OVERVIEW OF THE BOARD &

THE NATIONAL PATIENT’S RIGHTS CHARTER

DURING THE43RD KMA SCIENTIFIC CONFERENCE

NOBLE CONFERENCE CENTRE, ELDORETON 23RD APRIL, 2015

PROF. GEORGE MAGOHACHAIRMAN

MEDICAL PRACTITIONERS AND DENTISTS BOARD

MEDICAL PRACTITIONERS AND DENTISTS BOARD

• The Board is established under Section 4 of the Medical Practitioners and Dentists Act Cap. 253.

• The Act was enacted by Parliament in 1977 and became operational on 1st January 1978.

• The Mandate of the Board is to regulate the training, practice of Medicine & Dentistry as well as healthcare standards in Health Institutions and clinics in the country

LEGAL FOUNDATION

COMPOSITION OF THE BOARD

• The Chairman appointed by the Cabinet Secretary of Health;

• The Director of Medical Services/ Registrar;

• A Deputy Director of Medical Services nominated by the Cabinet

Secretary of Health;

• Four medical practitioners nominated by the Cabinet Secretary

of Health;

• Five medical practitioners and two dentists elected by the votes

of all medical and dental practitioners;

• Three representatives from Medical and Dental Schools in Kenya3

COMPOSITION

The Board has an established secretariat headed by the Chief Executive Officer.Departments:

AdministrationFinanceRegistration and LicensingLegal ServicesStandards and ComplianceICT

The staff establishment is 45 but currently only 21 officers are in place. Recruitment, training and capacity building on progress.

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BOARD’S SECRETARIAT

• Education & Training– Approval of Medical & Dental Schools, Core Curricula, Conduct Examination and CPD

• Registration– Medical, Dental practitioners and Health Institutions

• Licensing– Medical & Dental Practitioners, Foreign Doctors, Health Institutions and Clinics

• Inspections– Medical/ Dentals Schools, Internship Centers, Health facilities

• Disciplinary– Preliminary Inquiry Committee (National), Professional Conduct Committee (County)

and Tribunal(National)• Database

– maintaining a database of all registered and licensed medical & dental practitioners & health institutions

• Advisory-Ministry of Health and other government agencies• Collaboration & Partnership

– International, Regional and Local agencies – IAMRA,General Medical Council-UK, AMCOA, EAC & National Boards/Councils , Professional Associations like KMA, KMPDU

– Donor Agencies –University of Nairobi, CDC/Emory Project, IFC/WorldBank, FunzoKenya among others

• Monitoring & Evaluation- Performance contracting

FUNCTIONS OF THE BOARD

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The development of the Kenya National Patient’s Charter was necessitated by the dynamics of medical practice and constitutional dispensation and the review of other enabling legislation relevant to health

The Patient’s Charter meant to inform clients and patients of their rights and responsibilities.

Empowering them to demand quality services from health care providers

It provides guidelines for conflict resolutions arising between patients and health care providers.

NATIONAL PATIENT’S RIGHTS CHARTER

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• Defines and explains the patients’ rights, responsibilities and dispute resolution mechanisms.

• The rights outlined herein are anchored in the Constitution of Kenya 2010 and in particular Articles 19, 20(5), 21(2), 22(1), 26, 43(1)(2), 46, 53(1)(c) and 70.

NATIONAL PATIENT’S RIGHTS CHARTER

7Continued….

1.Right to access health care Include: promotive, preventive, curative, reproductive, rehabilitative

and palliative care.

2. Right to receive emergency treatment in any health facility. In emergency situations, irrespective of the patient’s ability to pay,

treatment to stabilize the patient’s condition shall be provided.

3. Right to be informed all the provisions of one’s Medical Scheme/Health Insurance Policy.

Anyone who is enjoying the provisions of a medical cover (insured) is entitled to know all the privileges accorded and also entitled to challenge, where and if necessary, the contents and decisions of the medical scheme and health insurance policy.

PATIENT’S RIGHTS

8NATIContinued….ONAL PATIENT’S RIGHTS

4. Right to choose a health care provider Shall not be unduly restricted by third parties so long as the provider of choice is qualified,

registered, retained and in current good standing with the Regulatory Authority to provide 5. Right to the highest attainable quality of Health care products and services

6. Right to refuse treatment. Documented and witnessed, should not endanger the life of patient or others and patient is

of sound mind.

