Gaps in the way patients are referred and transferred between medical facilities can, in some cases, leave them “in the middle”, without anyone clearly responsible for their care, a report published on Tuesday by the Patient Advocate’s Office found.

The report examined 23 typical scenarios involving patient referrals and transfers.

It found in 12 of the scenarios “the current framework allows patients’ rights to be violated”, while in another six the outcome “depends on whether someone correctly carried out a single step”.

Only five of the scenarios operate as provided for by law, the report said.

The central gap concerns who is responsible for a patient until their transfer has been completed.

Although the law provides that every medical institution approached by a patient must either admit them or arrange for their transfer and admission to an appropriate facility, it does not define with sufficient clarity when that process is considered complete or who remains responsible until then.

A phone call is not a referral

“A phone call is not an assumption of responsibility and a recommendation to ‘go elsewhere’ is not a referral,” Patient Advocate Marios Charalambides said.

“When providers disagree, the patient should already be receiving care, not waiting for the disagreement to be resolved.”

The report examined a range of situations, from transferring a patient who is already hospitalised and patients arriving at accident and emergency departments, to disagreements between medical facilities and the role of the treating doctor.

In scenarios where the process operates as provided for by law, three basic elements are present: written documentation, confirmed acceptance by the receiving facility and a clearly designated person responsible.

“Where even one of the three is missing, the patient is left in the middle,” the report said.

It also pointed out that the Health Insurance Organisation’s (HIO) referral protocol covers seven categories of emergencies at accident and emergency departments, while the relevant law applies to all patients.

The report also raised concerns over the recording of referrals, acceptances and refusals.

“Critical decisions are made over the phone,” it said, while referrals, acceptances and refusals “are often not recorded”, even when the rules require this.

Problem when medical institutions disagree

A particular problem arises when two medical institutions disagree over who should take responsibility for a patient.

The report said there is no body with the authority to decide within a matter of hours which institution must take the patient, potentially leaving the patient waiting while the dispute continues.

Around 380 patient transfers take place every month, according to the report.

The report also raises concerns over more complex patients.

It said that when compensation does not reflect the actual cost of treating complex cases, an incentive may be created to transfer those patients to another facility.

The shortcomings identified could affect a series of rights guaranteed under the Patients’ Rights Law, the report said.

The Patient Advocate called for the treating doctor to be personally designated as responsible for the patient and for a mandatory replacement to be named whenever that doctor is unavailable.