REPUBLIC OF LITHUANIA

REPUBLIC OF LITHUANIA REPUBLIC OF LITHUANIA LAW ON HEALTH CARE INSTITUTIONS No. I - 1367 Vilnius June 6, 1996 PART I GENERAL PROVISIONS Chapter I PURPOSE AND GENERAL CONCEPTS OF THE LAW Article 1. Purpose of the Law This Law shall designate the types of health care institutions, principles of their founding, reorganisation, liquidation, activities, state regulation, control measures, special features of administration and financing thereof, the nomenclature of the National Health Care System of Lithuania, procedure of individual health care services rendering at institutions of the National Health System of Lithuania, relations between health care institutions and patients and the principles of liability for violations of this Law. Article 2. The Basic Concepts and Abbreviations Employed in the Law 1. Health Care Institution (further - institution): 1) institution or enterprise, which has been accredited according to the procedure established by this Law and others and legal acts, to provide health care services (further - services); 2) institutions or enterprises engaged in other (non health care) activities, branches or departments, accredited to provide health care services. 2. LNHS denotes the Lithuanian National Health System, regulated by the Law on the National Health System. 3. Open Institution denotes an institution whose services are available to all or to population members of a corresponding (particular) territorial administration unit. 4. Closed Institution denotes an institution, whose services are only available to groups of residents specified by this Law. 5. Hospital denotes an institution accredited to carry on in-patient or also out-patient individual health care, to provide stipulated preventative, medical restorative aid, nursing, medical rehabilitation, social, health instruction and individual health expert examination services. 6. Vilnius University or Kaunas Medical Academy Hospital denotes a hospital in which the process of instruction, studies, professional improvement of the students in medical specialities, residents and health care specialists, is taking place and medical science is being developed. 7. Clinical Hospital denotes a hospital in which the active of Vilnius University or Kaunas Medical Academy carry on activities according to the procedure established by the Ministry of Health. 8. Clinic denotes a unit of the clinical department and hospital of the Vilnius University or Kaunas Medical Academy, wherein individual health care of the highest qualification is performed, health care specialists are trained and developed, and scientific work is conducted. 9. Rehabilitation Hospital denotes a hospital wherein specialised medical, social and professional rehabilitation of patients is conducted. 10. Hospital for Support Treatment and Nursing denotes an institution accredited to provide stipulated nursing and social services for patients with chronic diseases who have limited self help possibilities. 11. Tissue and Organ Transplant Bank denotes an institution accredited to carry out the functions of collection, storage, transportation and examination of tissue and organs intended for transplantation. 12. Sanatorium Health Resort Institution denotes an institution located in a resort area, accredited to provide designated medical rehabilitation services and to perform relapse prevention treatment of patients with chronic diseases. 13. Polyclinic denotes an institution accredited to render stipulated restorative and preventative medical aid, medical rehabilitation and health promotion services for patients (ambulatory as well as house-bound), and also one performing medical expert examinations regarding the patients’ ability to work. 14. Out-patient facility denotes an institution accredited to provide stipulated restorative, preventative medical aid, medical rehabilitation and health promotion services for patients (ambulatory as well as house-bound) and also one performing expert medical examinations regarding the patient's ability to work. 15. Medical Station denotes an institution accredited to render stipulated restorative, preventative medical assistance, medical rehabilitation and health promotion services to patients (ambulatory and house-bound). 16. Public Health Care Bureau denotes an institution, accredited to perform public health monitoring (the state of public health, social, economic and political factors influencing it, measures implemented by the local authorities, for health preservation and strengthening, primary health care resources and municipal health programmes), expert examination of public health (expert analysis of public health monitoring data) and prepare and implement according to its competence, health strengthening strategies within the municipal area. 17. Centre for Disease Prophylaxis and Control denotes an institution accredited to implement public health monitoring and perform expert public health examination in the area of non infectious (non contagious) disease prophylaxis and control, and to prepare and implement according to its competence, the strategies of disease prophylaxis and control within counties. 18. Public Health Centre denotes an institution, accredited to carry out state control of public hygiene, public health monitoring (work and living environment, food, drinking water), to perform expert examination of public health (to summarise and analyse corresponding data of public health monitoring in the municipalities of a county, and also monitoring data of labour and living environment, food, and pollution of drinking water), epidemiological care of contagious diseases, and to generalise implementation, application of health preservation and strengthening strategies within municipalities of corresponding counties and to propose measures for improving them. 19. Specialised Public Health Centre (labour medicine, environmental hygiene, nutrition, radiation protection, prophylaxis and control of contagious diseases etc.) denotes an institution accredited to perform state hygiene control, health expert examination, public health monitoring, epidemiological care of contagious diseases, prepare and implement measures of disease prophylaxis and control according to its competence. 20. Institution for Neutralisation of Infection - denotes an institution accredited to perform disinfection, disinsection and deratization services. 21. Accrediting of Institution denotes the granting an institution of the right to render services, the periodic review of the satisfaction of the legal act requirements, by the institution’s activities and the issuance of accrediting document license and accrediting certificate. 22. Patient denotes a person who avails himself of the services rendered by institutions, regardless of whether he is healthy or ill. 23. Types of Services denotes the types of health care and services stipulated by the Law on the Health System. 24. Free Services denotes health care supported by the state and municipal governments (free of charge), with the exception of services indicated in part 3 of Article 64 of this Law. Chapter II TYPES AND KINDS OF INSTITUTIONS, THEIR ACCREDITING, REGISTRATION AND THE PRINCIPLES OF STATE REGULATION OF ACTIVITIES Section I TYPES AND KINDS OF INSTITUTIONS Article 3. Types of Institutions 1. The types of institutions are as follows: 1) LNHS institutions; 2) Institutions that are not under LNHS. 2. LNHS Institutions: 1) state or municipal individual health care public institutions (non profit), whose activities shall be regulated by this Law and other laws of the Republic of Lithuania and legal acts. The principal source of funding for these institutions shall consist of compulsory health insurance funds, obtained according to the procedure established by the Law on Health Insurance. These institutions may obtain special purpose allocations as well, from the state or municipal budget for the purpose of providing free services and other funds designated by this Law and other laws; 2) state and municipal budgetary institutions for individual health care shall be regulated by institutions of the Budget in accordance with this Law or other laws. The principal funding source of these institutions shall be comprised of special purpose allocations from the state or municipal budget for the purpose of rendering free services. These institutions may obtain a contract order from the regional patients’ fund, for rendering individual health care services, guaranteed by compulsory health insurance as well as corresponding funds of the compulsory health insurance for implementing this order. For other services rendered and measures and health programmes implemented, they may also obtain other funds designated by this Law and other laws; 3) private individual health care state institutions, whose principal source of funding shall be comprised of the allocations earmarked for implementation of state-supported (free) individual health care. For services rendered, measures and health programmes implemented these institutions may obtain other funds also designated by this Law and other laws; 4) state and municipal public health care budgetary institutions, whose principal source of funding is comprised of state and municipal budgetary special purpose allocations for the implementation of requisite public health care measures. These institutions may also obtain other funds designated by this Law and other laws, for services being rendered and measures and health programmes being implemented; 5) state and municipal public health care institutions, whose principal source of funding is comprised of state or municipal authority budget-allocated special purpose funds for those requisite public health measures, which shall not be implemented by state or municipal public health care institutions. For services rendered, measures and health programmes implemented, these institutions may obtain also other funds designated by this Law and other laws. 6) profit health care institutions and public individual health care institutions of religious communities, associations and public organisations that may temporarily be subordinated to LNHS, if they shall draw up health care contracts, according to the conditions prescribed in Article 22 of this Law, with clients of LNHS with respect to the rendering or implementing of the services designated in paragraphs 1, 2 or 5 of part 2 of this Article, and perform the functions of LNHS institutions in accordance with these contracts. Health care contracts shall specify the duration of the institutions’ LNHS affiliation. Those profit institutions, who have formed contracts with the clients of LNHS activities, shall further in the Law, be referred to as LNHS institutions. 3. The institutions not under the LNHS, are profit institutions and also those individual public health care institutions of religious communities and associations and public organisations, who have not formed health care contracts with the clients of LNHS activities. Article 4. The Kinds of Institutions According to Services Being Rendered 1. In accordance with the individual health care services they render, institutions shall come under the following categories: 1) in-patient individual health care services such as hospitals, clinical hospitals and Vilnius University or Kaunas Medical Academy hospitals. According to their structure, these institutions may have departments or branches, rendering out-patient individual health care services; 2) specialised medical, social and professional patient rehabilitation hospitals; 3) support and nursing hospitals for the support treatment, nursing and social services for patients having chronic diseases and limited self-help abilities; 4) sanatoriums for medical rehabilitation of patients and relapse preventative treatment of patients having chronic diseases; 5) tissue and organ transplant banks for the collection, storage and transportation and examination of tissues and organs designated for transplantation; 6) blood donor institutions for reception of human blood for donorship purposes, its storage; 7) polyclinics and out-patient facilities for established replacement and preventative medical aid and medical rehabilitation services in accordance with the approved primary health care specialities of rendering to patients (those coming in for treatment and those at home, and other groups of individuals, stipulated by this Law), also for expert medical examination of patients’ ability to work and organising of health promotion work; 8) medical stations for rendering to patients (coming to obtain treatment and those at home, and other groups of persons established by this Law), the services of replacement and preventative medical aid, approved according to primary health care specialities; 9) offices of general practitioner doctors and general practitioner dentists for rendering established primary health care services and also, for performing expert medical examination of the patient’s ability to work and health promotion; 10) institutional (out-patient or in-patient) capable of rendering urgent medical aid - first medical aid or emergency hospitals; 11) maternity homes for supervision of those pregnant and rendering of stipulated individual health services to them; 12) mental health centres and psychiatric hospitals for the prophylaxis and control of stipulated mental diseases and rendering of individual health care to people with mental disabilities and mental patients; 13) dispensaries for the treatment of persons with skin and venereal diseases, and AIDS, out-patient and in-patient individual health care, health promotion, skin and venereal diseases and AIDS centres; 14) detoxification centres for those suffering of alcohol, narcotics or psychotropic substance poisoning, for individual detoxification or (and) elimination of the withdrawal syndrome; 15) individual health potential expert examination, medical rehabilitation and health promotion centres; 16) infants’ homes for support treatment, nursing, social services and medical and social rehabilitation of infants with congenital developmental disabilities as well as, sight deficiencies; 17) pathoanatomical expert examination, legal medical expert examination, legal psychiatric and narcological expert examination and medical and social expert examination institutions of established types of individual health expert examination institutions; 18) commissions of medical expert examiners of persons entering into service of national defence, internal affairs system, police or national defence institutions and also health potential expert examinations of military and internal affairs system officials; 2. The following institutions are listed according to public health services being rendered: 1) public health protection, including physician consultations in labour medicine, labour medicine centres, environmental hygiene (ecological medicine), radiation protection centres, nutrition centres and other specialised public health centres; 2) disease prophylaxis and control of diseases (non-infectious and (

