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Official Translation Official Translation REPUBLIC OF LITHUANIA LAW ON THE AMENDMENT OF THE LAW ON HEALTH CARE INSTITUTIONS June 6, 1996, No. I-1367 Vilnius (amended as of November 13, 2001, No. IX-593) ARTICLE 1. The Revised Edition of the Republic of Lithuania Law on Health Care Institutions To amend the Law on Health Care Institutions as follows: “REPUBLIC OF LITHUANIA LAW ON HEALTH CARE INSTITUTIONS PART I GENERAL PROVISIONS CHAPTER I PURPOSE AND GENERAL CONCEPTS OF THE LAW ARTICLE 1. Purpose of the Law This Law shall designate the classification of health care institutions, principles of their founding, reorganisation, liquidation, operation, state regulation thereof, control measures, special features of administration and financing thereof, the nomenclature of institutions of the National Health Care System of Lithuania, relations between health care institutions and patients and the principles of liability in violations of this Law. ARTICLE 2. The Basic Concepts and Abbreviations Employed in the Law 1. Health Care Institution (further - institution): 1) an institution or enterprise having the right according to the procedure established by this Law and others and legislative acts, to provide health care services (further - services); 2) a branch or department of an institution or enterprise engaged in other (other than health care) activities, having the right to provide health care services. 2. LNHS denotes the Lithuanian National Health System, regulated by the Law on the Health System. 3. LNHS Activity Clients denote state government and municipal executive institutions and also, the State and area patients’ funds. 4. Private Institution denotes an institution, whose services are only available to groups of residents specified by this Law. 5. Health Care Services (further - services) denotes the result of activity based upon an agreement between an institution and clients. Clients of services may be the clients of LNHS activity designated by the Law on the Health System and other legal and natural persons. 6. Licensing denotes determining of the conformity of institutional activity to the requirements of legislative acts, recognition of the right to provide services to an institution and the issuance of a certificate of licensing. 7. State Medical Audit denotes official control and expert investigation of all types of property forms of legal and natural persons, who are engaged in personal health care activity, and the availability, quality (suitability) and economic effectiveness of the services supplied. 8. Patient denotes a person who avails himself of the services rendered by institutions, regardless of whether he is healthy or ill. 9. Free Services denote services funded from the state or local budgets, or compulsory health insurance fund, or local government health fund monies. These services are ordered for enterprises and paid for by the LNHS activity clients. 10. Accreditation denotes an evaluation, voluntarily initiated by an enterprise in order to formally establish whether it meets established standards of health care quality in the services being supplied and issuance of an accreditation certificate. CHAPTER II THE TYPES OF INSTITUTIONS, THEIR LICENSING, ACCREDITATION, REGISTRATION AND THE PRINCIPLES OF STATE ADMINISTRATION OF ACTIVITIES ARTICLE 3. Classification of Institutions 1. The following are classified as LNHS institutions licensed for health care: 1) state or municipal government public (further - public LNHS institutions) and budgetary institutions (further - LNHS budgetary institutions) of individual health care. The Law on Public Institutions shall apply to LNHS public institutions only insofar as it shall not contradict this Law; 2) state and municipal public and budgetary institutions of public health care; 3) state and municipal enterprises and enterprises, over 50 per cent of whose shares belong to the state or municipality; 4) other enterprises and institutions who have drawn up contracts with the State or area patients’ funds or with other LNHS activity clients according to the procedure established by laws, during the validity period of such contracts. 2. Groups of institutions shall be identified according to the types of health care services they provide: 1) individual health care; 2) public health care; 3) miscellaneous. 3. Individual health care institution types according to service rendering time and location shall be as follows: 1) outpatient; 2) in-patient; 3) miscellaneous. 4. Kinds of institutions of individual health care, according to the health care services they provide shall be as follows: 1) medical assistance; 2) nursing care and support treatment (nursing); 3) medical rehabilitation and sanatorium treatment; 4) medical-social expert examinations; 5) specialised medical expert examinations; 6) miscellaneous. 5. The public health care institution kinds according to the public health care services assortment shall be as follows: 1) public health monitoring and public health expert examination; 2) public health protection (food and other than food product safety, radiation safety, environmental hygiene, labour medicine); 3) non-infectious diseases prevention and control; 4) prevention and control of communicable diseases; 5) public health development; 6) miscellaneous. 6. Legislative acts and bylaws (statutes) of these institutions, which regulate the licensing of health care by these institutions shall establish the distribution of institutions according to classification indicators. ARTICLE 4. The Use of Name by Institutions 1. The mark of an institution must be registered according to the procedure established by the laws of the Republic of Lithuania. 2. The names of the types of institutions or the groupings thereof must conform to their classification indicators. ARTICLE 5. Licensing of an Institution to Provide Health Care 1. Enterprises and institutions may provide health care services only upon obtaining a licence and having been registered in the State Health Care Institution Register. 2. The State Service of Accreditation under the Ministry of Health Care (further - Accreditation Service) shall issue licenses (reregister), refuse to issue them, suspend validity of licenses, renew and terminate them. 3. The procedure of issuance of health care licenses and the requirements for obtaining a license, shall be established by Health Care Licensing Regulations, approved by the Government or its authorised institution, which shall indicate: 1) activity being licensed; 2) authorisations of institution issuing license; 3) documents required to obtain license: 4) procedure and terms of document examination: 5) license kinds and conditions of issuance; 6) procedure of license re-issuance or reregistering; 7) procedure of registration of licenses being issued; 8) instances of refusal to issue licenses; 9) licensed activity conditions including, rights and obligations of license holders; 10) procedure of supervision of adherence to license conditions; 11) instances of interruption, renewal and withdrawal of license validity and procedure thereof; 12) requisites of license form. 4. Other requirements and conditions may be stipulated as well, by the Health Care Licensing Rules. 5. The conditions of license issuance and activity being licensed must not depend on the type of enterprise or institution acquiring the license. 6. Licenses shall be issued for an unlimited period of time, however they must be reregistered after two years and afterwards, every 5 years. 7. A license or a substantiated written refusal to issue (reregister) a license, must be submitted to an enterprise or institution within forty calendar days from the day of receipt of all documents required for obtaining a license. 8. A stamp tax shall be paid for issuance (re-registration) of a license. 9. The Accreditation Service shall have the right of refusing to issue a license, if: 1) not all of the documents required to obtain a license have been submitted; 2) submitted documents fail to correspond to established requirements or documents have not been properly put in order; 3) an enterprise or institution submits incorrect or falsified documents; 4) health care conditions present at enterprise or institution fail to meet the requirements of licensing, established by legislative acts. 10. The Accreditation Service may upon own initiative, recommendation of state institutions supervising health care activity, or an acting administrator of the institution, interrupt or annul the validity of a license. The Accreditation Service must inform the institution in writing, within five calendar days from adopting the decision. 11. The Accreditation Service shall have the right to annul the validity of a license: 1) upon institution initiative; 2) when it comes to light that in order to obtain a license the institution has submitted incorrect data or falsified documents; 3) when the state institutions which supervise health care activities establish that over the current year, the institution has repeatedly violated Lithuanian Republic laws and other legislative acts regulating licensing activity; 4) when more than ninety calendar days have elapsed from the day when the license should have been reregistered, and the institution has not submitted an application to reregister it; 5) on the recommendation of an acting administrator of the institution, who in the course of an audit at the institution, has established legal act violations. 