The document summarizes a discussion held in the Netherlands on the European Day of Patient Rights regarding patients' rights to privacy of medical information, continuity of care, and compensation for medical errors. The discussion focused on concerns about privacy of electronic patient records and ensuring patients have control over their personal medical information. Participants debated whether new laws are needed to better define and protect patients' rights, or if existing laws just need better enforcement. Overall the discussion highlighted balancing privacy concerns with using medical information to improve healthcare quality, and ensuring policies prioritize patients' interests.

1. Review on raw notes 18 april EU day of the patient rights. (version Siegfried van Hoek)
Present: Discussion members, and Public
Chairman discussion members Rob Oudkerk abbreviation of name R.O.
f.l.t.r. 1 Annemiek Gorris MBA Ass Health management Forum HMF
2 Mr. Wiro Gruissen CZ healthcare innovatie CZ
3 Drs. Pieter Vos Raad Volksgezondheid RVZ
4 Ir. Titia Lekkerkerk NPCF Ned. Patient.Cons.Forum NPCF
5 Mr. Paul Rijken KNMG Kon. Ned. Med. Geneesk.Ver. KNMG
6 Mr. John Beer Letselschade advocaat BEER ADV
7 Dr. Eric Verkaar Zorgbelang Ver. Zorggebruikers ZORGBELANG
8 Drs. Gita Gallé NVZ Ned. Ver. Ziekenhuizen. NVZ
R.O.: Welcome, and introduction of discussion members, declares the first debate of the Dutch
day for the European wrights for the patients started, held on initiative of Zorgbelang, together
with CZ and other organizations. He wishes that this day about the wrights for patients will
become an annual reappearing item. Some other countries in Europe do know this event as a
happening already.
R.O.: The patient should be the first party in stead of the 3rd. In the debate important is which
laws are important and how we shape these well. The debate is limited to three topics: the right
for privacy of medical information, the right for a good care interaction tuning in the care
chain, and the right for compensation in the case patients have been wrong treated. In the
discussion flowing, several party representing members of discussion will show their interest
and give a thought regarding the filling in how these pat9ent wrights will be guaranteed in
practical. With gratitude to WVS and CZ for the financing of this day.
R.O.: heard in his political carrier 16 years ago, that patients were seen as the 3rd party in the so
called healthcare triangle. 1st party were the healthcare providers, the insurance 2nd , the patient
3 rd and finally the political field 4th , wherein the question arises if the patient in this following
order is still having an influence in the care provision. What is the following order nowadays,
wherein the patient should be placed central, while the doctor only has a mere ten minutes for
patients each, wherein the physician has to perform the healthcare offered as good as possible.
The treatment of patients has in law some comparing with traffic vehicles. R.O. Compares
buying a car in a garage, where after some study a contract is made regarding the decision and
the service/care. The doctor offers something and the patient is also a consumer. Also on the
field of accidents are comparing to be made with traffic accidents.
R.O.: A new healthcare legislation is coming, wherein the position of the patient (with
including rights) will be described. This is the cause why to discuss upon on a day like this.
Here for today three main themes have been selected to talk about with a forgoing small film
documentary as introduction. 1) privacy and the permission for inspection copy (file sharing),
2) the right for a receiving a good tuning in of the health care, 3) the right for compensation.
The quality of the health care offered has to change. 40% of the healthcare consumers is of the
opinion that this is not so good, while 80% of the healthcare providers is sharing the opinion
that the quality absolutely can be improved! Do we need a legislation here for and is everything
set then? (Comparing of driving through the red light with the bicycle is punishable, while on a
regular Saturday afternoon 56% of the population is driving through red light in Amsterdam.)
Next to a legislation there should also be instruments to do something against it.
There have to be instruments to make possible that you can also act with this law.
R.O. is addressing himself to the public to mention that there is a microphone, and that giving a
reaction from the side of the public is allowed, but ... to the point. We now start the 1st film.
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2. Content of film one: The right for privacy. The small film is a bout a woman, who has had
undergone a psychiatric treatment with hospitalization for a year. Now she is active as an
expert of experience within the psychiatric health care field herself. She had had a fear
malfunction leading to bulimia. At first she remarked, that it had token her lots of time to find a
good a treatment with therapies. With a personal budget and personal support she started living
her life independently. After the treatment she had been unemployed for a while, before she
became project leader and member of staff policy. Mainly she was worried regarding the
medical file of her generalist, and for what kind of consequences this could have to her in
searching for a job etc. The demand for a copy of the generalists medical file went rather easy.
