very close to or practically the same as could be obtained in court.


Monika Rachtan
What is the humanisation of medicine for the Minister?

Bartłomiej Chmielowiec
This is a broad concept, but in such a holistic aspect we could say taking care of the patient not only from the strictly clinical side, i.e. from the side of medical procedures and from the side of current medical knowledge, but also, and above all, from this side related to empathy, dignity, and above all to fulfilling the patient's right to information. A very important right, that is, informing the patient about what we are doing now, what procedures, what we are going to do, what we are going to do in the future, answering all the patient's doubts and questions, and implementing this by all the medical staff during treatment in such a way that the patient has a sense, not just a feeling, has confidence that they are being properly looked after with due respect for the right to intimacy, dignity.

Monika Rachtan
Let's not be passive when it comes to our health. My guest was the Patient Ombudsman Bartłomiej Chmielowiec. Thank you very much.