12. The Accreditation Service shall set the term during which the license shall be suspended. The term may not exceed three months. This interval may be prolonged by order of the Minister of Health Care. 13. Upon request by the institution, the Accreditation Service shall have a right to adopt a decision to renew license validity, only upon becoming convinced that the violations, due to which license validity had been suspended, have been eliminated. The institution shall remunerate the expenses encountered in connection with renewal of license validity. 14. The Accreditation Service shall have the right to annul validity of a licence: 1) upon institution initiative; 2) upon receiving notice regarding liquidation or reorganisation ( when an institution, suspends its activity as an independent economic entity) of the institution; 3) if, upon suspension of license validity, the institution has failed to eliminate violations, during the stipulated term, or has failed to apply for a renewal of license validity; 4) upon recommendation of State institutions which supervise health care activity, if having suspended the supply of a part or all of the services, the institution fails to eliminate violations within the stipulated term; 5) when within the current year, a repeated recommendation is received from State institutions which supervise health care activity, to suspend validity of the institution’s license. 15. A decision by the Accreditation Service, refusing to issue (reregister) a license and suspend, renew or annul its validity may, according to the procedure established by laws, be appealed within 30 calendar days from the day the decision was adopted. An appeal shall not suspend implementation of decisions of Accreditation Service. 16. The Accreditation Service shall publish in the “Official Gazette,” information regarding the issuance of a license, suspension, renewal or annulment of validity thereof. ARTICLE 6. Accreditation of Institutions of Health Care 1. Institutions holding a license and at least, three years of experience in providing corresponding health care services, shall have the right to apply for health care accreditation. 2. The Accreditation Service shall accredit institutions and annul their accreditation, adopting the decision according to the procedure of the Rules of Accreditation for Health Care, approved by the Ministry of Health Care. 3. The decision by the Accreditation Service to accredit or not to accredit an institution must be adopted no later than within one hundred and twenty calendar days from the day of receipt of all of the documents required for accreditation. The Accreditation Service must inform the institution in writing about the adopted decision within five calendar days. 4. An institution shall be accredited for not more than a five-year term. 5. Expenses related to accreditation, shall be compensated by the initiating institution. 6. In accordance with the procedure established by laws, a decision by the Accreditation Service may be appealed in court within a period of twenty calendar days from the day it was adopted. 7. Universities and scientific institutions, along with health care expert organisations shall prepare accreditation requirements. The Ministry of Health Care or its authorised institution, shall order the preparation of requirements, confirm and register them. ARTICLE 7. Registration of Licensed Institutions 1. Licensed Institutions shall be registered in accordance with Republic of Lithuania Laws and other legislative acts. 2. Licensed institutions must be registered in the State Health Care Institution Register (further-Institution Register). Institutions must be registered no later than within three work days from the day the license was issued. 3. The Ministry of Health Care or an institution authorised by it, shall establish an Institution Register, registering the institutions therein and keeping it. 4. The Institution Register shall be part of the integral state register system and shall constitute a secondary register. The Government shall approve the register bylaws. ARTICLE 8.Use of Institution Register Data 1. Legal and natural persons shall have the right to make use of Register data in accordance with the procedure established by the bylaws of this register. 2.Only the administrator of the Institution Register and Government institutions shall have the right to make use of Institution Register data concerning restricted institutions of the Ministries of Internal Affairs and National Defence. ARTICLE 9. Legislative acts and Regulatory Documents, Establishing Institution Activity 1. Activity of enterprises shall be established by: 1) this and other laws, Government Resolutions, and other legislative acts; 2) Lithuanian standards as well as, international and foreign country standards, legally recognised according to procedure established in the Republic of Lithuania; 3) medical norms of Lithuania, approved by orders of the Minister of Health Care; 4) hygiene norms of Lithuania, approved by orders of the Minister of Health Care; 5) health care methodology, approved by orders of the Minister of Health Care; 6) institution statutes (bylaws). 2. If there are no valid legislative acts or regulatory documents, required for the institution’s activity, the institution shall prepare in accordance with the procedure established by the Ministry of Health Care, the chief of the institution shall confirm by order, the internal standards, and methods of health care. 3. Internal standards of institutions and health care methods may not contradict Republic of Lithuania laws and the legislative acts listed in part 1 of this Article. 4. The statutes (bylaws) of enterprises shall be confirmed by their founders according to the procedure established by laws. ARTICLE 10. The Rights of the Ministry of Health Care on Issues of State Regulation of Institution Activities The Ministry of Health Care shall: 1) found, reorganise or liquidate the LNHS institutions subordinate to it, according to the procedure established by this Law; 2) together with state universities or state scientific institutions shall found, reorganise and liquidate institutions, according to the procedure established by this Law; 3) keep the institution register; 4) establish for subordinate institutions mandatory health care tasks and procedure for funding and implementation thereof; 5) submit proposals to Government regarding granting guarantees of loans, which the LNHS institutions shall accept from credit institutions; 6) establish requirements of adequacy and acceptability of health care; 7) prepare with the Ministry of Finance proposals to the Government on State Budget assignations for LNHS institutions; 8) forecast the need for health care specialists and form a state request order for training of such specialists; 9) supervise, how institutions adhere to required health care conditions, laws and other legislative acts and regulatory act requirements; 10) together with the Ministries of Internal Affairs and National Defence establish a procedure for supplying services in the restricted institutions within the national defence or internal affairs systems and with these ministries supervise how legislative acts and regulatory act requirements are being observed in these institutions; 11) having co-ordinated with the Statistics Department at the Lithuanian Republic Government, confirm statistics forms on institution activities, and the procedure of institution activity accounting and bookkeeping procedure; 12) establish together with the State Patients’ Fund the minimum LNHS institution location and structure requirements and services need; 13) perform these and other functions established by this and other laws. ARTICLE 11. Establishment of the Need of LNHS Enterprise Location, Structure and Services Requirements 1. The Ministry of Health Care together with the State Patients’ Fund shall establish the minimum requirements of LNHS institution location, and structure thereof and need of services. 2. The founders of LNHS institutions must ensure that the minimum requirements of LNHS institution location and structure thereof shall be met. ARTICLE 12. Investments in Health Care 1. The use of funds in order to expand the range of services, implement new health care technologies and improve health care accessibility and quality (adequacy) shall be considered health care investments. 2. Laws and other legislative acts shall establish the procedure of economic incentive of health care investments. ARTICLE 13. State Regulation of Service Costs 1. The Ministry of Health Care shall establish the cost of LNHS services supplied. 