1. or)contagious diseases) prophylaxis and control centres; 3) public health monitoring, public health expert examinations, public health care bureaux, public health centres and health information centres; 4) public health strengthening, public health promotion centres; 5) institutions for prophylactic neutralisation of infection of the environment and sources of contagious diseases (disinfection, deratization and disinsection); 6) quarantine stations for the quarantine and medical protection of the borders and territory of the Republic of Lithuania from particularly dangerous contagious diseases. 3. The status of institutions indicated in parts 1 and 2 of this Article, shall be established by their founders (owners) according to the procedure established by laws. 4. The institutions of the kinds indicated in this Article, and the types and range of the services they shall be permitted to provide shall be indicated in documents attesting to the accrediting of the institutions, which shall be issued according to the procedure established by this Law and other legal acts. Article 5. The Name of Institutions 1. The name of an institution must be in keeping with the kinds of services provided by it, indicated in parts 1 and 2 of Article 4 of this Law. The symbol of the institution must be registered in accordance with the procedure established by the laws of the Republic of Lithuania. 2. The names of the types of institutions, indicated in parts 1 and 2 of Article 4 of this Law, or the combinations thereof, may be used by institutions only. Section II ACCREDITING OF INSTITUTIONS FOR HEALTH CARE Article 6. Accrediting of an Institution to Provide Services 1. In the Republic of Lithuania, services may be provided only by institutions, that are accredited for individual and (
2. or)public health care and have obtained a document (license, accrediting certificate), attesting to accrediting from the State Service of Accrediting for Health Care Activities at the Ministry of Health (further - Accrediting Service). In order to obtain this document, a declaration and documents, concerning readiness of an institution to engage in health care activities, must be submitted to the Accrediting Service. Accredited institutions shall have the right to commence implementation of health care activities, from the day of their registration in the State Health Care Institution Register (further - Institution Register). Institutions may also be registered in other registers established by laws. 2. This Law and regulations on health care and pharmaceutical activities approved by the Government, shall comprise the procedure for institution accrediting and the issuance of licenses and accrediting certificates attesting thereof. 3. An accredited institution shall have the right to render only the services stipulated on the license or accrediting certificate. An institution may not transfer the license or accrediting certificate to other persons. A fee in the amount established by the Government, shall be paid for issuance of a license or accrediting certificate. Issuance of an accrediting certificate and (
3. or)license will be announced in the “ Official Gazette.” 4. For institutions, in the process of being established, a license shall be issued to cover no more than a period of 6 months, in the course of which the institution must apply for issuance of an accrediting certificate. An accrediting certificate for all institutions is issued for a five-year period only. The term of validity of an accrediting certificate may be extended according to the procedure established by this Law and other legal acts, or a new certificate shall be issued. 5. The Ministry of Health shall prepare and approve the general and special accrediting requirements of institutions, while the accrediting requirements of closed institutions shall be handled by the Ministry of Health, in conjunction with the Ministry of National Defence or the Ministry of Internal Affairs. Article 7. Decisions of the Accrediting Service Regarding the Accrediting of Institutions 1. The Service for Accrediting must adopt a justifiable decision regarding accrediting of an institution within a period of two months from the receipt of the statement and other documents. 2. The Service for Accrediting shall examine the submitted documents within a period of 30 business days from the day of receipt of the application and other documents and shall establish whether they are in keeping with the approved requirements. Having established that the submitted data meet with the approved requirements, the Service for Accrediting shall assign experts to assess the local activities of the institution. 3. The Service for Accrediting shall approve a decision: 1) to accredit an institution or department (departments) thereof for health care activities; 2) to accredit an institution or its department (departments) for health care activities with stipulations: 3) to postpone accrediting of an institution or department (departments) thereof for health care activities; 4) not to accredit an institution or department (departments) thereof for health care activities; 5) to annul accrediting of an institution or department (departments) thereof, for all services or a part of such, should they fail to meet the requirements of legal acts and (
4. or)normative documents and also if this should actually endanger the patients’ health or cause harm to people’s health and result in damages to legal or physical persons. 4. The Service for Accrediting must inform no later than within 10 business days following the approval of the decision, the founder (owner) of the institution, regarding the adopted decision and if they have decided to accredit the institution for health care activities, to issue an accrediting certificate in the established form. 5. Upon expiration of the accrediting term of validity, the institution or department (departments) thereof may continue their activities for a term not to exceed 90 business days. 6. The Ministry of Health shall determine the conditions of accrediting with stipulations. 7. The Service for Accrediting shall have the right to postpone the accrediting for health care activities of an institution or department (departments) thereof. In this case it must indicate in writing to the founder (owner) of the institution the concrete shortcomings in the submitted documents, or in the rendering of services by an institution or department (departments) thereof and the terms of eliminating such. The institution or department (departments) thereof shall be accredited upon fulfilment of these conditions. 8. The Service for Accrediting may fail to accredit an institution or structural department (departments) thereof, for health care activities or annul its accrediting, only upon a justified recommendation by its authorised experts and also that of an inspector authorised by the State Medical Audit Inspectorate or the Minister of Health, approving a justified decision. 9. The Service for Accrediting must inform in writing the institution founders (owners) concerning deliberation of the accrediting material, no later than 7 work days prior to the deliberation, while the enterprise administration must be informed of the deliberation contents and date. Founders (owners) of the institution and their representatives shall have the right to participate during discussion of the question. 10. The Service for Accrediting must furnish a written notice, within 3 business days of adoption of the decision, to institution founders (owners), institution administration and the administrator of the institution register, concerning its decision not to accredit, or to annul the accrediting of an institution or the department (departments) thereof. 11. The decision of the Service for Accrediting, to interrupt the accredited activities of an institution or the department (departments) thereof, must be approved by the Minister of Health within three business days from adoption of the decision by the Service for Accrediting. 12. The decisions of the Service for Accrediting, regarding the accrediting of an institution or department (departments) thereof , may be appealed in court according to the procedure established by laws, during the period of 30 days following the approval of the decision. The appeal does not suspend implementation of the decisions by the Service for Acrediting. Section III REGISTRATION OF ACCREDITED INSTITUTIONS Article 8. Registration of Accredited Institutions 1. Accredited institutions must be registered in the Institution Register. 2. The Ministry of Health shall establish an Institution Register, registering the institutions therein and keeping it. The Ministry of Health may authorise another state institution to keep the Institution Register. 3. The Keeper of the Institution Register shall approve the rules for the establishment of the identification code of the registered institution. 4. The Government shall approve the Register regulations. Article 9. Procedure for the Registration in and Striking from the Institution Register of Accredited Institutions 1. Upon the accrediting of an institution, the Service for Accrediting must submit registration data to the Keeper of the Institution Register, within 3 days from approval of the decision to accredit the institution. 2. The Keeper of the Institution Register must register the accredited institution no later than within 5 business days from the submittal of the registration data to the Keeper of the Institution Register. If the registration data are not submitted in full or are inexact, the Keeper of the Institution Register may demand from the applicant to correct them within a period of 10 business days. 3. A registration certificate of the type established by the Ministry of Health shall be issued to the institution registered in the Institution Register. 4. Upon the occurrence of a change in the registration data and under other circumstances established by the law, the authorities must inform the Keeper of the Institution Register within a period of ten business days. 5. Institutions shall be removed from the Institution Register under the following circumstances: 1) upon annulment by the Service for Accrediting of an institution’s accrediting for health care activities; 2) upon expiration of the time limit of activity designated in the bylaws of the institution; 3) upon change in the type of activity of the institution (upon cessation of rendering of services); 4) upon reorganisation or liquidation of the institution, per decision of institution founder (founders) or owner (owners); 5) upon completion of bankruptcy procedure of the institution accredited for health care activities; 6) upon adoption of a court decision to liquidate institution, resultant from legal violations, established by laws; 7) in the event it should become evident that the submitted accrediting documents and registration data do not correspond with reality or have been registered in violation of this and other laws. 6. In the event of the circumstances denoted in part 5 of this Article, being present, the Service for Accrediting, institution founder (founders), institution administration head or institution liquidator must, within 7 business days from the coming to light of these circumstances and registering of documents, submit before the keeper of the register copies of the decision by the founder (founders) or owners to reorganise or liquidate the institution, the act of institution liquidation, court decision to liquidate institution, or other documents in connection with the procedure of striking of the institution’s registration from the Institution Register. 7. Within 3 business days, following the striking of an institution from the register, the Keeper of the Institution Register must declare its registration certificate no longer valid and must publish this in the “Official Gazette.” Within 3 days of this decision, the Keeper of the Institution Register must inform the administration of the institution. Following the striking of an institution from the register, the data relevant to the institution shall remain kept within the register, for a period of no less than 2 years and later they shall be transferred to the archives. 8. Institutions shall pay stamp duty for registration, in the amount stipulated by the Government. Article 10. Use of the Institution Register Data 1. Legal and natural persons shall have the right to make use of Institution Register data in accordance with the procedure established by the regulations of this register. 2. State and municipal institutions shall have access to Institution Register data free of charge. Other legal and natural persons must pay a stamp duty in the amount established by the Government, for the use of register data. 3. Only the Keeper of the Institution Register and State institutions shall have the right to use the data of the Institution Register, that concerns closed institutions of the Ministries of Internal Affairs and National Defence. Section IV THE PRINCIPLES OF STATE REGULATION OF INSTITUTION ACTIVITIES Article 11. Legal Acts and Normative Documents, Establishing the Activities of Institutions 1. The activities of institutions shall be established by: 1) this and other laws of the Republic of Lithuania; 2) Lithuanian standards and also international standards, legalised according to the procedure established in the Republic of Lithuania; 3) medical norms of Lithuania, approved by the decrees of the Minister of Health; 4) hygiene norms of Lithuania, approved by orders of the Chief State Hygiene Officer of the Republic of Lithuania; 5) certified health care methodology, approved by the decrees of the Minister of Health; 6) institution bylaws (statutes). 2. In the absence in Lithuania of current and required for institution activities legal acts or normative documents, the institution shall prepare and per order by head of the institution, shall approve standards of the institution and the health care methodologies and regulations of internal procedure. 