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Laboratory doctors, with a record of overwork?

2024-08-10 09:34:00, Aktualitet CNA

Laboratory doctors, with a record of overwork?

The double employment of doctors in Albania is an issue that is often the subject of debates. There are many doctors who work in state hospitals and at the same time in their clinics, or in other private entities.

This issue returned to the center of attention again in recent months, when some interceptions of the prosecutor's office showed that a doctor of the Oncology Hospital at QSUT was abusing his duty by referring patients to his private clinic.

From personal experience or that of close people, we know that referring patients from public hospital doctors to private clinics is a fairly widespread practice.

The unemployment of doctors not only poses problems of an ethical nature and conflict of interest, but in certain cases it also calls into question the possibility of doctors to perform their duties with due responsibility.

Entities operating in the market of private medical laboratories have shared with "Monitor" their concern about the mass unemployment of laboratory doctors.

According to these subjects, there are doctors employed in so many laboratories at the same time that it is physically impossible for them to actually perform their functions in each of the laboratories where they are employed.

This means that many managers perform their function only fictitiously, without fulfilling the duties required by the legislation in the realization and interpretation of medical analyses.

Laboratory doctors, with a record of overwork?

The unemployment of doctors, a problem for the laboratory market

Sources from the market tell "Monitor" that from the study that was made of the market of medical laboratories in Albania, there is a major problem of employment of clinical biochemical laboratory doctors, who have given the license as technical managers in many laboratories at the same time. whether these are separate medical laboratories or laboratories attached to other private and state health centers at the same time.

According to these sources, in Albania there are several laboratory doctors who are technical leaders in 10-15 laboratories at the same time, and in some cases even more than 20 different laboratories and clinics, from North to South. Whereas, most of them are technical managers in 4-5 different laboratories and clinics.

According to these sources, this practice is unacceptable and dangerous for the health of patients. Controlling and managing so many laboratories at once is physically impossible, not even with electronic means.

Order No. 49, dated 11.02.2011 of the Minister of Health for the approval of the regulation "On the Organization and Operation of Medical Laboratories", in article 10, point 1, defines that "The medical laboratory has a technical manager.

The realization and interpretation of laboratory medicine tests constitutes a medical act and consequently, the technical direction of the laboratory is essential for the performance offered by such a laboratory".

According to sources from the market, in Albania there are a total of 94 clinical biochemical laboratory doctors licensed by the Order of Physicians. If, for example, the German law were to be applied in Albania, the total number of medical clinical biochemical laboratories would be 94.

Based on this paragraph of the above Order, as well as referring to the work performed by the technical manager, in a clinical-biochemical laboratory in the performance, control, validation and interpretation of all analyzes performed in the laboratory, the sources state that it is impossible to accomplish the mission of the doctor for the protection of the patient's health.

"This considering the specific activity of conducting analyses; controlling the way of conducting analyses; their validation; their interpretation to the patient; the human and professional capacity for carrying out this activity; the physical time needed to perform the activity in a laboratory with an average capacity; from exercising the activity in many different places separately or at the same time; for the protection and guarantee of the standards of qualified persons; for the protection of the public from the malpractice of the profession; for the protection of the patient as a consumer; for competition in the field of commercial activity of medical laboratories; etc." these sources express.

Considering the above problems, the subjects suggest that some restrictions be placed on the double employment of laboratory doctors, determining as a minimum that for the Technical Director, double employment will be allowed only within the city.

This provision would guarantee the best protection of public interests, through the correct exercise of the doctor's profession and ensuring the quality of professional services and respecting the patient's right to receive the service.

On the other hand, the employment of technical managers in many workplaces (in many laboratories), in addition to clearly violating the quality of the service provided, burdens and undermines the position of laboratories that exercise their activity on the basis of the law, in compliance with quality of service and fair competition.

Laboratory doctors, with a record of overwork?

