Le Conseil national de l'Ordre des médecins a deux avis emis which we reproduce below the contents verbatim. The first deals with the political projects of reform of the Order, the second of the controversial project BeHealth
Lookout National Council on proposed reform of the College of Physicians
(November 26, 2005)
On 15 January 2005, the National Council of the College of Physicians published its position on legislative proposals relating to reform of the College of Physicians, then under consideration by the Committee on Social Affairs "Senate (see Appendix). To determine this position, which was limited to ideas strength of the proposals, the Council had relied primarily on the text martyr "Proposed legislation establishing a Supreme Council of Professional Ethics of health care, and laying down general principles for the establishment and operation of the Orders health care professionals. " The text martyr having now undergone major changes, the National Council discussed in its meetings on 22 October and 26 November 2005, the version of the text of the October 6, 2005 and the draft law following it, filed by A. Van de Casteele, P. Vankrunkelsven and cs ..
The National Council notes that account was taken of a certain many of his remarks made January 15, 2005. The National Council believes, however, necessary to return to the main comments that were not selected and add some new ones.
I. BOARD OF PROFESSIONAL ETHICS OF HEALTH CARE
Although not himself convinced of the usefulness of a Higher Council of Health Care Professions, National Council understands that certain categories of professional practitioners do not opt for a order for now, but want a body that sets rules for them to conduct and which offers the possibility of disciplinary action for failure to comply with these rules. The addition Section 3 of the missions of the Supreme Council meeting and explain this choice at the same time one of the comments made by the National Council.
Paragraph introduced in Article 3, § 4, regarding the Code of Ethics is, according to the National Council, inaccurate and incomplete. It is that there are high-quality care for which the community does not have the means available or not sufficient, while a practice socially acceptable is a very vague criterion. The National Council offers a text read as follows: "The Code of Conduct aims in particular to contribute to high quality care with the primary objective is the interest the patient and the community, and are provided in a manner acceptable both for society and for members of the class to which the professional practitioner belongs ".
Regarding incompatibilities provided for members of the Board of Governors and members of provincial councils, territorial or similar Orders, boards of appeal and sections of the national councils of the Orders, the National Council emphasizes that the exclusion members of an organ or the direction of a health facility, means that no surgeon and no member of the Medical Council - which is a member of the hospital - only be considered one term. The National Council believes that this can not be accepted.
In addition, the National Council wondered if the body by means of a combination of advocacy professionals, members of a legally established corporation? The National Council believes that such a provision does not reach its goal.
II. ORDERS OF OCCUPATIONAL HEALTH CARE
The memorandum provides for the commentary to article 29: "It goes without saying that compared to physicians and pharmacists, the new law shall come into force until date of Royal Decrees No. 79 and 80 of November 10, 1967 will be adapted with This proposed law, or replaced by a new legal regulation..
Regardless of Choice, the National Council believes that the basic principles of the creation and operation of the Orders of the health care professions should be the same for all orders and they must find their place in a general law and not in separate legal regulations per practitioner.
This notice covers the following: the election of board members, the composition of the provincial councils or related disciplinary proceedings, collecting contributions, Regulation of internal order, national councils and sanctions.
ELECTIONS
In its opinion of 15 January 2005, the National Council had already highlighted the risks associated with the direct election of members of boards of appeal and national councils by professional practitioners of a class. Indeed, the probability is high in this case that the persons elected to these mandates are mostly professional practitioners constantly one of the medical press. Their reputation is not necessarily associated with knowledge or interest in ethics. The National Council proposes to elect members of boards of appeal and national councils directly elected by the members of provincial councils, territorial or similar. This mode of election offers more guarantees of knowledge and interest in ethics that direct elections by the practitioners of a category. In addition, we can not say elections in increments they are not democratic.
The National Council has long taken the view that it is undemocratic to put age limits in elections. The voter has sufficient wisdom to judge whether a candidate is too young or too old. The National Council considers it appropriate to include in the general law that the only could not ask for election are professional practitioners who have been suspended from exercising the profession and have not been rehabilitated. The National Council believes that this democratic principle applies to all categories of professional practitioners and, as such, should be included in a general law.
In addition, it should be added that a maximum age limit for members to be appointed is also unacceptable. Such a rule should also be introduced to all relevant bodies on ethics and science. No person familiar with the operation of these bodies ignore the negative consequences of this rule for these bodies.
It is stated that it is mentioned explicitly in the general law that all professionals who practice regularly in Belgium and the nationality of a Member State of the Union, may be candidates for both terms to be elected as for terms to be named.
can also ask whether it is democratic in a statute to determine that no more than two thirds of the candidates may be of the same sex. For the provincial council elections, voting is not done via lists but relates directly to individual candidates. Some candidates should they be denied? To achieve the objective, it would not be possible in the event of a tie or when a call for candidates where appropriate, to give precedence to the criterion of age but on the sex, the number of minority candidates.
THE COMPOSITION OF PROVINCIAL COUNCIL AND RELATED BODIES
The fact that boards interprovincial have not been included in the version considered, increases the interest of the provincial councils. In the proposed law under review, the College of investigation consists of only two members of which at least is a professional practitioner of the relevant class. The National Council believes that the college investigation must consist of two elected members and a judge or a lawyer. According to the National Council, the President of the College of investigation must be a professional practitioner of the relevant class. A magistrate or a lawyer does not generally have the technical knowledge necessary to conduct a disciplinary investigation.