3. Institutional standards and health care methodology and internal procedural regulations must not be contrary to the legal acts, currently in effect in Lithuania and the normative documents listed in paragraphs 2, 3 and 4 of part 1 of this Article. 4. Institution bylaws (statutes) shall be approved by their founders according to the procedure established by laws. Article 12. The Rights of the Ministry of Health Regarding State Regulation of Institution Activities The Ministry of Health shall: 1) establish, reorganise or liquidate the institutions of tertiary level of organising of LNHS activities, in accordance with the procedure established by this Law; 2) establish, reorganise or liquidate in conjunction with Vilnius University or Kaunas Medicine Academy, the Vilnius University or Kaunas Medicine Academy hospitals, in accordance with the procedure established by law; 3) keep the Institution Register; 4) establish for subordinate institutions the requisite health care tasks and the procedure for their financing and implementation; 5) furnish the Government with proposals concerning guarantees for granting loans, which the LNHS institutions obtain from credit institutions; 6) establish the requirements of health care suitability and acceptability; 7) prepare proposals for the Government, in conjunction with the Ministry of Finance on state budgetary allocations to LNHS institutions; 8) anticipate the need for health care specialists and formulate the state order for the training of these specialists; 9) control how institutions observe the essential health care conditions, laws and other requirements of legal acts and normative documents; 10) establish in conjunction with the Internal Affairs and National Defence Ministries, the procedure for rendering of services within the closed institutions of the national defence system or the internal affairs system and control, along with these ministries, how the requirements of legal acts and normative documents are being adhered to; 11) approve, upon co-ordination with the Statistics Department at the Government of the Republic of Lithuania, the forms of statistics on institution activities, records of institution activities and accounting procedure; 12) implement the other functions established by this and other laws. Article 13. Approval of the Normative Acts of LNHS Institutions 1. The Government shall approve the following minimal normative acts of the LNHS infrastructure: 1) the nomenclature of the number of institutions established by this Law of the primary, secondary and tertiary level of organising of activities of LNHS institutions; 2) nomenclature of individual and public health care specialities of primary, secondary and tertiary levels of organising of LNHS activities; 3) specific profiles of the number of beds within in-patient institutions of individual health care; 2. The Ministry of Health, county governors and executive institutions of municipal government must ensure minimal normative acts on the infrastructure of LNHS institutions, stipulated by the Government; 3. Other laws of the Republic of Lithuania may establish also other normative acts of infrastructure of LNHS institutions. Article 14. State Regulation of the Cost of Services Rendered by Profit Institutions 1. The founders (owners) of profit institutions shall establish the costs of services rendered by the institutions. These costs may not exceed the service costs established for the LNHS institutions, by more than 60 (sixty) per cent. 2. The pure income (profit), obtained by the institutions for services rendered, shall be taxed according to procedure established by laws, in applying a preferential tax rate, if the institution uses more than 75 per cent of its pure income (profit) for investments in expanding its assortment of services, for implementation of new health care technologies and improvement of health care availability and suitability. Article 15. Pricing Principles of Services Rendered by LNHS Institutions and the Special Features of Cost Compensation 1. The Health Ministry, having co-ordinated this with the State Service for Competition and Consumer Rights Protection at the Government of the Republic of Lithuania, shall determine the cost of services rendered by LNHS institutions. Pricing principles of the services rendered by LNHS institutions: 1) fair competition; 2) information availability on the cost of services; 3) cost limitation; 2. The costs of services of requisite health promotion activities of equal complexity level, rendered at LNHS institutions, may not vary by more than 20 percent with the basic costs, which shall be established in accordance with the procedure established by the Law on the Health System. If the factual costs of the services rendered by an institution, amount to more than 20 per cent of income, received for services rendered according to established basic costs, the client of LNHS activities may reimburse for the difference in cost, only in the course of one calendar year. It is prohibited for institutions which render services of more than one kind, to include the cost of one service into the cost of another being rendered. The Ministry of Health shall determine the procedure of reimbursing the difference between the costs of services. Article 16. Special Features of the Privatisation of LNHS Institutions 1. LNHS institutions or the parts thereof, which are capable of acting as independent functional departments, may be privatised according to procedure established by laws and other legal acts, if they are no longer being accredited. 2. The funds obtained upon privatisation of these health care institutions or the parts thereof, shall be transferred according to procedure established by law or other legal acts, to state or municipal health funds, correspondingly. 3. The Seimas upon the recommendation of the Government, shall approve the decision on privatisation of LNHS institutions. Proposals on privatisation of an LNHS public institution may be submitted to the Government: 1) for privatisation of institutions of primary level of organising of LNHS activities, by the municipal council, having co-ordinated with the Ministry of Health; 2) for privatisation of institutions of secondary level of organising of LNHS activities, by the Ministry of Health having co-ordinated with the county governor; 3) for privatisation of institutions of tertiary level of organising of LNHS activities, by the Ministry of Health. 4. The privatisation of LNHS institutions must not worsen the level of compulsory health promotion activities established by legal acts. Article 17. Legal Protection of the Institution Activities of Health Care Specialists 1. Employers shall be prohibited from exerting influence upon the institutions, regarding labour relations in connection with the professional activities of health care specialists, if these do not violate the legal acts and requirements or normative documents. 2. Employers shall be held liable in accordance with the laws, for interference with the performance by health care specialists, of their professional duties and adoption of legal decisions. Article 18. Keeping of Institution Records 1. Institution records shall be kept in the Lithuanian language. Disease diagnosis, instructions on medicines for the patient during the history of his illness or nursing, and prescriptions shall be written in Latin, and other medical terms, and procedural designations shall be written in Lithuanian or Latin. 2. The Ministry of Health shall regulate the preservation of institution documents, according to the procedure established by laws. PART II HEALTH CARE INSTITUTIONS Chapter I PROFIT HEALTH CARE INSTITUTIONS Article 19. Legal Acts of the Republic of Lithuania, Establishing the Founding, Reorganisation and Liquidation of Profit Institutions The Law on Enterprises, the Law on Register of Enterprises, laws on individual types of institutions and other laws and legal acts shall regulate the questions of the establishment of accredited branches, reorganisation and liquidation of profit health care institutions (further - profit institutions), accredited to provide services, and also of enterprises which are engaged in other (non health care) activity, to provide services. Article 20. Restrictions of Profit Institution Activities 1. Profit institutions may be established for all types of individual health care, with the exception of the individual health care services, included on the list approved by the Ministry of Health. 2. Profit organisations may be established only for these types of public health care activities: 1) health promotion; 2) expert hygienic examination according to the list approved by the Ministry of Health; 3) assessment of labour and environmental hygiene; 4) for list approved by the Ministry of Health and (
5. or)microbiological research; 5) disinfection, deratization and disinsection. 3. The Ministry of Health shall establish the procedure for approval of conclusions of assessment of the rendering of services indicated in part 2 of this Article, expert hygienic examination, of labour and environment. Article 21. Special Features of Profit Institution Activities 1. First aid and out-patient urgent medical aid provision to patient shall be reimbursed to the profit institution out of municipal budgetary funds in accordance with the approved costs of LNHS institution services and also, the nomenclature and assortment thereof. 2. Medical and social expert examination of labour potential at profit institutions shall be performed in accordance with the procedure established by the Ministries of Health, and Social Protection and Labour. 3. For use of LNHS institution services (tests, specialist consultations) profit institutions must reimburse them in accordance with the service costs established for LNHS institutions. 4. Profit institutions must, according to their competence and their funds, implement the requisite public health care measures, which shall be established by the Ministry of Health. 5. If a state or municipal institution seeking to obtain profit during the current calendar year, receives more than 75 percent of its income for work performed according to a contract with clients of LNHS activities (budgetary funds and compulsory health insurance funds, obtained for the extent and quality of services rendered to the population, are included in the limit), thus, it may be re-registered into a LNHS public institution during the next calendar year. Article 22. Basic Conditions in Contracts of Profit Institutions with the Clients of LNHS Activities 1. If the LNHS institutions have no possibilities of rendering individual types and assortments of services, reimbursed from state and municipal budgets or compulsory health insurance funds, LNHS clients shall have the right to form health care contracts with a profit institution, through public tenders for rendering these services. The Government shall establish the conditions and procedure of the public tenders. 2. The basic conditions of contracts of LNHS clients and profit institutions shall be established by the Government: 1) the costs of health care services rendered by profit institutions, may not exceed the costs of health care services established for LNHS institutions. 2) individual health care profit institutions must carry civil responsibility insurance in order to compensate damages incurred by the patients in the course of rendering of individual health care services, if other laws do not provide for this type of insurance; 3) profit institutions must render services in accordance with established indicators of accessibility of services; 4) a profit institution must possess no less than two years of service- rendering experience in services corresponding to those for which health care contracts shall be formed and a state medical evaluation (upon establishment of a state medical audit inspectorate). 3. Advance payment shall not be required for services rendered during account settling of the clients of LNHS activities with profit institutions. Chapter II LNHS INSTITUTIONS Section I LNHS BUDGETARY INSTITUTIONS Article 23. The Concept and Founders of LNHS Budgetary Institution 1. LNHS budgetary (further - budgetary institution) is an institution founded by state or local authority institutions and accredited in accordance with the procedure established by this Law, to render free services or implement the requisite public health care measures. 2. A budgetary institution is an institution maintained by the state or local authority budget and thus listed in its founding act and statutes. 3. The Government, the Ministry of Health, the Ministry of Internal Affairs, the Ministry of National Defence and the county governors may be founders of budgetary institutions, supported from the State Budget. 4. Municipal councils are founders of budgetary institutions supported from municipal budgets. 5. The Ministry of Health shall approve the standard statutes of budgetary institutions, in accordance with the nomenclature of budgetary institutions established by this Law. Article 24. Legal Acts of the Republic of Lithuania, Establishing the Founding, Reorganisation and Liquidation of Activities of Budgetary Institutions The Law on Budgetary Institutions, the Law on the Health System, this Law and other laws and legal acts shall regulate the questions of the founding, activities, management, reorganisation and liquidation of budgetary (open and closed) institutions. Article 25. Special Features of Budgetary Institution Management, Activities and Utilisation of Funds 1. The statutes of budgetary institutions shall establish the procedure of the formation, area of competence, functions and liability of the managing bodies of budgetary institutions. The administration shall be the managing body of the budgetary institution, which will administer the institution according to the procedure established by its statutes. A board of directors, treatment, nursing, and public health boards and other boards and medical ethics commissions may be established within the budgetary institution. 2. Heads of administration, branches and departments of a budgetary institution, accredited for secondary and tertiary level of organising of LNHS activities, and health care specialists shall be hired for a term of five years, by means of public tender. 