There should be a screening in forethought with the generalist what based upon relevancy
should be shown file sharing and what should not. She was also worried about the electronic
patients file EPD, of which she had not been aware. She was wandering to what extend sensible
information will be visible to everybody. A generalist can pass through simply all information
to another treating doctor without any pre-selection. Sensible information can lead to prejudice
and to taking the patient less serious with their opinion. Besides psychiatric information is also
kept longer. And to what extend a EPD can have a harming effect in for instance a demand for
a mortgage etc. The EPD has its advantages and also its disadvantages, in the case of a
psychiatric treatment the information can be token as a burden, but on the other hand
information regarding the use of medication or diabetes is very useful when given in an EPD.
After this film the members of conversation start their plight.
R.O.: is informing still about the setting of the public. The majority were healthcare consumers,
probably there were also quiet some journalists seen the number of people taking notes. There
was well counted one healthcare provider under the public!
KNMG: The EPD is to enforce the quality of healthcare providers, privacy is a variable term,
information cannot be left out of a file that easily, whereupon healthcare providers have to
perform their provision of health care to the patient.
NPCF: But the interests of the consumer should be taken in account with.
RVZ: Advises will be given to WVS for (Ministry of Healthcare, wellbeing and sports).
CZ: We want to help customers to receive good healthcare (care innovation)
Zorgbelang: We are talking about the future of the health care and its development direction.
R.O.: But we are talking here about the protection guarding of privacy?
KNMG: Here for we do not need a new law, the law is already there: law personal registration.
R.O.: Yes, but with the EPD comes a new law? There is anguish regarding privacy guarantees.
KNMG: The health-carer has a duty to keep up a decent file. The patient has the right to ask a
copy. But there is an objection/problem in/with requests for erasing of medical information,
because the danger can appear that a health-carer in the extreme consequence is lacking
essential information and will arrive in a wrong track (interpretation) for treating a client.
NPCF: The health-carer here carries the authority, but the file is also property of the client. The
patient gets the right to decide regarding the contents of a medical file, maybe this should be
translated into the right to decide which parts can be for what level of healthcare visible.
CZ: The report of information is important to make healthcare better together.
R.O.: Yes, but could you be more precise? As insurer there is also a certain interest?
CZ: Next to medical information of professional quality, there is also the information of
experience from healthcare consumers. The fear for violation of privacy) is real, but it should
be trusted to the system. It has become the moment to show confidence. R.O.: What happens
when nowadays the information is stolen by a computer hacker?
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3. RVZ: It might be relatively easy for a hacker to retrieve information on his screen, but this is
not the main problem. Privacy is not the main problem, so why such a discussion regarding the
EPF? The quality of the healthcare is the most important topic. Where this fear is coming
from? Is this because of the image shaping, that the health-carer and the insurance are seen as a
natural alliance?
R.O.: How do you solve that? Everything is based upon trust.
HMF: Things go wrong once and a while, the quality could be much better.
R.O.: There simply has to come a legislation that will settles this vast, in order to be able to
arrange matters correctly up to the Higher Court.
KNMG: The current laws are sufficient. The problem is the application of laws. Only a few
people can change that flow around laws. New legislation is suggested as the solution. Typical
is that WVS (policymaker/legislator) is not present today, while today it is the more also the
first time such a meeting is held in the Netherlands.
Public: Privacy is according to the government an existing real problem (the screening of
personal medical information) in searching a job for instance. There certainly are certain social
consequences for an individual (on the micro-level), for instance in labor reintegration projects,
where in micro scale a questionable way medical information can be handled.
HMF: That is why the question arises what the legislation should contain in order to describe
limits, so they offer the guarantee to approachable claim.
KNMG: I don t think that new laws will make society better, the people have to do that.
HMF: This legislation has to come, because it will give more mainstay, whether being on the
1 st 2nd or 3 rd place (rather 4th or 5th ), the patient will get more rights then is having now.
Within the system everybody can appeal for what it will contain or not. The public can be
informed better via Internet, and involved in the discussion what information will be shown.
This could even be done with Hyves/Twitter conferences.
R.O. Will this not result in a kind of rear-guard action?
RVZ: the privacy for med. info isn t absolute anyhow because of contagious diseases.
