9 Cristian Iorga

8/3/2019 9 Cristian Iorga

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Analele Universit ii Constantin Brncui din Trgu Jiu, Seria tiine Juridice, Nr. 3/2010

Annals of the Constantin Brncui University of Trgu Jiu, Juridical Sciences Series, Issue 3/2010

169

ASPECTE JURIDICE PRIVIND

MALPRAXISUL MEDICAL

Cristian IORGA, Doctor n medicina,Asistent universitar UMF Carol Davila

BucuretiClinica de chirugie general Sp. Sf.

Pantelimon BucuretiProf. univ. dr. Pantelimon MANTA,Facultatea de tiine Juridice i Litere,

Universitatea Constantin Brncui din Tg-JiuCristina PUSCU, doctorand, Clinica de

chirugie general Sp. Sf. PantelimonBucureti

Abstract: Am realizat prezentarea cadruluilegislativ actual cu privire la malpraxisul medical, dela prima adoptare a Legii privind reforma ndomeniul sanitar n 2006,cu amendamentele i

completrile ulterioare (ultimul amendament adoptatn 2010). Reiese o continu preocupare pentruarmonizarea legislaiei noastre cu cea europeana, nsensul simplificarii procedurilor de lucru. Dei aceste

legi exist de aproximativ 5 ani n ara noastr seconstat n continuare prezena unor neconcordanentre legea malpraxisului i prevederile Codului

Penal.

Cuvinte cheie: malpraxis medical, CodulPenal, Legea privind reforma n domeniul sanitar

Profesiunea medical, prinspecificul ei, este supus respectrii unornorme deontologice i juridice.

Normele deontologice (raspundereaprofesional medical) sunt reglementatede Codul Deontologic al ColegiuluiMedicilor din Romnia. Acesta respectnormele internaionale de deontologiemedical cuprinse n Declaraia de laGeneva din 1948 dup Codul de la

Nrnberg (1947) i amendat n 1983 dectre Asociaia Mondial Medical.

Raspunderea profesional medicaleste rezultatul nclcrii normelor

specifice profesiunii, fr a aduce

JURICAL ASPECTS REGARDING

MEDICAL MALPRACTICE

Cristian IORGA, PhD, Assistant ProfessorUMF Carol Davila Bucureti, GeneralSurgery Department Sf. Pantelimon

Hospital, BucharestProfessor PhD Pantelimon MANTA,

Faculty of Juridical Sciences and Letters,Constantin University of Tg-Jiu

Cristina PUCU, Candidate to PhD,General Surgery Department Sf.

Pantelimon Hospital, Bucharest

Abstract:I have made the presentation of the

present legislative framework regarding the medicalmalpractice, starting from the first enactment of the Law regarding the reform within the healthcare in2006 with further amendments and addenda (thelatest amendment was adopted in 2010). It has hereinappeared a continuous concern for the reconcilabilityof our legislation with the European legislation for

the purpose of simplifying the working procedures.

Although these laws have been in our country foralmost 5 years, it can still be hold that there are somedisparities between the law of malpractice and thestipulations of the Penal Code.

Keywords: medical malpractice, the PenalCode, the Law on reform within the healthcare field

The medical profession, by itsspecificity, is subject to compliance with ethicand legal rules.

The codes of professional ethics(professional medical liability) are governed by the Code of Ethics of the RomanianMedical Council. This respects theinternational medical ethics standards whichare contained in the Declaration of Geneva in1948.

The professional liability is the resultof the infringement of the rules specific forthe profession, without prejudice to any

person.

The legal provisions specific to the


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prejudicii unei persoane. Normele juridice specifice

profesiunii medicale sunt cuprinse n Legea95/2006 privind reforma n domeniul

sntii, unde se stipuleaz rspundereacivil a personalului medical i afurnizorului de produse sau serviciimedicale, sub forma malpraxisului.