3. Persons who may become heads of administration, branches and structural departments of a budgetary institution, accredited for secondary or tertiary levels of organising of LNHS activities, must be individuals who satisfy the qualification requirements and conditions approved by the Ministry of Health and tender conditions for heads of administration or structural departments of this institution. 4. An individual over the age of 65 may not become an administrator or a branch head of a budgetary institution, accredited for secondary or tertiary level of organising of LNHS activities. 5. The statutes of budgetary institutions must indicate the procedure of rendering the requisite level of health promotion services and implementing of requisite state or municipal health programmes and also the procedure of informing the public concerning the activities of a budgetary institution. 6. The state or municipal budget funds obtained by budgetary institutions, shall be used to implement the requisite level of health promoting activities and to render services. 7. A budgetary institution shall have the right to obtain non-budgetary funds for rendering of services in accordance with health care contracts, if these services are not attributable by laws and other principles designated by the Government. Expenses in connection with service rendering are totally reimbursed from non budgetary funds. Article 26. Nomenclature of Budgetary Institutions of Individual Health Care Levels of Organising of LNHS Activities 1. Municipal budgetary institutions of individual health care of primary level of organising of LNHS activities: 1) municipal medical stations; 2) municipal mental health centres; 3) municipal authority detoxification centres; 4) municipal emergency aid stations; 5) municipal support treatment and nursing hospitals; 2. A municipal executive institution shall organise and administer the regional institutions of the nomenclature indicated in part 1 of this Article, according to the normatives approved by the Government. 3. Budgetary institutions of individual health care of secondary level of organising of LNHS activities: 1) specialised hospitals (tuberculosis, skin and venereal diseases, oncology, narcology, psychoneurology, psychiatry, infectious diseases and others), included on the list approved by the Ministry of Health; 2) county maternity homes; 3) county infants’ homes, dedicated to the care of infants with developmental defects; 4) county medical and social expert examination institutions. 4. The county governor shall organise and manage the nomenclature institutions in the county, indicated in part 3 of this Article, in accordance with the normatives approved by the Government. 5. Budgetary institutions of individual health care of tertiary level of organising of LNHS activities: 1) tissue and organ transplant banks; 2) specialised hospitals (oncological, physiopulmonary, tuberculosis, psychiatry, infectious and medical rehabilitation etc.), included on the list approved by the Ministry of Health; 3) institutions of pathologoanatomical expert examination, court medical expert examination, court psychiatric and narcological expert examination, medical and social expert examination. 6. Upon recommendation by the Government and adhering to the normatives approved by the Government, the Ministry of Health and the Ministry of Labour and Social Protection shall organise and administer, according to their competence, the nomenclature of the institutions, indicated in part 5 of this Article, of the tertiary level of organising of LNHS activities. Article 27. Nomenclature of the Budgetary Institutions of Individual Health Care Levels of Organising of LNHS Activities 1. Nomenclature of the municipal authority budgetary institutions of individual health care of primary level of organising of LNHS activities: 1) municipal authority labour medical consultation station; 2) municipal authority health care bureau. 2. A municipal authority executive institution shall organise and administer institutions within the municipal region, that are included in the nomenclature, indicated in part 1 of this Article, according to the normatives approved by the Government. 3. Nomenclature of budgetary county institutions of public health care of the secondary organising level of LNHS activities: 1) county centre for public health promotion; 2) county centre for disease prophylaxis and control; 3) public health centres subordinated to the State Service for Public Health Care. 4. The county governor shall found and maintain the district institutions indicated in paragraphs 1 and 2 of part 3 of this Article in accordance with the normatives approved by the Government. 5. The State Service for Public Health Care, at the Ministry of Health, shall found and maintain the county institutions, indicated in paragraph 3 of part 3 of this Article, in accordance with the normatives approved by the Government. 6. Nomenclature of budgetary institutions of public health care of tertiary level of organising of LNHS activities: 1) centre for the promotion of public health; 2) nutrition centre; 3) centre for labour medicine; 4) centre for environmental hygiene (ecological medicine); 5) centre for radiation protection; 6) centre for the prophylactics and control of contagious diseases; 7) health information centre; 8) other specialised public health centres. 7. The Ministry of Health or with its recommendation, the State Service for Public Health Supervision at the Ministry of Health shall, upon the recommendation of the Government, organise and manage the institutions of the tertiary level of organising of LNHS activities, indicated in part 6 of this Article, according to the normatives approved by the Government. Article 28. Concept of Closed Budgetary Institution and Special Features of the Foundation and the Activities thereof 1. A closed budgetary institution is an institution founded and maintained by state property and budgetary funds, rendering services of the requisite health promotion level, for indicated groups of individuals, indicated in the statutes of this institution and implementing health programmes. 2. Closed 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. Closed budgetary institutions, analogous to institutions of primary level of organising of LNHS may be founded only for the health care of active military personnel. 3. The Ministry of Health shall have the right to found a closed 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, other state institutions, designated by laws, shall also have the right to found closed budgetary institutions for the health care of active service military personnel and persons, located in deprivation of liberty or pre-trial detention areas. 4. The statutes of closed budgetary institutions established within national defence and internal affairs systems, shall be approved by their founders, following co-ordination with the Ministry of Health. 5. The laws shall establish the nomenclature of closed budgetary institutions. 6. State medical audit of a closed budgetary institution shall be conducted in accordance with the procedure established by the Government. Section II LNHS PUBLIC INSTITUTIONS Article 29. The Concept and Status of a LNHS State and Municipal Public Institution 1. A LNHS state or municipal public institution (further-public institution) is a non-profit institution established with state or municipal property and funds, accredited for health care activity and rendering the requisite and contract level of health promotion activities and health insurance services. 2. Profit shall not be the goal of public institution activities. It may not designate the obtained profit for its founders. A public institution shall be public with respect to the services it shall render to members of the public. Article 30. The Founders of a Public Institution 1. The Ministry of Health, the county governor and municipal council may be founders of a public institution. 2. With the permission of the Government the Ministry of Health, in conjunction with the University of Vilnius, shall found the Vilnius University Hospital. 3. With the permission of the Government, the Ministry of Health in conjunction with the Kaunas Medical Academy, shall found the Kaunas Medical Academy Hospital. 4. The municipal council shall found the public institutions of the primary, the county governor, the secondary, and the Ministry of Health, the tertiary levels of organising of LNHS activities, with the exception of the Vilnius University and Kaunas Medical Academy hospitals. 5. The Ministry of Health may authorise the State Service of Public Health Care to implement all or a part of the designated functions of the founder of public institutions of public health care. Article 31. Competence of the Public Institution Founder (Founders) The competence of the public institution founder (founders) shall enable: 1) to approve, change and amend the bylaws of a public institution; 2) to establish requisite activity targets; 3) to obtain information regarding the activities of the public institution; 4) according to the procedure established by law, to establish or participate in determining the costs of services and methodologies of their calculation; 5) to appoint the administration chief of an institution by means of public tender, to determine his salary, on the basis of laws and, also to dismiss this chief from his duties. 6) to establish the salaries of the members of governing bodies (if such have been established) and of the inspector (auditor); 7) to establish institution branches, reorganise and liquidate a public institution; 8) to appeal in court according to the procedure established by laws; 9) to have other rights and obligations not established by this Law, if they are not contrary to laws; Article 32. Foundation of Public Institutions 1) The founder (founders) of public institutions must form an agreement of establishment of a public institution. If the founder shall be one person, he must draw up an act of establishment, in order to establish a public institution. 2. The agreement (act) of the establishment of a public agreement (act) must indicate: 1) founder, founders (legal persons titles and their addresses); 2) name of institution; 3) area of institution activities, goals and targets; 4) obligations of founder (founders); 5) compensation of founding expenses; 6) time limits of institution activities; 3. The founder (founders) or persons authorised by them, shall sign the agreement (act) of establishment. Article 33. The Rights of a Public Institution A public institution shall have the right to carry on the activities designated in the bylaws: 1) to hold settlement and currency accounts; 2) to administer and use institution property and dispose of it according to the Republic of Lithuania laws, other legal acts and its own bylaws; 3) form agreements; 4) establish the internal structure of institution; 5) to publish tenders for implementation of health programmes and other measures; 6) to found branches; 7) to use funds in accordance with the procedure established by estimates; 8) to establish ties with public institutions of other states and to exchange specialists; 9) to join associations of public institutions according to procedure established by laws, including international ones, and to participate in their activities; 10) to have other undefined rights and obligations, provided they do not contradict the laws of the Republic of Lithuania. Article 34. The Bylaws of the Public Institution 1. The bylaws are a document, which must provide guidelines for the public institution. Bylaws shall be approved by the founder (founders) of the institution. 2. Public institution bylaws must indicate: 1) the name of the institution; 2) the location; 3) the institution founders; 4) the rights and obligations of founders; 5) the area of activities, goals and tasks of the institution; 6) the competence and convocation procedure of founders’ meeting (if there are several founders); 7) the competence of observer board and procedure of the convocation of this board; 8) the procedure of organisation of public tender for the hiring of administration and branch heads and specialists; 9) the procedure of establishing managing bodies and the recall of their members and competence, and the functions and responsibility of such organs. 10) the procedure for founding and liquidation of branches; 11) the procedure for disposing of institution property; 12) funding sources and the procedure for fund utilisation; 13) the control of financial activities; 14) the procedure of changing and amending the bylaws; 15) the procedure for reorganising and liquidation of an institution; 16) the duration of institution activities; 17) other regulations in connection with the special features (specifics) of the institution, not contrary to laws. 3. The administration, the collective managing body and the founder (founders by joint decision) of an institution shall have the right to change and amend the bylaws by right of initiative. The founder (founders) shall approve the changed or amended bylaws. 4. The bylaw changes and amendments shall come into effect from their legal re-registration according to the procedure established by laws. Article 35. The Registration, Accrediting and Registration of the Accreditors 1. Public institutions shall be registered, re-registered and struck from the register in accordance with the procedure established by laws. 2. Accrediting of public institutions and registration of the accreditors shall be conducted in accordance with the procedure established by this Law and the regulations of the Service for Accrediting. Article 36. The Branches of the Public Institution 1. A branch is the subdivision of an institution, having an individual location and administration. A branch is not a legal person and shall act in accordance with the statutes of the public institution and the authorisation given it by the head of its administration, which must be stipulated in the institution bylaws and branch statutes. The number of public institution branches shall not be limited. 3. The branch shall be registered and struck from the register in accordance with the procedure established by this Law. 4. A public institution shall be prohibited from founding branches which are not related to health care activities. Article 37. The Managing Bodies of the Public Institution 1. The managing bodies of a public institution shall be comprised by taking into consideration the type of an institution and its inclusion into the nomenclature of institutions of the corresponding level of organising of LNHS activities. 