Ley 96 del 2008
Resumen
Esta ley enmienda la "Ley de Derechos y Responsabilidades del Paciente" para garantizar que los pacientes en instalaciones médico-hospitalarias tengan el derecho de elegir y acceder a los servicios de un podiatra para el tratamiento de sus afecciones podales. Establece que las instalaciones deben incluir podiatras en su personal, evaluados de manera similar a otros especialistas, y que los privilegios clínicos y quirúrgicos se basarán en su educación, capacitación y experiencia.
Contenido
(No. 96)
(Approved June 19, 2008)
AN ACT
To add a new subsection
(e) to Section 6, and to amend subsection
(a) of Section 9 of Act No. 194 of August 25, 2000, as amended, known as the "Bill of Rights and Responsibilities of the Patient", for the purposes of allowing the patients in the medical-hospital facilities to choose a Podiatrist to treat their foot health; and for other purposes.
STATEMENT OF MOTIVES
Act No. 61 of April 11, 2000, as amended, states that a "Podiatrist" is the health professional who is awarded an academic degree as "Doctor of Podiatric Medicine," upon completion of a Bachelor's degree, or having taken the courses needed to enter a school of medicine, and completed a rigorous four-year academic and scientific program in a School of Podiatric Medicine, accredited by the United States Department of Education. Subsequent to graduation as a "Doctor of Podiatric Medicine", many of these health professionals are able to enter post-graduate Resident programs accredited by the United States Podiatric Medicine Education Council. These programs are held in hospitals accredited by the Council, and there are, at present, four different types of accredited programs: Podiatric Surgery (Orthopedic and Reconstructive Surgery of the Foot and Ankle), Primary Podiatric Medicine, Podiatric Orthopedics, and a Rotational Podiatric Residency. These programs are of one to four years of duration. To summarize, these health professionals have a curriculum that is similar to that of any medical specialty, with regard to subject matter and duration.
A Doctor of Podiatric Medicine examines, diagnoses, treats, prevents and cares for illnesses and afflictions of the human foot, using medical knowledge and methods, and allopathic surgery. A Doctor of Podiatric Medicine is authorized to prescribe medications and controlled substances, as well as to be a part of the medical faculty of accredited hospitals, and treat, or surgically operate on patients that are hospitalized therein.
On the other hand, Act No. 194 of August 25, 2000, as amended, known as the "Bill of Rights and Responsibilities of the Patient," was created with the objective of furthering the purposes of the Government of "ensuring that all citizens obtain proper access to quality medical-hospital services and facilities according to their needs and regardless of their socioeconomic conditions and payment capacity." In harmony with this legislative intention, Act No. 194, supra, is hereby amended in order to allow patients suffering from foot illnesses or conditions access to Podiatrists in all medical-hospital facilities.
All Puerto Ricans have the right to be guaranteed quality health services. This entails that the patient should have the power to choose a health professional prepared to treat his/her foot conditions. If the medical-hospital facility admits patients with foot conditions, it is its responsibility to provide them with a health professional that has the specialized training to render said service. In this manner, the proper cost-effective and quality health services are ensured, while fully complying with its responsibility to the patient.
In Puerto Rico, patients with foot conditions or diseases cannot exercise their right to receive specialized treatment in medical-hospital health facilities. Since the latter do not provide the access to these specialists, the medical-hospital health facilities cover their responsibility by referring
patients with foot conditions to other health professionals who do not have the specialized training of a Podiatrist. This occurs because health facilities limit their medical staff to doctors of medicine (M.D.) and dentists (D.M.D.) or (D.D.S.).
This practice could be considered discriminatory and detrimental to the patient, since it attempts against his/her right to demand that a Podiatrist (D.P.M.), which is a qualified specialist specifically authorized by law to treat foot conditions, provides him/her the services. The treatment of foot conditions provided by a Podiatrist promotes the direct and prompt attention to these conditions and reduces the time the patient remains hospitalized, as well as the risk of worsening of the condition, the costs for the patient and those of the health insurance plan.
The patient should be aware of his/her right to receive specialized treatment for foot conditions, and that the Podiatrist is the qualified specialist to treat said conditions. This Legislature deems that to the extend that medical-hospital health facilities offer services which are included in the scope of practice of a Podiatrist, the hospital has the responsibility to evaluate and admit a Podiatrist to its staff based on his/her education, training and individual experience.
BE IT ENACTED BY THE LEGISLATURE OF PUERTO RICO:
Section 1. - A subsection
(e) is hereby added to Section 6 of Act No. 194 of August 25, 2000, as amended, known as the "Bill of Rights and Responsibilities of the Patient," to read as follows: "Section 6.—Rights Concerning Plan and Provider Selection.— Regarding the selection of health care plans and medical and hospital health care service providers, all patients, consumers or users of such plans and services in Puerto Rico are entitled to:
(a) ...
(b) ...
(c) ...
(d) ...
(e) Every public and private medical-hospital facility shall allow its patients to choose and have access to health services and treatment provided by a Podiatrist, if available, and shall have the services of said provider within its staff after he/she have been evaluated by the credentials committee of said hospital, in the same manner as any other specialized doctor of the institution, without discriminating as a professional class. The requirement for the inclusion of the Podiatrist into the medical faculty shall be to have completed a Medical and Podiatric Surgery Residency accredited by the "Council of Podiatric Medical Education" and the "American Podiatric Medical Association." The clinical and surgical privileges of said Podiatrists shall be granted on the basis of education, training and expertise, as well as on individual experience, and also based on the recommendations made by the "American College of Foot and Ankle Surgeons."
Section 2. - Subsection
(a) of Section 9 of Act No. 194 of August 25, 2000, as amended, known as the "Bill of Rights and Responsibilities of the Patient," is hereby amended to read as follows: "Section 9.- Rights Concerning Participation in Decisions on Treatment.-
All patients, consumers, or users of medical and hospital health care services in Puerto Rico are entitled to:
(a) Participate fully in all decisions concerning their medical and health care, including the right to choose and demand that their foot
conditions be treated by a Podiatrist. In the case of patients suffering from diabetes or other chronic conditions, he/she shall request a previous evaluation by an Endocrinologist or Nephrologist or a specialist in the corresponding medicinal field. In the cases of patients, consumers, or users of medical and hospital health care services who are unfit to participate fully in decisions concerning their medical and health care, such patients, consumers, or users shall be entitled to be represented in said decisionmaking process by either parent, their tutor, custodian, guardian, or spouse; a relative; or by legal counsel, proxy, or any person appointed by court for such purposes."
Section 3. - Effectiveness. This Act shall take effect 30 days after its approval.
CERTIFICATION
I hereby certify to the Secretary of State that the following Act No. 96 (S.B. 2145) of the $7^{ ext {th }}$ Session of the $15^{ ext {th }}$ Legislature of Puerto Rico:
AN ACT to add a new subsection
(e) to Section 6, and to amend subsection
(a) of Section 9 of Act No. 194 of August 25, 2000, as amended, known as the "Bill of Rights and Responsibilities of the Patient", for the purposes of allowing the patients in the medical-hospital facilities to choose a Podiatrist to treat their foot health; and for other purposes, has been translated from Spanish to English and that the English version is correct.
In San Juan, Puerto Rico, today $30^{ ext {th }}$ of September of 2008.
Francisco J. Domenech Director