In addition, the bill provides for a mediation function is incompatible with membership of the College of investigative and disciplinary board in the same case.
In its opinion of January 15, 2005, the National Council stressed that to make a decision, the disciplinary colleges should have a sufficient number of members. Given the importance of the decision to take the National Council estimates that six professional practitioners are a minimum of eight members and offer more guarantees. If we add the two members of the College of investigation and the mediator, one arrives at a number of eleven-member professional practitioners. This addition takes no account of absence or withdrawal or disqualification of members. For now, provincial councils are composed of at least twelve members and is commonly used to alternate members for achieving quorum.
The National Council believes it is appropriate to replace the vague provision of Article 13, § 1, a, which refers to "a majority of practitioners directly elected" by "at least 12 directly elected members, practitioners professionals in the relevant category referred to in Article 4, § 1, 2 to 8.
The National Council also considers that the composition proposed above for disciplinary colleges is also a guarantee of expertise and objectivity of all college disciplinary professional practitioners and should therefore be included in the Act General.
DISCIPLINARY PROCEEDINGS
The National Council is pleased that the bill provides for the replacement of two judges by lawyers or lawyers for the treatment of disciplinary matters by the provincial councils and boards related.
As stated above, the National Council believes that one of two members must be part of the college investigation. The second is to sit at the bottom.
In this way, we encounter the design of the Appeals Board and Dutch speakers whereby the presence of a single magistrate during the investigation and handling of the case on the merits is contrary to Article 6 1, the ECHR, which guarantees everyone the right to a fair and impartial trial.
In addition, the Council considers that the joint intervention of judges and lawyers to appeal as provided for in Article 19 § 1 of the bill, can cause difficulties in practice. The National Council considers simpler to assign the right to appeal the judge or lawyer who sits on the bottom. This judge or lawyer is better placed than his colleague in the College of investigation for this, because he is aware of the considerations of the disciplinary board members that led to the decision.
COLLECTION OF CONTRIBUTIONS
The National Council notes that, despite the arguments in its opinion of 15 January 2005 in order to maintain the current system of determining the amount of contributions and their perception, the bill continues to believe that fixing the amount of the annual fee is a mission of the National Council.
The National Council regrets not find the text in its proposal for the collection of dues for non-payment. In this regard, it should be noted that a number of young doctors (such as aid workers), the fee is not required or is reduced (first years of practice), it is even doctors sick or older living in difficult social conditions.
As explained in the opinion of 15 January 2005, the collection of unpaid assessments is through the magistrates' courts. A conviction by the magistrate is not always sufficient, because some doctors are paid by the corporation they work for an income so low that it makes them actually insolvent. Many physicians are frustrated by the fact that fellow with a thriving practice, beyond the payment of an assessment by a legal construction. It can be remedied this inequity by amending the last sentence of Article 10 as follows: The amount of this fee is set by the National Council and is caused by them or by the person (s) corporation (s) for which / whom they work.
may be surprised that the Council places a strong emphasis on this amendment because it is only a few dozen doctors. That some members do not pay dues for more than thirty years infuriates many doctors and all the provincial councils. Repeatedly, the National Council, which acts to justice on behalf of the College, agreed to execute accused of lax judgments of justices of the peace only in part or not at all. Now a new law is in preparation, the National Council considers should use this opportunity to address once and for all this social injustice.
THE RULES OF PROCEDURE
The National Council does not understand that after having been approved by the National Council, the rules of procedure must still be submitted for ratification to the minister in public health in its attributions. Next
the proposed law, all provincial councils are composed of two particular lawyers, and a senior judge is in each section of the national councils, so it is unlikely that these regulations could include provisions contrary to the rules defined by statute or by an order of execution. These rules delineate the organization of functioning of the provincial councils, so that the National Council wondered why a small selection from the narrow remaining possibilities must still be ratified by the Minister.
NATIONAL COUNCIL The National Council notes that the proposed legislation, like the original text, moreover, does not preside over the division by a professional practitioner in the category. The National Council continues to believe that this provision should be included in a general law and can not be abandoned neither the king nor specific legislation for a specific category. The National Council is satisfied that other categories of professional practitioners who want a college, will embrace this position. In this framework, the National Council refers to the arguments already set out in its opinion of January 15, 2005.
Regarding the composition of the sections of the National Council, the National Council wishes to emphasize that each section must have the same number of members, which is not expected.
In addition, the National Council think that as regards the composition of the sections, it is necessary that all universities that issue a diploma in legal practice of the class are represented in section by at least one member of the professional group. This may result in the number of elected representatives of the relevant class is lower than the number of appointed, which is contrary to Article 17 § 2 of the bill. This problem could be solved by ensuring that practitioners can co-opt members elected.
In addition, the Council believes it should be added to Article 16, 4, that, upon registration of a foreign doctor, the National Council takes to the concerned authority country of origin or provenance of the candidate, the same information as requested for a Belgian candidate. The National Council, more than the provincial councils, has the international contacts necessary to accomplish this mission.