R.O. OK, but what if somebody wants to receive a mortgage and they want to turn someone
inside out with questions?
RVZ: Such a legislation limits the unlimited demands of for instance a mortgager and also
creates the possibility to deal responsible with a medical file. Seen from the pathology side it is
irresponsible to delete information from the EPD. It is a negative opinion to think that working
professionally and responsible that exchange of medical information happens backstairs
Public: Main parts of the EPD should be covered. The client needs certain wrights in the
disposal of medical information. Necessary information needed regarding current pathologies
and medical situations of treatment should be mentioned with. Is it needed a non psychiatric
care-provider to be informed with information regarding a psychiatric case history medically?
KNMG: The question for is: Who is actually owning this Medical File? Who is allowed to do
What with a file. The healthcare is allowed to work if the client gives its permission. The
health-carer is owner of the medical file.
NPCF: Who is allowed to do what with a medical file? The health-carer in the provision of
healthcare, but with the permission of the client. People feel haunted with a psychiatric history
for instance and risk not to be token seriously. KNMG: Put trust on the privacy in the
healthcare relation with the EPD.
Public: OK, but how can a department protect and control the extend of visibility in a more and
more private sector? The visibility of who has seen what in the EPD is important for the
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4. client. Will clients also guard this? Does everybody has a computer at home, and is everybody
able to protect their own interests?
KNMG: There will not arise a new legislation for. Legislation is a symbol. A new law could
even weaken the position of the client Actualize the current legislation at the developments
within healthcare is possible, but the legislation is sufficient.
RVZ: That is why the choice to secure available information should be moored by law, i.e.
basic value marks should be anchored in legislation.
R.O. Coupling of information, but indeed with permission of the client before?
CZ: What are we talking about? The patients (need to) know what are their rights. To couple
information a client has to give permission before, for giving information visible for third
parties.
R.O.: How do we secure legislation for everybody and all?
NPCF: By describing the rights for the patients well. Information of logging in on an EPD
should be registered, it should verifiable it should be claimable.
HMF: And there is mobile phone to reach or to inform a client.
RVZ: 67% do want to see their information privacy protected.
Beer ADV: In any situation their is the demand to request permission of the patient to be
allowed to look into a file containing medical information! There is an interest for the patient to
a certain screening before and/or by the client selves!
Content of film two: The right for a good tuning in (cooperation) in the healthcare chain.
The little documentary was about a woman, mother of 5 children, with some still living at
home, next to this she also performs a voluntary job, while she is suffering various pathologies.
She was suffering for instance of diabetes, she had had surgical treatments at the sinuses of the
forehead, and is carrying there likewise also a protease, etc. She s consuming a vast amount of
medication, in her situation it is important that acting doctor is aware of the combination of
active pathologies and treatments. In short she had several doctors treating her, whereof one
due to a vacation temporarily was replaced with a doctor in training. The replacing doctor
proposed at consult a treatment, that according to her would cause disastrous results to her.
That client was underestimated in her knowledge, and she had herself being talked down
(Unlucky for her), which caused a situation worse. Moral on the story is: a central pointed out
direction in the healthcare chain should have been there, whereupon in the transference more
attention should have been put in here medication situation, because of the complexity of
several pathologies together with according medications next to each other. Next to a poor
transference maybe there also was an issue of lacking in empathy, causing she had to fight in
the proposed medical treatment for her wellbeing. In complex situations it would be good if
some specific specialists are aware of a medical file. In the installation of a central direction it
would be desirable there also exists a system of catcher beyond. Remarkable in the film was
the positive carriage in life of her. Accept a pathology. Learn to live with it, life doesn t stop
with it. And be happy and show respect for the healthcare offered upon inevitable happenings
of life like a serious pathology.
Next to the demand for a better tuning in within the healthcare chain including pharmacy, it is
also interesting to see differences in the medication prescriptions of patients each. She carries
the opinion that patients are responsible themselves for the medication being used, they remark
themselves best what is working best in what doses. 80% of the healthcare consumers find the
tuning in the healthcare not good, 70% of the providers share this opinion. De limiting question
is: what is ideal for the patient keeping safety and quality in mind.
KNMG: The tuning inn indeed can be improved.
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5. HMF: There are 86 general hospitals and 8 academic ones, all member of her association next
to several associations of several revalidations and other categorical institutes. The hospital as a
autonomic deciding institute does not exists anymore. The medical specialists define their
methods of acting themselves.