2. The administration is a necessary body of institution governing, which organises administration activities and manages them. A public institution must have an administration head and a senior finance officer (accountant). 3. The administration head of a public institution shall establish employee positions and hire by way of public tender, health care specialists and also dismiss them. He shall hire and dismiss other employees, in accordance with the procedure established by laws. The competence and functions of the head of the administration shall be established by the statutes of the public institution. 4. The positions of administration head and chief finance officer (accountant) cannot be filled by the same person and persons, who are related by birth or marriage (parents, adoptive parents, marriage partners, brothers, sisters, children and also the brothers, sisters, parents and children of a marriage partner). 5. The functions of the chief finance officer (accountant) may be performed according to an agreement, by another legal person or an institution not having the rights of a legal person. 6. The head of administration shall approve the labour regulations of the administration of the public institution. 7. Collective bodies of management (board of observers, board of directors, boards for treatment, nursing and public health) may be formed at a public institution. Article 38. Collective Bodies of Management of a Public Institution Accredited for the Primary Level of Organising of LNHS Activities Collective bodies of administration may be formed at a public institution, accredited for the primary level of organising of LNHS activities, per decision of the founder. The bylaws of the institution shall regulate the size of their membership, their obligations, rights, the procedure for their hiring and dismissal, conditions of work compensation and liability. Article 39. Collective Bodies of Management of a Public Institution Accredited for the Secondary or Tertiary Level of Organising of LNHS Activities 1. Public individual health care institutions, accredited for the secondary or tertiary level of organising of LNHS activity must, depending on their kind, have an observers’ board, treatment board and nursing board. A board of directors may also be formed per decision of the public institution founder. The public institution must have a public health board of the institution. 2. Per approval of the founder, permanent or temporary specialised boards, which shall have the right to adopt recommendation-type decisions, may also be established at a public institution, accredited for secondary or tertiary level of organising of LNHS activities. 3. The bylaws of the institution shall establish for the public institutions accredited for the secondary or tertiary level of organising of LNHS activities, the size of the collective membership of managing bodies, procedure of forming such bodies, rights and obligations of their members and conditions of work compensation and liability. Article 40. Heads of Administration, Branches and Departments and Health Care Specialists of the Public Institution, Accredited for the Secondary or Tertiary Level of Organising of LNHS Activities 1. Administration, branch and department heads and health care specialists of a public institution, accredited for the secondary and tertiary level of organising of LNHS activities, shall be hired by way of public tender for a five-year-period. 2. Persons who meet the qualification requirements for heads of administration or departments of this institution, approved by the Ministry of Health, and the conditions of the tender, must become heads of the administration, branches and departments of the public institution. 3. A individual over the age of 65 may not become head of a public institution administration or branch. Article 41. Heads of the Administration, Branches, Departments and Health Care Specialists of Vilnius University Hospital and Kaunas Medical Academy Hospital 1. The Minister of Health shall appoint the head of administration of Vilnius University or Kaunas Medical Academy for a five-year-period or dismiss him, upon the recommendation of the rector of Vilnius University or Kaunas Medical Academy. An individual over the age of 65 may not become head of administration of Vilnius University or Kaunas Medical Academy Hospital. 2. According to the procedure established by the statute, the chiefs of the clinics of Vilnius University or Kaunas Medical Academy hospitals shall be correspondingly elected by the Vilnius University Medical Faculty Board or the Kaunas Medical Academy Board. 3. Heads of the Vilnius University or Kaunas Medical Academy hospital branches and departments shall be employed by means of public tender for a five-year-period. 4. Health care specialists of the Vilnius University or Kaunas Medical Academy Hospitals shall be employed by means of public tender for a five-year-period. Article 42. The Rights and Obligations of the Heads of Administration, Departments and Branches of the Public Individual Health Care Institutions, Accredited for the Secondary and Tertiary Level of Organising of LNHS Activities 1. The head of administration of a public individual health care institution, accredited for the secondary and tertiary level of organising of LNHS activities: 1) shall reduce the number of beds, if the resources available are not fully utilised, according to the normatives established by the Government. Shall increase the number of beds, if the resources of the institution are being utilised too intensively and exceed the normatives established by the Government; 2) upon co-ordinating with the treatment board, shall reorganise or liquidate the departments and branches that do not work effectively. If the treatment board does not agree to the proposal of reorganising or liquidating the departments and branches, the head of the administration must direct the proposals to the founder, including the written opinion of the treatment board; 3) having co-ordinated with the founder and the treatment board, may approve the financing regulations of individual departments or branches; 4) shall increase or decrease the assortment of services rendered in accordance with the procedure established by the Ministry of Health; 5) shall employ by, means of public tender, health care specialists who possess licences to engage in individual health care, dismiss them according to established procedure and employ and dismiss other workers. 2. The head of administration of a public institution must: 1) interrupt the activities of the departments and branches of the institution, if due to their ineffective or illegal activity and acting or failure to act, a danger should develop for the health or life of patients, or if these departments and branches fail to be accredited, or their accrediting for health care activities is annulled; 2) inform investigative bodies, upon determination by the nursing board or an institution which supervises institution activity of the fact of a specialist’s negligence which caused the death of a patient or some harm to his health; 3) reimburse the observers’ board and the founder for their services. 3. The head of administration of a public institution shall also have other rights and obligations established by laws or institution bylaws. 4. The bylaws of the public institution shall establish the rights of the heads of public institution branches and departments. 5. The head of a public institution branch or department must inform the head of the administration and the treatment or nursing board, as well as the medical ethics commission of the institution, concerning the facts of negligence by a health care specialist of this branch or department, which has resulted in death of patients or damage to their health, and about the decisions adopted. 6. The heads of public institution branches and departments shall also have some duties designated by the bylaws of the institution. Article 43. The Observer Board of the Public Individual Health Care Institution, Accredited for Secondary and Tertiary Level of Organising of LNHS Activities 1. Public individual health care institutions, accredited for secondary and tertiary level of organising of LNHS activities, shall establish an observer board in order to ensure openness of its activities. 2. The observer board of a public individual health care institution (further - observer board) shall be an advisory body, established to serve during a five-year-period. 3.The observer board of a public individual health care institution, with the exception of the Vilnius University Hospital and Kaunas Medical Academy Hospital, shall be comprised of two representatives designated per joint decision of the institution founder (founders); one member of the council, of the municipality wherein the said institution is located; one public representative appointed by the council of the municipality wherein it is located and one representative appointed by the trade union of health care specialists. 4. The observer board of the Vilnius University or Kaunas Medical Academy hospitals shall be comprised of two representatives appointed by the Minister of Health; two representatives appointed by the rector of Vilnius University or Kaunas Medical Academy; one public representative appointed by the council of the municipality wherein Vilnius University or Kaunas Medical Academy hospitals are located and one representative appointed by Vilnius University or Kaunas Medical Academy hospital trade union of health care specialists. 5. Persons who are employed in the institution administration, state or regional patients’ funds, and also insurance organisations which handle health insurance. 6. The observer board: 1) shall analyse the activities of the institution administration; 2) shall hear the annual account of activities prepared by the institution administration and make it public; 3) shall propose to the founder to motivate the chief of administration of the institution or impose administrative penalties on him; 4) shall follow the tender sponsored for the election of administration, department or branch chiefs of the institutions and shall inform the founder of his opinion; 5) shall implement other functions established by laws and the bylaws of the public institution. 7. Meetings of the observer board shall be convened at least twice a year. Decisions of the observer board shall be adopted by a simple majority vote, and if the votes become evenly divided, they shall be decided by the chairman’s vote. Decisions of the observer board shall be legal, if more than one half of the observer board members, have taken part in the approval thereof. 8. The founder ( founders) of the institution shall convene the first meeting of the observer board no later that within 30 days following the formation of the founding agreement (act) of the public institutions. 9. The laws and public institution bylaws shall establish the responsibilities, rights and liability of observer board members and the procedure of formation and recall as well as, conditions of the observer board members work compensation. Article 44. The Treatment Board and Nursing Board of a Public Institution of Individual Health Care, Accredited for Secondary and Tertiary Level of Organising of LNHS Activities 1. The treatment board of public individual health care institutions, accredited for the secondary or tertiary level of organising of LNHS activities (further - treatment board), shall be comprised of the chiefs of the departments and branches of the institution. 2. The treatment board shall deliberate questions of individual health care organisation and improvement, shall periodically prepare clinical conferences and deliberate questions of the acquisition of new individual health care technologies. With reference to questions under deliberation, the treatment board may submit to the administration of the institution some proposals as recommendations. If the administration of the institution fails to agree with the proposal, the treatment board may submit its proposal to the founder (founders) 3. The nursing board of the individual health care institution (further - nursing board) shall be comprised of nursing specialists from the departments and branches of the institution. 4. The nursing board shall deliberate issues of organising and improving the nursing care of patients. This board through the issues under discussion, may submit to the administration of the institution proposals in the form of recommendations. If the administration of an institution does not accept the proposal, the board of nursing may submit its proposal to the founder (founders). 5. The chief of administration of an institution or an administration employee delegated by him, shall chair the treatment or nursing board. The formation of the treatment and nursing board, the rights and obligations of these boards, the procedure of work, rights and obligations of members, their appointment and dismissal, conditions of work compensation and liability shall be established by the laws and bylaws of public institutions. Article 45. The Medical Ethics Commission of the Individual Health Care Public Institution, Accredited for Secondary and Tertiary Level of Organising of LNHS Activities 1. A medical ethics commission shall be formed at an individual health care public institution, accredited for the secondary and tertiary level of LNHS activities, which shall supervise, how medical ethics requirements shall be adhered to. 2. Model bylaws approved by the Ministry of Health shall establish the procedure of formation and activities of the medical ethics commission of a public institution. Article 46. The Rights and Obligations of the Chiefs of Administration, Departments and Branches of Public Institutions in Public Health Care Institutions, Accredited for Secondary and Tertiary Level of organising of LNHS Activities 1. The head of administration of a public health care institution, accredited for secondary and tertiary organising level of LNHS activities shall: 1) reorganise or liquidate ineffectively working departments and branches, having co-ordinated this with the public health board. If the public health board fails to agree with the proposal to reorganise or liquidate the branches or departments, the administration head, must submit his proposals to the founder, enclosing a written opinion of the public health care board. 