2. The cost of services supplied by institutions which do not belong to the LNHS shall be established by their governing bodies or owners according to the procedure established in the bylaws of these institutions. ARTICLE 14. Privatisation of LNHS Public Institutions of Individual Health Care LNHS public institutions of individual health care or their independent functional branches may be privatised according to the procedure established by laws and other legislative acts, if: 1) a license is refused to them; 2) the license issued to them is annulled; 3) a conclusion by the State Medical Audit Inspectorate exists concerning future inexpediency of the institution’s activity; 4) other stipulated by laws instances exist. ARTICLE 15. The Procedure of Hiring Chiefs and Health Care Specialists at LNHS Budgetary and Public Institutions, Their Divisions and Branches 1. Chiefs of state and local government budgetary and public institutions shall be hired by public tender for a five-year term. The public tender shall be organised and its rules confirmed by the founder of the corresponding institution, having co-ordinated the qualification requirements stipulated in tender conditions, with the Ministry of Health Care. 2. Chiefs of state and local government budgetary and public institutions shall become certified on a mandatory basis no later than within three-years of the formation of work contracts with them. During the term of a five-year contract, chiefs may be certified not more than one time, excepting instances of extraordinary certification. A certification commission, formed by the Minister of Health Care shall certify these chiefs in accordance with the procedure and requirements of the Ministry of Health Care. Uncertified chiefs shall be relieved of their duties upon the initiative of the Ministry of Health Care or founder according to the procedure established by laws. 3. Chiefs of state and local government budgetary and public institution divisions and branches shall be hired by way of a public tender for a term of five years. The chief of a corresponding institution shall organise the public tender and approve its bylaws. The chief of an institution shall have the right to organise certification of divisions and branches. 4. Persons who meet the qualification requirements approved by the Ministry of Health Care, may become chiefs of LNHS budgetary and public institutions and divisions and branches thereof. 5. A person over the age of 65 may not become chief of LNHS budgetary or public institution, its division or branch. 6. Standard bylaws of these institutions, approved by the Ministry of Health Care, shall establish the rights and obligations of chiefs of the LNHS budgetary and public institutions and, their divisions and branches. 7. Health care specialists of LNHS budgetary and public institutions, their divisions and branches, providing tertiary health care shall be hired by way of public tender for a five-year term. The chief of a corresponding institution shall organise the tender and approve its bylaws. 8. The provisions of paragraphs 1-7 of this Article shall not apply for chiefs of LNHS budgetary and public institutions their divisions and branches whose founders are the Ministry of National Defence or Internal Affairs Ministry. ARTICLE 16. Institution Bookkeeping 1. Institution books shall be kept in the Lithuanian language. Medical documents (history of illness or nursing, in-patient records, procedural designations, etc.) shall be filled in the Lithuanian language. Diagnosis of illness, medicine designations and recipes may be written in the Latin language. 2. The Ministry of Health Care shall establish the procedure of institution document storage. 3. The founder of the institution, having co-ordinated with the Ministry of Health Care, shall establish the procedure of storing documents of the institutions founded by the Ministries of National Defence and Internal Affairs. PART II HEALTH CARE INSTITUTIONS CHAPTER I INSTITUTIONS NOT UNDER LNHS ARTICLE 17. Founding of Institutions not under LNHS 1. Issues of the founding, reorganisation and liquidation of institutions which are not under the LNHS, shall be regulated by The Law on Enterprises, Law on Public Institutions, Law on the Institution Register, the laws of individual types of enterprises, other laws and legislative acts. 2. A licence, issued by the local authority within the territory whereof an institution is being founded, shall be required in order to establish institutions of primary healthcare not under the LNHS and the branches thereof. The local government council shall determine the procedure of issuing the licence. The licence shall be refused, if the establishment of primary healthcare institutions and (

  1. or)the branches thereof, shall be contrary to the programme (plan) for the development of primary healthcare approved by the local government council. ARTICLE 18. Limitations of Activity of Institutions not under LNHS Institutions not under LNHS shall be able to render all types of individual and public health care services, except for the individual and public health care services, included on the list approved by the Ministry of Health Care. ARTICLE 19. Special Features of Activity of Institutions not under LNHS 1. The expenses of institutions not under LNHS, for basic medical assistance to patients shall be compensated from funds of natural and legal persons who through their illegal activity have caused harm to these patients. The Law on Health Insurance shall regulate the budgetary funds principles and procedure of compensation of these expenses from the compulsory health insurance fund. 2. An expert medical investigation of temporary work disability at institutions not under LNHS shall be performed in accordance with the procedure established by the Ministries of Health Care and Social Security and Labour. ` 3. Institutions not under LNHS may use the services of LNHS institutions (investigations, specialist consultations, etc.) only in accordance with the contract drawn up with these institutions. The services shall be compensated according to contractual prices, which may not be less that the LNHS established prices. 4. Institutions not under LNHS jurisdiction must, according to their own competence and funded by own funds, implement urgent public health care measures, which shall be established by the Ministry of Health Care. 5. If according to the established procedure, institutions not under LNHS jurisdiction should receive funds from state or municipality budgets, the Ministry of Health Care and State Control officers authorised by it and local authority controllers shall have the right to verify how those funds are being used. CHAPTER II LNHS INSTITUTIONS ARTICLE 20. The Conception and Founders of LNHS Budgetary Institution 1. A LNHS budgetary institution is an institution totally or in part supported from state or local authority budgets. It also may receive funding from the compulsory health insurance fund, health funds and receive other non budgetary funds. 2. The founders of LNHS budgetary institutions, maintained from the State Budget, may be the Government, Ministry of Health Care, state services at the Ministry of Health Care, Ministry of Social Security and Labour, Ministry of Internal Affairs, Ministry of National Defence and county governors. 3. Municipal authority councils shall be the founders of the budgetary institutions maintained from the municipal authority budget. ARTICLE 21. The Republic of Lithuania Legislative Acts Establishing the Founding, Activity, Reorganisation and Liquidation of Budgetary Institutions The Law on Budgetary Institutions, Law on the Health System, this and other laws and legislative acts shall regulate issues concerning the founding, activity, management, reorganisation and liquidation of budgetary institutions. ARTICLE 22. Special Features of Budgetary Institution Management, Activity and Use of Funds 1. Budgetary institution bylaws shall establish the procedure of forming administrative bodies, competence, functions and liability of budgetary institutions. The administration which manages the institution in accordance with the procedure established in its bylaws shall be the managing body of a budgetary institution. Collective management bodies, whose bylaws shall be approved by the head of the administration, may be formed in a budgetary institution. 2. A budgetary institution shall have the right to form health care contracts with the clients of LNHS activity, other legal and natural persons regarding free and paid service supply, to receive non-budgetary funds for the supply of paid services. Budgetary institutions of public health care shall have the right to engage in the activity linked to their competence regarding publishing activities and to receive non-budgetary funding from these activities. ARTICLE 23. Nomenclature of the LNHS Budgetary Institutions of Individual Health Care The budgetary LNHS institutions of individual health care are: 1) medical centres for sport; 2) infants’ homes for infants with developmental disabilities; 3) organ and tissue transplantation bank established by the Ministry of Health Care; 4) court psychiatric and narcological personal expert examination institutions; 5) pathologo-anatomical expert examination institutions; 6) medical and social expert examination institutions; 7) restricted budgetary institutions of individual health care identified in this and other laws; 8) centres for illnesses of dependency; 9) other LNHS budgetary institutions the nomenclature whereof shall be established by the Government. ARTICLE 24. Nomenclature of LNHS State and Municipal Authority Institutions of Public Health Care 1. The LNHS budgetary institution of public health care is the health care bureau of the municipal authority. 