Article 24, § 1, provides that decisions can ultimately be referred to the Court of Cassation, including the chairman of the Appeals Board. The National Council believes that the President of the Appeals Board may apply for the quashing of a decision of the board he chairs. The National Council believes that in this paragraph, the chairman of the Appeals Board should be replaced by the president the Supreme Council and the Presidents of the National Council.
SANCTIONS
In its opinion of 15 January 2005, the National Council stressed that it was appropriate to allow a period of limitation for disciplinary action. The National Council believes that this period may not be too short. It proposes a period of five years (with possibility of suspension and termination as in criminal proceedings). With regard to sexual offenses, the National Council proposes a limitation period of ten years starting from the majority of the victim.
The National Council had also requested to provide the possibility probationary conditions under suspension of the passing and stay of execution of sentences. CONCLUSION
determining its position, the Council has taken into account whenever possible fallout from his comment on all college discipline within the healthcare sector. The National Council is satisfied that only observations based on years of experience of the disciplinary law will benefit all categories of professional practitioners.
Appendix:
Lookout National Council on the reform of the College of Physicians
(November 15, 2005)
In its meetings 16 October 11 and December 18, 2004 and January 15, 2005, the National Council reviewed the proposed legislation concerning the reform of the College of Physicians, currently discussed in the Committee on Social Affairs of the Senate. As part of this work, the National Council met with the offices of the provincial councils, 20 November 2004. For definition of this position, which is limited to lines of force of the proposals, the National Council is based primarily on the text martyr "Proposed legislation establishing a Supreme Council of Ethics for Occupational Health and laying down general principles for the establishment and operation Orders Occupational Health Care "(version linked to the press conference the Minister Demotte, 23 September 2004)..
Board of Ethics of Health Care Professions
Since 1980, the year in which the Lode Hanck member filed the first bill providing an umbrella structure for health care professions, many things have changed in the field of health care.
During the past 25 years he has been so legislated on health care that is somewhat surprising to note that there would still a real need for a body to establish the basic principles of ethics, common to all professional practitioners or more classes of them. With regard to a number of ethical issues as euthanasia, palliative care, embryo research and experimentation on human beings, the basic principles have been established by law. In addition, healthcare practitioners, who will be represented on the Board, all familiar since August 22, 2002 the law on patient rights that apply to each of them. In the form of patient rights, the law includes all the rules Essential ethics. It is so far not shown that this law had neglected some basic principles of ethics aimed at all professional practitioners. The National Council of the College of Physicians therefore wondered about the usefulness or any appreciation that might still be a Board of Ethics in 2004.
Pluridisciplinarity has become a daily reality and collaboration has evolved over the years from a hierarchical model towards a model of cooperation with the concern and interest of the patient as a common goal. The ethical obligations arising for all disciplines will therefore hand in hand, taking into account the specificities and professional responsibilities. It is striking that, in the proposed composition of the Board, it was thought that only the representation of professions in the Royal Decree No. 78 dated 10 November 1967 on the exercise of care professions health, as if they were only playing a role in health care. Multidisciplinary work is one of the keywords of Rights Act which requires the patient's attending physician, in a complex situation, to resort to multidisciplinary consultation before making a decision. This corresponds to the rules of conduct recommended by the College for years.
Pluridisciplinarity not confined to a concrete collaboration around the patient. There are many organs in which doctors already deliberating with other professional practitioners: the provincial medical boards, commissions in the Inami, the National Council of Physiotherapy, the National Council of the art of nursing, the National Council allied health professionals, the Board of health care practitioners, the Federal "Patient rights", the Advisory Committee bioethics, etc.. Also raises the question whether enough care practitioners trained health ethics are still available and willing to invest in such Board.
Regarding the tasks of the Higher Council, the Council notes that it will not be easy to draw a line between basic principles and specific rules for each category of professional practitioners. The provision that a principle should be considered "basic principle" when it applies to several occupational fields, such as doctors and dentists, further complicate the delimitation. For professional practitioners who have not opted for an Order (Article 21, fourth paragraph), the basic principles are the only standards for assessing their behavior by the Council of First Instance. This could result in members of the Board who do not have a recommended order another design of the basic principles that members of the Board that they have a good college. The absence of a definition of ethics in the text martyr can also lead to different descriptions. The National Council believes that it is possible to show delivery within the Higher Council endless discussions that could have a chilling effect on the operation of the Orders of the health care professions.
Orders Occupational Health Care
It is clear from the discussion with the offices of the provincial councils as the points of the text martyr's most important to them are: the election of provincial council members, board composition, the modification of the competence and disciplinary proceedings, disclosure of the decision to the complainant, the method of collection of contributions and the drafting of internal regulations.
Elections
The National Council understands that it was not possible because of widely different numbers of practitioners in each of the professions concerned health care, fix the text in a single martyr valid procedure for elections in all categories of professional practitioners.
In the Royal Decree No. 79 dated 10 November 1967 on the College of Physicians, Articles 7, 8 and 9 relate to elections. The National Council considers it essential to maintain, for physicians, the organization of elections by district as defined in Article 7, because it guarantees a good distribution of members in the province. Article 9 can also be maintained. It said that voting is compulsory and secrecy, and provides a weighted voting, which is fair. Article 8, which determines the conditions under which a candidate must meet, should be reviewed. The National Council believes that all practitioners listed in Table and are paid their fees can apply, with the sole exception of a member who has incurred a suspension, provided at least he has obtained a pardon. It may not be admitted as candidates who have a relationship with a member of a professional association, a mutual insurance company or a national union of mutual societies, or with a body or management of a care facility, are excluded. As he already emphasized in its opinion of 28 February 1998, the National Council believes that rely on the wisdom of the voter to determine whether a candidate is too young or too old.
