{"id":20456,"date":"2024-11-21T07:13:12","date_gmt":"2024-11-21T06:13:12","guid":{"rendered":"https:\/\/www.podivinsky.cz\/?p=20456"},"modified":"2024-11-21T07:13:22","modified_gmt":"2024-11-21T06:13:22","slug":"za-jakych-podminek-smi-lekar-ukoncit-peci-o-pacienta","status":"publish","type":"post","link":"https:\/\/www.podivinsky.cz\/?p=20456","title":{"rendered":"Za\u00a0jak\u00fdch podm\u00ednek sm\u00ed l\u00e9ka\u0159 ukon\u010dit p\u00e9\u010di o\u00a0pacienta?"},"content":{"rendered":"\n

<\/h1>\n\n\n\n

Pr\u00e1vo ve zdravotnictv\u00ed<\/a><\/h4>\n\n\n\n

KMVS, advok\u00e1tn\u00ed kancel\u00e1\u0159, s. r. o.<\/h4>\n\n\n\n

Tisk do PDF<\/a><\/p>\n\n\n\n

\"Aktu\u00e1ln\u011b<\/figure>\n\n\n\n

Pacienti n\u011bkdy um\u011bj\u00ed sv\u00fdm chov\u00e1n\u00edm l\u00e9ka\u0159\u016fm zp\u016fsobovat nemal\u00e9 pot\u00ed\u017ee. Maj\u00ed l\u00e9ka\u0159i k dispozici z\u00e1konem garantovan\u00e9 prost\u0159edky, kter\u00fdmi se proti takov\u00e9mu chov\u00e1n\u00ed mohou br\u00e1nit? A za jak\u00fdch podm\u00ednek mohou l\u00e9ka\u0159i v souladu se z\u00e1konem p\u00e9\u010di o pacienta ukon\u010dit? Na tyto ot\u00e1zky se zam\u011b\u0159\u00edme v dne\u0161n\u00edm \u010dl\u00e1nku. Pod\u00edv\u00e1me se, jak tuto problematiku upravuje z\u00e1kon, a uk\u00e1\u017eeme si tak\u00e9 ned\u00e1vn\u00e9 rozhodnut\u00ed Nejvy\u0161\u0161\u00edho spr\u00e1vn\u00edho soudu, kter\u00fd se touto problematikou zab\u00fdval.<\/p>\n\n\n\n

D\u016fvody, na jejich\u017e z\u00e1klad\u011b m\u016f\u017ee poskytovatel zdravotn\u00edch slu\u017eeb (d\u00e1le jen \u201eposkytovatel<\/strong>\u201c) p\u0159istoupit k ukon\u010den\u00ed p\u00e9\u010de, jsou taxativn\u011b stanoveny v \u00a7 48 odst. 2 z\u00e1kona \u010d. 372\/2011 Sb., o zdravotn\u00edch slu\u017eb\u00e1ch, ve zn\u011bn\u00ed pozd\u011bj\u0161\u00edch p\u0159edpis\u016f (d\u00e1le jen \u201ez\u00e1kon o zdravotn\u00edch slu\u017eb\u00e1ch<\/strong>\u201c). Z\u00e1kon o zdravotn\u00edch slu\u017eb\u00e1ch ur\u010duje, \u017ee poskytovatel m\u016f\u017ee ukon\u010dit p\u00e9\u010di o pacienta pouze v p\u0159\u00edpad\u011b, \u017ee:<\/p>\n\n\n\n