7. Right to confidentiality Even after death. Disclosure allowed in public interest or by law.

8. Right to informed consent to treatment Nature of one’s illness, diagnostic procedures, proposed treatment, alternative treatment and

the costs involved except in emergency cases. The decision shall be made willingly and free from duress.9. Right to information Full and accurate information on their health and health care.

Continued….

PATIENT’S RIGHTS

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10. Right to be treated with respect and dignity11. Right to a second medical opinion In regards to diagnosis, procedures, treatment and/or medication from

any other qualified health professional of one’s choice.12. Right to complain to relevant authorities, such complaint should be investigated and

receive a response from the authority within a reasonable time that does not exceed twelve months. Where there is a delay, the relevant authority shall provide the reasons.

13.Right to insurance coverage without discrimination on the basis of age, pregnancy, disability, illness including mental disorders.

14.Right to donate his or her organs and/or any other arrangements / wishes upon ones demise.

Continued….10

Every patient has a responsibility to: 1. Take care of his/her health by adopting a healthy lifestyle;2. Protect, care and provide healthy lifestyle for a minor

(parent/guardian)3. Adopt a positive attitude towards their health and life;4. Protect the environment; 5. Respect the rights of others and not to endanger their life and health.6.Give health care providers relevant, accurate information to facilitate

diagnosis, treatment, rehabilitation and/or counseling while being truthful and honest on past health care;

7. Take care of the health records in his or her possession and avail produce them if and when required by the health care provider;

PATIENT’S RESPONSIBILITIES

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8.Keep scheduled appointments, observe time and if not possible, communicate to the health care provider;

9. Follow instructions, adhere to and not abuse or misuse prescribed medication or treatment and/or rehabilitation requirements.

10. Enquire about costs of treatment and rehabilitation and to make appropriate arrangements for payments;

11. Be aware of the available health care services in his or her locality and to make informed choices while utilizing such services responsibly;

12. Inform the health care providers, where necessary, when one wishes to donate his or her organs and/or any other arrangements / wishes upon ones demise;

13. Make decisions on health care services where a adult patient is not competent to do so. Next of kin and guardian shall accord protection and care to the patient.

Continued….12

Disputes may arise from the following areas: 1) Patient and health care provider;2) Patient and financier/insurer;3) Patient and the employer, and 4) Patient and Regulatory Body.

The patient may lodge the dispute directly with the Health CareProvider. The provider may resolve the dispute amicably,formulate an internal inquiry, establish a committee and/orinternal body to consider it and thereafter take makeappropriate steps which resolves the complaint conclusively tothe satisfaction of all the concerned parties.

DISPUTE RESOLUTION

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The patient may opt to lodge the compliant with the relevant Regulatory Authority or body as set out by the applicable Statutes, which includes;

(i) The Public Health Act, Chapter 242 of the Laws of Kenya;(ii) The Medical Practitioners & Dentists Board Act, Chapter 253 of t he

Laws of Kenya;(iii) The Pharmacy & Poisons Board, Chapter 244 of the Laws of Kenya;(iv)The Nursing Council of Kenya;(v) The Clinical Officers Council;(vi) The Kenya Medical, Laboratory, Technician and Technologists Board;(vii) The Radiation Protection Board; (viii)The Nutritionists and Dietician Institute, (ix) The Consumer Protection Act, and(x) The Public Health Officers and Technicians Act, 2013

Continued….

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Legal provisionsThe disciplinary powers are conferred upon the Board by Section 20 of

the Medical Practitioners and Dentists Act. Cap 253 laws of Kenya as read together with the Medical Practitioners and Dentists ( Disciplinary Proceedings) (Procedure) Rules under the Act.

Under section 23 (b) of Cap. 253 the Minister/ Cabinet Secretary in consultation with the Board can make rules to provide for the procedure to be followed by the Board in an inquiry under Section 20

Health services are determined by the following factors; history, culture, geography, economic empowerment, political persuasion, spatial distribution and a host of other unique factors. The practice of medicine is an indispensable service to the public.

Medical malpractice cases have been there since mid-nineteenthcentury. There has been a periodic rise due to public awareness.

DISPUTE RESOLUTION AT THE MEDICAL PRACTITIONERS AND DENTIST BOARD

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Definition:

“professional negligence by an act or omission of a health care provider in which the treatment provided falls below the accepted standards of practice in the medical community and causes injury or death to the patient”.