If he could appear in the text martyr that applications are not subject to age limits and no one can apply the professional practitioner who has incurred a suspension and has not been rehabilitated, it should be said in a separate law.
Regarding the election of the members of the College other than the provincial councils, the National Council can not accept that it takes place by direct vote of all doctors in the province. In practice, this will amount to probably that there are, money to be awarded, only one effective candidate and one alternate candidate to elect for the entire province. Only practitioners enjoying a high profile will have a chance in these elections, and fame does not necessarily go hand in hand with knowledge and interest in ethics. The current system in which provincial councils elect these members, offers a guarantee of competence and should therefore be retained.
The composition of the provincial councils
Regarding the elected members, the National Council deems it preferable, as already motivated above, the present system is maintained. One can argue that this leads to some provinces to a large number of members, but it gives more guarantees to the accused of an objective assessment that provides him with too few members. The proposal Vankrunkelsven proposes a provincial council of six elected, which is clearly too little, to reconcile both, hear and decide.
The text provides a martyr as appointed members "at least two lawyers with particular expertise respectively in health law and contract law" (art. 13, first paragraph b). The National Council is aware that the provincial councils with a significant workload involving some specific missions or alternate magistrate, a non-lawyer magistrate. This will require doubling the current number of judges. The National Council is aware that it is impossible to appeal to forty judges to the functioning of Provincial Councils and he'll have to rely on non-lawyers judges.
The National Council believes that these lawyers should primarily have the knowledge and experience of the disciplinary law. That is why the National Council proposes to provide by law that lawyers are submitted for appointment by the College of Bars and Law Societies and the Flemish Bar Council. This does not preclude the submission of these instances of judges or retired judges with experience of disciplinary law.
Competence and Disciplinary Procedure
Given the importance of decisions, the offices of the provincial councils have focused on the fact that the disciplinary courts should have a high number of members. A sufficient number of members ensures the objectivity and expertise. Four doctors are insufficient under any circumstances, at least six to eight members are needed. This number is lower than what is happening now in provincial councils.
The National Council notes with satisfaction that the suspension of the pronouncement of sentence, suspension of execution of penalties, cancellation of minor disciplinary sanctions, rehabilitation and the possibility of reinstatement were provided in the text martyr. It is also to provide for a limitation period for disciplinary action and to impose the suspension of imposition and suspension of enforcement of sentences of probation conditions.
About the assessment of a complaint, it was felt that a written report of the investigating commission is insufficient; Rapporteur of the instruction should be explicit in its report the presence of the accused so that all persons entitled to that effect have the opportunity to ask additional questions or comments.
The most important topic during the discussion with the offices of the provincial council was created under the proposed law of the Interprovincial. Martyr in the text, the Council delivers all the inter-disciplinary as a court of first instance while in the proposal Vankrunkelsven, provincial councils impose penalties minor, and all cases where they consider it necessary to impose suspension or disbarment, are referred to the Interprovincial Council. This formula has met with no favor at the National Council for discussion.
The major objections to the creation of the Interprovincial are practical. This proposal was considered impractical and unworkable.
This question has been deepened by a working group within the National Council. The Interprovincial Council must not only deal with cases in which the defendant must appear, but must also examine all records, on the advice of the provincial councils, may be classified. This is an enormous task. In one session, it is possible to treat a maximum of two cases requiring the attendance of the accused (including a serious business appraisal report and a discussion followed where appropriate arguments of counsel, require two hours or more easily and cases of minor severity require about one hour). In addition, we must also devote the time necessary for the evaluation of records of notice to discontinue the proceedings. Assuming that the Interprovincial Council meets once a week, you get to 40 meetings per year, about 80 cases annually. Given the number of cases handled by the provincial councils, in the years, should provide, where inter-building advice offered, two bedrooms and two bedrooms Dutch speaking with each of them a judge and a magistrate effective substitute.
For physicians, this means that each provincial council shall be filled with four members and four alternate members. Each full member must ensure that he or his deputy will be present in Brussels on the dates and times agreed forty times a year, for a meeting that lasted four hours on average. Taking into account the distance and hours of attendance, some will stop work at 15 hours, with the negative effect that implies about their professional practice. It follows that only doctors working in group practice (25% of GPs) and specialists working in hospitals and doctors association had almost no activities will be considered for membership of the Interprovincial Council. This yields a board whose composition is not representative. This can be the intention.
The National Council therefore endorses the conclusions of the working group considers that councils and inter-as proposed in the text martyr are not feasible.
The National Council believes that it is nevertheless possible to achieve the goals of the Interprovincial creating within each provincial council an autonomous council concerned with the tasks laid down in Article 17 of the text and martyr whose composition guarantees the independence and impartiality necessary so that the strict separation of investigation and decision on the one hand, and embodies the consistency of the disciplinary case law on the other.