2) approve the financing regulations of departments or branches upon co-ordination with the founder or the observer board; 3) decrease the assortment of available services, upon co-ordinating with the Ministry of Health; 4) employ by way of public tender, health care specialists, who hold licenses to engage in public health care, form labour contracts with them, and also, dismiss them and employ and dismiss other employees in accordance with the procedure established by law. 2. The head of a public institution must: 1) interrupt the work of departments or branches, if these are not being accredited or their accrediting for health care activities is being annulled; 2) render an account of its work to the observer board and founder. 3. The head of administration of a public institution also shall have other rights and obligations established by laws and public institution bylaws. 4. The rights and obligations of the heads of public institution departments and branches shall be established by the bylaws of these institutions. Article 47. The Public Health Board of the Public Institutions of Public Health Care, Accredited for the Secondary and Tertiary Level of Organising of LNHS Activities 1. The public health board of a public health care public organisation, accredited for the secondary and tertiary level of organising of LNHS Activities (further - public health board) shall be comprised of heads of the departments and branches of this institution. 2. The public health board of a public institution shall deliberate issues of public health care organisation and improvement, prepare conferences on public health care topics and deliberate issues regarding the acquisition of new public health care technologies. The public health board of the institution may submit these proposals on the issues deliberated, as recommendations to the administration of the institution, if the administration of the enteprise fails to agree with the proposals. 3. The head of the institution’s administration or an administration representative delegated by him, shall chair the public health board. The laws and institution bylaws shall establish the procedure for the formation of the public health board of the institution, the rights and obligations of its members, the procedure for the work of the public health board, the rights of the members of the public health board, their obligations, the conditions for their appointment and dismissal, the conditions of labour compensation and liability. Article 48. The Control of the Financial Activities of a Public Institution 1. The state or municipal control institutions shall control the financial activities of a state or municipal public institution, according to the procedure established by laws. 2. At least one auditor or an auditing commission shall be elected (appointed) for the control of the financial activities of the institution according to the procedure established in its bylaws. 3. The administration of public institutions must submit to the institutions of state or municipal control and entities of financial activity control stipulated in the institution's by-laws, the institution documents required by them. 4. The founder (founders) of public institutions must organise an independent audit of the institution, at least once every two years. Article 49. The Funds of the Public Institution 1. The sources of public institution funds shall consist of: 1) state and municipal funds earmarked for extraordinary expenses; 2) state and municipal funds earmarked for rendering services free of charge and implementing other measures of compulsory health promotion activities; 3) compulsory and supplemental health insurance funds in accordance with the health insurance agreements with state or regional patients’ funds or supplemental health insurance organisations. Expenses incurred in this regard, shall be reimbursed from health insurance funds; 4) special purpose allocations of state and municipal budgets; 5) funds from state and municipal health funds, designated for the financing of state and municipal health programmes; 6) funds from legal and natural person funds, intended for the financing of health programmes and supporting institution activity programmes; 7) funds obtained from natural and legal persons in accordance with health care contracts for services rendered; 8) funds for paid services established by laws and Government decrees; 9) funds obtained as donations, support or gifts, and also those obtained through a testament designation; 10) general allocations of the Ministry of Education and Science, designated for the study and science requirements of Vilnius University and Kaunas Medical Academy hospitals; 11) other legally-obtained funds. 2. An estimate of expenditures must be prepared on the funds obtained from Lithuanian state or municipal budgets and the state and municipal health funds. A public institution shall prepare one annually. The founder (founders) of the public institution shall approve the estimate. An estimate shall be prepared on the funds obtained from other sources, should this be required by the supplying entities. 3. A public institution shall keep the funds received from the state or municipal budgets in a separate institution fund account. 4. A public institution shall use the funds received as charitable donations or support and also, designated by testaments, for activities designated and accredited in the bylaws as indicated by the charitable contribution (support) contributor or the testator. Charitable donations or support, as well as funds resultant from a testament, shall be kept in a separate account of the funds of the public institution. Article 50. The Property of the Public Institution 1. The property of a public institution shall be comprised of long-term material property, property obtained as charitable donation or support, property obtained according to a testament, financial resources and other legally-acquired property connected with the activities of the institution. 2. The founders shall transfer the property to a public institution on a loan basis. 3. A public institution may sell, transfer, rent and mortgage long-term material property, and also may warrant or guarantee through it the fulfilment of obligations of other entities, only with the permission of the founder. The detailed procedure of requests in order to obtain these licenses must be indicated in the bylaws of the institution. 4. Having sold the material properties which are worn out, or not required for its activities, the public institution makes use of the obtained income in accordance with the procedure established in the bylaws. Article 51. Reorganisation of a Public Institution 1. The reorganisation of a public institution shall denote reorganisation of an institution as a legal person. The founders of a new public institution derived from reorganisation and continuing activities following reorganisation, shall be the successors to all rights and obligations of the reorganised public institutions. The founders of a public institution shall have the right of initiative of reorganising a public institution. 2. Public institutions may be reorganised as follows: 1) by joining or merging; 2) by division. 3. A public institution may be reorganised by joining or merging as follows: 1) along with the public institution, which shall continue its activities, through merging other (one or several) public institutions, that shall terminate their activities as legal persons; 2) from the institutions, which shall terminate activities as legal persons, upon the founding of a new public institution. 4. A public institution may be reorganised by division: 1) by doling out to other public institutions an institution which terminates its activities; 2) by founding new public institutions from the property of an institution, which has terminated its activity; 3) by separating parts of an institution that continues its activities, and joining them to other public institutions, or those from which new public institutions shall be founded. 5. A plan shall be formulated for the reorganisation of the institution. It shall include: the name, address, initiator of reorganisation, method of reorganisation, basis for the reorganisation of each institution being reorganised, procedure of inventory, property assessment, successors of obligations and documents and terms of succession, rights accorded to the administration and experts during the period of reorganisation and terms of reorganisation. Plans of bylaws of public institutions which shall function following reorganisation must be prepared with the reorganisation plan. 6. Founders of public institutions which are being reorganised and those which come into being following reorganisation, shall approve the plan of reorganisation of a new institution. Experts for an expert examination of this plan may be appointed by the founders approving the reorganisation plan. Experts shall have the right to obtain from the institutions undergoing reorganisation all of the information connected with it. 7. Upon reorganisation of a legal person, his property (rights and obligations) shall be transferred to other persons according to procedure established by the Civil Code. Article 52. The Liquidation of the Public Institution 1. The basis for liquidation of a public institution may be: 1) termination of the institution’s period of activity, established by laws; 2) a decision adopted by the founder (founders) according to the procedure established by the laws and bylaws of the institution; 3) a court decision to liquidate a public institution for violations of the law which have been stipulated by laws. 2. An institution which has decided to liquidate an institution, shall appoint a liquidator, establish terms of liquidation and the procedure of inventory and property transfer. Since the day of appointment of a liquidator, the collective governing body and the administration of the institution shall lose its authorisation and their functions shall be carried on by the liquidator. 3. The documents of the public institution being liquidated shall be kept according to the procedure established by the Law on Archives. 4. In liquidating an institution, its employees shall be dismissed in accordance with the procedure established by the Law on Labour Contract. 5. Upon formation of the act of liquidation of a public institution, two public announcements shall be made, concerning the liquidation of the institution, within an interval of no less than one month. 6. The remaining property shall be transferred over to the founders, in accordance with the procedure established by law. Article 53. Authorisations of the Liquidator of the Public Institution 1. The liquidator of a public institution shall exercise rights and duties of an administration chief. He shall represent the institution under liquidation at state and municipal institutions, in court and in relations with other legal and natural persons. 2. The liquidator of a public institution shall: 1) prepare a financial account (liquidation balance) of the institution at the inception of the liquidation period; 2) settle state and municipal accounts; 3) complete implementation of obligations in accordance with the previously formed contracts of the institution and draw up new agreements in connection with liquidation of the institution; 4) transfer the remaining property of the public institution to the founder (founders); 5) formulate a liquidation act of the 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 losses incurred through his fault. Article 54. Allotment of the Income of Public Institutions and Tax Reliefs 1. The income of public institutions shall be allotted: 1) for the principal activities established in institution bylaws and for the implementation of obligations; 2) for budget taxes established by law; 3) for raising the qualifications of institution personnel; 4) for the acquisition and introduction of new health care technologies; 5) for major repair and reconstruction. 2. The balance of the income may be used for the employee cultural and social needs, that have been established in collective agreements. 3. The founder shall establish the normatives of income distribution. A public institution shall not have the right to use for other purposes the income it has obtained, until it has paid the taxes stipulated by laws. 4. Tax reliefs for public institutions shall be applied according to the procedure established by laws. Article 55. The Nomenclature of Individual Health Care Public Institutions of the Levels of Organising of LNHS Activities 1.The nomenclature of municipal individual health care institutions of the primary level of organising of LNHS of activity, shall be as follows: 1) offices of physicians of general practice; 2) offices of dentists of general practice; 3) municipal polyclinics (with day in-patient facilities); 4) municipal out-patient clinics (with day in-patient facilities). 2. The municipal government executive institution shall organise and manage the nomenclature institutions listed in part one of this Article, within the municipal region, according to the normatives of the institution infrastructure established by the Government. 3. The nomenclature of county individual health care institutions of secondary LNHS organisation level of activity : 1) county hospitals (with polyclinic departments); 2) specialised hospitals, included on the list approved by the Ministry of Health; 3) county polyclinics; 4) institutions of medical rehabilitation, included on the list approved by the Ministry of Health; 5) blood donorship institutions; 6) sanatorium-type resort institutions, included on the list approved by the Ministry of Health; 7) county centres of sport medicine. 4. The county governor shall organise and manage the nomenclature institutions indicated in part 3 of this Article, in accordance with the normatives of infrastructure of the institutions established by the Government. 5. Nomenclature of individual state health care public institutions of the tertiary level of organising of LNHS activity: 1) Vilnius University and Kaunas Medical Academy Hospitals; 2) specialised hospitals and medical rehabilitation hospitals, included on the list approved by the Ministry of Health; 3) blood donorship institutions, performing specialised functions (production of blood preparations, immunological activity etc.); 4) sanatorium-resort institutions, included on the list approved by the Ministry of Health. 