Standards and regulations for medical malpractice vary by country and jurisdictions;

MEDICAL MALPRACTICE

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1. Termination of pregnancy- the Laws of Kenya do not permit termination of pregnancy which is only allowed in a few exceptions.

2. Gender reassignment- is not permitted on demand.3. In-vitro Fertilization (IVF) and assisted reproduction-patients in need of IVF

should always be referred to an IVF accredited center.4. Sex selection- it is unethical for practitioners to engage in such a practice, to

support or to encourage sex selection.5. Abuse of professional confidence- practitioner shall not disclose to a third party

information which has been obtained in confidence from the patient or patient’s guardian. However; there are exceptions to this rule

6. Abuse of relationships between practitioners and patients:- health practitioners are privileged people who gain confidential information by virtue of their position of trust.

7. Abuse of financial opportunities- practitioners should adhere to consumer rights as provided for in Article 46 of the Constitution.

8. Advertising, canvassing and related professional offences9. Conduct negatively affecting the reputation of the profession10. Medical errors which include: mis-diagnosis, failure to diagnose, Wrong

treatment/ medication, Emergency room errors, Surgical errors, Patient abandonment, Transfer without proper instruction, Lack of consent, lack of informed consent, Dental errors , Psychiatric malpractice

Type of conduct raising disciplinary inquiry

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The Board may receive complaints from the following:-Patients or their relatives /Advocates,Aggrieved members of the public,Director of Medical services,Health institutions,Professional bodies/ Associations,Office of the Ombudsman, Media etc.

COMPLAINTS

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A. PRELIMINARY INQUIRY COMMITTEE1. Conduct inquiries into the complaints submitted to it under

these Rules and make appropriate recommends to the Board.2. Ensure that the necessary administrative and evidential

arrangements have been met so as to facilitate the Board to effectively undertake an inquiry under rule 6;

3. Promote mediation and arbitration between the parties and refer matters to such mediator or arbitrator as the parties may in writing agree; and

4. At its own liberty, record and adopt mediation agreements or compromise between the parties on the terms agreed and thereafter inform the chairperson.

DISPUTE HANDLING MECHANISMS

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1. Conduct inquiries into the complaints within such counties as the Board may specify and make appropriate recommendations to the Board;

2. Ensure that the necessary administrative and evidential arrangements have been met so as to facilitate the Board to effectively undertake an inquiry under rule 6;

3. Convene sittings in respective counties to determine complaints; 

4. Promote arbitration between the parties and refer matters to such arbitrator as the parties may in writing agree.

DISPUTE HANDLING MECHANISMS

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B) PROFESSIONAL CONDUCT COMMITTEE (“PCC”)

• The Full Board exercising judicial or quasi judicial functions to determine disciplinary matters is known as a Tribunal

• Board members act as the jury.

• The Tribunal hears matters referred to it by the Preliminary Inquiry Committee and the Professional Conduct Committee.

DISPUTE HANDLING MECHANISMS

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C. TRIBUNAL

a. To admonish a doctor, dentist or the institution and conclude thecase.b. Make an order compelling a medical practitioner or dentists to undergo

continuous professional development of not more than fifty points.c. Suspend the licence of a medical institution for a period of not more than

six months.d. Make an order for the closure of an institution pending the compliance by

that institution, of a conduction or requirement under the licence issued to it under the Act;

e. Make such further recommendations as the committee deems fit;f. Levy reasonable costs of the proceedings from the parties

Penalties underPreliminary Inquiry Committee (PIC) and Professional Conduct Committee (PCC)

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a) Admonish a doctor, dentist or institution and conclude the case.b) To place the doctor or dentist under probation( the Board may at itsown discretion direct the doctor or dentist to be supervised during the

probation period which does not exceed six (6) months.c) To order for the payment of costs for the Board’s sitting(s) to be paid by

the medical or dental practitioner or the institution on such terms as shall be deemed fit in the circumstances;

d) To direct the suspension of a doctor’s or dentist’s registration or licence for a period not exceeding twelve (12) months

e) To direct removal from the register;f) To suspend licenses for medical institutions for up to six (6) monthsg) To order the closure of medical/ dental institution until compliance with requirements of operating licenses.

PENALTIES UNDERTHE TRIBUNAL

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Thank you