The independence of this body may be secured by the appointment of a judge as chairman. As already noted, this college must consist of at least 6 to 8 physicians-members. So that their neutrality is guaranteed, simply provide that each member is obligated, upon receipt of the notice of the meeting, to inform, as appropriate, that the President is unable to sit with impartiality and independence required, and without prior knowledge, in one or more items on the agenda. In addition, the president shall ascertain whether the composition of the college is not likely, apparently, to arouse in the mind of the accused or others justifiably suspected of impartiality.
To emphasize the independence of this body and achieve consistency in the disciplinary case law, it might be appropriate to include in the composition of this college, in addition to members and physicians of the provincial council registration of the doctor continued, members -physicians from two or three other provincial councils.
The content of the above on a practical level can be determined by each provincial council in its rules of procedure which must be approved by the National Council.
The National Council believes that this alternative achieves the objectives in the text martyr, and it is feasible.
The communication of the decision to the complainant
The National Council believes that this reform of the Order is the most difficult to resolve. For decades, the Order means that non-disclosure of the complainant's decision demonstrates a lack of openness and even some evidence that it stifles some matters on behalf of professional solidarity misinterpreted. These reviews may include, but are not justified. Anyone familiar with the general provisions of the disciplinary law knows that the communication of the decision to the complainant will have serious consequences on the process existing disciplinary.
text martyr trying to solve this problem. It is well provided for in Article 23, § 2, third paragraph, that the decisions of the interprovincial and appeal boards shall be communicated to the complainant, but the following paragraph says that these decisions can not be used in a litigation before the courts, covered in the Civil Code or the Code of Criminal Procedure. It seeks to avoid this fact a number of possible consequences of disclosure of the decision to the complainant. The lawyers argue, however, that the mere communication of the decision the complainant is already a violation of rights of defense if the defendant is required to cooperate in the investigation. If the accused is not obliged to assist in the instruction and example, he refuses to disclose the documents requested by the board of education, it will necessarily expand the scope of inquiry, for example by giving the Committee skills similar to those of doctors inspectors Inami. The offices of the provincial councils that refuse to extend the powers of appraisal fees in provincial councils. They rightly feel that this is inconsistent with the functions of the College as a forum for consultation and mediation.
At the hearing before the Committee on Social Affairs, March 10, 2004, the president of the National Council of the College drew attention to a distinction that is almost never did so far between different categories of "complainants". Based on his presentation, the Council believes it can be no communication of that decision to the complainant when the latter is either the patient himself or his representative or, after her death, her husband (se) or steady partner or a close relative. It may still not be considered to communicate the decision to a whistleblower who was not prejudiced or employer who has filed a complaint because of a false certificate or a colleague who brought a complaint under a mutual conflict.
Regarding the situation of patients, the National Council notes that the law on patient rights has completely changed it. Previously, a patient who did not want to go to Justice, had no choice but to file a complaint with the provincial council of the College. Now there is a function of mediation and it is essential that good collaboration is established between the provincial councils and the mediation function. Boards Provincial already advise patients to directly address some complaints ombudsman, easily accessible to the patient. This does not exclude a patient may complain for ethical misconduct to a provincial council, but then preferably after consultation with the mediation function. Should this dialogue a complaint with the provincial council is indicated as a mediator will inform the patient beforehand so that he will be spared disappointment and will be advised of what he can not s address to the disciplinary jurisdiction in the general interest without ever becoming a party to the disciplinary procedure that will eventually aroused.
But it is important that the executive should take the necessary steps to give concrete form to the right of the patient, so that each patient can make complaints to an easily accessible at all if he has a complaint against d a professional practitioner. For now this is possible only in respect of professional practitioners and hospitals. Although theoretically anyone can go to the mediating function of the Federal "Patient rights", it is not a serious post patients who have problems with outpatient care provider or doctor Controller, City Administrative State in Brussels.
contributions to the College
martyr In the text, section 9 provides that the levy is set by the National Council.
For now, the National Council determines the required contribution to its activities and those of the Board of Appeal. This amount is added by each provincial council in the amount it considers necessary for its own activities. Provincial councils decide exemptions and fee reductions.
Responses offices of the provincial councils surveyed on this subject have shown that the current system does not striking difference in premiums. The advantage of the current system lies in the fact that each doctor knows the amount he owes for the operation of the provincial council, and this is clear. The current system also allows more accurately judge the merits of the reductions and exemptions required. This assessment is given on a case by case basis by the provincial councils, which is not the task of the National Council, which also lacks the necessary data.
The National Council therefore considers appropriate to maintain the current system determination and collection of dues.
In discussion with the provincial councils, it emerged that he should find a solution to the problem of non-payment of dues. The National Council believes it is inappropriate to impose disciplinary penalties for non-payment. The collection of dues for non-payment, takes place at this time through the justices of the peace. The National Council find it tedious, but do not see how to avoid it.
But a conviction by the magistrate is not always enough because some doctors are paid a salary so low by the corporation for which they work, they are practically insolvent.
This problem can be solved by adding a few words to the last sentence of the last paragraph of Article 9: "This contribution includes the amount for the activities of the National Council is perceived by the provincial council and is therefore due from such persons or by the corporations for which they work. "
Internal Rules Article 19, 3, martyr text states that the National Council of the College's mission is to offer advice and counseling inter-provincial model rules of procedure and after acceptance by them to approve these regulations and present ratification communicated to the Minister of Public Health in their duties.
