Code of Rights Workshop

8/2/2019 Code of Rights Workshop

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Code of rights

Background

Health and disability commissioner act came, which lead to writing and drafting the code of rights,

which became law later.

Quasi-legal- it isnt an act, but it counts as law due to the original health and disability

commissioner act (see heaps of examples below where we use Right 4(2)

Other way to make law apart from passing an act through parliament is case law

Look at previous judgements and check precedents set by judgesThe code is wide ranging:

Wide ranging in terms of who needs to be responsibleo Applies to registered health providerso Also applies to anyone providing health information

E.g. health food shops, old peoples home Also wide ranging in terms of who is covered (i.e. has right under it)

o Also covers disability services Such as giving a bath for disabled people

o And of course, people under the care of registered health professionalsThe commissioner can investigate wherever he pleases without a response to a specific complaint

Also, it doesnt entitle anyone to treatment, only gives you rights once you start treatments (or

equivalent)

Right 3- can opt out of the code if resources are constrained, or due to clinical issues. Onus of proof

(burden of proof) is on the health care provider.

So its not a get out of jail free card

In response to a complaint, the commissioner can choose to:

Ignore complainto Minor complaint not worth chasing upo Malicious intent the complaint was only made to piss people off

Teams at the commission will initiate an investigationo Investigative teamo Legal team

Two further decisionso Decide no breach (no action taken)o Publish opinion somewhere (such as breaches)

Then make recommendations (such as apologies, additional trainingrequired etc.)

o If its severe, it would be sent to the disciplinary council E.g. pharmacy council

Complaints must come here first, and then go to the pharmacy council.

1500 complaints per year in comparison with events (millions of consultations every year)SO they are not common.


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Will this crap be assessable? Likely.

Case 1

Summary: Right 6, right to be fully informed. Right 4 as well (Every consumer has the right to have

services provided that comply with legal, professional, ethical, and other relevant standards.)

Doctor should have told her of the side effects, under Right 6(1), as she should have receivedall the appropriate information, which includes the side effects.

o This applies to the pharmacist too, should have told her the side effects Doctor should have disclosed his involvement with the Aloe Vera juice company, under Right

6(3)(b). She needed an honest and accurate recommendation, but didnt get one.

o Right 2, need to be free from financial exploitationo Pharmacy ethics code 1.9, shouldnt have commercial interests

Finally, can complain, right 10.Protip: question about a code of rights will (almost) always hit Right 4(2) and others.

Case 2

Summaries:

precedent set, pharmacies should have an independent checking system (i.e. dispensershouldnt check it off)

precedent set, stocktaking should not be taken during normal hoursLaw:

Bottles are incorrectly labelled, under R13 of MR 1984, he didnt label the bottles correctly,and the contents of the bottle doesnt reflect the label

o R12, R13 and R23 especially Inappropriate standard of care provided, under Right 4, a patient has the right to services

which complies with legal etc. standards. Mislabelled bottles fails to comply with any

standard

o Again, see how Right 4(2) is involved again beware: cases will quote the old code of ethics, but understand its still a breach in ethics

Case 3

Summary:

Midwife laid a complaint (thats allowed) Right 4(2) involved again1. No, as it was in accordance with current operating procedures, so it is in line with current

practices, because annotation is normal within the pharmacy

a. So it doesnt breach Right 4(2)2. Yes, the repeat is a breach of MR 1984, as it doesnt comply with prescribing power laws

a. Midwives cant prescribe this medication past 3 months after delivery (no repeat)


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b. Therefore, it breaches Right 4(2) as well, because it now doesnt comply with legalstandards.

3. No, because it could have been a breach of privacy to ask. It was the prescribers job to doso.

a. Prescribers role IN THIS CASE for getting information about breastfeeding

Case 4

Breaches of the pharmacy vs. breaches of the pharmacy owner

1. Breached Right 4(2) of the code because it didnt meet:a. Legal standardsb. Ethical standards

2. Mr B breached Right 4(2) by failing to provide quality healthcare due to incorrect proceduresput in place.

a. Error prone systemb. Cant tell who made the dispensing mistake (no accountability)3. The pharmacy owner is responsible for putting into place the systems of a pharmacy to

make sure its running correctly

Case 5

Summary:

Code allows application of other standards because of Right 4(2) Therefore, Right 4(2) will allow commissioner to use all the standards to judge your practice

Case 6

Saying sorry

Understanding the patients perspectiveo Face-to-face meetings are helpful to understand the patients perspective to help

professionals understand what went wrong

When and how to apologiseo An honest, heartfelt apology early can prevent it from getting to the HDC

Distinguishing expressions of dismay and responsibilityo Express sorrow and own up for your breach of the code

A good apologyo Let the patient know youre aware of what they are going througho Express responsibility and regret for your actionso State how this has changed practices for the better

Regret and reassurances A lifetime lesson learned

Summary:

Acknowledge something has gone wrong Apologise Rectify the situation (minimize error, such as calling GP, giving correct pills) Explain processes have been changed so no one else has to go through it


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o Explain what went wrongNote: ACC gives no-fault compensation in NZ. You get compensated regardless of who was

responsible. But in other countries, if you admit youre wrong (acknowledge something happened or

apologise), you will get your pants sued off you.

Therefore, in NZ, dont be worried about explaining what went wrong.

Case 7

Who makes the error?

Dispensing error

Are processes followed?o Error can still occur after thiso Finds breach in Right 4(2)

Sent to disciplinary councilo Professional misconduct charge

Prescription errors

Doctor makes a wrong prescriptiono Adult dose instead of child dose

Pharmacist properly dispenses the medication for this wrong dose Commissioner found the pharmacist breaching the code

o Should have called the doctor Results after disciplinary councils:

o GP was found to be guilty of misconducto Pharmacist was not found to be guilty

Doesnt agree with this, because pharmacists are supposed to be theguardian of medications

More practicing rights we get = the more responsibility we should takeOverall: understand how the code can make many different standards which arent pieces of law,

have legal power. This is done by Right 4(2).

Documents

Code of Rights Workshop