Malpraxisul medical este definit caun comportament neprofesional, inferiorunor standarde de competen i pricepereunanim stabilite i acceptate de ctrecorpul profesional , avnd la bazneglijena sau incompetena i caregenereaz ngrijiri deficitare cu consecine

asupra pacientului.Art. 68 din Legea 95/2006 prevedeconstituirea la nivelul fiecrei autoriti

publice judeene i a municipiuluiBucureti a unei comisii de competen

profesional pentru cazurile de malpraxis.n urma sesizrii acestei comisii de

ctre persoana presupus prejudiciat printr-un act de malpraxis, se desemneaz ungrup de experi nsrcinat cu efectuareaunui raport asupra cazului. Raportul se

nainteaz ctre comisie n termen de 30 dezile, iar comisia are obligaia de a adopta odecizie asupra cazului n maxim 3 luni dela data sesizrii. Decizia comisiei prin carese stabilete dac a fost sau nu vorbadespre un caz de malpraxis se comunic

persoanelor implicate n termen de 5 zile,contestaiile la aceast decizie putnd fidepuse n termen de 15 zile de la datacomunicrii.

Persoana prejudiciat printr-un actde malpraxis se poate adresa instaneicivile de judecat, dup parcurgerea

procedurii stabilirii cazurilor de malpraxis,drept prevazut in art.673 din Legea95/2006.

Rspunderea juridic a medicului poate avea caracter penal, adic medicultrebuie s produc o infraciune, o faptcare prezint pericol social, svrit cuvinovie i prevzut de legea penal(art.

17 Cod Penal).

medical profession are contained in the Law95/2006 on the reform in healthcare, wherethe civil liability of the health-care providersand of the supplier of medical products or

services are stipulated in the form ofmalpractice.The medical malpractice is defined as

an unprofessional behavior, inferior to somestandards of competence and skills,unanimously set and accepted by the

professional body, based on negligence orincompetence, generating poor patient carewith consequences on the patient.

The article 68 of the law 95/2006 provides for a commission of professional

competence for the malpractice cases to be setup at the level of each public countysauthority and at the level of the municipalityof Bucharest.

After the person alleged prejudiced bya malpractice act refers to this commission,shall be designated a group of experts chargedwith making a report on the case. The reportis submitted to the Commission within 30days, and the commission is obliged to adopta decision on the case within 3 months from

the date of referral. The commissionsdecision which determines whether or not itwas a case of malpractice shall becommunicated to the persons concernedwithin 5 days and the appeals to this decisioncan be submitted within 15 days from the dateof communication.

The person prejudiced by an act ofmalpractice may appeal to the civil court aftergoing through the process of establishing themalpractice cases, a right derived from thearticle 673 of the Law 95/2006.

The legal liability of the physicianmay have a criminal nature, meaning thedoctor should produce a crime, an act thatshows social danger, committed with guiltand stipulated by the criminal law (article 17of the Criminal Code).

Referring to the character of themalpractice, the law 95/2006 introduces thenotion of informed consent of the patient, i.e.

the doctors obligation to inform the patient


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Rmnand la aspectul malpraxisuluimedical, legea 95/2006 introduce noiuneade consimmnt informat al pacientului,adic obligaia medicului de a informa

pacientul i de a obine acordul acestuia nscris nainte de a fi supus la proceduri dediagnostic i tratament, explicnd

pacientului diagnosticul stabilit, natura iscopul tratamentului, riscurile iconsecinele tratamentului propus,alternative de tratament , prognosticul boliifr aplicarea tratamentului.

Totui, obinerea consimmntuluiinformat nu scutete medicul de rspundere

profesional, civil sau penal. Eroarea

medical poate produce prejudicii grave pacientului, de natur fizic sau moral,astfel ca prin art 656 din Legea 95/2006 afost introdus obligativitatea personaluluimedical de a ncheia o poli de asigurarede rspundere civil profesional (demalpraxis).

n Romnia, mai ales dup aderareala Uniunea European, a fost obligatorieadoptarea unei legislaii care s stipulezemalpraxisul medical. Numrul cazurilor

sesizate ctre comisiile ColegiuluiMedicilor a crescut de la an la an, dartotui numrul celor gsii vinovai estemic.