The last paragraph of Article 5 of Royal Decree No. 79 in force on 10 November 1967 on the College of Physicians states that each provincial council shall establish its rules of procedure and submit to the National Council make the final text. When reviewing these documents, including the National Council verifies the absence in the internal regulations presented, otherwise the law in general and to the Royal Decree No. 79 and his arrest execution.
Offices Provincial Councils believe that the provincial councils should have the right to determine their own internal operations and a review by the National Council is sufficient. The approval of these regulations by the executive which, under Article 11 of the text martyr, also determines by implementing decrees throughout the organization, establishment and operation of provincial councils is equally unacceptable to National Council.
The National Council The National Council is surprised by the obligation of its two sections sit together for the exercise of powers referred to in Articles 9 para. 1 and 19, para. 1, 1, 6 and 9. He insists on maintaining the mode of operation as provided for in Article 14 § 1 of the Royal Decree No. 79 dated 10 November 1967 - namely: "The National Council of the College of Physicians has two sections : one French-speaking and one Dutch-speaking. They can deliberate and decide together on such matters under Article 15 § 1 and § 2, 2, 3 and 4. "- A formula which has proven its effectiveness.
A chapter on the analysis of the National Council of the Order, the attention of the National Council was particularly attracted by the Presidency and the composition of the sections. These two elements are also strongly related to each other.
According to Article 20, § 1, text martyr both divisions of the National Council each have their own president. For now, the two sections of the National Council shall be chaired by one senior judge who also chairs the National Council. It is striking that the martyr text leaves open the question of who will be entrusted the presidency, so that, depending on the category of professional practitioners King can decide whether it will be attributed a senior magistrate or a professional practitioner.
The National Council believes it is illogical to leave that decision to the King and the legislature must decide itself on this subject. He does not accept the College of Physicians is still the only College in Belgium whose president is not the occupation. Internationally Belgium is also a unique example. The National Council does not think having to justify this position is obvious. This does not detract from the merit of all judges who chaired the National Council so far. During contacts with the media and political bodies, all the presidents of the National Council have in principle always kept in the background, because they felt that medical ethics should be explained by the doctors themselves. This illustrates sufficiently the need for change.
If the legislative chambers agree that the Presidents of the National Council are physicians, the National Council has no objection to non-physicians are appointed as members of the sections of the National Council. The National Council believes that, apart from the magistrate, the number of appointed members with voting rights, can not exceed the number elected members.
Regarding physicians appointed members, the National Council believes that each medical school must be represented with voting rights. It is equally clear that a senior judge is appointed as a member of the National Council. In addition, the National Council can accept without a problem in medical ethics expert and an expert on patient rights are among the appointed members. It seems appropriate that the first city to be presented by the Bioethics Advisory Committee, and the second city by the Federal "Patient rights".
The National Council believes that Presidency of the sections must be entrusted to a member-doctors of the section and this preferably by internal vote.
In conclusion
After a thorough analysis of bills submitted, the Council wishes to emphasize that he appreciates the work done by senators to achieve a reform of the College of Physicians. The National Council is satisfied that it will take into account statements made by its representatives at the hearings of March 10 and October 6, 2004 as well as comments and proposals made in this note.
On the basis of what has been said by eminent lawyers at the hearings and what is being proposed by senior judges, as well as what has already been done in other countries, the National Council is a
saw that the time has come for a comprehensive approach to the disciplinary law. The application of disciplinary bodies is significantly increasing in our society, so that a framework law on disciplinary law would be socially useful.
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Project BeHealth
Letter to Dr. J.-P. Dercq Cell, "Art of Healing, Sanitary Surveillance and Health Professions," Mr. cabinet R. Demotte, Federal Minister of Health and Social Affairs:
At its meeting on 26 November 2005, the National Council has again discussed the draft BeHealth.
He noted that the project is currently under construction. He learned in this regard by the parliamentary annals [1] that "the development strategy of health care electronically based on three complementary and distinct sites, each to be a regulatory initiative specific. The National Council
you made known its objections against the final draft law which he has knowledge as it has've sent via e-mail dated 10 October 2005 so you can consider his remarks as part of the three "sites" for the implementation of the project BeHealth.
These remarks are the following:
1 / health data.
Article 2 1 of the draft law defines health information as follows:
"any personal data that book by its contents or use information about the prior, present or future physical or mental health of an individual identified or identifiable with the exception of data that are legitimately and exclusively used for administrative purposes or accounting related to prevention, care or application of social rights ".
This definition is not devoid of consequences on professional secrecy. It is also manifestly inadequate.
1.1 / An inadequate definition
The National Council believes that the definition of health data, as set out in the draft law, suffers at least two pitfalls:
1 / If a personal data on health is in itself a given health, the opposite is not always true: a given health is not always personal.
(A simple stock number is an example of health data without in any case constitute a personal data concerning health. That would be the case if the stock number would attest to a given treatment an identified or identifiable).
An anonymous health data does not necessarily require special protection of privacy or professional secrecy. A personal data on the health cons deserve special protection precisely because it concerns an identified or identifiable.
legislation on privacy, supported in this by the Commission for the Protection of Privacy Act, has always considered the personal data concerning health or sensitive information as soon as they endeavor to identified or identifiable, and therefore they are not used in a given context.
