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April 2014

PRESS CONFERENCE UPON THE WORLD HEALTH DAY “Two court verdicts that proved medical mistake in the treatment of minor Agush”

07.04.2014

press_whdStill there is not enough information about how human rights in health care are applied in practice, especially for protection against discrimination in the realization of the right to health in the marginalized groups in the Republic of Macedonia.

Namely, there are a number of international and national standards for protection of the right to health, and yet so far in administrative, civil and criminal proceedings in the national legislation, the number of initiated infringement proceedings oabuse of the rights of health care is very small, while in the case of the Roma community cases have been completely absent.

Hence, the dilemmaas to whether health workers are so flawless in the execution of their duties to Roma patients or authorities do not see their responsibility from the legal point of view?

In this context and in order to monitor and record legal practices, ROMA S.O.S. starting in 2010, implemented the project “Roma Health – Basic Human Right”, financially supported by the Open Society Foundations. This project offers legal assistance to Roma in exercising the rights of health care and access to services, as well as documenting cases of violations.

In individual cases documented between 2010 and 2013the clearest violations of rights are noted: violation of the right to conscientious treatment, violation of the right of access to information, violation of the right to appropriate medical services, violation of the right to protection of the personal data, violation of the right to use of medications and further health services, violations of the right to use services of compulsory health insurance, violation of the right to compensation for damages suffered because of a disability, violation of personal rights to physical and mental health, violation of the right of access to medical records, violation of the right to equal treatment in the provision of health services, violation of the principleof humanity, affordability and health care, as well as violation of the right to privacy and dignity.

Since the beginning of the project, a total of four cases of judicial and quasi -judicial proceedings have been initiated before the authorities for protection in the Republic of Macedonia, and one of those cases is the caseof minor Agush Salioski from Prilep in which it was determined that irregular and untimely treatment resulted in severe consequences to his health – a disability was caused. With the improper treatment the doctor made a departure from the rules of the profession, medical science, ethical principles and expert attention, as proven in a civil action.

1.  Facts about the case

agushOn 10th September 2008, seven year old Agush from Prilep suffered a broken left forearm while playing near the family home. The child was taken to P.H.I. General Hospital “Borka Taleski” Prilep – Department of Orthopedics and Traumatology where he underwent immobilization of the broken arm. The doctor on duty found no need for surgery, but decided to keep Agush in the hospital in order to monitor his condition. Agush began to complain of pain in his arm, after which (the next) doctor on duty concluded that surgical intervention is required, so he left Agush without food and water in order to prepare him for surgery in case the colleagues decided it was needed. That day a decision for surgery was not made, and the cast was only cut. After this, changes in the color of the arm and swelling were noticed, and the cast was removed, and signs of gangrene were noticed on the arm. On 14th September, Agush was transferred to the P.H.I. Pediatric Surgery Clinic – Skopje where due to his life-threatening condition, he underwent amputation of the arm.Consequently, Agush now is permanently disabled.

2. THE TRIAL – Criminal proceeding

press_whd2October 2008– the Minister of Health formed a Committee to determine the facts and circumstances in the case which determined that there was inadequate treatment by the doctors, untimely surgical treatment of the wound, late registration of the change in the arm and untimely removal of the cast.

October 2008– The case was taken by the Public prosecutor, Prilep. 

June 2011–The association ROMA S.O.S. hired the lawyer Blagoj Dimovski from the law office “Petlichkovski” Bitola for protection of the rights of the minor during court proceedings.

*Basic Court Prilep

18.11.2011– Criminal case was filed by the Public Prosecutor Prilep against 6 orthopedic doctors from the P.H.I.General Hospital “Borka Taleski” Prilep for criminal offense“Serious crimes against public health” and“Reckless treatment of sick people”.

29.03.2013 – After 16 hearings, a verdict was made and only two orthopedic doctors were found guilty and those were the doctors who were on duty on the critical days of 12.09 and 14.09.2008. The penalty is a fine, 50 Euro, and if within one year they do not commit a new crime, no payment is required.

*Court of Appeals Bitola

29.04.2013 –An appeal was submitted against the verdict of the Basic Court Prilep by the Public prosecutor for incomplete determination, so that other doctors would be obliged to provide adequate health services to the patient.

15.07.2013– The appeal was adopted by the Court of Appeals in Bitola and the case was returned for re-trial at the Basic Court Prilep with directions given to accurately determine the disputed facts.

*Retrial in front of the Basic Court Prilep

30.10.2013 – A prosecutor dropped further prosecution of the 5 doctors and continued prosecution for only one doctor, the doctor on duty who received Agush for treatment. The lawyer as a private plaintiff continued the prosecution of all six doctors.

06.11.2013 – A verdict found the doctor against whom the Public Prosecutor had continued the prosecution guilty and a suspended sentence of three months in prison was adopted. If within one year he does not commit a new crime, no prison will be served. The remaining 5 doctors are free of all charges.

3. THE TRIAL – Civil Procedure 

press_whd1March 2013 – An expert forensic medical report was prepared by specialists in forensic medicine and criminology at the Department of Forensic Medicine at P.H.I. Clinical Hospital Dr.Trifun Panovski Bitola to establish the relations of the cause and effect in the way of healing and the damage that was done. Gaps in healing and treatment were determined.