Ministry: Laboratories are controlled by the inspectorate

Regarding the concern expressed by the subjects of this market, "Monitor" addressed a request for information to the Ministry of Health.

The questions we addressed to the Ministry of Health were:

"Do you find the existence of such a problem, where there are doctors who are employed in so many laboratories at the same time, that it would be physically impossible for them to perform their functions correctly (in addition to the implications related to the possible conflict of interest)?

If so, how can such a problem be addressed?” and "More generally, from your information and inspections, do you find that the activity of medical laboratories is carried out according to legal standards and requirements, and are reliable results guaranteed today for the analyzes and tests performed by these laboratories?".

The response of the Ministry of Health was a reference to Law No. 10081, dated 23.03.2009 "On Licenses, Authorizations and Permits in the Republic of Albania" as amended, which lists the activities in the field of health where the decision maker is the Ministry of Health. Among these activities, there are also laboratory services.

Further, the Ministry of Health adds only that the State Health Inspectorate is responsible for all the inspection functions of the ministry responsible for health, with the exception of the inspection of activities in the pharmaceutical field, which is carried out by the responsible structure according to the legislation in force.

Inspectorate: The law does not limit the dismissal of doctors

Based on the response of the Ministry of Health, the same questions were forwarded to the State Health Inspectorate.

In the official response, this institution states that based on Law No. 10 433, dated 16.06.2011 "On Inspection in the Republic of Albania", the State Health Inspectorate, ISSH, performs programmed inspections based on the annual program and monthly inspection plans, as well as inspections outside the program.

In the case of scheduled inspections, the subject to be inspected is notified seven days before the inspection through the inspection authorization of the dates when the inspection will be carried out and the object of the inspection.

The inspection body communicates with the technical manager of the laboratory, who is also responsible for the personnel and product of this service (analysis sheet).

ISHH does not have the legal competence to verify the performance and procedure of this process, since the medical laboratory analysis constitutes a medical act, which is verified by specialized institutions and clinical auditors. The health inspection of ISHH has an administrative and sanitary-sanitary character, where the assessment is carried out through the inspection of sanitary-sanitary and health documentation.

Licensing of health entities is carried out by the National Business Center, KKB, where the interested entity itself declares according to the defined criteria.

Based on Law No. 10 107, dated 30.03.2009 "On health care in the Republic of Albania", as amended, the ISHH inspects entities that provide health services according to the provisions of this law.

Medical laboratories are inspected by the SIA as health institutions, which provide a type of health service, specifically medical laboratory service.

This inspection consists of the inspection of legal applicability in the field of public health, excluding pharmaceuticals and medical devices which are inspected by other institutions.

According to the ISSH, the inspections have found deficiencies in the hygiene and health documentation and deficiencies in the physical conditions of the subjects.

Regarding the functions of doctors, ISSH states that the medical staff who perform their functions in this health institution, medical laboratory, have the same obligation and responsibility as the medical staff of a health institution that offers another medical service.

According to ISHH, the legislation does not prohibit some medical personnel from being employed.

Who assures us that the laboratory tests are reliable?

Not infrequently, media reports and investigative broadcasts have shown open violations of standards and the performance of fictitious analyzes of samples submitted to these laboratories.

One of the questions we addressed to the Ministry of Health was whether in Albania reliable results are guaranteed today for the analyzes and tests carried out by private laboratories. For this question, the Ministry of Health addressed us to the State Health Inspectorate.

For its part, the ISSH answers that "it does not have the legal competence to verify the performance and procedure of this process, since the medical laboratory analysis constitutes a medical act, which is verified by specialized institutions and clinical auditors."

The health inspection of the ISSH has an administrative and hygienic-sanitary character, where the evaluation is carried out through the inspection of the hygiene-sanitary and health documentation."

From the communication with the Ministry and ISHH, it is not clear which institution is responsible for checking or certifying whether the results of the analyzes we perform in the Albanian laboratories are reliable./ Monitor.al





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