Intensive Care Units (ICU): Introduction of legal arrangements and administrative practice



In previous annual reports, the Ombudsman has made reference to the problem of limited availability of ICU beds in the public health system, forcing people to seek hospitalisation in private hospitals.

It is therefore considered imperative to take measures for the rational allocation of available beds both within the hospital, but also in the framework of the public health system and the private hospitals involved. Rationalisation of this allocation may be achieved by establishing a specific procedure with regard to the admission of patients into hospitals, the coordination and supervision of the availability of ICU beds.

A characteristic case of the problems in this sector is that of a patient who was taken by ambulance to a big public hospital, where, after being examined, he was taken to the pathological ward. The next day, according to the complainant, he was subjected to a CT scan and intubated, since his health was considered critical. The patient remained intubated for about ten days in a common ward, where he eventually died without ever being transferred to an ICU bed in the same or any other hospital.

The Ombudsman through mediation with the hospital, tried to clarify if the patient had received the appropriate medical treatment in the common hospital ward or if he should have been transferred to an ICU bed; if yes, why had this not happened.

In 2008 a ministerial decision (PY/5936/2008) under the title ‘Reform of the admission, programming and supervision of the Intensive Care Units’ was laid down, aiming at the establishment of a National Health Operation Center composed of medical, paramedical and administrative personnel, that would ensure the transparent, impartial and documented allocation of the Intensive Care Units.

Furthermore, for the supervision of the implementation of the aforementioned decision, the setting up of a hospital-ICU operation control committee was provided, responsible for the supervision of the ICU of all hospitals of the country, on the basis of a specific protocol.

However, despite having legislated the reforms, the system of admission, programming and supervision of ICU, has not been implemented either at the hospital level or at a central level. The omission of implementing the specific 2008 ministerial decision constitutes a serious case of typical infringement of legality, given that the decision has not been revoked or amended. It is still in effect and constitutes applicable law; compliance with it is not at the discretion of the public services but is directed by the principle of legality.

Following the Ombudsman’s mediation, the competent ministry asked the authorities involved to explain the reasons for which the ministerial decision had not been implemented.

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