Colegiul poate da mustrri,avertisment sau poate solicita retragereadreptului de practic. Astfel n Bucureti in2009 au fost sesizate 270 cazuri din partea

pacientilor (dublu fa de anul precedent),Colegiul aplicnd sanciuni n 44 de cazuri,dintre care in cazul a trei cadre medicale s-a aplicat interdicia de a profesa o anumit

perioad de timp.n anul 2010 au fost nregistrate

dou cazuri de malpraxis n care pacieniiprejudiciai s-au adresat justiiei i auobinut compensaii materiale.

Din necesitatea acordrii unorcompensaii materiale a aprutobligativitatea medicilor de a ncheia

poliele de rspundere civil

profesional.Totusi, niciuna dintre

and to obtain his written consent before beingsubject to diagnostic and treatment

procedures, explaining to the patient theestablished diagnosis, the nature and the

purpose of the treatment, the risks and theconsequences of the proposed treatment,alternatives of the treatment, prognosis of thedisease without treatment application.

However, obtaining the informedconsent doesnt exempt the physician from

professional, civic or criminal liability. Themedical error can cause to the patient serious

prejudices, physical or moral, so that thearticle 656 of the law 95/2006 introduced acompulsory liability of the health-care

providers to conclude a policy of professionalliability insurance (for malpractice).

In Romania, especially after joiningthe European Union, the adoption of alegislation stipulating the medical malpracticewas required. The number of cased notified

by the commissions of the Medical Councilincreased from year to year, yet the number ofthose found guilty is low.

The Council may give warnings,reprimands or may ask the withdrawal of the

practice right. Thus, in Bucharest, in 2009,270 cases were notified by the patients(double in comparison with the previousyear). The Council applied sanctions in 44cases, of which on three cases of health

providers it was applied the prohibition topractice a certain period of time.

In 2010 there were registered twocases of malpractice, in which the prejudiced

patients appealed to the justice and obtainedmaterial compensation.

The necessity of offering materialcompensation caused the conclusion ofcompulsory liability by health-care providers.However, none of the insurance companiesfrom Romania has paid any compensation toany patient.

The insurance market in Romania is below the level of 10 million euros, thehealth-care system in Romania havingapproximately 200.000 employees, of which

40.000 are doctors. Due to their compulsory


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companiile de asigurri din Romnia nu apltit nicio despgubire vreunui pacient.

Piaa asigurrilor din Romnia sesitueaz sub nivelul a 10 mil de euro,

sistemul sanitar din Romnia avndaproximativ 200.000 de angajai, din care40.000 sunt medici.

Fiind obligatorii, majoritateamedicilor percep aceste polie ca pe nitetaxe, i le ncheie pentru sumele minime

prevazute de legislaia n vigoare (deexemplu, 62.000 euro n cazulspecialitilor chirurgicale), sumeinsufciente pentru plata unor daune cerutede pacient. Companiile de asigurri afirm

c lipsa plii unor despgubiri nu sedatoreaz n principal excluderilor din

poli, ci mai ales procesului laborios, caredureaz ani de zile pn cnd instana de

judecat d un verdict.De aici i necesitatea simplificrii

legisaliei n acest domeniu, aprnd noireguli aplicate n cazurile de malpraxis. Aufost adoptate n mai 2010 modificri lalegea 95/2006 n care se prevede

posibilitatea de a soluiona cazurile de

malpraxis pe cale administrativ, prinnelegerea ntre victim, furnizorul deservicii medicale i reprezentantulsocietii de asigurare. n cazul n careComisia constat un caz de malpraxis,asiguratorul face o ofert celui prejudiciat

pentru a se ncheia o nelegere. Dacvictima prejudiciului i personalul medical,furnizorii de servicii medicale acceptaceast nelegere se va ncheia un contractde tranzacie. Dac cel prejudiciat nu estede acord cu oferta asiguratorului, atunci,tot ca o noutate, soluionarea conflictelorexistente ntre cel care reclam malpraxisuli personalul medical va fi realizat dectre mediatori autorizai angajai de ctredireciile de sntate public.

Astfel se ncearc o armonizare alegislaiei cu cea european care seadreseaz mai degrab despgubirii celui

prejudiciat dect pedepsirii medicului.