R.O: Your opinion Mr. Beer?
Beer ADV: We are dealing with the enforcement of the juridical position of the patient.
RVZ: Tuning inn with defined guidelines is needed. A professional standard shows the
professional level of health care.
KNMG: The healthcare is becoming more complex with more then one acting doctor on a
client. We want to clarify points of attention needed for, but legislation will not add more in
this. Regarding the method of acting described responsibility has to be given. But the client
also has a responsibility in the tuning inn of healthcare. When a client has a complaint
regarding a medical treatment, then the right exists to make a complaint according the wrights
of the group of profession.
Beer ADV: I agree with Mr. Rijken, but the judge also carries its own opinion regarding the
content of a case in the administer of justice. The legislation makes it mandatory to offer
descent health care. This debate deals with the enforcement of the rights of the client after all.
NVZ: A legislation does not contribute anything, but the question is if tuning inn, coordination
and communication could be better arranged a bit in protocols.
R.O.: In practice there has to come a better tuning inn, doctors do not communicate that well?
NVZ: In the education more value should be made of carefulness in the transference of medical
information, and the transcription of healthcare appointments.
R.O.: Who is carrying the final responsibility herein?
NPCF: The patient also has a free choice, but important is that the client receives one central
point to address to, because how many times a clients has to tell their complete story...
But can a healthcare coordinator be put responsible for the behavior of others?
Beer ADV: The hospital is the central responsible for. How the communication can be
improved. A complaint a court for correctional matters can help in an individual case.
KNMG: That legislation according the responsibility will not arise, but in case a central point
to address to can be pointed out lacking in the healthcare offered can be cached up. The
healthcare coordinator is the person in question where the client should address to with all
questions, who s keeping control and sight upon al processes of healthcare offered. As first
point of addressment it is also their duty to arrange this well.
RVZ: The system of healthcare is complex and governmental institutes don t understand this.
In 60-80% of the sub-legislation arises the question what we are dealing with, it is an illusion to
think that legislation can control too complicated system.
Beer ADV: The situation is different then the government would like to see in its construction
of legislation. The law does not solve the problem in the interest of the patient. How many
times a client has to tell the complete story over and over again etc... In spite of the proposed
measures everybody will keep on working solitarily?
KNMG: Good mutual tuning inn is needed for good health care provision, wherein the client
should be token serious, but that is also depending on the client. Reason to plight for the
adjustment in practice vs. the legislation of the position of the healthcare consumer. But this
legislation does not settle the communication between regular and alternative physicians, the
regular doctors do not have a list of alternative doctors available. This could only work if the
alternative doctor also has a regular doctors diploma. But the wrights seen from that
perspective remain equal for the consumer unesteemed visiting a regular doctor or not.
Beer ADV: Patients have to have/keep the possibility to choose their healthcare provider, and
regular treating doctors are impairing the options of choice. BIG (registry of allopathic doctors)
affect the possibility of choice (in the demand for tuning in of the chain of health care). The
ministry WVS however do want a legislated tuning inn about central coordination in the
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6. healthcare chain. Organizations of patients should form a collective system about providers of
healthcare and their experiences with in the transition of the old system to the new one. There
is a problem with the information given with healthcare being offered by allopathic and
alternative providers. There are more disciplinary cases under regular doctors then alternatives.
NVZ: Within the hospital there are several developments going with a discrimination between
care paths and clinical care. In providing responsible care the client also should know who is
the addressable person for him/her. That development is going within the culture of the hospital
and that is important. But it has not been defined clearly yet. The legislation is not giving
enough content/clarity about care paths and clinical paths. Who finally is responsible herein?
NPCF: Report notes with personal medical in formations are written vice versa now. (In steps
parts of information should be possible to request for.)
CZ: 40% of the diabetes patients for instance find that they are treated well, but they do not
know who to address to incase the client wants to take part actively by proper wish. The
organization of healthcare is a task the healthcare insurer could fulfill. The rejection of a
protocol can be rejected with.
KNMG: Provide to the client the right to address him/herself for saying inn in the decisions.
RVZ: Attention is remains needed, to guarantee the free right in options of choice.
(In the regional debate of Amsterdam this was also treated in the perspective of psychiatric
clients that had undergone a treatment, and the role of the healthcare provider..)
Content of filmpje three: The right for compensation when clients have been wromg treated.