    \n
  1. prokazateln\u011b p\u0159ed\u00e1 pacienta s\u00a0jeho souhlasem do\u00a0p\u00e9\u010de jin\u00e9ho poskytovatele,<\/li>\n\n\n\n
  2. pominou d\u016fvody pro\u00a0poskytov\u00e1n\u00ed zdravotn\u00edch slu\u017eeb,<\/li>\n\n\n\n
  3. pacient vyslov\u00ed nesouhlas s\u00a0poskytov\u00e1n\u00edm ve\u0161ker\u00fdch zdravotn\u00edch slu\u017eeb,<\/li>\n\n\n\n
  4. pacient z\u00e1va\u017en\u00fdm zp\u016fsobem omezuje pr\u00e1va ostatn\u00edch pacient\u016f, \u00famysln\u011b a\u00a0soustavn\u011b nedodr\u017euje navr\u017een\u00fd individu\u00e1ln\u00ed l\u00e9\u010debn\u00fd postup, pokud s\u00a0poskytov\u00e1n\u00edm zdravotn\u00edch slu\u017eeb vyslovil souhlas, nebo\u00a0se\u00a0ne\u0159\u00edd\u00ed vnit\u0159n\u00edm \u0159\u00e1dem a\u00a0jeho chov\u00e1n\u00ed nen\u00ed zp\u016fsobeno zdravotn\u00edm stavem,<\/li>\n\n\n\n
  5. p\u0159estal poskytovat sou\u010dinnost nezbytnou pro\u00a0dal\u0161\u00ed poskytov\u00e1n\u00ed zdravotn\u00edch slu\u017eeb; to\u00a0neplat\u00ed, jestli\u017ee neposkytov\u00e1n\u00ed sou\u010dinnosti souvis\u00ed se\u00a0zdravotn\u00edm stavem pacienta.<\/li>\n<\/ol>\n\n\n\n

    K bodu b) je t\u0159eba poznamenat, \u017ee se nevztahuje na tzv. registruj\u00edc\u00ed poskytovatele, kter\u00fdmi z\u00e1kon o zdravotn\u00edch slu\u017eb\u00e1ch rozum\u00ed poskytovatele ambulantn\u00ed p\u00e9\u010de v oboru v\u0161eobecn\u00e9 praktick\u00e9 l\u00e9ka\u0159stv\u00ed, v oboru praktick\u00e9 l\u00e9ka\u0159stv\u00ed pro d\u011bti a dorost, v oboru zubn\u00ed l\u00e9ka\u0159stv\u00ed nebo v oboru gynekologie a porodnictv\u00ed, kter\u00fd p\u0159ijal pacienta do p\u00e9\u010de za \u00fa\u010delem poskytnut\u00ed prim\u00e1rn\u00ed ambulantn\u00ed p\u00e9\u010de. K bodu d) a e) je pak t\u0159eba dodat, \u017ee poskytovatel nesm\u00ed ukon\u010dit p\u00e9\u010di o pacienta z t\u011bchto d\u016fvod\u016f, pokud jde o pacienta, kter\u00e9mu je t\u0159eba poskytnout neodkladnou p\u00e9\u010di, jde\u2011li o porod nebo jde\u2011li o zdravotn\u00ed slu\u017eby, kter\u00e9 jsou nezbytn\u00e9 z hlediska ochrany ve\u0159ejn\u00e9ho zdrav\u00ed nebo ochrany zdrav\u00ed p\u0159i pr\u00e1ci, anebo tak\u00e9 jde\u2011li o krizov\u00e9 situace nebo v\u00fdkon ochrann\u00e9ho l\u00e9\u010den\u00ed na\u0159\u00edzen\u00e9ho soudem. Pro v\u0161echny uveden\u00e9 d\u016fvody pak plat\u00ed, \u017ee ukon\u010den\u00edm p\u00e9\u010de nesm\u00ed doj\u00edt k bezprost\u0159edn\u00edmu ohro\u017een\u00ed \u017eivota nebo v\u00e1\u017en\u00e9mu po\u0161kozen\u00ed zdrav\u00ed pacienta. Pro usnadn\u011bn\u00ed ukon\u010den\u00ed p\u00e9\u010de o nevhodn\u011b se chovaj\u00edc\u00edho pacienta je d\u016fle\u017eit\u00e9 zakotvit do vnit\u0159n\u00edho \u0159\u00e1du zdravotnick\u00e9ho za\u0159\u00edzen\u00ed z\u00e1kaz agresivn\u00edho \u010di vulg\u00e1rn\u00edho chov\u00e1n\u00ed k l\u00e9ka\u0159i, a to p\u0159edev\u0161\u00edm ve sv\u011btle ned\u00e1vn\u00e9ho rozsudku Nejvy\u0161\u0161\u00edho spr\u00e1vn\u00edho soudu ze dne 3. \u010dervna 2024, sp. zn. 5 As 155\/2023 \u2011 37, v n\u011bm\u017e soud jednozna\u010dn\u011b podpo\u0159il pr\u00e1vo l\u00e9ka\u0159e ukon\u010dit p\u00e9\u010di o pacienta pro nerespektov\u00e1n\u00ed vnit\u0159n\u00edho \u0159\u00e1du.<\/p>\n\n\n\n

