A report by the Office of the Patient Advocate identifies gaps in the patient referral and transfer process, which in some cases may leave the patient “stranded,” with no clear party responsible for their care, are highlighted in a report by the Office of the Patient Ombudsman.
The report, titled “The Patient Left in the Lurch Between Medical Centers,” examines 23 typical scenarios involving patient referrals and transfers.
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According to the findings, in 12 of these cases, “the current framework allows for the violation of patient rights,” while in six others, the outcome “depends on whether a single step was performed correctly.”
According to the report, only five scenarios operate as required by law.
The main gap concerns who is responsible for the patient until their transfer is complete. Although the law stipulates that any medical facility to which a patient is referred must either admit the patient or arrange for their transfer and admission to an appropriate facility, it does not specify with sufficient clarity when the process is completed and who remains responsible until then.
“A phone call is not an admission, and a recommendation to ‘go elsewhere’ is not a referral,” says the Patient Ombudsman, Marios Charalambides.
As he notes, “when providers disagree, the patient must already be receiving care and not left waiting for the dispute to be resolved.”
When the patient is left “in the lurch”
The report examines various scenarios, ranging from the transfer of a patient already hospitalized to admission to the Emergency Department, to disputes between medical institutions and the role of the attending physician.
In scenarios where the process operates as prescribed by law, three key elements are identified: written documentation, confirmed acceptance by the receiving institution, and a clearly designated person in charge.
“Where even one of these three is missing, the patient is left in limbo,” the report states.
The report also points out that the OAU referral protocol covers seven categories of emergency cases at emergency departments, while the relevant law applies to all patients.
Excluded from this specific protocol are, among other things, postoperative complications, the transfer of patients already hospitalized, ambulance transfers, and the role of the attending physician.
Critical Decisions “Over the Phone”
The report also addresses the documentation of referrals, acceptances, and refusals.
According to the report, “critical decisions are made over the phone,” while referrals, acceptances, and refusals “are often not recorded,” even when required by the rules.
According to the report’s findings, the OAU had to remind stakeholders of or tighten relevant rules at least twice, in 2024 and 2026.
Moreover, a problem arises particularly when two medical institutions disagree on who should admit a patient. As noted, there is no authority with the power to decide within a few hours which facility will take the patient, with the result that the patient remains in limbo.
Approximately 380 transfers per month
According to the report, approximately 380 patient transfers take place each month. However, refusals, delays, and disagreements are not recorded separately.
At the same time, according to the report, there is no central registry of bed availability, which means that neither claims of a bed shortage nor whether such claims are justified can be effectively verified.
The report also expresses concern regarding patients with more complex conditions. As noted, when reimbursement does not reflect the actual cost of complex cases, this may create an incentive to transfer them to another facility.
The report clarifies, however, that it does not find discrimination in any specific case, but points out that the system “lacks the safeguards that would prevent it.”
Which rights are affected
According to the report, the gaps identified affect a number of rights enshrined in the Law on Patients’ Rights.
These include the right to uninterrupted continuity of care and cooperation among providers, the provision of care within a reasonable time, transfer only with the receiving facility’s consent, referral and assurance of transport in emergency situations and cases of acute medical emergencies, the right to equal care without adverse discrimination, as well as the right of the patient and their family to information and participation in decision-making.
“No referral without a written commitment”
A key recommendation of the Patient Ombudsman is the establishment of a clear rule that no referral or transfer is finalized without a written, named acceptance by another appropriate medical facility”.
Until such written acceptance is provided, responsibility for the patient’s care should, according to the proposal, remain with the facility to which the patient was referred.
Acceptance by the receiving institution must be “explicit, in writing, and by name,” specifying the time and the name of the person in charge.
“A referral, a phone call, or a verbal agreement is not sufficient,” the proposal emphasizes.
The Ombudsman also recommends a written request and referral form for each transfer, as well as a record of any refusal, including the time, reason, and the name of the person in charge, as well as the specific accountability of the attending physician and the mandatory designation of a substitute when the attending physician is unavailable.
On-call OAU coordinator
The recommendations also include the creation of an on-call OAU coordinator, with the authority to decide within hours which medical facility will admit the patient when there is a disagreement among providers.
At the same time, the Ombudsman is calling for the creation of a central bed registry, a precise declaration of each provider’s capacity, a review of compensation for complex cases, and measurable oversight, with metrics for the time required to admit a patient.
The key requirement, according to the report, is that there must always be at least one responsible entity and one responsible individual, so that responsibility is not shifted from one provider to another.
It is clarified that the report does not constitute a finding regarding a specific incident, does not name those responsible, and does not judge the medical soundness of decisions.
Source: KYPE