2. LNHS budgetary institutions of public health care are: 1) county centre for the development of public health ???; 2) county public health centre; 3) specialised budgetary institutions of public health care, whose founder is the Ministry of Health Care: Centre for Public Health Development, ??? Nutrition Centre, Centre for the Prevention and Control of Communicable Diseases, Radiation Protection Centre, Centre for Health Information, Health Emergency Centre, AIDS Centre of Lithuania, State Mental Health Centre and other public health care institutions, established according to the procedure established by other laws and legislative acts; 4) divisions or branches of budgetary institutions of individual health care, implementing public health care; 5) Institute of Hygiene of the Ministry of Health Care, other state science institutions, university divisions or branches, having the right to engage in public health care. 3.The State Public Health Service shall co-ordinate the health care activity of the LNHS budgetary institutions of state public health care. 4.The LNHS budgetary institutions of public health care shall have the right to establish divisions or branches for the purpose of supplying public health care services. 5. The Ministry of Health Care shall approve the standard bylaws of LNHS budgetary institutions of municipal authority and state public health care. ARTICLE 25. Concept of Restricted Budgetary Institution and Special Features of the Establishment and Activities thereof 1. A restricted budgetary institution is an institution founded and maintained from state property and budgetary funds, providing services to groups of persons indicated by laws and implementing health programmes. 2. Restricted budgetary institutions may be founded to provide health care only within locations of active service military, persons located in deprivation of liberty and pre-trial detention centre areas, mental patients, who have committed dangerous crimes against society and have been adjudged criminally incapable and illegal immigrants. These institutions shall also implement public health care measures, included on the list of the Ministry of Internal Affairs or the Ministry of National Defence and approved by the Ministry of Health Care. 3. The Ministry of Health Care shall have the right to establish a restricted budgetary institution for the health care of mental patients, who have committed dangerous crimes against society and have been adjudged criminally incapable. Following co-ordination with the Ministry of Health Care, other state institutions, designated by laws, shall also have the right to found restricted budgetary institutions for the health care of active service military personnel and persons posted in deprivation of liberty or pre-trial detention areas, police detention facilities, distribution units and illegal immigrants. 4. The statutes of restricted budgetary institutions established within national defence and also the internal affairs systems, shall be approved by their founders, following co-ordination with the Ministry of Health Care. 5. State medical audit of a restricted budgetary institution shall be conducted in accordance with the procedure established by the Government or institutions authorised by it. ARTICLE 26. The Conception and Status of LNHS Public Institution 1. A LNHS public institution shall be a public institution founded from state or municipal authority assets and funds, supplying the services stipulated in its bylaws according to the contracts with clients. 2. A public institution shall be a non-profit institution. It may not distribute the acquired income among its founders, and shall use it only in accordance with the procedure stipulated by laws and legislative acts. ARTICLE 27. The Founders of LNHS Public Institution 1. Founders of a LNHS public institution may be: 1) the Ministry of Health Care; 2) county governors; 3) municipal councils; 4) state universities with the Ministry of Health Care, upon obtaining permission of the Government; 5) state culture and science institutions with the Ministry of Health Care, upon obtaining permission of the Government; 2. Founders of LNHS institutions may authorise other institutions also, to implement functions assigned to their competence. ARTICLE 28. Competence of Founder (Founders) of LNHS Public Institution Competence of LNHS public institution founder (founders) shall include: 1) adoption, amending and supplementing the bylaws of LNHS public institution; 2) stipulation mandatory activity tasks; 3) obtaining information concerning activity of the LNHS public institution; 4) establishing or participating in the establishment of service costs and methods of computing them according to the procedure established by law; 5) establishing regulatory norms of the LNHS public institution expenditures, designated for labour compensation and medicines, or assigning the LNHS public institution to confirm them itself; 6) organising of public tender to fill the position of LNHS public institution administration chief and approving the bylaws of this tender and forming a labour contract with the winner of this tender and also, to withdraw this contract in accordance with the procedure established by laws; 7) detail the procedure of use, administration and disposal of assets of LNHS public institution, in accordance with the procedure established by the Government or its authorised institution. 8) determine the salaries of members of administrative bodies and auditor; 9) found branches of LNHS public institution, reorganise and liquidate a LNHS public institution; 10) possess other rights and obligations, provided they are not contrary to laws. ARTICLE 29. The Bylaws of LNHS Public Institution 1. The bylaws shall constitute a legal document, which a LNHS public institution shall follow. 2. The following must be indicated in the bylaws of a public institution: 1) name of institution; 2) location; 3) founders of institution; 4) founders’ rights, obligations; 5) institution’s area of activity, goals and tasks; 6) competence of the founders’ meeting and procedure of convocation (if there are several founders); 7) competence of supervisors’ council; 8) council and procedure of convocation of this council; 8) procedure of public tender for hiring administration and branch officials and specialists, competence, functions and liability of these bodies; 9) procedure of forming administrative bodies and recalling of the members thereof and the competence, functions and liability of these bodies; 10) procedure of founding and liquidation of branches; 11) procedure of disposing of the assets of institution; 12) funding sources and procedure of using funds; 13) control of financial activities; 14) procedure of amending and supplementing bylaws; 15) procedure of institution’s reorganisation and liquidation; 16) terms of institution’s activity; 17) other provisions linked with special features (specifics) of institution’s activity, which are not contrary to laws. 3. The institution’s administration, its collective administrative body and founder (founders by joint decision) shall have the right to amend and supplement bylaws. Amended or supplemented bylaws shall be approved by the founder (founders). 4. Amendments and supplements to the bylaws shall enter into force from their legal re-registration according to the procedure established by laws. ARTICLE 30. Administrative Bodies of LNHS Public Institution 1. A public institution must have an administration chief, who shall form labour contracts with health care specialists and other institution personnel or inate them in accordance with laws. The chief of the administration, having co-ordinated with the institution’s supervisors’ council, shall approve the procedure of compensation of institution personnel. The bylaws of the LNHS public institution shall establish other functions and competence of chief of administration. 2. The administration shall be a essential governing body of a LNHS public institution. It shall organise and administer the institution’s activity. The chief of administration shall approve administration’s labour regulations. 3. A public institution must have a chief financial officer (bookkeeper) or his functions may be performed according to contract, by another legal person or an institution not having the rights of legal person. ARTICLE 31. Advisory Governing Bodies of LNHS Public Institutions 1. LNHS personal public health care institutions must have an supervisors’ council, treatment council and nursing council. A LNHS public institution of public health care, which is engaged in secondary and tertiary health care, must have an supervisors’ council. 2. The bylaws of LNHS public institutions shall determine the number of members in the collective governing bodies, procedure of forming these bodies, the rights and obligations of its members, conditions or work salary payment and liability. ARTICLE 32. Administration Chiefs of State Universities, State Scientific Institutions and Institutions Founded by the Ministry of Health Care A state university or scientific institution together with the Ministry of Health Care shall organise a public tender for the position of administration chiefs of state universities, state scientific institutions and institutions which were established by the Ministry of Health Care. The Minister of Health Care shall form and terminate a contract with the institution chief who won the public tender. ARTICLE 33. Supervisors’ Council of LNHS Public Institution 1. A supervisors’ council shall be set up in order to ensure the openness of a LNHS public institution. 