Normele europene i internaionale prevd

character, most physicians/doctors perceivethese policies as a kind of taxes and theyconclude them for the minimum amounts set

by the existing legislation (for example,

62.000 euros for surgical specialties),amounts insufficient to pay damages for thepatient. Insurance companies say that the lackof payment of damages is not due to theexclusions from the policy, but mostly to thelaborious process that takes years until thecourt gives a verdict.

Hence the necessity of a simplifiedlegislation in this area, due to the emergenceof new rules applied to the malpractice cases.In May 2010 new amendments to the law

95/2006 were adopted, providing the ability tosolve cases of malpractice by administrativemeans, by an agreement between the victim,the health-care provider and the representativeof the insurance company. In case that theCommission determines a malpractice case,the insurance company makes an offer to the

prejudiced person to conclude a deal. If thevictim of the prejudice and the medical

personnel, the health-care providers acceptthe deal, then a transaction contract will be

concluded. If the prejudiced person does notagree with the insurers offer, then, again as anovelty, the conflict resolution between the

person claiming the malpractice and themedical personnel will be conducted byauthorized mediators, employed by publichealth departments.

Hereby, has been attempted aharmonization with the European legislationthat targets rather the compensation of the

prejudiced person than punishment of thedoctor. The European and international rulesstipulate that it is not ethical and legallycorrect to punish by criminal law a doctorwho committed a mistake without intentionand recognizes that, after he has savedthousand of lifes during his practice.

Tha malpractices law shows the legalway to the agreement between the parties andobtaining material compensation for the

prejudiced person, without involving the legal

system into the criminal or civil action.


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c nu este etic i nici juridic corect spedepseti penal un medic care a svrit ogreeal fr intenie i pe care orecunoate, dup ce n activitatea sa a

salvat mii de viei.Legea malpraxis-ului arat caleajuridic pentru nelegerea prilor iobinerea de compensaii materiale pentrucel prejudiciat fr a antama sistemul

juridic n cadrul procesului penal ori civil.n continuare este nevoie de

armonizarea legii malpraxisului cu cadrulpenal actual , n special art. 182 i 184 C.P.ce prevd infraciunile contra vieii i

persoanei, respectiv lovirii i altor violene,

vtmrii corporale i vtmrii corporalegrave, n sensul de a se permite mpcarea

prilor n cadrul legislativ al legii specialea malpraxis-ului.

Desigur c pacientul poate pstradreptul de a aciona oricnd medicul ninstan, pe plan penal, cnd se constatcomiterea unei infraciuni.

n concluzie, n mod teoretic existcadrul legislativ pentru constatarea ieventuala pedepsire a cazurilor de

malpraxis. Exist n continuare preocupri pentru armonizarea legislaiei isimplificarea procedurilor pe care un

pacient trebuie s le urmeze n reclamareaunui caz de malpraxis. De asmenea existun interes mai mare pentru despgubirea

pacientului prejudiciat, dect pentrupedepsirea medicului vinovat.

n mod practic, pn n acest an, procesele intentate de pacienii reclamaniau avut o durat de aproximativ 2-3 ani,iar sentinele date au fost de cele mai multeori n favoarea medicilor.

n 2010 au fost nregistrate douacazuri de sentine judecatoreti carestipulau plata unor despgubiri importante(de 500.000 euro n fiecare caz). Aici artrebui s intevina societile de asigurarecu care medicul are ncheiat polia deasigurare, dar, cum am spus i pn acum

poliele au fost incheiate pentru sume mici

(n cazurile chirurgicale sumele asigurate

Thenceforth, there is a need ofreconciability of the law of malpractice withthe actual criminal frame, especially thearticles 182 and 184 of the Criminal Code

wich stipulate the crimes against life andpersons, and corporale violence and violenceof other type respectively, injury and serious

body injury, with the purpose to allow thereconcilation of the parties within thelegislative frame of the special law ofmalpractice.

Of course, the patient can preserve theright to go to court against the doctor, in thecriminal proceedings, when it is determinedthe last has committed a crime.

In conclusion, theoretically there isthe legislative framework meant to hold andeventually punish the cases of malpractice.There is still great concern shown for thereconcilability and simplification of the

procedures which a patient has to followwhen vindicating a case of malpractice.Moreover, there is even a greater interest forthe compensation of the injured patient, otherthan punishing the doctor who is guilty ofcharge.