    Soud se v dan\u00e9m p\u0159\u00edpad\u011b zab\u00fdval postupem poskytovatele zdravotn\u00edch slu\u017eeb (ambulantn\u00ed zdravotn\u00ed p\u00e9\u010de), kter\u00fd ukon\u010dil poskytov\u00e1n\u00ed zdravotn\u00edch slu\u017eeb pacientovi pro poru\u0161ov\u00e1n\u00ed vnit\u0159n\u00edho \u0159\u00e1du, kter\u00e9ho se pacient dopou\u0161t\u011bl psan\u00edm ur\u00e1\u017eliv\u00fdch e\u2011mail\u016f poskytovateli a tak\u00e9 verb\u00e1ln\u00edmi a agresivn\u00edmi ur\u00e1\u017ekami l\u00e9ka\u0159ky poskytovatele v pr\u016fb\u011bhu vy\u0161et\u0159en\u00ed. Zpr\u00e1vu o ukon\u010den\u00ed p\u00e9\u010de pacient odm\u00edtl podepsat a p\u0159evz\u00edt, jen aby se n\u00e1sledn\u011b dostavil k l\u00e9ka\u0159ce poskytovatele a do\u017eadoval se dal\u0161\u00edho vy\u0161et\u0159en\u00ed kv\u016fli ban\u00e1ln\u00edmu probl\u00e9mu \u2011 \u0161kr\u00e1b\u00e1n\u00ed v krku. L\u00e9ka\u0159ka poskytovatele pacienta odm\u00edtla o\u0161et\u0159it, a to s odvol\u00e1n\u00edm na ukon\u010den\u00ed p\u00e9\u010de a \u201eodregistrov\u00e1n\u00ed\u201c pacienta od zdravotn\u00ed poji\u0161\u0165ovny. Soud ve sv\u00e9m rozhodnut\u00ed nejprve stvrdil v\u00fdklad z\u00e1kona o zdravotn\u00edch slu\u017eb\u00e1ch, kter\u00fd d\u00e1v\u00e1 mo\u017enost vytv\u00e1\u0159et vnit\u0159n\u00ed \u0159\u00e1dy i poskytovatel\u016fm ambulantn\u00ed zdravotn\u00ed p\u00e9\u010de. Konkr\u00e9tn\u011b soud v rozhodnut\u00ed pouk\u00e1zal na to, \u017ee neexistuje rozumn\u00fd d\u016fvod, pro\u010d by poskytovatel l\u016f\u017ekov\u00e9 nebo jednodenn\u00ed p\u00e9\u010de tuto mo\u017enost ukon\u010den\u00ed p\u00e9\u010de o pacienta m\u00edt m\u011bl, zat\u00edmco poskytovatel ambulantn\u00ed zdravotn\u00ed p\u00e9\u010de nikoliv. Soud tak\u00e9 zd\u016fraznil smluvn\u00ed povahu vztahu poskytovatele a pacienta (smlouva o p\u00e9\u010di o zdrav\u00ed dle ob\u010dansk\u00e9ho z\u00e1kon\u00edku) a p\u0159ipomn\u011bl, \u017ee pacient m\u00e1 pr\u00e1vo svobodn\u00e9 volby poskytovatele, zat\u00edmco poskytovatel m\u016f\u017ee odm\u00edtnout pacienta pouze ze z\u00e1konem stanoven\u00fdch d\u016fvod\u016f. Pro zachov\u00e1n\u00ed principu rovnosti stran mus\u00ed b\u00fdt poskytovateli d\u00e1na mo\u017enost, jak smluvn\u00ed vztah ukon\u010dit a chr\u00e1nit se prost\u0159ednictv\u00edm vnit\u0159n\u00edho \u0159\u00e1du p\u0159ed pacienty, kte\u0159\u00ed poskytovatele nerespektuj\u00ed, nedodr\u017euj\u00ed jeho pokyny, naru\u0161uj\u00ed poskytov\u00e1n\u00ed p\u00e9\u010de a chovaj\u00ed se hrub\u011b a vulg\u00e1rn\u011b. Proto\u017ee z\u00e1kon o zdravotn\u00edch slu\u017eb\u00e1ch neobsahuje definici vulg\u00e1rn\u00edho a ur\u00e1\u017eliv\u00e9ho chov\u00e1n\u00ed, pr\u00e1v\u011b vnit\u0159n\u00ed \u0159\u00e1d m\u00e1 slou\u017eit jako n\u00e1stroj pro stanoven\u00ed mantinel\u016f mo\u017en\u00e9ho fyzick\u00e9ho a verb\u00e1ln\u00edho projevu pacienta a jeho poru\u0161en\u00ed m\u016f\u017ee za ur\u010dit\u00fdch podm\u00ednek v\u00e9st k ukon\u010den\u00ed p\u00e9\u010de o pacienta. Stejn\u011b jako \u017e\u00e1dn\u00fd pacient nem\u016f\u017ee b\u00fdt nucen k podstoupen\u00ed l\u00e9ka\u0159sk\u00e9ho v\u00fdkonu a je vy\u017eadov\u00e1n jeho informovan\u00fd souhlas, tak ani poskytovatel zdravotn\u00edch slu\u017eeb nem\u016f\u017ee b\u00fdt nucen k poskytov\u00e1n\u00ed zdravotn\u00ed p\u00e9\u010de pacientovi, kter\u00fd se chov\u00e1 hrub\u011b, vulg\u00e1rn\u011b, ur\u00e1\u017e\u00ed jej \u010di napad\u00e1, za p\u0159edpokladu, \u017ee v souladu s \u00a7 48 odst. 2 in fine z\u00e1kona o zdravotn\u00edch slu\u017eb\u00e1ch ukon\u010den\u00edm p\u00e9\u010de nedojde k bezprost\u0159edn\u00edmu ohro\u017een\u00ed \u017eivota nebo v\u00e1\u017en\u00e9mu po\u0161kozen\u00ed zdrav\u00ed pacienta. Soud tak\u00e9 do\u0161el k z\u00e1v\u011bru, \u017ee se poskytovatel nezachoval protipr\u00e1vn\u011b, kdy\u017e odm\u00edtl toto\u017en\u00e9ho pacienta znovu p\u0159ijmout do p\u00e9\u010de a o tomto odm\u00edtnut\u00ed nevyhotovil p\u00edsemnou zpr\u00e1vu. V dan\u00e9 situaci ji\u017e ne\u0161lo o svobodnou volbu poskytovatele zdravotn\u00ed p\u00e9\u010de ze strany pacienta, jeliko\u017e ten si byl v\u011bdom toho, \u017ee do\u0161lo k jeho \u201eodregistraci\u201c z d\u016fvod\u016f nevhodn\u00e9ho chov\u00e1n\u00ed. Pokud z\u00e1kon p\u0159ipou\u0161t\u00ed mo\u017enost p\u00e9\u010di o pacienta ukon\u010dit, tak postr\u00e1d\u00e1 logiku, aby byl poskytovatel povinen stejn\u00e9ho pacienta obratem op\u011btovn\u011b p\u0159ijmout.<\/p>\n\n\n\n