The definition, as set out in the draft law does not reflect this fact.
2 / In Furthermore, the National Council believes that to define a personal data on health through use to be made is a logical error.
Like a chair still a chair even when nobody is sitting on it, a personal data on health remains the same if used in an administrative context, or accountant.
In this regard, the Council finds that it is clear from Article 7 of the Act of 8 December 1992 on the protection of privacy with regard to the processing of personal data (especially Articles 7, § 2, b), c) i)) that personal data concerning health remain so, even when used in an administrative context, or accountant.
1.2 / A definition of serious consequences.
The definition of "health data" reflected in Article 2 of the draft law is fraught with negative consequences in terms of confidentiality and protection of privacy.
- Privilege
reminder, Article 458 of the Penal Code reads as follows:
"Physicians, surgeons, health officers, pharmacists, midwives and all other persons who, by status or profession, trade secrets entrusted to them, which, except in cases where they are called to give evidence in court (or before a parliamentary commission of inquiry) and the time the law requires them to share these secrets, have proved to be punished with imprisonment from eight days to six months and a fine of one hundred francs to five hundred francs. "
The Court of Cassation, in a landmark decision of December 16, 1992, states that "the privilege to which section 458 of the Penal Code subjects the practitioners of the healing art, based on the need ensure full security to those who need to confide in them. "
The new definition given health greatly reduces the scope of legal privilege, considering the data used in a context such as accounting or administrative data freely transferable.
Since the personal data concerning health or do not lose their personal character when used in an administrative context or accountant, the National Council believes that disclosure of such data in such contexts is may violate confidentiality.
Maintain the principle of professional secrecy and gradually limiting considerably the applicability of secrecy leads to an "empty shell". The practical consequences for the patient could be multiple.
Patients are very attached to their physicians' professional secrecy: it is in their interest.
- The protection of privacy.
The definition of "health data" reflected in Article 2 of the draft law is also fraught with negative consequences for the protection of privacy. If it is
not true that personal data concerning health would lose its personal context administrative or accounting, it is legitimate that even in these contexts, protection of such data is guaranteed.
Article 7 of the Act of 8 December 1992 does not it is also wrong.
Experience of the National Council and Provincial Councils of the College of Physicians is sufficient to show that personal data concerning health deserve much, if not especially, in protection of professional secrecy and privacy in Administrative Context or accountant in the field of prevention or in that of social rights.
The National Council is therefore of the opinion that it would be more appropriate to define the personal data on health rather than the broader health data.
This definition would be: "any personal data that delivers information about the prior, present or future physical or mental health of an identified or identifiable.
2 / personal health identification number (NISP)
The idea identifying a specific health for each individual, through which we could access all of its episodes of health from the cradle to the grave, provided of course that each episode was narrated by unit care or medical care and that all institutions have been interconnected, is not new.
In this case, it is assigned a unique number which will be grouped under any personal data relating to the health of the individual, regardless of where or when care were given to him.
The National Council is concerned about the use which might be made of the personal health identification number for purposes other than medical or scientific research.
While the Committee on protection of privacy has on several occasions recommended the use of a unique patient number (Notice No. 14/2002 of 8 April 2002, Opinion No. 19/2002 of 10 June 2002, Opinion No. 30/2002 of August 12, 2002, Opinion No. 33/2002 of August 22, 2002, Opinion No. 10/2004 of September 23, 2004, Opinion No. 01/2005 of 10 January 2005). However, this recommendation regularly accompanied by a caveat: it should ensure tightness of the circuits of information between the personal data concerning health and those of social security, and between personal data relating to health and those of the national registry.
This sealing is not guaranteed in the current government project, and, for at least three reasons:
1 / Article 3, § 1 end:
The coupling logic between NISP ( personal health identification number) and NISS Identification number (social security), even if it is deemed irreversible individually, allows the reconstitution of a national register of NISP from the National Register or the Register of NISS.
The National Council considers that the NISP should absolutely be randomly generated, and in no way derived from the processing logic of personal data, it was deemed irreversible.
2 / Article 3, § 3, 5.
quinto The 3rd paragraph of Article 3 allows the coupling between the social security data and personal data concerning health.
3 / Article 12, § 3.
Article 12, § 3, the project is as follows:
"In cases where the doctor is the overall manager of the medical record of the patient, insurers provide the following information:
- the Identification of GP registered
- patient identification via a personal health identification number. "
If the insurer can provide the identification number of patient's personal health, we The conclusion is that it can couple the NISP and NISS.
The National Council is also concerned that the Be-Health is organizing itself for monitoring transactions of health data it operates.
3 / shared health record.
The draft law establishes the principle of a shared health record.
Several remarks can be made on this subject.
3.1 / methodology.
The National Council is not convinced of the real appreciation of the therapeutic health record shared as described in the current project.
Transmission completeness of the personal data on the health of an individual is not always necessary for the administration of quality care and it is generally not required to have a complete inventory of past medical patient, but only its relevant elements.
health record shared as described should not be implemented without its scientific value is demonstrated.
3.2 / Privacy and confidentiality
It is clear that the shared health record causes major disruption in how far it is required to protect privacy. The National Council does not consider until now have enough evidence to be able to grasp the significance of these changes.
