Hungary: Whether doctors are obligated to report serious or crime-related injuries; requirements and procedures to obtain medical reports within Hungary, including who can obtain them; whether they can be obtained from abroad, including requirements and procedures (2013-August 2016)

Research Directorate, Immigration and Refugee Board of Canada, Ottawa

1. Reporting Obligations

In correspondence with the Research Directorate, the Head of the Patients' Rights Program at the Hungarian Civil Liberties Union (HCLU), a Budapest-based human rights organization that aims to protect citizens "against undue interference by those in position[s] of public power" (HCLU n.d.), stated that because of the importance of the patient's right to confidentiality, "in most cases doctors and other medical professionals must not report any injuries without the consent of the patient" (ibid. 15 July 2016). The same source noted that in 2014, at the instigation of HCLU, the Chief Medical Officer of Hungary instructed all doctors to refrain from notifying the police about crime-related injuries without the patient's permission, particularly in drug-related cases (ibid.).

Sources indicate, however, that according to Act XLVII of 1997, doctors must report injuries that take longer than 8 days to heal, and are suspected of being the result of a crime (ibid.; Lawyer 11 July 2016; Hungary 28 July 2016). Sources also stated that in such cases, the patient's consent is not required (ibid.; Lawyer 11 July 2016). A translation of excerpts of Act XLVII of 1997 Concerning the Handling and Protection of Health-care Data and Related Personal Data is attached to this Response (Attachment 1). In correspondence with the Research Directorate, an official from the Embassy of Hungary in Ottawa, who collected information from relevant ministries in Hungary, further explained that in such cases, the doctor provides the patient's name, date and place of birth, and address to the police (Hungary 28 July 2016). For information on reporting injuries to the police in cases of domestic violence or child abuse, see Response to Information Request HUN130946.

The Head of the Patients' Rights Program stated that medical records in Hungary are generally not sufficiently accurate and sometimes, the discharge summary is missing (HCLU 15 July 2016). He provided the opinion that it can be "really problematic to reconstruct a medical process based on the documentation," which makes it difficult to use such documentation as evidence in a court proceeding (ibid.). Corroborating information could not be found among the sources consulted by the Research Directorate within the time constraints of this Response.

2. Regulations on Obtaining a Medical Report from Within Hungary

Act CLIV of 1997 on Health provides the following information concerning a patient's right to access medical records:

[translation]

The Right to Become Acquainted With the Medical Record

Section 24

(1) A patient shall have the right to become acquainted with the data contained in the medical record prepared on him or her, and shall have the right to request information on his or her health care data….

(2) The health care provider shall dispose of the medical record, while the patient shall dispose of the data contained therein.

(3) The patient shall have the right to

be informed of the management of the data related to the medical treatment,

become acquainted with the health care data relating to him,

gain access to the medical record and to receive copies thereof at his own expense,

be given a discharge summary upon discharge from the healthcare institution (Section 137),

receive a written summary or abridged opinion of his health data for justified purposes, at his own expense.

…

(7) In the course of health care delivered for his current condition, a patient shall have the right to give written authorization to a person designated by him to inspect the medical record relating to him and to have copies made thereof.

(8) Following the conclusion of the patient's medical treatment, only the person being authorized by the patient in a fully conclusive private deed shall have the right to inspect the medical record and to have a copy made thereof.

…

Section 137

At the conclusion of a therapeutic procedure consisting of several parts or following care in an inpatient facility, a written summary report (discharge summary) shall be prepared and, excepting the case as set forth in Subsection (1) of Section 14, this report shall be given to the patient. (Hungary 1997)

Subsection (1) of Section 14 of CLIV 1997 states:

Section 14

(1) A patient with full disposing capacity may waive the right of being informed, except in cases when he must be aware of the nature of his illness in order not to endanger the health of others. If an intervention takes place at the patient's initiative and not for therapeutic purposes, such waiver of the right of being informed shall only be valid in writing. (ibid.)

The Embassy Official indicated that "[t]he fundamental rights of patients include the right to review medical documentation," and that any patient may request information on their medical treatment or health from healthcare providers, review medical documentation, request an excerpt or copy (made at the patient's expense), receive a final report when discharged from an inpatient clinic, obtain a treatment sheet at the completion of outpatient care, and/or receive a summary of their medical information or a brief written opinion (at the patient's expense) (Hungary 25 July 2016).