The little film was about The experiences of Dhr. John Kleijn founder of the foundation
Dimitri. Experiences reaching from a very insufficient treatment of a newborn sun with an
open back, what also knew a (reproachable) mortal ending, up to the following fight for
information and honest treatment of the complaint. In the hospital they did not really know how
to deal with this medical case, and the specialist did not wanted to such an external second
opinion. Also an internal decision not to move the child to elsewhere in the hospital was not
respected, and under this treatment it also got a flatted long, and finally also an MRSA
infection causing death. The very rude treatment of the parents after and the resistance they
encountered in the aftermath did arise the foundation Dimitri. The parents also did not receive
no guidance at all in the loss of their son. There was no after care, and appointments made
again were violated by the hospital. Also the medical information was not given available for
inspection, reason for the parents to go to the maximum extend to bring information on the
table. With the final stab in the back that there were no mistakes being made in (mis-)treating
their sun. Finally after a long excessive fight the parents were put in their rights on three of the
four points in their complaint. But there are so many Dimitris, the compensating amount of
money to be received they also wanted to use for a donation for the Ronald McDonald hospital.
Moral on the story: that experience proves again that the patient is not put central in the care.
We refer shortly to the film on their site, as well as the site of the foundation www.dimitri.nu
KNMG: Liability claims to another person is an individual right. Compensation is the most
important right adjudged to a client.
R.O.: The right for compensation exists, but the most important is the recognition that mistakes
can (have) happen(ed) unesteemed the question of culpability.
RVZ: There has to come a legislated standard for settlements regarding medical injury of harm.
Recently on march 31 was spoken about this too, but then a decision-making (also) did happen.
(A short expatiation over the regional debate held on march 31 2009 in Amsterdam follows: no
decision-making followed. From the public was mentioned that patients in a psychiatric clinic
arrive with the diagnostics of a healthcare provider in a kind of laboratory.
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7. Zorgbelang: The position pf the client has to be enforced, and the possibilities start with the
position of the client in the purchase of healthcare.
Continuation of the national debate after this short excursion about that regional debate.
RVZ (Back in junction on the film of Dimitri, with 2 themes discussed: errors in the healthcare
chain in practic and in the settlement of mortal injury of harm, the reaction): Independent
investigation should have been done after for the damage to be compensated.
R.O.: Acknowledge mistakes in healthcare can happen, and that mistake s are recognized by
healthcarers. Nobody can diminish this: I m sorry, I should not have done that .
Beer ADV: The right for compensation is generally anchored in our Civil legislation book.
Patients have the right for a compensation, make up what has been lost by acts (reproachable)
performed by others. Its is compensation of loss by guilt. In this recognition of damage there is
also the comparing between age and medical injury of harm. (How much money is it worth ?)
Zorgbelang: The care has to improve to deliver what patients are having a rights for.
CZ: The insurer has in her duty of care also a responsibility regarding medical injury of harm.
The insurer could address himself to the health-carer regarding circumstances of healthcare.
Selection of healthcare providers is possible by making demands for a certain healthcare
institution to arrange things well within a period of time (five years).
Beer ADV: We do not have American affairs, where one has to pay all themselves, also the
doctor. But also in the Netherlands we do have a problem in the settlement of medical injury of
harm. What in the case you can not work (anymore), that is lots of damage when you are still
Young. The treatment of medical injury of harm is settled.
NVZ: No it is not settled well the treatment of medical i jury of harm. The guidance of damage
is a lost chance to settle things, in spite of the question of guilt. The settlement of medical
injury of harm has to be arranged well. In France they even know a fund for non reproachable
medical injury of harm. As a client one has to prove that the healthcare provider has made a
mistake. We could ask why in the new legislation proposal the treatment of medical injury of
harm has not been settled.
Zorgbelang: In the interest of care the damage also should be investigated, and on the social
level there should be recognition for the client unesteemed the question of guild. Contracts with
healthcare providers could be short termed, in order to exclude dysfunctional providers from
installation. It is not that easy to get a mistake evaluated by another doctor.
Beer ADV: It is a utopia to think the problem around medical injury of harm is to solve.(!)
R.O.: Short termed contracts with insurers could help.
KNMG (R.O.) Short-term contracts in theory can be made with the care insurer, that already is
happening once in a while. The insurer provides the duty of care, a mistake made also counts
under that duty of care. We (KNMG) are responsible for the care, but we cannot fulfill this
responsibility alone.