2. The LNHS public institution’s supervisors’ council (further - supervisors’ council) is an advisory body, set up for a five-year term. 3. With the exception of institutions founded by state universities or state scientific institutions and the Minister of Health Care, the supervisors’ council shall be comprised of two representatives, appointed by the founder (founders) of the institution by joint decision; one council member appointed by the council of the municipality in which the institution is located; one public representative appointed by the council of the municipality in which the institution is located and one representative appointed by the professional health care specialists’ union. 4. The supervisors’ council of state university or state scientific institution and institutions founded by the Ministry of Health Care, shall be comprised of two representatives appointed by the Ministry of Health Care, two representatives appointed by heads of state universities or state scientific institutions; one from the municipality within the area of which the state university is located, a council member appointed by the council; one from the area where the state scientific institution is located, a representative appointed by the council and one representative of this institution appointed by the professional health care specialists’ union. 5. Persons who are employed in the institution administration, and the State or area Patients’ Fund, as well as those in the health insurance enterprise, may not be part of the supervisors’ council. ARTICLE 34. The Treatment Council and Nursing Council of LNHS Public Institution 1. The treatment council of LNHS public institution (further-treatment council) shall be comprised of institution departments and branch physicians. 2.The treatment council shall deliberate issues of organisation and improvement of personal health care, periodically hold clinical conferences, deliberate issues on the acquisition of new health care technologies. With respect to issues being deliberated the treatment council may submit proposals to the institution administration of a recommendation capacity. Should the administration fail to agree with the proposal, the treatment council may submit its proposal to the founder (founders). 3. The nursing council of a personal health care institution (further-nursing council) shall be comprised of nursing specialists of the departments and branches of the institution. 4.The nursing council shall deliberate issues regarding organisation and improvement in patient nursing. This council may submit on deliberated issues recommendation type proposals to the institution’s administration. Should the administration fail to agree with its proposal, the nursing council may submit its proposal to the founder (founders). 5. The administration chief of the institution or an administration staff member, authorised by him as representative shall chair the treatment or nursing council. The bylaws of public institutions shall establish the formation of a treatment or nursing council, rights and obligations of these councils, work procedure, members’ rights and obligations, conditions of appointing or dismissing them, conditions of work compensation and liability. ARTICLE 35. The Medical Ethics Commission of LNHS Public Institution 1. A medical ethics commission, which shall control how the requirements of medical ethics are being adhered to, shall be established at the LNHS public institution. 2. Standard bylaws of the medical ethics commission of the LNHS health care institution, approved by the Ministry of Health Care shall establish the procedure of formation and activity of the medical ethics commission of the LNHS public institution. ARTICLE 36. Assets of Public Institution 1. Assets of a public institution shall be comprised of long-term material assets, assets received as charity or assistance, assets received as inheritance, financial resources and other legally-acquired assets linked with the activity of the institution. 2. State and municipal institutions (founders) shall transfer assets to public institutions on a use basis in accordance with the procedure established by laws and the Government. 3. The LNHS public and state public health organisations of public health may, according to the procedure established by the Government or an institution authorised by it sell, transfer, lease, exchange long-term material assets, and also warrant or guarantee by it fulfilment of obligations of the other entities, only upon written approval of the founder (founders). The Ministry of Health Care shall issue such a license to state university institutions or state scientific institutions and institutions founded by the Ministry of Health Care. 4. A public institution, having sold obsolete or not required by its activities material assets, shall use the acquired assets according to the procedure established in its bylaws. ARTICLE 37. Liquidation of a Public Institution 1. The basis for liquidation of a public institution may be: 1) expired time limit of the institution’s activity as stipulated by the statutes; 2) decision adopted by the founder (founders) to liquidate the public institution, adopted according to the procedure established by laws and institution statutes; 3) court decision to liquidate public institution for violations of the law, established by laws. 2. An institution which has decided to liquidate the public institution, shall appoint a liquidator, establish terms of liquidation and the procedure of inventory and transfer of assets. The collective governing body and administration shall lose its authorisation and its functions shall be performed by the liquidator. 3. Documents of the public institution under liquidation, shall be kept in accordance with the procedure established by the Law on Archives. 4. In liquidating an institution, its employees shall be relieved of their duties in accordance with the procedure established by the Law on Labour Contract. 5. Upon drawing up of the act of liquidation of a public institution, published reports shall be issued twice within an interval of no less than one month occurring between these. 6. The remaining assets shall be transferred to the founders in accordance with the procedure established in the bylaws. ARTICLE 38. The Powers of the Liquidator of a Public Institution 1. The liquidator of a public institution shall have the rights and responsibilities of a head of administration of the institution. He shall represent the institution being liquidated among state or municipal institutions, in court and in relations with other legal or natural persons. 2. The liquidator of a public institution shall: 1) prepare the financial accounting record (balance of liquidation) of the institution at the time of the commencement of the liquidation; 2) settle creditors’ accounts according to the procedure established by laws; 3) complete the implementation of obligations in accordance with previously formed transactions of the institution and forms transactions in connection with the liquidation of an institution; 4) shall transfer the remainder of the public institution’s assets to the founder (founders); 5) draw up the act of liquidation of a public institution; 6) strike the liquidated institution from the register according to the procedure established by laws. 3. The liquidator shall be liable to the institution and the founder (founders) for the losses incurred through his fault. ARTICLE 39. The Nomenclature of LNHS Municipal and State Public Institutions of Individual Health Care 1. The nomenclature of LNHS municipal public institutions of individual health care: 1) primary health care centres; 2) municipal polyclinics; 3) municipal out-patient facilities; 4) mental health centres; 5) general practitioner doctors’ offices; 6) general practitioner dentists’ offices; 7) municipal medical units; 8) municipal first aid stations or subsidiaries acting as independent legal persons or departments of primary health care centres, indicated in items 1 and 2 of paragraph 1 of this Article; 9) municipal maintenance treatment and nursing hospitals; 10) city and district municipal hospitals, included on the list approved by the Ministry of Health Care (they may have departments-consultation polyclinics); 11) medical rehabilitation and sanatorium treatment institutions, included on the list approved by the Ministry of Health Care. 2. The institutions indicated in items 2 - 9 of paragraph one may act as separate legal persons or may be reorganised through joining into primary health care centres. 3. The local government executive institution shall organise and administer the institutions of the nomenclature indicated in paragraph 1 one of this Article located in the territory of the municipality, according to the minimum regulatory acts of LNHS institution location, requirements of their structure and need of their services. 4. The nomenclature of state public institutions of personal health care which are subordinate to counties: 1) county hospitals, included on the list approved by the Ministry of Health Care (they may have branches namely, consultative polyclinics) ; 2) specialised hospitals, institutions of medical rehabilitation and sanatorium treatment, included on the list approved by the Ministry of Health Care; 3) blood donation institutions; 4) county maternity homes. 5. County governors shall organise and administer institutions of the nomenclature stipulated in paragraph 4 of this Article, according to established minimum requirements of LNHS institution location, their structure and need of services. 