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 judges The code is wide ranging: Wide ranging in terms of who needs to be responsible o Applies to registered health providers o 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 professionals The 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 complaint o Minor complaint not worth chasing up o Malicious intent the complaint was only made to piss people off Teams at the commission will initiate an investigation o Investigative team o Legal team Two further decisions o Decide no breach (no action taken) o Publish opinion somewhere (such as breaches) Then make recommendations (such as apologies, additional training required 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.

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 received all 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 exploitation o 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. dispenser shouldnt check it off) precedent set, stocktaking should not be taken during normal hours Law:

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 again 1. 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)

b. Therefore, it breaches Right 4(2) as well, because it now doesnt comply with legal standards. 3. No, because it could have been a breach of privacy to ask. It was the prescribers job to do so. 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 standards b. Ethical standards 2. Mr B breached Right 4(2) by failing to provide quality healthcare due to incorrect procedures put in place. a. Error prone system b. 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 perspective o Face-to-face meetings are helpful to understand the patients perspective to help professionals understand what went wrong When and how to apologise o An honest, heartfelt apology early can prevent it from getting to the HDC Distinguishing expressions of dismay and responsibility o Express sorrow and own up for your breach of the code A good apology o Let the patient know youre aware of what they are going through o Express responsibility and regret for your actions o 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

Explain what went wrong

Note: 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 this o Finds breach in Right 4(2) Sent to disciplinary council o Professional misconduct charge Prescription errors Doctor makes a wrong prescription o 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 misconduct o Pharmacist was not found to be guilty Doesnt agree with this, because pharmacists are supposed to be the guardian of medications More practicing rights we get = the more responsibility we should take Overall: understand how the code can make many different standards which arent pieces of law, have legal power. This is done by Right 4(2).