The law is clear: every medical facility to which a patient is referred must either admit the patient or ensure that the patient is transferred to and admitted at an appropriate facility. However, no rule explicitly defines when this transfer is complete or who is responsible for the patient until then. This is a key finding of the report “The Patient Caught in the Middle, Between Medical Centers,” released today by the Office of the Patient Ombudsman. The report does not concern a single incident: it examines the framework within which all GESY providers—both public and private—operate, and concludes that the gap is systemic.
| 12 out of 23 transfer scenarios where the current framework allows for the violation of patient rights | The OAY referral protocol covers 7 categories of cases and specific data. The law applies to all cases. | ~380 patient transfers per month. Refusals, delays, and disputes are not counted | At least twice (in 2024 and 2026), the OAY had to remind stakeholders of or tighten rules that were not being followed |
What the mapping shows
ΣΧΕΤΙΚΑ ΑΡΘΡΑ
The report maps out 23 typical referral and transport scenarios: ranging from the transfer of a patient already hospitalized and admission to the Emergency Department, to disputes between medical institutions and the patient’s communication with their attending physician. In 12 of these, the current framework allows for the violation of patient rights. In 6 others, the outcome depends on whether a single step was taken correctly. Only 5 scenarios operate as prescribed by law. What they have in common is that there is written documentation, confirmed acceptance, and a designated person in charge. Where even one of these three is missing, the patient is left in the lurch.
| “A phone call is not an acceptance of responsibility, and a recommendation to ‘go elsewhere’ is not a referral. When providers disagree, the patient should already be receiving care, not waiting for the disagreement to be resolved.” Patient Advocate |
What the report found
- The law covers every patient. The OAU protocol covers only seven categories of emergencies at the Emergency Department. Excluded are complications from surgeries, transfers of patients already hospitalized, ambulance transfers, and the role of the attending physician.
- Critical decisions are made over the phone. Referrals, acceptances, and refusals are often not documented, even when required by regulation. The OAU had to remind them of this at least twice (in 2024 and again in 2026).
- When two medical institutions disagree, no one makes a decision. There is no authority with the power to determine within hours which one will take the patient. In the meantime, the patient waits.
- The lack of beds cannot be verified. There is no central registry of bed availability, so no one can check when someone cites a shortage—or whether it is justified.
- Patients with more complex conditions are at greater risk. When reimbursement does not reflect the cost of complex cases, there is an incentive to transfer them elsewhere. The report does not find discrimination in any specific case. It finds that the system lacks the safeguards that would prevent it.
Which patient rights are affected?
These gaps affect rights that the Law on Patients’ Rights explicitly guarantees:
| Right (article) | How it is affected |
| Uninterrupted continuity of care and cooperation among providers — 4(4) | Disagreements among providers interrupt care, rather than being resolved without burdening the patient. |
| Care within a reasonable timeframe — 4(1) | Without a deadline and without a decision-making body, the transfer process can take days. |
| Transfer Only Upon Acceptance by the Receiving Facility — 4(6)(a) | The patient is sent elsewhere without anyone having agreed to admit them. |
| Referral and assurance of transport in emergencies and to the Emergency Department — 8, 9 | This obligation applies to every patient, but for most cases, there is no established procedure. |
| Equal care without adverse discrimination — 7 | The most complex and “costly” patients are more likely to experience delays in care. |
| Information, shared decision-making, and family support — 4(3), 5, 10–12 | The patient and their loved ones make decisions without the full picture and bear the burden of the process alone. |
| THE MISSING RULE No referral or transfer is complete without a written, named acceptance from another appropriate medical facility. Until then, responsibility for the patient lies with the medical facility to which they were referred, regardless of which one it is. |
Three requirements that must be met for every transfer
- Confirmed acceptance by the receiving medical facility: The referral or transfer is complete only when another appropriate facility has explicitly accepted the patient in writing and by name, specifying the time and the name of the person in charge. A recommendation, a phone call, or a verbal agreement is not sufficient, and the patient’s arrival does not constitute acceptance.
- Responsibility of the referring medical facility until acceptance: The facility to which the patient was referred retains responsibility for the patient’s care until another facility formally assumes responsibility in writing, and may not shift the burden of waiting to the patient or their family. This responsibility is institutional: it rests with the administration, which must designate a specific person in charge and establish a procedure.
- Responsibility of the attending physician and their medical institution: the attending physician designates a substitute when they are unavailable and informs the patient and the family. When a patient first contacts the physician or the physician’s institution, the physician shall not refer the patient elsewhere without a written and substantiated request and a confirmed agreement to accept the case. Whoever performs a procedure bears responsibility for its foreseeable complications, and whoever cannot manage them should not undertake the procedure.
These responsibilities are not mutually exclusive. The patient must always have at least one responsible entity and one responsible individual, and neither may invoke the other as a reason to cease care.
What the Ombudsman is requesting, in summary
- An immediate circular from the OAU to ensure that the rule of confirmed written acceptance applies to every referral or transfer (applicable in all cases).
- A written request and referral form for every transfer, and a record of every refusal, including the time, reason, and name of the person responsible.
- Personal responsibility of the attending physician: a substitute must be designated when the attending physician is unavailable, and no patient may be referred elsewhere without a documented request and confirmed acceptance.
- An on-call OAU coordinator, with the authority to decide within hours which medical institution will take on the patient when institutions disagree.
- A central bed registry, an accurate statement of capacity, a study on compensation for complex cases, and measurable oversight, with metrics for the time to admission, and measures for anyone operating outside the framework.
