According to the Supreme Administrative Court, a doctor is not obliged to treat a vulgar patient
In the relationship between the health service provider and the patient, contractual freedom is significantly restricted. According to Act No. 372/2011 Coll., on Health Services, the patient has the right to choose the provider of health services. The other side of the same coin is the obligation of the physician to accept the patient; the physician may refuse the patient or terminate the patient’s care only for reasons defined in Section 48 of the Health Services Act (“HSA“).
Reasons for termination of care include the patient’s failure to follow the provider’s internal rules and the patient’s behaviour is not due to a medical condition. If a physician wants to terminate care for a patient who is behaving in an unruly or even vulgar manner, he or she must first issue an internal regulation prohibiting that conduct, then find a violation of the internal regulation and infer a reason for terminating the patient’s care.
The provision of Section 48 of the ZOZS is, however, somewhat awkwardly drafted. The reasons for which a patient may be refused do not include the fact that the physician has previously terminated care for the patient. Thus, a formal linguistic interpretation of the text of the law could lead a doctor to find himself in a vicious circle with a stubborn patient: the doctor terminates the care of the patient because of the patient’s violation of internal regulations. However, the patient may subsequently exercise his or her right to choose a health care provider again. The next day, he or she will see the same doctor again, and unless the doctor has some objective reason for refusing the patient under Section 48(1) of the CPA (e.g., full capacity), purely according to the text of the law, he or she should be obliged to accept the patient again. This logical contradiction was addressed in a recent decision by the Supreme Administrative Court, which held that a physician is not obliged to re-admit a patient to care when he or she is terminated for vulgar behaviour.
Although this conclusion does not follow from the provision of § 48 of the ZOZS itself, the court argued on the basis of logical and historical interpretation as follows: “If section 48(2) of the Health Services Act allows for the possibility of terminating care, it lacks logic to be obliged to readmit the patient, whereas the grounds for refusing a patient are very limited under section 48(1) of the Health Services Act and are unlikely to be met in the case of a previous termination of care. The Supreme Administrative Court refers to the aforementioned explanatory memorandum to the Health Services Act, which states that a provider may admit patients “whose behaviour, not caused by their medical condition, interferes with the provision of health services…”. Thus, there is a clear legislative intent that in the event of termination of health care pursuant to Section 48(2)(d) of the Health Services Act, it is not the duty of the health care provider to readmit such a patient to care.”
(Decision of the Supreme Administrative Court Case No. 5 As 155/2023 – 37 of 3 June 2024)
In the case under review, the court annulled the decision of the Ministry of Health, according to which a fine was imposed on the health care provider for violation of the conditions for refusal of a patient pursuant to Section 48(1) of the Health Care Act.
This article is for informational purposes only and does not constitute legal advice or guidance for any particular case.
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