6. Nomenclature of state public health care institutions of personal health care, which are under the jurisdiction of the Ministry of Health Care. 1) institutions founded by state universities or state scientific institutions and the Ministry of Health Care; 2) blood donation institutions; 3) specialising hospitals, medical rehabilitation and sanatorium treatment institutions, included on the list approved by the Ministry of Health Care. 7. The Ministry of Health Care shall organise and administer the institutions of the nomenclature stipulated in paragraph 6 of this Article according to minimum requirements of LNHS institution location, structure and need of services. ARTICLE 40. Nomenclature of LNHS State and Municipal Public Institutions of Public Health Care 1. The LNHS state and municipal public institutions of public health care are: 1) LNHS municipal public institutions of public health care, whose founders are municipal councils; 2) a Centre of Health Law and Economics, whose founder shall be the Ministry of Health Care; 3) other LNHS State public institutions of public health care, whose founders are the Ministry of Health care or county governors. 2. LNHS State and municipal public institutions of public health care shall implement their activities and supply services according to contracts with the clients ( municipal executive institutions, county governors, state institutions, other legal and natural persons) of this activity and services. 3. The list and standard bylaws of LNHS municipal and state public institution of public health care shall be confirmed by the Ministry of Health Care. ARTICLE 41. Funding of LNHS Institutions from State and Municipal Budgets 1. The allocations from the State Budget intended for health care shall: 1) support restricted budgetary institutions stipulated by this and other laws; 2) support budgetary institutions whose founders are the Government, or its authorised institutions (ministries, county governors, state services); 3) fund individual and public health care of refugees, illegal immigrants; 4) fund public health care measures established by the Ministry of Health Care along with the Ministry of Internal Affairs, or the Ministry of National Defence, at institutions and units subordinate to the Ministry of National Defence and the Ministry of Internal Affairs; 5) fund public health care measures, intended to prevent the occurrence and spread of dangerous and especially dangerous communicable diseases, liquidate outbreaks of communicable diseases and epidemics, and also to prevent the occurrence of medical effects of radiation accidents and ecological disasters, and measures of the liquidation thereof; 6) fund state health programmes; 7) fund applied research in medical science according to priority programmes approved by the Ministry of Health Care, provided that this research shall be dedicated to resolve actual problems of LNHS administration and the protection, restoration and strengthening of health, service adequacy, accessibility, rendering thereof, and expansion of social justice to solve urgent problems. 2. From municipal budget allocations intended for health care to: 1) support budgetary institutions whose founder is the municipal council; 2) provide additional support for the care of persons in need of social support categories as established by the municipal councils; 3) fund compulsory health programmes of municipalities; 4) finance primary public health care measures established by the Ministry of Health Care. These measures must be co-ordinated with the Lithuanian Association of municipalities. 3. Public institutions shall have the right to obtain state and municipal budgetary funds for providing services according to health care contracts with the Ministry of Health Care, county governor and mayor of the municipality. 4. Extraordinary LNHS expenses may be funded from the state or municipal budgets and through state investment programmes. ARTICLE 42. Accounting of Non-medical Expenditures at LNHS Institutions Should a LNHS institution engage not only in health medical care, but also in non-medical activity, it must keep separate health care and non-medical expenditure accounting, to the procedure established by legislative acts. ARTICLE 43. The Procedure of Funding Student and Resident Training and Improvement of Health Care Specialist Qualifications at LNHS Institutions 1. The corresponding training institutions or the trainees themselves, shall cover student and resident training expenses at LNHS institutions, according to the procedure and conditions established by the Ministry of Health Care. 2. LNHS institutions shall have the right to compensate for the training of residents in accordance with the procedure and conditions established by the Ministry of Health Care or the Compulsory Health Insurance Council under the Government of the Republic of Lithuania. 3. The expenses of professional improvement training of LNHS institution health care specialists shall be compensated according to the procedure established by the Ministry of Health. CHAPTER III THE RIGHTS AND RESPONSIBILITIES OF INSTITUTIONS ARTICLE 44. Institution Rights The Law on the Health System, this and other laws and legislative acts shall establish the rights of health care institutions. ARTICLE 45. The Responsibilities of an Individual Health Care Institution 1. An individual health care institution must: 1) ensure basic medical assistance; 2) ensure that the basic public health care measures, required in accordance with the list approved by the Ministry of Health Care, be implemented; 3) provide only such individual health care services as indicated on the license issued to the institution; 4) use only those health care technologies which are approved according to established procedure and (
  2. or)permitted to be used in the Republic of Lithuania. The medical products must be included in the Register of Medical Products, whose bylaws shall be approved by the Ministry of Health Care; 5) fill in and protect patients’ medical case histories and out-patient cards and provide information concerning the patient to state institutions and other institutions according to the procedure established by the Ministry of Health Care; 6) ensure equal rights of patients to health care services that are being rendered; 7) compensate for the harm inflicted upon the patient’s health in the course of rendering services; 8) protect the medical confidentiality of patient, with the exception of instances, when a personal health care institution must provide information regarding the patient or when the patient agrees to have the information concerning the state of his health, made public; 9) inform the Ministry of Health Care, institution founders or owners, according to the procedure established by legislative acts, concerning instances or outbreaks of internal infection and other cases of harm inflicted upon the health of patients; 10) supply free, planned health care services, upon ascertaining that the patient has a right to receive such services. ARTICLE 46. Internal Procedure Regulations of Individual Health Care Institutions 1 Individual health care institutions must have internal procedure regulations and ensure that they would be accessible for patient familiarisation. 2. The internal procedure regulations must indicate: 1) the procedure of patient application to the institution; 2) nomenclature and assortment of free services and procedure of the rendering thereof; 3) patient rights and responsibilities at the institution; 4) procedure of patient visiting, discharge and transfer to other individual health care institutions; 5) procedure of settling disputes and conflicts between the institution and patients; 6) procedure of providing information to patient and his family, concerning the state of his health; 7) procedure of making duplicate copies of case histories of illness, out-patient cards and other documents, and issuance thereof to patient or other natural or legal persons; 8) work hours of the administration of the institution and its other support services; 9) provisions of the laws regulating work safety, and of other legislative acts and regulatory documents; 10) procedure of registration and safekeeping of articles made of precious metals, expensive prostheses and money, in the patient’s possession. 3. Institution employees must have a job description. ARTICLE 47. The Procedure of Admitting a Patient to an In-patient Institution 1. It shall be prohibited to admit a person to an in-patient institution without his approval. 2. It shall be prohibited to admit to an in-patient institution a minor or legally incapable person without the approval of his legal representatives. 3. The approval of a patient or of his legal representatives shall not be required if: 1) the person’s life is endangered and he himself is unable to give such approval; 2) the minor’s or legally incapable person’s life is endangered and it is impossible to locate his legal representatives quickly; 3) other instances established by laws. 4. The procedure of a person’s speedy admission to an institution shall be established by the Ministry of Health Care. ARTICLE 48. Patient Registration at Individual Health Care Institutions 1. Institutions must administer patient registration and submit to the Ministry of Health Care, or an institution authorised by it, approved forms concerning the health care of patients. Every patient’s record must be arranged to include an illness or nursing history, an out-patient card or an entry in the registration journal concerning his application. The originals of these documents shall be kept at the institution. 