6.The Ministry of Health shall administer the nomenclature institutions belonging to the tertiary level of organising of LNHS activity, indicated in part 5 of this Article, in accordance with the normatives of infrastructure approved by the Government. Article 56. Nomenclature of the Public Institutions For Public Health Care Levels of Organising of LNHS Activity Levels 1.The institutions for neutralisation of infections (prophylactic disinfection, disinsection and deratization) belong to the nomenclature of municipal public institutions of public health care of the primary level of organisation of LNHS activity. 2. The executive institution of municipal government shall organise and administer the institutions located in the municipality, listed in part 1 of this Article, in accordance with the normatives of institution infrastructure, established by the Government. 3. The state public institutions of public health care of the secondary and tertiary levels of organising of LNHS activity shall be the institutions under the jurisdiction of the State Public Health Care Service, providing public health care services. Section III SPECIAL FEATURES OF THE FINANCING AND MATERIAL SUPPLY OF LNHS INSTITUTIONS Article 57. The Procedure of Utilisation of Sources of Financing of LNHS Institutions 1. The laws and other legal acts shall establish the sources of LNHS institution financing. 2. Institutions which render identical health care services may not be reimbursed from several sources of financing, with the exception of free services and requisite public health care measures and state and municipal compulsory health programmes. The laws and other legal acts shall establish the procedure of financing these services from several sources. 3. The limitations in part two of this Article shall not apply to funds received as donations and support and also those designated for health care by the health funds and other funds. Article 58. Financing of LNHS Institutions from the State and Municipal Budgets 1. From allocations from the state budget, intended for health care: 1) free services of secondary and tertiary level of organising of LNHS activity shall be financed, in accordance with the procedure established by this Law, for population members of the corresponding counties on the secondary level, and all population members on the tertiary level, as well as the requisite medical assistance services for all population members; 2) implementation of the requisite public health care measures, included on the list, approved by the Ministry of Health, shall be financed; 3) obligatory state health programmes shall be financed; 4) extraordinary expenses and those expenditures for the acquisition and introduction of medical apparatus and equipment, which are not reimbursed by allocations for service rendering, shall be reimbursed for institutions, accredited for the secondary or tertiary level of organising of LNHS activity; 5) closed budget institutions of the national defence system and the internal affairs system and the financed Ministry of Health system; 6) applied research in medical science shall be financed. 2. The municipal budget allocations intended for health care: 1) shall finance free services by institutions, accredited for the primary level of LNHS activity, rendered in accordance with the procedure established by this Law, to population members of the municipality, and requisite medical assistance services rendered to all permanent residents of the Republic of Lithuania; 2) established requisite public health measures, included on the list noted in paragraph 2, part one of this Article, shall be financed by the Government or upon its recommendation, by the Ministry of Health. These measures must be co-ordinated with the municipality association of Lithuania; 3) shall finance compulsory health programmes in municipalities; 4) shall reimburse the extraordinary expenses and those expenditures for the acquisition and introduction of medical apparatus and equipment, which are not reimbursed by allocations for service rendering, of institutions, accredited for the primary level of organising of LNHS activity. Article 59. The Requirements of LNHS Institutions in Acquiring Health Care Technologies 1. LNHS institutions must co-ordinate with the Ministry of Health the questions concerning the acquisition of health care technologies, employed in rendering free services, if the cost of such technologies exceeds the amount established by the Ministry of Health. 2. LNHS institutions must co-ordinate with the Ministry of Health and the State Patients’ Fund the questions of acquiring health care technologies for rendering services compensated by compulsory health insurance, if the cost of such exceeds that established by the Ministry of Health. 3. In allocating the health care technologies included on the list approved by the Government, the Ministry of Health shall extend priority consideration to LNHS institutions, accredited for the tertiary level of organising of LNHS activities. Article 60. Instances of Centralised Supply of Health Care Technologies to LNHS Institutions 1. In order that the health care technologies employed by the institutions accredited to levels of organising of LNHS activities and the lesser expenditures of supplying the institutions with these technologies might be the equal, the Ministry of Health shall have the right, in accordance with the programme approved by the Government, to purchase these technologies in a centralised fashion and to determine the procedure for their allocation. 2. The Ministry of Health, Service for Accrediting, State Medical Audit Inspectorate, State Medicines Control Agency, State Patients’ Fund and State Public Health Care Agency shall participate in preparation of the programme for supplying the LNHS institutions with health care technologies and unifying them. 3. Centralised purchasing of health care technologies may only be effected by means of public tender. Article 61. The Record of the Expenses of Non-Medical Activities of LNHS Institutions If an LNHS institution is to perform not only basic health care, but also non-medical activities, it must maintain a separate record of health care and non-medical activity expenses. Article 62. The Procedure of Compensation of the Expenses of Instruction of Students and Residents at LNHS Institutions Corresponding educational institutions or the students themselves shall pay the expenses of instruction of the students and residents of LNHS institutions, according to the procedure and conditions established by the Ministry of Health. Chapter III INDIVIDUAL HEALTH CARE INSTITUTIONS OF RELIGIOUS COMMUNITIES AND ASSOCIATIONS, AND PUBLIC INSTITUTIONS Article 63. Individual Health Care Institutions of Religious Communities and Associations, and Public Organisations 1. Religious communities and associations, and public organisations, in their bylaws established for the implementation of health care purposes and goals, shall have the right to found individual health care institutions. 2. Individual health care institutions shall be founded from the property of these organisations and maintained from the funds legally acquired by them. According to their contracts with the clients of LNHS activities, these institutions may obtain funds from the state or municipal budgets, compulsory health insurance or state and municipal health fund. These contracts are formed only with the existence of the basic conditions for contract formation of Article 22 of this Law (with the exception of paragraph 1 of part 2 of Article 22).The institutions shall work in accordance with the standard regulations approved by the Government. Article 64. The Founding, Accrediting, Registration, Management, Activity, Reorganisation, Liquidation, Funds, Financing and Control of Financial Activity of the Individual Health Care Institutions of Religious Communities and Associations and Public Organisations 1. Religious communities and associations and public organisations shall be permitted to found only the public institutions, which according to their type of activity, are analogous to the nomenclature of institutions of the primary and secondary organising level of LNHS activity. 2. LNHS requirements for public institutions shall be applied for the founding, accrediting, registration, management, activity, reorganisation and liquidation of such institutions. 3.These institutions shall be obliged to provide free individual health care services to members of the population. 4. The funding sources and financial activity management procedure of these institutions shall be regulated by the Laws on Charity and Sponsorship, Public Organisations, Religious Communities and Associations, this Law and other laws and legal acts. Chapter IV THE RIGHTS AND OBLIGATIONS OF INSTITUTIONS Article 65. The Rights of Institutions The rights of health care institutions shall be established by the Law on the Health System, this and other laws and legal acts. Article 66. The Obligations of Individual Health Care Institution 1. An individual health care institution must: 1) ensure requisite medical aid; 2) ensure the implementation of requisite public health measures in accordance with the list approved by the Ministry of Health; 3) render the individual health care services, that are indicated in the accrediting certificate issued to the institution; 4) ensure the use of such health care technologies, as are approved by established procedure and (
6. or)allowed to be used in the Republic of Lithuania; 5) ensure that the case histories of patients and their out-patient cards would be recorded and kept, and that information concerning the patient would be furnished to state institutions as well as other offices, in accordance with the procedure established by the Ministry of Health; 6) ensure equal rights for patients to the health care services rendered; 7) compensate for damages caused to the health of the patient in the course of rendering services; 8) protect the medical confidentiality of the patient, with the exception of instances when the health care institution must furnish information concerning a patient or when a patient agrees to have the information concerning his health made public; 9) to inform the Ministry of Health and institution founders or owners, according to the procedure established by legal acts, about the occurrence of instances or outbreaks of internal infections at the institution and other instances of harm being caused to the health of patients. 2. The laws and other legal acts may establish also other obligations for individual health care institutions. Article 67. The Internal Procedure Rules of Individual Health Care Institutions 1. The individual health care institutions must have internal procedure rules and must ensure, that they would be accessible for the patients to familiarise themselves with. 2. The internal procedure rules must indicate: 1) the procedure for patient contacting the institution; 2) nomenclature and assortment of free services and those compensated by the compulsory insurance fund and the procedure for rendering them; 3) the rights and obligations of patients at the institution; 4) the procedure of patient visitation, discharge, or transfer to other individual health care facilities; 5) procedure for resolving disputes and conflicts between an institution and patients; 6) procedure of providing information for a patient and his family members concerning his state of health; 7) procedure of making copies of patient history, out-patient records and other documents, for issuing these to patients or other natural or legal persons; 8) work hours of institution administration and other auxiliary agencies; 9) provisions of laws regulating work safety, and other legal acts and normative documents; 10) procedure for safe keeping and registration of articles made of precious metals, expensive prosthetic appliances and money,in the patient’s possession. 3. Institution employees must have duty instructions. Article 68. The Procedure of Patient Admittance to an In-Patient Institution 1. It shall be prohibited to admit a patient to an in-patient institution without his consent. 2. It shall be prohibited to admit a minor or legally incapable individual to an in-patient institution without the consent of his legal representatives. 3. The consent of patient or his legal representatives shall not be required: 1) when the life of a patient shall be at stake and he himself shall be unable to provide such consent; 2) when the life of a minor or legally incapable individual shall be at stake, and it shall be impossible to locate his legal representatives, without delay; 3) in other instances stipulated by laws. 4. The Ministry of Health shall establish the procedure for an individual’s urgent admission to an institution. Article 69. The Patient Register at Individual Health Care Institutions 1. The institutions must keep the records of patients included in the register, and to provide an accounting of the patients’ health care to the Ministry of Health. These must include a history of illness or treatment and his out-patient card, for each patient and information about his visit must be included in the registration journal. The originals of these documents shall be kept at the institution. 2. The Ministry of Health shall establish the procedure for state or municipal institutions of providing patient records and approve the regulations of the patients’ register. Article 70. Obligations of the Individual Health Care Institution upon the Death of a Patient 1. Upon the death of a patient, the institution must notify the members of his family, his legal representatives or individuals designated by the patient while he was alive, of this no later than within a period of 12 hours. 2. The Ministry of Health shall establish the procedure for certification of the death of a patient at the institution. 