CZ: The Insurer of the care provider also has a duty (of care) when a mistake has been made.
Liability on circumstances in the care provision is possible, but the reality is not arranged to
this. But maybe it is within a term of five years...?
R.O.: Care insurers do not support patients in real practice.
HMF: Hard labor is needed to improve the quality.
Public: Very Interesting Mr. Beer, but how a patient can prove an error has occurred?
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8. KNMG: The professional association mutually have the responsibility in amicable evaluation.
The patient is told an error had been made. There should be installed a code of behavior where
upon an advocate of medical injury of harm can open a case. But for this the liability insurance
of medical profession should cooperate as well. We do our best, but alone we cannot settle this.
Beer ADV: In case of a dispute between a client and a doctor a short cause could be started
against the hospital, because actual reports regarding a medical treatment exists, but they are
kept closed, they are not to see inn that easy...
HMF: How to deal with apologizes, the information that becomes demanded to see inn, the
requests for second opinion and recovery treatment? It all certainly can be better.
NVZ: Patients and consumer organizations together with SER etc are negotiating about the
terms for delivery. There are registered settlements here about. We have to settle sharply how
to deal with complaints. The policy has to be clear here about.
Public: But the structure is wrong and with the new economic crisis this will become even
more visible. There has to come a change in the structure on European level. In case someone
loses its right leg while it should have amputated its left leg, then the results in treatment are
visibly. But who is carrying the blame? A complete regiment of doctors was involved, and they
are all hiding after each others back, not in favor of the harmed /aggrieved patient. Therefore
the blame should be put at the desk of the hospital, they will have to deal with that question
internally. The clients in fact are not supported. But is more or less clear that something went
wrong, and in emotional sense cutting of the wrong leg does have far going consequences. The
person needed to help a client could be a functionary of complaint, where the complaint should
be posed intermediary.
R.O.: In Amsterdam we had brigade to help to fill inn papers to help the people with
complicated documents, while these papers also could have been made more understandable.
Why is it such problem before damage is recognized? People are people, the doctor as well as
the patient that sitting in front of. One is afraid of the recognition a doctor can make a mistake.
Public: Doctors refuse flatly to recognize errors to the victims.
KNMG: A code of behavior has to be made with a counsel for medical injury of harm, with an
open culture where medical files are to be seen inn. To shorten inn the tragedy around medical
injury of harm by keeping the procedure short termed. We do our best, but we can not do this
alone, the liability insurance has a role in this too.
Beer ADV: The doctor is your friend, except if you are having a dispute with him, then he is
your foe. How can you prove that an error has been made? How can you prove a mistake has
been made. There is a difference between criminal activities in the silence (concealment) of
medical injury of harm and the juridical being blamable for a mistake.
Zorgbelang: But damage (lost) is suffered.
Beer ADV: People want to know what has happened: What has happened doctor ?
Zorgbelang: the damage has to be fixed. Social recognition of the suffered damage has to be
there, unesteemed the question of guilt. The settlement for medical injury of harm should be
dealt with central and short termed. With the recognition of damage nothing happens to learn
from with examination: how could this have happened, and (how) can we prevent this in future.
Public: There is a difference between something went wrong and something was done wrong.
Additional aspects like financial compensation also could be invested in a separate funding.
NVZ: The tax office showed even to claim fist at the door of the victim for her share in the
payment of a financial compensation, even before the actual payment of the compensation for
medical injury of harm was done in fact. In France there is even a fund for medical injury of
harm for injuries without blame, a blamable case then means a juridical case.
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9. R.O.: The right for compensation should not lead to a culture of claim. The foe image does not
reduce this. One could start with a excuse: I m sorry, I should not have done that.
Public: But structural it is settled wrongly. Use the occasion to improve the structure.
First of all there is a set back of the client in his position. Do not make your decisions
(legislator etc.) over the head of your patients. Install an autonomous organization for
complaints registering these. The quality in the healthcare is differing very much.
Where issues regarding the settlement regarding medical injury of harm is going quiet bad?
There is a problem with the reportage of errors.
Public: There is a cult of silence regarding medical activities. Clients become deliberately
harmed in their juridical rights. The question arises if doctors (in silence) form a criminal
organization meant to harm the clients in their rights in the case medical injury of harm
appeared. There also is the right for information from insurers. A wrong leg amputated is
relatively easy (visible to a layman) in the determination of medical injury of harm in relation
to more hard cases. It is a shame, in practice in fact nothing is done at all!
