Busy time behind you?
It has been very busy since I started working at the Office of the KIF, i.e. since March 2018. At that time, the Office was being established and we had to build certain structures, including the legal department, implement procedures required by law, define the internal legal framework to ensure the operation of the Chamber in many areas so that it could fulfil the tasks specified in the act. All of that requires legal interventions. What’s more, our activity is governed by regulations that often do not provide us clear answers and require settling very complicated legal issues and deciding certain actions. Legal support is necessary in almost every area of the activity of the PChP, from legal servicing of ongoing administrative proceedings (granting a licence to practice the profession, recognising professional qualifications), providing legal services to the Polish Chamber of Physiotherapists, in particular the National Council of Physiotherapists. So far, the KIF has passed almost 600 resolutions that were prepared or verified by the legal department.
The scope of tasks of the Legal Department of the KIF include issuing opinions on legislative proposals (laws, regulations). There have been over 350 such proposals so far, and we submitted our objections to 120 of them, asserting the position of physiotherapists.
We should also not forget about the advisory service we provide to physiotherapists. We have issued around 8500 opinions, either by e-mail or as part of legal assistance. These are only some of the areas of our activity.
It was quickly apparent that the legal department required expansion. Currently, it consists of three legal advisers with many years of experience gained in institutions specialising in medical law, a lawyer’s trainee and a fifth-year law student. With some matters, such as dealing with disciplinary courts, supporting the disciplinary ombudsman or in tax-related issues, we are helped by specialised law firms.
What regulations facilitating the work of physiotherapists have been successfully implemented over these years?
The solutions that have been introduced strengthened the professional autonomy of physiotherapists. After the act on the profession of physiotherapist came into force, another milestone was the regulation changing the regulation on guaranteed services in therapeutic rehabilitation, which has been in force since 1 January 2019. It gave a physiotherapist new competencies in the area of functional diagnostic of a patient and planning of physiotherapeutic procedure as part of health services financed by the NHF. This was a breakthrough decision, because it allowed a physiotherapist to be independent from a doctor in ordering physiotherapeutic services.
Of importance for physiotherapists was also the regulation of 6 April 2020 on medical records. The act on the profession of physiotherapies stated that a physiotherapist is obliged to keep medical records, but it did not specify what documents he/she should fill in and with what information. The regulation filled that gap, indicating medical records to be kept in physiotherapy practices as well as in medical entities, including hospitals. What’s more, even a hospital discharge summary report includes information about physiotherapeutic procedure. As a result, physiotherapists can feel more independent and treated equally with other medical professions.
Another change was introduction of physiotherapy practices.
This is probably the most important amendment to the law we successfully demanded. Initially, the 2015 act stated that physiotherapists can run medical activity but only as part of medical entities. The requirements for medical entities are relatively high, and in order to fulfil them, substantial financial resources are needed. With a large number of small physiotherapy practices, running medical activity was not reasonable. Thanks to the regulation, it is no longer necessary to meet stringent sanitary requirements, requirements with respect to the premises, equipment or the sum insured in order to be able to legally run a physiotherapeutic medical activity.
An important achievement was also the possibility of providing telerehabilitation as part of NHF services. Thanks to that change, during the pandemic patients were still under the care of physiotherapists.
And how did the pandemic affect the work of the legal department?
We definitely had more work to do. It was mainly due to the legal inflation we faced at the beginning of the pandemic. The legal situation was changing overnight. We had to update physiotherapists about relevant regulations, including the so-called “shields”.
At the beginning, rehabilitation was practically shut down. We argued that this decision should be changed, considering patients’ health needs in particular. We managed to achieve that more quickly than we assumed. The situation was very dynamic. One day something functioned, the next day – it didn’t. We worked under the pressure of time, at nights, during weekends. The regulations introducing restrictions connected with the epidemic were usually published on Fridays in the evening. I remember regulation from October, from the beginning of the second wave. Earlier, re-closure of health resorts was indicated at the press conference. On Friday night, it turned out that the provision of the regulation is so constructed that it actually closes entire rehabilitation. And it was to happen next day! We had to urgently explain that and indicate physiotherapist what to do.
What problems do physiotherapists report to the legal department?
A lot of questions we receive concern actions outside of strictly medical activity. Examples include practising the profession of a physiotherapist in nursing home cares, schools, sports clubs, spas. There are certain differences that have to be taken into account when providing physiotherapeutic services there, e.g. with respect to keeping records. A lot of questions concern a break in practising the profession and how to calculate the length of the period of inactivity or the minimum wage. When rehabilitation was closed, many questions concerned the forms of government aid or KIF’s social assistance. Now, when physiotherapists were granted powers to qualify for and give vaccines against COVID-19, they ask about issues related to that, e.g. whether liability insurance covers their additional competencies. The issues vary a lot. Some concern a physiotherapist’s individual situation in a medical entity and mobbing or limitation of professional autonomy.