2. The Ministry of Health Care shall establish the procedure of submitting patient registration and accounting about the patients’ health care. ARTICLE 49. The Responsibilities of a Health Care Institution Following The Death of a Patient 1. Following the death of a patient, the institution must inform the members of his family, his legal representatives, or in the event he is still living, persons, designated by him not later than within a period of 12 hours. 2. The Ministry of Health Care shall establish the procedure of certification of a patient’s death at the institution. 3. Upon death of a patient at an institution, an autopsy shall be performed by a pathologist in cases: 1) members of the family of the deceased or his legal representatives demand this; 2) death occurs suddenly and unexpectedly; 3) cause of death is unclear; 4) death occurs following surgical interventions, diagnostic or treatment procedures; 5) death occurs as a result of occupational or infectious diseases or a suspicion arises that an occupational or infectious disease is the cause of death; 6) a new-born infant or child dies; 7) a pregnant woman or one giving birth dies; 8) a person, who has not spent 24 hours as an in-patient, dies; 9) in other instances stipulated by law. 4. Following the death of a patient, a legal medical expert examination shall be performed in instances when: 1) death occurs as a result of an injury, poisoning or criminal abortion; 2) identity of the deceased is unknown; 3) suspicion exists that violence is the cause of sudden death; 4) it is impossible to establish the cause of death by any other means; 5) in other instances stipulated by law, upon obtaining a requirement from law protection institutions. 5. The institution shall guarantee free protection of the body of the deceased until such time as it shall be claimed by members of the family of the deceased, his legal representatives, or the persons stipulated by the patient, while still alive, but no longer than covering a period of 4 days, following an autopsy by a pathologist or performance of a legal medical expert examination. 6. Upon expiration of the time limit indicated in paragraph 5 of this Article, the body of the deceased shall be released to the local morgue. ARTICLE 50. The Responsibilities of a Public Health Care Institution 1. A public health care institution must: 1) ensure implementation of basic public health care measures; 2) provide only such services, as are stipulated by the accreditation certificate issued to the institution; 3) employ only such research methods and only those health care technologies which are approved and allowed in the Republic of Lithuania; 4) ensure the commercial confidentially of natural and legal persons. 2. The laws and other legislative acts may also establish other responsibilities for public health care institutions. ARTICLE 51. Internal Procedure Regulations of Public Health Care Institutions 1. Public health care institutions must have internal procedure regulations approved according to the procedure established by the statutes of the institution. 2. The internal procedure regulations must indicate: 1) the procedure governing applications by natural and legal persons to the institution; 2) the rights and responsibilities of legal and natural persons in connection with the institution; 3) the procedure of resolving disputes and conflicts arising between the institution and legal or natural persons; 4) the procedure of providing information to interested legal and natural persons, concerning the institution’s activity; 5) the institution’s work hours and distribution thereof. 3. Employees of the institution must have job descriptions. PART III SUPERVISION OF THE ACTIVITY OF INSTITUTIONS ARTICLE 52. State Supervision of the Services Provided by Institutions 1. State supervision of the services provided by institutions irrespective of the form of their assets, shall be implemented by: 1) officers appointed by the Minister of Health Care; 2) State Medical Audit Inspection - state supervision regarding accessibility, quality (suitability) and economic effectiveness of individual health care services; 3) State and local Patients’ Fund - of individual health care services, compensated from the compulsory health insurance fund budget, quantity and quality control, and the financial and economic analysis of the use of compulsory health insurance fund money at institutions having contracts with local patients’ funds for rendering services and compensating; 4) Lithuanian Medical Ethics Commission - of state supervision of the correspondence of services, rendered by an individual health care institution, to medical ethics requirements; 5) State Public Health Care Service - of state supervision of accessibility, adequacy and effectiveness of services rendered by public health care institutions; 6) State Hygiene Inspectorate under the State Public Health Care Service - State hygiene control. 2. State control of services at health care institutions, the founders whereof are the Ministries of National Defence and Internal Affairs, shall be exercised according to the procedure established by the Government or its authorised institutions. ARTICLE 53. The Rights and Responsibilities of State Institutions Controlling Rendering of Services 1. The heads of the institutions, indicated in Article 53 of this Law, or the officers appointed by them (further-officers), shall have the right: 1) to enter an institution without hindrance and verify, at any time, upon submitting a document of appointment to the head or his representative, whether the requirements of legislative al and (
  3. or)regulatory documents are being violated; 2) to request and obtain the required information, documents, material, laboratory exams, data on patient medical check ups and test results, verbal and written explanations of institution heads and other employees, which are required in order to effect verification; 3) to request additional tests for patients; 4) to submit a substantiated proposal to the Minister of Health Care or his authorised representative, to interrupt or annul the validity of a doctor’s medical practice licenses or other licences established by laws to engage in health care; 5) to request the head of administration of an institution to remove health care experts for up to one month, and verify their professional competence, if professional shortcomings have been established in the activities of these experts, that could have posed or did pose harm or danger to patients’ health, or if the qualifications of health care experts do not meet the stipulated requirements, or if these specialists are unable to perform their duties due to the state of their health. The Ministry of Health Care shall establish the procedure of verification of the professional competence of health care specialists. During the period of suspension from work, work compensation shall be withheld from health care specialists; 6) to bring charges according to the procedure established by laws, against workers of an institution for violations of laws and other legislative acts of health improvement practices. 2. The head of administration of an institution must comply with the request of an officer to dismiss a health care expert. A health care expert shall have the right to lodge a complaint against such a decision by an officer, with the Ministry of Health Care, which must examine his application within seven days from the day it was submitted. 3. An officer must submit within the stipulated time limit, an act of verification, conclusions and recommendations to the head of the institution who ordered the verification investigation and the head of the institution which was being investigated. 4. Interference with the officer’s performance of his duty, shall bring upon the head of the institution liability established by laws. 5. For exceeding their authority, officers shall be liable in accordance with the procedure established by laws. ARTICLE 54. Termination of the Rendering of Services at an Institution 1. The Accreditation Service, State Medical Audit Inspection, State Public Health Care Service and State Hygiene Inspectorate shall have the right to terminate the rendering of certain or all services at an institution, by decisions adopted according to their competence if: 1) the institution or a department (branch) thereof, shall engage in a type of activity for which they do not hold a licence or accreditation certificate; 2) health care provided by an institution or by a division thereof, shall fail to correspond to legislative acts or requirements of regulatory documents and therefore, shall pose actual danger to the health of patients or cause harm to people’s health and losses to legal and natural persons; 3) the institution is not registered in the Institution Register or is registered in violation of the requirements of this Law and has not been implementing the requirements of the register administrator for more than 3 months; 4) persons not having the right engage in health care are engaged in it, at the institution; 5) the premises, operation and health care technologies of an institution or a branch thereof, fail to correspond to requirements of legislative acts and (