R.O.: Error made means Error happened means Wrongly done.
Public: A compensation fund has to be there in stead of personal compensation, because that
kind of payments go for a main part to the tax-office.
Public: The EPD could give interesting findings regarding the reportage of medical injury of
harm. Research by the foundation de Ombudsman Hilversum showed out, that 75% of the
medical injury of harm files appeared to be incomplete on crucial points for being able to point
out the cause of medical injury of harm. In my experience even proving a case as a client was
remarkable. First one was not able to see case, then thereafter they mentioned they were not
able to stand by in such a severe ( proved and all ) case!
R.O.: Have you done? Are you ready? Public: no, just one moment please R..O.: Oh
Public (continues): The minister of Justice does not want (for the time being) to set improper
medical activities punishable. That KNMG man is even mentioning that new laws will not
come. What is the use of a new legislation if that one isn t respected anyhow? Do you think
KNMG-man, Mr. Rijken, that improper (violating) activities should not be persecuted as well?
Mr. Rijken: however has the opinion that improper violations indeed should be persecuted!
Beer ADV: People want to know what has happened, and they want to prevent that a mistake
can occur again. To be able to prevent an error can happen again, in the first place, is the most
important for claims of damage.
Public: People that underwent a psychiatric treatment in the past are carrying social stigma
with, they even get aggrieved by the social welfare, and they risk to be aggrieved even more in
the case of medical injury of harm. Victims of war also are getting compensated for the still
going consequences?
KNMG: Healthcare became more complex with several medical treatments simultaneously.
The more people are cooperative active in a medical treatment, the more the chance for errors
arises. 10% goes wrong... How many people can work together in a treatment responsibly?
HMF: Blamable damage should be compensated. But one needs a system for that, wherein is
clear where to claim for.
NVZ: The complexity increases. What are the processes most risk full? The reportage of errors
is useful. But one has to know a lot in order to analyze an error.
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10. Public: Patients can be active with an error endlessly, but please be rather positive about the
medical aid offered.
RVZ: We never tire of talking about it, but the patient should be the first party.
Beer ADV: The client should be the 1 st party but he is the 3 rd. 1) healthcare professional 2)
assurances/government. Your law you are searching for will not arises that quickly, there are to
many objections for the moment. Beer advocaten wants to improve situations, but doesn t see
that much change.
RVZ: A straight healthcare path/legislation will not arrive quickly: 16 ½ million people.
NPCF: Whether this legislation is coming or not, there has to come more quality in the
healthcare, that is of importance.
R.O.:WVS also wants options of choice in the way damage can become claimed. This has to be
settled well. As a client one has to prove that a treating physician has made a mistake. Do listen
out once on the internet the last interview with Pim Fortuyn, half an hour before his death in
the Radio program of Ruud de Wild. To err is human, but place the client on the 1 st place.
R.O.: Do you have an optimistic or a pessimistic view regarding the position of the client?
KNMG: We are optimistic regarding, and we want to work at what is not going well. We also
want to present twelve measures regarding the provision of professional care. The client needs
a position of rights. Do look above all to what is going well too.
NPCF: I m not becoming that misj (happy) of it. Of course there are also matters going right in
the healthcare. In the exchange of info one should use the info regarding what does go well.
RVZ: I do not see lots of change in the near future, in the politic domain the topic is difficult,
but there has to come a rightful position of the client within the healthcare.
NVZ: The hygiene in hospitals is an item at this moment. It is incredibly unpleasant that the
hospitals are not clean. Personal hygiene of medical personnel should be performed every day.
Openness and mutual addressment regarding is of importance herein, but even more important
is the transparency is increasing. Now for instance a reportage is made about with hidden
camera s.
R.O.: 17% of the Dutch mail is not washing their hands often, we do not need to implement a
legislation for in the healthcare, the person should be addressed regarding in practice.
Beer ADV: Beer advocaten is taking the attempt to improve the wrights of patients pessimistic.
Fortuitous Dimitri John Kleijn appeared strong enough to fight for.
CZ: Exactly those initiatives of individuals is appealing to the insurer. People that have the
strength to do something, but that is a proves of 4/5/6/ year in becoming strong in position.