Practically, so far, the law suitsentered by the plaintiff patients have lastedfor almost 2-3 years, while the decretorysentences have mostly been in favour of thedoctors.

In 2010 there were recorded two casesof Court decisions which stipulated the

payment of very important compensations (of500.000 euros in each of the cases). It is theinsurance companies the doctor hasconcluded on insurance who should haveintervened, but, as I have already said, theinsurance policies had been concluded onsmall amounts (for the surgery cases theinsured sums being almost 10 times smallerthan the sums decided on by the Court ascompensations).

Therefore it is necessarily importantthat also doctors and insurers realize thenecessity of rendering insurance policieswhich should cover all potential risks as well

as cover the compensations decided on as


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fiind de aproape 10 ori mai mici dectsumele obinute ca despagubiri n instan).

Deci este important ca i medicii iasiguratorii s realizeze necesitatea

ncheierii unor polie care s acopere toateriscurile poteniale i care s poat acopericompensaiile oferite drept despgubire.

Numrul sesizrilor adresateComisiei de Disciplin a ColegiuluiMedicilor a crescut n fiecare an, n anul

precedent nregistrndu-se un numr dublufa de 2008, ceea ce nseamn c pacieniisunt din ce n ce mai informai, din ce n cemai pretenioi cnd vine vorba desntatea proprie. Totui numrul

sesizrilor anuale este de cteva sute, pecnd n Germania de exemplu exist 3900de cazuri de malpraxis pe an. n continuareeste nevoie de informarea i educarea

populaiei cu privire la drepturile iobligaiile pe care le au ca pacieni.

Bibliografie

1.Curca G.C. Reglementareamalpraxisului medical ntr-un cadru

coerent este o necesitate n domeniulsanitar, Revista Romna de Bioetic vol. 3nr. 42.Codul Deontologic al medicilor dinRomnia 19973.Codul penal. Codul de procedur penal(ed. Dan Lupacu), ed. a III-a, Ed. Rosetti,Bucureti, 20034.Dressler M.L., Probleme de deontologiei rspundere medical, n Tratat demedicin legal, vol. II sub redacia V.Beli, Ed. Medical, Bucureti, 19965.Legea 95/2006 privind reforma indomeniul sanitar6.Predescu O. Convenia european adrepturilor omului i Dreptul penal roman,Editura Lumina Lex Bucureti 20067.Trif A.B., Astarastoae V.,Responsabilitatea juridic medical nRomnia. Premise pentru un viitor dreptmedical. Ed. Polirom, Iasi, 2000

indemnification.The number of acts of apprehension

addressed to the Disciplinary Committee ofthe College of Physicians has been increasing

every year, last year having registered adoubled number than in 2008, which meansthat the patients are more and more informed,more and more pretentious when it comes totheir own state of health. However, theannual number of acts of apprehension is onlyof only a couple of hundreds, while inGermany, for example, there are 3900 casesof malpractice per year. It is hereby needed tohave the population informed and educatedregarding the rights and obligations patients

have.

Bibliography

1. Curca G.C. Regulation of the MedicalMalpractice Within a Coherent Framework isa Necessity at the Level of the HealthcareSystem, The Romanian Magazine ofBioethics, vol. 3 n 42. The Deontological Code of Physiciansfrom Romania 1997

3. The Penal Code. The Code of PenalProcedure(Dan Lupascu Publishing House),3rd Edition, Rosetti Publishing House,Bucharest, 20034. Dressler M.L., Problems of Deontologyand Medical Liability, in Treatise on Legalmedicine, vol. II under V. Belis, MedicalPublishing House, Bucharest, 19965. Law 95/2006 regarding the reform withinthe healthcare system6. Predescu O. The European Convention ofHuman Rights and Romanian Penal Law,Lumina Lex Publishing House, Bucharest20067. Trif A.B., Astarastoae V., The JuridicalMedical Responsibility in Romania. Premisesfor a Future Romanian Medical Law, PoliromPublishing House, Iasi, 2000

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9 Cristian Iorga