While using the zVEM portal, a complainant whose daughter had an appointment to be examined by an orthodontist accidentally discovered a few months before an examination that her daughter's referral for an orthodontist examination had been cancelled, about which she was not informed. The Ombudsman assessed the complaint as well-founded and concluded that the patient's right to information and the right to high-quality, appropriate, and safe medical treatment were violated. Therefore, he proposed to the Ministry to inform the providers (concessionaires) of medical services about their duty to inform patients about all changes concerning the waiting list and which could affect the implementation of the medical service for which the patient has an appointment.

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The Human Rights Ombudsman of the Republic of Slovenia (Ombudsman) received a letter from a complainant whose daughter had an appointment to be examined by an orthodontist. By that time, her daughter had been waiting for an examination for two years. A few months before the examination, the complainant accidentally discovered while using the zVEM portal that her daughter's referral for an examination by an orthodontist had been cancelled. The complainant was not informed about this. The complainant asked the Ombudsman for help to get her daughter to the orthodontist as soon as possible. The Ombudsman addressed the inquiry to the orthodontist, Ministry of Health (MZ), Health Insurance Institute of Slovenia (ZZZS), and National Institute of Public Health (NIJZ).

The orthodontist explained that her office was closed due to her retirement at the beginning of the year. The orthodontist submitted a notice regarding the return of the concession due to her retirement in accordance with the concession contract in mid-June 2022, namely to the MZ, ZZZS, Medical Chamber of Slovenia, and Sežana Health Centre. She also inquired about her duties in relation to notifying patients on the waiting list for a first examination. She also explained that she had been informed that the NIJZ would arrange this. She personally informed the patients who had an appointment at the beginning of the year that the examination appointment was cancelled. The MZ informed the Ombudsman that healthcare providers are obliged to inform their patients of all changes that affect the course of treatment. The new concessionaire chosen to replace the retiring orthodontist will take over the insured patients who have already started treatment with her. The MZ also estimated that the new selected concessionaire will start work in April 2023. The NIJZ explained that at the beginning of the year, it received a notification from the ZZZS that the orthodontist had stopped practicing due to retirement. The ZZZS asked the NIJZ that, in the event that there are unresolved referrals left in the system, it returns them to the system so that they are available to other providers that the patients can decide on and can be used. The NIJZ "released" the referrals in question and provided the ZZZS with a list of referrals that were once again available for appointments with another healthcare provider. The NIJZ also explained that other tasks in the event of cessation of medical activities are not part of the tasks of the NIJZ. The ZZZS referred to the Rules on the referral of patients, the management of waiting lists, and the maximum permissible waiting times (Rules). It follows from the Rules that the healthcare provider must have a person responsible for the waiting list, who, among other things, is obliged to ensure that the waiting list is kept up-to-date. The ZZZS believes that the person responsible for the waiting list of the healthcare provider, i.e. the orthodontist, should inform the patients or return the referral document to them.

The Ombudsman finds that, in accordance with Article 4 of the Rules, providers, healthcare workers, or healthcare associates and patients are responsible for making effective appointments for healthcare services at the primary, secondary, and tertiary levels of healthcare activity. Point 4 of Article 12 of the same Rules stipulates that when the medical service cannot be provided due to the termination of the provision of the services of a certain provider (e.g. termination of the licence to perform medical activity, revocation of the concession, bankruptcy, etc.), the referral document is returned to the patient with a notice of the termination of the provision of services health services of this provider, namely within three days from the termination of the provision of health services.

The Ombudsman assessed that it is the task of the person who takes care of the waiting list at the healthcare provider to inform the patients about all changes that could possibly affect the course of treatment, including the fact that the healthcare provider intends to cease performing the activity. The Ombudsman took the position that it is irresponsible of the provider not to explain to the patients on their waiting list the potential risk that can be brought by, for example, their planned retirement. The Ombudsman does not claim that this was the behaviour of the orthodontist, because we do not know the reason for her retirement. Likewise, the Ombudsman does not have information on who, as stated, gave the orthodontist the information that it is not her duty to inform the patients on the waiting list who are waiting for a first examination that she will stop working and that the NIJZ will take care of it.

The Ombudsman assessed the initiative as well-founded. He believes that it was the duty of the healthcare provider to inform the patients in time that she would stop working. The Ombudsman notes that the patient's right to information (Article 20 of the ZPacP) and the right to high-quality, appropriate, and safe medical treatment were violated (Article 11 of the ZPacP). The Ombudsman proposed to the MZ to inform the health activities providers (concessionaires) of their duty to inform patients about all changes affecting the waiting list and which could affect the provision of the health service for which the patient has an appointment. 9.4-8/2023