The principle, however, the shared health record, as described in the draft, immediately raises the following remark: it is unacceptable that every health professional (including pharmacists , physiotherapists, dentists and nurses) involved in care has access to all patient data.
The way will be designated professionals involved in care is also particularly nebula (see below). The question of whether the exchange of information is secure enough remains largely unresolved. This question is essential to ensure the confidentiality of personal data relating to patient health. The National Council wishes to point out here that access to the shared health record MUST be applied differently depending on the category or specialty health care professional.
We also note that the way are treated personal data may vary from one profession to another, given that the concept of "privilege" may be applied differently between different disciplinary rights. The shared health record thus questions the right discipline.
The National Council believes that the principle of "shared health record" deserves close examination.
3.3 / Feasibility
Reading the provisions of the draft concerning the shared health record, we are allowed to wonder about its practicality.
- Computerization
The idea of the shared folder is based entirely on the premise that health professionals have adequate computer equipment and files they manage their patients through specific software compatible.
Computerization comprehensive and organized of all health professionals takes time and commitment: we are doubtful about the real possibilities of implementation on the ground, now and in the medium term measures advocated by the draft law.
- Funding
Computerization widespread health records represent a significant cost.
The draft law does not specify how the measures it recommends will be financed and what budget will be spent. It is clear however that the practical application of the provisions of the draft will depend largely on the support given.
The National questioned the financial feasibility of the draft law.
- The administrative overhead
The implementation of shared health record as provided in the preliminary project involves administrative overload for the physician.
doctor is asked to divide the shared health record into sections: the "health record summary," the "record health history" and any specific sections (section 12). This sorting results certainly extra administrative work.
- Access to the DMP
In principle, only physicians called to treat the patient would have access to the shared health record. In the preamble of the draft law, it states:
"After being identified and authenticated, both as person and as a health professional, the practitioner must receive authorization to access an application locoregional and an individual file handled at the application. Permission shall be granted only if he exercises an effective relationship of nursing vis-à-vis the patient. If a patient changes doctors, the doctor who treated him lose his access to the file. Medical confidentiality is organized by the attending physician (general practitioner or, where appropriate, specialist) who will decide, as is the case now, what are the professional team who will have access to what data, and this according to their involvement in care for this patient. "
After reading this excerpt, we are allowed to question as to whether it intends to make access to health records shared with the permission of the treating physician.
This would be both objectionable in terms of ethics and free choice of doctor but it would also be unrealistic.
The way the doctors have access to the shared health record is in all cases described in a particularly nebulous in the preliminary bill. Clarification is needed.
In addition, the Council finds that the authentication status of a doctor is done by consulting the database of federal health care professionals, under the law of 29 January 2003 (art. 13, 2) . The Council underlines that such authentication is under the Royal Decree No. 79 dated 10 November 1967, the jurisdiction of the Provincial Councils of the College of Physicians, responsible for compiling the table.
4 / telematics organs.
Beside the Commission "standards telematics sector health care "And the Committee of privacy, new" organs "are created that would receive a number of skills telematics
- a" sectoral committee for health data, created within the commission protection of privacy.
- a "telematics platform Be-health".
The specific role of each of these bodies and their interrelationships are not clear. Doubts also remain about their independence from political authorities and in relation to social security agencies.
5 / Telemedicine.
Regarding the aspect of the draft law relating specifically to telemedicine, the National Council recalls two fundamental considerations, which respect does not seem warranted in the current bill:
1 / In the framework for electronic communication and remote experts can not agree to make diagnoses or to install treatment, with neither questioned nor personally examined the patient. Their role is that of aid to diagnosis and decision. The place where the medical procedure that is asked is where the physician applicant. This is also a problem of medical liability.
2 / Electronic prescription issued by a qualified health professional, as an electronic file must respect the free choice of the patient.
The National Council invites you to refer to his earlier views on telemedicine and medical practice remotely. CONCLUSION
The National Council
1 / denies the definition of health given as set out in the draft: it considers detrimental to professional secrecy and the law relating to protection of privacy. The use of the terms "personal data concerning health" appears more appropriate.
2 / rejects any form of logic links between NISP one hand, and the NISS or NRN (national registration number), on the other.
The NISP can be generated as randomly and in no way derived from the processing logic of personal data, it was deemed irreversible.
Use of NISP should remain strictly limited to the administration of care.
3 / states that the arrangements put in place and access to "shared medical records" are imprecise and do not in this state, to ensure confidentiality.
The National Council believes that disclosure of health information electronically between health professionals, by a public or a private network not local, can operate under any circumstances without prior recourse to methods of encryption and secure certified signature.
4 / stresses the lack of independence of "telematics platform Be-Health", vis-à-vis both the public authorities (including competent social security) that the insurers.
5 / believes that telemedicine must serve the applicant who is an attending physician.
6 / refuses centralization, a single instance, security systems and identification, the notarial transactions, labeling software and, in particular, the data transfer.
7 / is not convinced of the real appreciation of the therapeutic concept of "shared health record, as listed in the draft.
For these reasons, the National Council wishes to revise the bill in a more respectful of the requirements, legal and ethical, necessary for doctor-patient relationships.
[1] Request for an explanation of Mr. Jan STEVELYNCK the Minister of Social Affairs and Public Health on "Action Plan on e-health care", No. 3-1060, October 27 2005, Senate records No. 3-131, p. 59.
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