We encourage physiotherapists to contact us if they have any legal problems connected with practising their profession. Currently, assistance is provided by stating position in a case, but also in the form of a meeting with a legal adviser or lawyer. We will improve that assistance. We want physiotherapists to receive professional help as quickly as possible. We also want legal support to be available in the other regions of Poland, not only centrally.
Nurses and paramedics have been raising awareness of the problem of aggressive patients for several years. Do physiotherapists report similar issues?
Unfortunately, they do. We had several such cases. If a patient is aggressive, we recommend reporting it to the police or the prosecutor’s office. A physiotherapist who feels under threat while delivering rehabilitation services, has to consider refusing to provide them, but do so very cautiously. Sadly, the act on the profession of physiotherapist does not explicitly grant the right to refuse to provide a service, even in the case of the loss of trust. We are appealing to the Minister of Health for change in that regard.
But I also remember a different case, when a physiotherapist had problems with providing services because the patient was obese. Rehabilitation of such a person is problematic because he/she needs to be lifted, mobilised, and there was no appropriate equipment in this patient’s house. These are also the issues we deal with.
Do patients write to you as well?
Such situations happen. Usually, these are issues and reports concerning irregularities during a therapy. We refer them to the disciplinary ombudsman.
At present, the legal department only provides legal assistance to physiotherapists.
You still face a lot of challenges. What are the specific goals?
It is still organic work. Other organisations governing medical professions, e.g. nurses and midwives, have over 30 years of activity. We are trying to quickly catch up. The most important thing is to make sure physiotherapists are not overlooked in legal solutions pertaining to health care. We always call for including physiotherapy in the process of a patient treatment, in various opinion-giving and advisory bodies in the area of health care, and in the powers granted to medical professions. But decision makers still forget about physiotherapists. Apparently, physiotherapist as a medical profession is still not firmly rooted in the consciousness of officials.
From the very beginning, we point out the necessity of increasing the salaries of physiotherapists. This may sound bombastically and someone could ask what the legal department has to do with that? A lot of issues concerning remuneration result from legal regulations. We always demanded that physiotherapists are included as beneficiaries of the funding provided by the National Health Fund for salary increases on principles analogous to those applied to nurses, midwives or paramedics. Therefore, we addressed a request to the Constitutional Tribunal to declare these provisions unconstitutional. We are waiting for the date for the hearing to be set.
The issue of salaries is connected with the need for higher valuation of physiotherapeutic services.
Yes, and the present one is definitely not satisfactory. We will request that physiotherapy practices are allowed to sign contracts with the NHF. We achieved a partial success with respect to the Solidarity Fund, but excessive and illegitimate requirements regarding the delivery of services, in particular with respect to equipment and medical devices are concerned, still pose an obstacle.
We also still grapple with the NHF requirements to obtain a patient’s signature confirming the service delivered. There is no such requirement for other health services delivered by persons practising medical professions. This indicates lack of trust in one professional group and is very unfair. Secondly, it is not clear how this can be solved in the case of keeping medical records in an electronic form. Thirdly, sometimes a patient is unable to put a signature on his/her own and it is put by someone who e.g. shouldn’t have access to the patient’s medical records.
So the lion’s share of your work is fighting with officials?
That’s true. I have fought for the position of a physiotherapist in the system. It can be frustrating. We write comments on various projects and every time we read that although they are sound they are not taken into consideration because they do not pertain to the scope of the regulations. Or that they will be considered in the next amendment. But when the next amendment is adopted, they forget about us, although after the fact the officials usually admit we were right. This was the case with inclusion of physiotherapists in the operation of various advisory bodies, e.g. those dealing with rare diseases, public health council. We stress that these bodies are concerned with health and the presence of physiotherapists in them is necessary. Sometimes, our remarks, although obvious from our point of view, are simply not taken into consideration and we do not receive any explanation for why this happened or the explanation is very evasive. This was the case with the law concerning the minimum salary. We argued that the rate should depend on the education of a physiotherapist instead of the education required at a given position. In this situation, medical entities will level down and state that it is enough to have a degree of technician or Bachelor at the post held by a person with a Master’s degree in physiotherapy and this will be translated to lower remuneration. Situations like that are really numerous. We are overcoming this resistance of the matter slowly, but I am convinced that with time we will be able to achieve more and more.
And if you caught a golden fish, what job-related wish would you ask it to grant on behalf of your team?
I would wish myself effectiveness. I’d like our efforts to be reflected in legal regulations and make physiotherapists’ work easier. I would ask the golden fish for stabilisation of the legal environment so that we don’t have to inform physiotherapists about new changes and bureaucratic obligations. This is burdensome for physiotherapists in particular, but for us as well. First, there was a lot of organisational work, then the pandemic came, other problems showed up and many things could not be achieved. Now, elections are coming. It is a very busy time, so a calm period would be good so that we can focus on implementing the goals set by the governing organisation, which are most important from the perspective of physiotherapists