  4. or)regulatory documents. 2. The rendering of services by an institution may be interrupted for not more than 3 months. The state institutions indicated in part 1 of this Article, having adopted such a decision, must inform the head of the institution about actual motives behind such a decision and the time limit for the elimination of violations or shortcomings. 3. Heads of an institution, who fail to implement the decisions adopted according to this Law, to interrupt provision of all or a part of the services, shall be liable in accordance with the procedure established by laws. 4. Following interruption of health care supply at a personal health care institution, patients of the institution shall be transferred (re-registered) to other institutions according to the procedure established by the Ministry of Health Care. 5. An institution must eliminate the shortcomings over the time limit indicated by state institutions in Part 1 of this Article. Following the elimination of obstacles, the activity of the institution may be renewed per directive of the state institutions indicated in part 1 of this Article. 6. Should the institution fail to remove obstacles over the established time limit, the institution which has interrupted activities shall apply to the Accreditation Service regarding annulment of institution accreditation and to the Ministry of Health Care concerning the removal of the administrative bodies of the institution and appointment of a temporary administrator. ARTICLE 55. Procedure of Removal of the Administrative Bodies of an Institution and Appointment of a Temporary Administrator 1. The administrative bodies of the institution shall be removed and a temporary administrator appointed if: 1) the institution shall not eliminate established violations or shortcomings and a threat be posed as a result of this, that services rendered by it shall be unsuitable and prove to be harmful to the health of patients, however there still exists an actual possibility of remedying the situation; 2) within that same year an outbreak of hospital infection shall recur at the institution, due to the shortcomings in the institution’s administrative activity; 3) more than one case of death shall occur within the same calendar year, at the institution, through the fault of an institution specialist or several specialists. 2. A temporary administrator shall be appointed for a period of up to 6 months. Upon request of the temporary administrator, the Minister of Health Care may extend this request for up to a one-year term. ARTICLE 56. The Temporary Administrator of an Institution 1. The temporary administrator of an institution is the head of the health care institution designated by the Minister of Health Care for the period of removal of the administrative bodies of an institution. The Ministry of Health Care shall establish qualification requirements of temporary administrators. The employee of an institution whose administrative bodies are being removed, may not become a temporary administrator of the institution. The Minister of Health Care or his appointed representative, shall form or annul the contract with a temporary administrator. 2. All of the authorisations of the governing bodies of the institution shall be transferred to the temporary administrator from the day of the temporary administrator’s appointment. 3. The temporary administrator shall have the right to annul or form labour contracts with members of the administrative bodies and other employees. 4. The temporary administrator is not obligated to comply with the decisions of the institution’s founder with the exception of the instances cited in part 5 of this Article. 5. The temporary administrator can not sell or otherwise transfer, mortgage property, reorganise or liquidate the institution, resolve other questions within the exclusive competence of the institution founder or owner. 6. The temporary administrator must inform the Minister of Health Care, the Accreditation Service and the institution founder or owner about the progress and results of administrating, according to the procedure and terms established by them. 7. The temporary administrator must establish revision of the institution and perform hygienic, epidemiological, labour safety and medical audit expert examinations. Expert examinations must be conducted within a 3-month period from the day of appointment of the temporary administrator. 8. Having established violations of laws, other legislative acts and (
  5. or)regulatory documents, in the course of revision, the temporary administrator shall apply to the Accreditation Service for annulment of licence and inform the Ministry of Health Care thereof. 9. The temporary administrator shall answer for the harm caused to the institution through his fault, according to the procedure established by laws. ARTICLE 57. Recall of the Temporary Administrator of the Institution The temporary administrator of an institution shall be recalled prior to the expiration of his term, per order of the Minister of Health Care if: 1) the Accreditation Service establishes, that the institution may function in a reliable and stable manner; 2) validity of licence of the institution is cancelled. ARTICLE 58. The Rights of State Institutions which Supervise Institution Activities 1.The state institutions indicated in this Law, which supervise the activity of institutions, shall according to their competence, have the right to: 1) admonish the institution regarding the shortcomings and violations in its activities and establish the terms of their elimination; 2) issue administrative reprimands to the heads of administrative bodies in accordance with the law; 3) require, that the professional qualification of the institution’s health care specialists be verified; 4) to interrupt the rendering of all or a part of the services; 5) to enjoy other rights established in this and other laws. 2. The state institutions, indicated in this Law, which supervise institution activity shall apply control measures and sanctions to institutions, taking into consideration the content of violation on the basis whereof the control measure shall be applied. 3. The decisions of the state institutions indicated in this Law, which supervise institution activity, concerning control measures or application of sanctions, may be appealed during a period of 30 days, in accordance with the procedure established by law. The appeal shall not interrupt implementation of the decisions by the state institutions supervising the activities of institutions, cited in this Law. ARTICLE 59. The Principles and Procedure of Applying Control Measures of Institutions’ Activities 1. State institutions which supervise the activities cited in this Law, shall adopt a decision concerning the measures of supervision of institution activities and application of sanctions stipulated in this Law, if at least one of the following conditions shall be present: 1) the state institutions cited in this Law which supervise the activity of institutions, have not been furnished the information or documents necessary in supervision of institution activity, or such information and documents fail to correspond to reality; 2) the laws which have been violated and requirements of other legislative acts and (
  6. or)regulatory documents, regulating the activity of institutions. 2. The question of applying a control measure to an institution shall be deliberated in the presence of its representatives. Should the representatives of an institution fail to be present at the deliberation of the question, the decision to apply a control measure shall be adopted without them. 3. The decision regarding application of control measures, with the exception of the control measure, indicated in item 2 paragraph 1 of Article 58, must be adopted within 3 months of the day of the establishment of the violation. Control measures may not be applied for violations from the day of establishment of the committal whereof, more than one year has elapsed. ARTICLE 60. Activity Supervision of Restricted Budgetary Institution 1. Activity supervision control of a restricted budgetary institution shall be carried out according to the procedure established by the Government. ARTICLE 61. Final Provisions 1. Active personal and public health care institutions must obtain licences for the health care activities they engage in, by December 31, 2002, in accordance with the planned schedule approved by the Lithuanian Republic Ministry of Health. Health care rendered by these institutions without a licence, shall become illegal from January 1, 2003. 2. Heads of LNHS public and budgetary institutions must be certified within three years from coming into force of this Law. ARTICLE 2. Acknowledgement of Laws as Being no Longer Valid 1. To acknowledge that the Republic of Lithuania Law on Implementation of the Republic of Lithuania Law on Health Care Institutions shall be considered as invalid. 2. To acknowledge that Article 1 of the Republic of Lithuania Law on the Amendment of the Law on the Implementation of the Law on Health Care Institutions shall be considered as invalid. I promulgate this Law passed by the Seimas of the Republic of Lithuania. PRESIDENT OF THE REPUBLIC VALDAS ADAMKUS

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