3. A pathoanatomical examination shall be performed at the institution, upon the death of a patient when: 1) it shall be requested by family members or legal representatives of the deceased; 2) the death is sudden or unexpected; 3) cause of death is unclear; 4) death occurs following surgical intervention, diagnostic and treatment procedures; 5) death occurs as a result of professional or infectious diseases, or the suspicion exists that death was caused by a professional or infectious disease; 6) death of a new-born infant or child; 7) death of an expectant woman or one giving birth; 8) a person dies, who has been at the in-patient hospital less than 24 hours; 9) other instances stipulated by laws. 4. A legal medical expert examination shall be performed following the death of a patient, if: 1) death occurs as a result of injuries, poisoning or criminal abortion; 2) the identity of the deceased is unknown; 3) suspicion exists that violence is the cause of sudden death; 4) it is impossible to determine the cause of death by other means; 5) upon receipt of requirement from law protection institutions, in other instances stipulated by laws. 5. An institution shall guarantee free storage of the body of the deceased until such time as it shall be claimed by family members of the deceased, his legal representatives or persons designated by the patient, while he was alive, but no longer that for 4 twenty-four hour intervals following the pathoanatomical investigation or fulfilment of court medical expert examination. 6. Upon expiration of the term indicated in part 5 of this Article, the body of the suddenly-deceased shall be transferred to the area morgue. Article 71. The Obligations of the Public Health Care Institution 1. A public health care institution must: 1) ensure that the requisite public health care measures shall be implemented; 2) provide only those services which are indicated on the accrediting certificate issued to the institution; 3) employ only such testing methods and only such health care technologies, as are approved and permitted in the Republic of Lithuania; 4) ensure the commercial confidentiality of natural and legal persons. 2. The laws and other legal acts may establish for public health institutions other obligations as well. Article 72. The Regulations of Internal Procedure of Public Health Institutions 1. Public health care institutions must have internal procedure regulations, approved according to procedure stipulated by the bylaws of the institution. 2. The internal procedure regulations must indicate: 1) procedure for a legal and natural person in contacting an institution; 2) the rights and obligations of the legal and natural persons connected with the institution; 3) procedure of resolving disputes and conflicts arising between the institution and legal or natural persons; 4) procedure for providing information to interested legal and natural persons, regarding activity; 5) work hours of the institution and their distribution. 3. Institution employees must have work instructions. PART III CONTROL OF INSTITUTION ACTIVITY Article 73. The Inspector of Institutions 1.The Minister of Health may appoint an inspector to investigate institution activity. Officers of the Ministry of Health, its subordinate state institutions and institution specialists may carry out the duties of inspectors. 2. An inspector shall have the right: 1) upon presentation of a document of appointment, free access to an institution and to verify whether the requirements of legal acts and (
7. or)normative documents are being violated; 2) to request and receive all necessary information, documents, material, laboratory tests, data of medical examinations and tests of patients and verbal and written explanations by institution heads and other employees, which are needed in order to conduct an inspection; 3) to request performance of additional tests (performed at the institution) for patients; 4) to request that the head of the administration of the institution dismiss a health care specialist, within a one-month-period and verify his professional competence without fail, if shortcomings in the professional activity of this specialist have been determined, which may have or have posed danger to, or inflicted damage upon the health of patients. The Ministry of Health shall establish the specific bases for the suspension from work of specialists and the procedure of the verification of professional competence. The work pay of the health specialist shall be interrupted during the period of the suspension from work of the health care specialist; 5) to hold the employees of institutions liable according to procedure established by laws, for violations of health promotion laws and other legal acts. 3. The head of administration must implement the inspector’s request to relieve a health care specialist of his duties. The health care specialist shall have the right to lodge a complaint about such a decision before the Ministry of Health, which must examine his statement within 7 days of the submittal thereof. 4. Interference with the inspector’s fulfilment of his duties shall incur upon the officers the liability stipulated by laws. 5. The inspector must submit an inspection certificate, conclusions and recommendations to the Minister of Health. 6.The inspector, basing himself upon the inspection materials, shall have the right to submit conclusions and recommendations to the Minister of Health, the Service for Accrediting and other state institutions controlling the activity of state institutions regarding: 1) assessment of the qualification or suspension or annulment of the license to engage in health care, of a health care specialist (specialists) who has violated the law; 2) dismissal from work (duties) of an individual (individuals) who has violated the law; 3) annulment of the accrediting for health care activities of a department or branch of an institution; 4) suspension of institution activity; 5) removal of the managing bodies of the institution and appointment of a temporary administrator. 7. According to the procedure established by laws, the inspector shall be liable for exceeding his authorisation. Article 74. The Suspension of the Rendering of Services at an Institution 1. Following the substantiated recommendation by the inspector appointed by him, or the Service for Accrediting, the Minister of Health shall have the right to suspend the rendering of all, or a part of, the services at the institution if: 1) the institution, its department or branch are engaged in non-accredited activity; 2) the health care provided by an accredited institution or a department or branch thereof, shall fail to conform with the requirements of legal acts or normative documents therefore posing certain danger to the health of a patient, or causing damage to people’s health and losses to legal and natural persons; 3) the institution is not registered in the institution register or has been registered in violation of the requirements of this Law, and has not been implementing the requirements of the institution register administrator for over a period of 3 months; 4) health care at the institution is carried out by individuals who are not authorised to perform such activities; 5) the facilities of the institution or its department, exploitation and health care technologies do not meet the requirements of legal acts and (
8. or)normative documents. 2. The rendering of services by an institution may be suspended for no longer than a 3-month period. Having approved this type of decision, the Minister of Health must notify the institution in writing of actual motives behind such decision and the term of time allowed for the elimination of such violations or shortcomings. 3. Following suspension of services at an institution, the patients shall be transferred to other institutions according to the procedure established by the Ministry of Health. 4. The institution must eliminate the shortcomings, within the time period indicated by the Ministry of Health. Its activity may be renewed, only in this instance, per order of the Minister of Health. 5. Should the institution fail to eliminate said shortcomings, the accrediting of the institution shall be annulled or, upon dismissal of the governing bodies of the institution, a new temporary administrator shall be appointed. 6. The losses suffered by the institution due to unfounded or illegal suspension of services shall be compensated in accordance with the procedure established by the Ministries of Health and Finance. 7. The disputes regarding the decision to suspend services shall be resolved by the court according to the procedure established by laws. Article 75. The Procedure of Dismissal of the Managing Bodies and the Appointment of a Temporary Administrator 1. The managing bodies of an institution shall be dismissed and a temporary administrator appointed if: 1) the institution shall fail to eliminate established violations or shortcomings thereby giving rise to a threat to the appropriateness of the services it renders and the health of patients, however there still remains an actual possibility of remedying the situation; 2) an outbreak of hospital infection at the institution, due to shortcomings in the organising activities of the institution administration, shall repeat itself within the same year; 3) more than one instance of death, due to the fault of the institution specialist or specialists, shall occur within the same calendar year. 2. The temporary administrator shall be appointed for up to a six-month period. Per request of the temporary administrator, the Minister of Health may extend this term up to one year. Article 76. The Temporary Administrator of the Institution 1. The temporary administrator of an institution is a chief of the health care institution, appointed by the Minister of Health during the period of the dismissal of the managing bodies. The Ministry of Health shall establish the qualification requirements of temporary administrators of an institution. An employee of an institution the managing bodies whereof are being dismissed, may not be its temporary administrator. 2. All of the authorisations of the governing bodies shall be transferred to the temporary administrator, from the day of appointment of the temporary administrator. 3. The temporary administrator shall have the right to terminate or form labour agreements with members of the governing bodies and other employees of the institution. 4. A temporary administrator shall not be bound by the decisions of institution founder or owner, with the exception of those instances indicated in part 5 of this Article. 5. A temporary administrator may not sell or otherwise transfer or exchange property, reorganise or liquidate an institution, and resolve other issues falling within the exclusive competence of the institution founder or owner. 6. The temporary administrator must inform the Minister of Health, the Service for Accrediting and the founder or owner of the institution, concerning the course and results of administration, according to the terms and procedure established by them. 7. The temporary administrator must assign an institution audit and hygienic, epidemiological, labour safety and medical audit expert examinations. The expert examinations must be conducted within 3 months from the day of appointment of the temporary administrator. 8. Having established, in the course of an audit, violations of laws and of other legal acts and (
9. or)normative documents, the temporary administrator shall appeal to the Service for Accrediting to have the accrediting annulled and shall inform the Ministry of Health thereof. 9. The temporary administrator shall be held liable in accordance with the procedure established by the laws, for damage incurred by the institution through his fault. Article 77. Recall of the Temporary Administrator of the Institution The temporary administrator of an institution shall be recalled prior to the expiration of his term of office, by order of the Minister of Health, if: 1) it shall be established by the Service for Accrediting that the institution may function in a reliable and stable manner; 2) the accrediting of the institution has been annulled. Article 78. Control of the Activity of the Service for Accrediting Institutions 1. The Service for Accrediting shall have the right; 1) to warn the agency concerning shortcomings and violations of its activity and to set the time limits for the removal thereof; 2) to set administrative penalties for heads of governing bodies, in accordance with the procedure established by laws; 3) to require verification of the qualifications of health care specialists of institutions; 4) to annul the accrediting of all services or a part thereof. 2. The Service for Accrediting shall apply measures of activity control, taking into consideration the content of violation on the basis of which the measure of supervision shall be applied. 3. The decisions of the Service for Accrediting regarding the application of supervisory measures may be appealed during a period of 30 days, according to procedure established by law. An appeal shall not interrupt the implementation of the decision by the Service for Accrediting. Article 79. The Principles and Procedure of the Application of Control Measures of Institution Activities 1. The Service for Accrediting shall adopt a decision regarding the application of measures of control application to the institutions, listed in this Article, if at least one of the following reasons shall be present: 1) vital information or documents necessary for the implementation of control of institution activity have not been submitted to the Service for Accrediting or this information and documents do not correspond to reality; 2) laws and the requirements of other legal acts and (
10. or)normative documents regulating the activity of institutions, have been violated. 2. The question of applying a control measure to an institution shall be deliberated with the representatives thereof participating. If the representatives of the institution fail to attend during deliberation of the question, the decision to apply a measure of control shall be adopted without them. 3. The decision on the application of control measures to an institution, with the exception of the control measure, indicated in paragraph 2 of part one, Article 78, must be adopted within 3 months of the day when the violation was established. Measures of control may not be applied, if more than one year has elapsed from the day of the committal of such. Article 80. Control of the Activity of Health Care Specialists Conducted by the Service for Accrediting If a health care specialist, in rendering services, has through illegal actions endangered or damaged the health or life of the patients, the Service for Accrediting shall have the right to: 1) require to relieve the health care specialist of his duties for up to a month, in order to assess his professional competence. His salary shall be suspended for the duration of his absence from his position; 2) require to assess the professional competence of a health care spec