Sources indicate that medical records must be kept for 30 years, while discharge reports must be kept for 50 years (ibid.; Lawyer 5 July 2016; HCLU 15 July 2016), as specified by §30 of Act XLVII of 1997 (ibid.; Lawyer 5 July 2016). In addition, the Embassy Official stated that diagnostic images must be retained for at least 10 years, and any medical reports made from such images must be retained for at least 30 years (Hungary 25 July 2016). The same source added that, after the mandatory retention date, medical records must be destroyed, unless they are required for medical treatment or scientific research (ibid.).

3. Procedures to Obtain Medical Documents from Within Hungary

Sources indicated that the procedures for issuing copies of medical records is not specified in the legislation, so procedures may vary depending on the medical institution's internal policies (HCLU 19 July 2016; Hungary 25 July 2016).

In correspondence with the Research Directorate, a Miskolc-based lawyer stated that medical documents are given to patients automatically at the end of their treatment (Lawyer 11 July 2016). The same source explained that a request for further medical records needs to be made in the form of a "private document providing conclusive evidence," which he explained means that the request has to meet one of the following criteria:

The document is hand-written and signed by the requestor;

The request is printed or written by a different person, but signed by the requestor and two witnesses in person;

The requestor's signature is notarized; or

The docu ment is countersigned by an attorney (which is done in person) (ibid. 5 July 2016).

The lawyer also indicated that the law does not explicitly state whether the application should be made in person, or can be made via email or mail (ibid. 11 July 2016). He added that in an official opinion, the Ombudsman stated that because medical data is sensitive, it is preferred that this information is only provided in person (ibid.). According to the lawyer, former patients rarely ask for their medical information, and the willingness of doctors to provide the information may vary (ibid.). Corroborating information could not be found among the sources consulted by the Research Directorate within the time constraints of this Response.

The Head of the Patients' Rights Program provided the information in the following paragraph regarding the procedures to obtain medical records.

A discharge summary, which includes only "the scope of the treatment," is provided when the patient is released from the hospital, rather than detailed medical records (HCLU 15 July 2016). To obtain detailed medical records, the patient must submit an application at the hospital, for which a patient can get legal assistance from a "patient advocate" [1] (ibid.). Such applications can be made by the patient, an authorized representative, or a patient's relative in cases prescribed by the law, such as when a patient is unconscious (ibid.). Depending on the hospital, applications for copies of medical records can be made in person, via email, or post, but not by phone (ibid. 19 July 2016). Some hospitals use forms - posted online or in paper format- to facilitate the process, but using such a form is not a requirement to obtain the medical reports (ibid.). The applicant needs to pay a fee for the cost of the photocopies of between CAD$0.30-CAD$0.50 per page, and some hospitals add a search fee of between CAD$12 and CAD$15 (ibid.). The requestor has to pick up the medical documentation in person showing a valid ID (ibid. 15 July 2016).

3.1 Using a Representative to Obtain Medical Reports from Within Hungary

Sources indicate that, pursuant to Article 7 of Act XLVII of 1997, medical documentation may be released to someone authorized by the patient (Lawyer 11 July 2016; Hungary 25 July 2016). The Embassy Official explained that such authorization must comply with legal formalities, either by written authorization given during the time of the patient's care, or by authorization in a private document with "probative value" after the care has ended (Hungary 25 July 2016). The same source explained that a handwritten and signed document has full probative value, as does a printed document which is signed and verified by two witnesses over the age of 18 (ibid. 29 July 2016). For further information on legal requirements for private documents with probative value under Hungarian law, see attachment 2 of this Response to Information Request.

The Head of the Patients' Rights Program indicated that if a patient cannot or does not want to apply for medical documentation in person, they can authorize a representative - a lawyer or someone else - through a written authorization, signed by both the patient and the representative in the presence of two witnesses (HCLU 19 July 2016). He further indicated that the authorization document has to contain the patient's basic identity information, including the patient's ID number, address, date and place of birth, and mother's name (ibid.). Corroborating information could not be found among the sources consulted by the Research Directorate within the time constraints of this Response.