    Dle rozsudku Nejvy\u0161\u0161\u00edho soudu ze dne 27. z\u00e1\u0159\u00ed 2023, sp. zn. 25 Cdo 517\/2022 pak plat\u00ed, \u017ee informace o verb\u00e1ln\u011b agresivn\u00edm chov\u00e1n\u00ed mohou b\u00fdt sou\u010d\u00e1st\u00ed zdravotnick\u00e9 dokumentace pacienta, nebo\u0165 je opodstatn\u011bn\u00e9, aby v n\u00ed byly zaznamen\u00e1v\u00e1ny vedle informac\u00ed o anamn\u00e9ze a diagn\u00f3ze i informace o vz\u00e1jemn\u00e9 komunikaci poskytovatele zdravotn\u00ed p\u00e9\u010de s pacientem, z\u00e1znamy o pou\u010den\u00edch poskytnut\u00fdch pacientovi, informace o dotazech pacienta \u010di jeho dal\u0161\u00edch sd\u011blen\u00edch, kter\u00e1 by mohla m\u00edt vliv na poskytov\u00e1n\u00ed zdravotn\u00ed p\u00e9\u010de a n\u00e1sledn\u011b i na v\u00fdvoj jeho zdravotn\u00edho stavu. Chov\u00e1n\u00ed pacienta, zp\u016fsob jeho komunikace (verb\u00e1ln\u00ed i neverb\u00e1ln\u00ed), reakce na vn\u011bj\u0161\u00ed podn\u011bty apod. jsou i v\u00fdrazem jeho du\u0161evn\u00edho stavu a v tomto smyslu i relevantn\u00edmi informacemi o zdravotn\u00edm stavu, kter\u00e9 bezpochyby do zdravotn\u00ed dokumentace pat\u0159\u00ed.<\/p>\n\n\n\n