(KNMG: we do see some results, yes.) NVZ: Either the legislation will arrive in future I
do not know, but I do hope there are reasons to implement this legislation such as.
R.O. : In final recalls an anecdote regarding his period active for the PvdA in the Tweede
Kamer (labor house). Staatssecretaris : ,,I have such a problem, de client actually is the first
party, because healthcare starts with their request for medical aid. How do you deal with this as
a generalist for instance? By listening at your patient. Listening to your client should be placed
at the first level. The society is made by people not by laws.
Zorgbelang: Eric Verkaar (organizer debate) is thanking everybody for visiting this event, and
he expresses his wish that the legislation for the rights of patients will be an item on the
political agenda. The minister has to hear what kind of opinion patients are carrying. The
manifest is the result of a action of report at the foundation Zorgbelang organized by them,
readjustments might follow still. The minister did not wanted to receive it personally, that is a
pity. I express my gratitude for your coming to this debate. 16.59 end of meeting.
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11. 11 Siegfried van Hoek external comment
In pursuit of developments within Europe finally the Dutch Government will pay attention to
the rights of the healthcare consumer. The foundation Zorgbelang also carries the opinion that
there is lacking some in the legislation proposal of WVS: like the right for a better settlement
of medical injury of harm with an eventual recovery treatment. The foundation Zorgbelang
presented in addition on this debate a Manifest called Mij een Zorg ( Who Cares ) regarding
the rights of the patient (healthcare consumer). The members of debate (however) shared the
opinion that demands of WVS do not match with the healthcare practice in fact. As like as the
here formed macro-image is neglecting serious situations going on in the micro-level? Next to
the large group of healthcare consumers and likewise interested it appeared that only one
healthcare provider in person was present under the public. And there was no real debate with
the public, one was abled to speak out their opinion.
The debate wasn t held about what the most important rights are for healthcare consumers,
as was announced in the brochure, but rather an after talk in conclusion upon the three themes
discussed at the regional debates: the right for privacy, the right for a good tuning inn in the
chain of healthcare provision, and the right for compensation for the healthcare consumer.
These three themes are part of the most important group of rights for the client. The first two
themes (privacy and the tuning in within the chain of healthcare offered) only becomes an
issue when damage arises... In short the key for the debate is laid within the third theme called
the right for compensation or else creating the position for the client in the right for an equal
strength (lawful position) in the liability legislation. In spite of an exciting legislation the
situation in practice is quiet bad for victims of medical injury of harm. The right is still denied
by the ministry of Justice, proving the KNMG note veilig melden ( safe reporting ): improper
violations for the meantime do not have to be persecuted. Everybody agreed that things can be
better, but the issue is that complex that forming a new legislation is not adding something new
in order to deal with. Even more, adaptation and addition in the exciting law is more realistic.
And apparently when it is too difficult to evolve the medical legislation? Then centralise the
legislation around the safety of the patient, inhere blameable handlings can judged better and
more honest for all parties. When a doctor is performing in reconciliation his/her healthcare
task with his/her conscience and in respect with the patients safety, then there is northing to
worry from a judgement about medical handlings, also when the result is unwanted. There is a
difference between things that went wrong and things that were done wrong. In case things
were done wrong, the accusation of blame for arises. But the accusation of blame also can be
divided into an unwanted act and a (badly) meant mis-treatment.The last category should
expect punishment, the first one should expect guidance in how we together can make it better
further. The researches (inspectional) for financial liability and medical cause in effect should
be independent from each other. Take in mind what a clients needs to continue after in society.
There is a need for more integrity in the application of the law, and with less subjectivity
within. Laws do not create society, people are indeed creating that, also in the case of non
observance of the legislation. Legislation is there to describe values and to punish (unwanted)
violation of these values. In order to be able to change in the excising system one should set a
course, when also new legislation in itself cannot improve the situation / or when not respected:
1) Acknowledge society is made together with mutual liability.
2) Integrity is the backbone of the existence of state and legislation, guard this together.
3) Put patient safety central in legislation also in the liability.
4) Judgement of medical injury of harm should be made neutral governmental responsibility.
5) Do research after medical injury of harm, and create a knowledge base serving everybody.
6) Set medical violations punishable, without sanctional tools every law is just a low comedy.
Would these guidelines respected only, then within the real situation an new more honest
situation in the wanted direction of development of legislation could come starting from the
current one. Set the safety in genesis entirely central in legislation.
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