4. Obtaining Medical Information from Outside Hungary

The Embassy Official indicated that there are no separate procedural rules for obtaining medical information from abroad in the legislation on medical care, but "typically, documents can be made available if conditions set by the healthcare institution for requesting the issuance of medical documents are met" and provided that the transmission meets general rules of privacy and data protection requirements (Hungary 25 July 2016). According to the same source, a patient can obtain Hungarian medical documents from abroad "through an authorized representative," provided the request complies with the formalities relating to such authorizations (ibid.). He added that to "make any authorization issued in a foreign country fully probative in Hungary, it needs to be certified by a Hungarian delegation authority competent in the place of issuance" (ibid). The Embassy Official further explained that this means that either the consular officer needs to authenticate the document and verify the signature of the Hungarian citizen, or the consul can apply "diplomatic authentication" to a document signed before a [local] notary public or commissioner of oaths, in which case a prior authentication by the local ministry of foreign affairs might be required (ibid. 28 July 2016).

The Head of the Patients' Rights Program similarly stated that a person residing abroad needs to provide authorization to a representative to obtain medical records (HCLU 15 July 2016). According to the same source, in practice, it is possible for the person abroad to write an authorization letter, sign it, and send the original to their representative in Hungary, where the representative and two witnesses sign it (ibid. 19 July 2016). He further noted that although legally, this document would not be valid since it was not signed by all parties at the same time and place, such a document might still be used to obtain a medical report since it would be impossible to verify the circumstances under which it was signed (ibid.).

5. Regional Variance, Including Challenges in the Miskolc Area

The Embassy Official stated that the legislation pertaining to medical records applies "uniformly and with mandatory effect" throughout Hungary but given that the procedural regulations are not uniform, there may be variations in the processing times, formalities for making the request, and administration of the request, depending on the type, size and organizational structure of a given institution (Hungary 25 July 2016). The same source added that procedural differences should not lead to significant regional differences in access to the documents (ibid.). The Head of the Patients' Rights Program indicated that, to his knowledge, there may be minor variances in the procedures for obtaining medical records across the country, but that these should not be significant (HCLU 15 July 2016). He added that some institutions might be able to provide the medical data on CD or DVD (ibid.).

According to the lawyer, there are no specific challenges to applying for medical reports in Borsod-Abaúj-Zemplén county [of which Miskolc is the capital] (5 July 2016). Further and corroborating information could not be found among the sources consulted by the Research Directorate within the time constraints of this Response.

This Response was prepared after researching publicly accessible information currently available to the Research Directorate within time constraints. This Response is not, and does not purport to be, conclusive as to the merit of any particular claim for refugee protection. Please find below the list of sources consulted in researching this Information Request.

Note

[1] Patient advocates are patients' rights workers who are affiliated with hospitals throughout Hungary (Szószóló n.d.).

References

Hungarian Civil Liberties Union (HCLU). 19 July 2016. Correspondence from the Head of the Patients' Rights Program to the Research Directorate.

_____. 15 July 2016. Correspondence from the Head of the Patients' Rights Program to the Research Directorate.

_____. N.d. "About Us." [Accessed 21 July 2016]

Hungary. 28 July 2016. Correspondence from an Official of the Embassy of Hungary in Ottawa to the Research Directorate.

_____. 25 July 2016. Correspondence from an Official of the Embassy of Hungary in Ottawa to the Research Directorate.

______. 1997. Act CLIV of 1997 on Health. [Accessed 22 July 2016]

Lawyer, Miskolc. 11 July 2016. Correspondence with the Research Directorate.

_____. 5 July 2016. Correspondence with the Research Directorate.

Szószóló Foundation for Patients' Rights Budapest. N.d. Dr. Titusz Fábián. "Patient Advocacy System in Hungary." [Accessed 4 Aug. 2016]

Additional Sources Consulted

Oral sources: two Budapest-based Lawyers; Miskolc Semmelweis Hospital and University Teaching Hospital; NANE Women's Rights Association; Phralipe Independent Roma Organization; Rózsakert Medical Center.

Internet sites, including: Amnesty International; Ecoi.net; Factiva; Human Rights Watch; Hungarian Helsinki Committee; Hungary - Ministry of Health, Ministry of Justice, National Health Insurance Fund, National Institute for Health Development, National Public Health and Medical Officer Service; UN - Office of the High Commissioner for Human Rights, Refworld, World Health Organization; United States - Department of State, Embassy in Budapest.

Attachments

1. Hungary. 1997. Act XLVII of 1997 Concerning the Handling and Protection of Health-Care Data and Related Personal Data. Excerpts translated by the Translation Bureau, Public Services and Procurement Canada. [Accessed 11 Aug. 2016]

2. Hungary. 1952. Article 196 (1) of Act III of 1952 on the Code of Civil Procedure. Excerpts sent by an Official of the Embassy of Hungary in Ottawa to the Research Directorate on 28 July 2016.