    Lze tedy uzav\u0159\u00edt, \u017ee se vyplat\u00ed v\u011bnovat n\u00e1le\u017eitou pozornost pe\u010dliv\u00e9 p\u0159\u00edprav\u011b vnit\u0159n\u00edho \u0159\u00e1du zdravotnick\u00e9ho za\u0159\u00edzen\u00ed a tak\u00e9 \u0159\u00e1dn\u011b zaznamen\u00e1vat informace o chov\u00e1n\u00ed pacienta a o komunikaci s n\u00edm.<\/p>\n","protected":false},"excerpt":{"rendered":"

    Pr\u00e1vo ve zdravotnictv\u00ed KMVS, advok\u00e1tn\u00ed kancel\u00e1\u0159, s. r. o. Tisk do PDF Pacienti n\u011bkdy um\u011bj\u00ed sv\u00fdm chov\u00e1n\u00edm l\u00e9ka\u0159\u016fm zp\u016fsobovat nemal\u00e9 pot\u00ed\u017ee. Maj\u00ed l\u00e9ka\u0159i k dispozici z\u00e1konem garantovan\u00e9 prost\u0159edky, kter\u00fdmi se proti takov\u00e9mu chov\u00e1n\u00ed mohou br\u00e1nit? A za jak\u00fdch podm\u00ednek mohou l\u00e9ka\u0159i v souladu se z\u00e1konem p\u00e9\u010di o pacienta ukon\u010dit? Na tyto ot\u00e1zky se zam\u011b\u0159\u00edme v dne\u0161n\u00edm \u010dl\u00e1nku. Pod\u00edv\u00e1me se, jak tuto problematiku upravuje z\u00e1kon, a uk\u00e1\u017eeme si tak\u00e9 ned\u00e1vn\u00e9 rozhodnut\u00ed Nejvy\u0161\u0161\u00edho spr\u00e1vn\u00edho soudu, … Pokra\u010dov\u00e1n\u00ed textu Za\u00a0jak\u00fdch podm\u00ednek sm\u00ed l\u00e9ka\u0159 ukon\u010dit p\u00e9\u010di o\u00a0pacienta?<\/span> →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[26],"tags":[],"class_list":["post-20456","post","type-post","status-publish","format-standard","hentry","category-zdravotni-informace"],"_links":{"self":[{"href":"https:\/\/www.podivinsky.cz\/index.php?rest_route=\/wp\/v2\/posts\/20456","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.podivinsky.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.podivinsky.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.podivinsky.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.podivinsky.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=20456"}],"version-history":[{"count":1,"href":"https:\/\/www.podivinsky.cz\/index.php?rest_route=\/wp\/v2\/posts\/20456\/revisions"}],"predecessor-version":[{"id":20457,"href":"https:\/\/www.podivinsky.cz\/index.php?rest_route=\/wp\/v2\/posts\/20456\/revisions\/20457"}],"wp:attachment":[{"href":"https:\/\/www.podivinsky.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=20456"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.podivinsky.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=20456"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.podivinsky.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=20456"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}