*Basic Court Prilep

05.09.2011 – A lawsuit on behalf of Agush was submitted by the lawyer Blagoj Dimovski to the Basic Court Prilep for compensation of 10.000.000,00 denars in total against P.H.I. General Hospital “Borka Taleski” Prilep as well as request for a lifetime award due to reduced general activity and need of constant aid by his family. A lawsuit on behalf of Agush was submitted by the lawyer Blagoj Dimovski to the Basic Court Prilep for compensation of 10.000.000,00 denars in total against P.H.I. General Hospital “Borka Taleski” Prilep as well as request for a lifetime award due to reduced general activity and need of constant aid by his family.

29.02.2012 – At the hearing that was held, a decision was made that the procedure will be suspended until final completion of the criminal proceeding that will determine which of the defendant doctors is guilty of the violation.

* Court of Appeals Bitola

12.03.2012- – A complaint by the lawyer was submitted against the Decision of the Basic Court Prilep requesting the procedure to continue since there was a legal basis for it. A complaint by the lawyer was submitted against the Decision of the Basic Court Prilep requesting the procedure to continue since there was a legal basis for it.

* The procedure for payment of lifetime monetary support in front of the Basic Court Prilep is ongoing.

4. CONCLUSION

      By the verdict in the criminal procedure, protection of the right to health as an internationally recognized right is accomplished, a right that is defined in the  International Covenant on Economic, Social and Cultural Rights as:

“Right to health as inclusive right includes timely and appropriate health care”.

By the verdict in the civil proceeding Agush exercisethe right to compensation which is guaranteed at the international level and under the Law on Health Care of the Republic of Macedonia:

“Member of health care has the right to seek compensation if mistakes or inappropriate treatment affect his/her health”

This is the second case for which a positive verdict was obtained in proceedings for protection of the right to health and equal treatment of Roma as patients in front of the health facilities in the past 7 months – in September 2013, the verdict about the case of a 63 year old Roma woman from Delcevo was announced for which the Basic Court Kocani adopted a verdict for compensation of 200.000 denars due to inappropriate healing.

Through advocacy of these cases, case law has been created regarding the sentences made by local courts for the determination of medical errors as basis for criminalizationand inappropriate treatment of the patients in accessing health services to be considered legally and not just in terms of respect of the Hippocratic oath and the duty to human activity.

Positive decisions in the interest of injured Roma, encourage the Roma population to seek accountability from health care workers in order to convey fairness and to confirm the “right to health for all without discrimination”.

Photographs of the activity

ROUND TABLE BITOLA: Health Advising Centre in the settlement Bair will work with support of the local health facilities/institutions

02.04.2014

trkalezna-masa-bitolaAssociation ROMA S.O.S. from Prilep and the Unit of the Local self government Bitola onDecember 12th2013, signed a Memorandum of cooperation by which theycommitted to implement the project Health Advising Centre as a positive practice to improve the health of Roma and they pledged to open HealthAdvising Centre in the settlement Bair in order to resolve the problems of the community in front of the facilities easier, and to bring institutional procedures and activities closer to Roma.

In order to actualize the way of cooperation between NGOs and health facilities/institutions to implement joint activities and overcome the constraints identified withRoma in access to health services, on April 2nd 2014 a round table in the Millennium Hotel, Bitola was organizedwhere the need for opening a Health Advising Centre was presented as well as the planned activities for the current 2014.

In addition, the activities of the responsible parties for implementation of the Local Action Plan on Roma health 2012-2015 were reviewed, adopted by LSG Bitola in 2011 as a public policy within the Decade of Roma Inclusion.

Presentations at the roundtable were givenby Nesime Salioska, executive director of ROMA S.O.S.and Violeta Nalevska, representative of LSG Bitola, and during the discussion, speeches on the conditionwere given by the representatives of the Clinical Hospital “Trifun Panovski”, Centre for Public Health, Health Centre, Health Insurance Fund of Macedonia, C.D.R.C. “Bairska Svetlina”.

The discussion resulted in the following conclusions:

1.There is insufficient information between Roma about the rights of health care since priority is given to realization of the rights of social care because of the financial situation they are in,

2.There is lack of Roma Health Mediators in the municipality of Bitola and Roma couriers as part of the team of the Office of immunization which complicates the work of the Office and finding Roma children on the field,

3.There is lack of interest of the state to fulfill its obligations in terms of its engagement in the communities where RHM are missing, and employment of Roma in theinstitutions,

4.Parents are being indifferent for regular vaccination of the children and monitoring of the immunization calendar that affects the percentage and regular immunization of the children,

5.Frequent migrations from one place to another in search for work are significant and that results in lower literacy of the Roma community and drop-out from the educational process,

6.There is tendency to increase the number of people using psychotropic substances particularyamong young Roma, due to the lack of information about the consequences of this addiction.

7.Health institutions are willing to sign a Memorandum of cooperation with associations of citizens as a commitment to improve the health status of Roma from the municipality of Bitola by actualizing the barriers in the access to health services and achieving the objectives of the Local Action Plan on Roma healthfrom the municipality of Bitola.

Photographs of the activity

March 2014

THREE DAY FIELD ACTION IN THE ROMA COMUNITIES IN PRILEP AND BITOLA

21.03.2014

SLIKA_PP_BTThe organization of the sefield activities aimed to increase the number of informed citizens who have lower incomes, are unemployed and hav e received state-funded health to meet their legal obligation to submit a Statement for revenues for the previous year to the Health insurance Fund of Macedonia by 31.03.2014 in order to continue their right to health insurance.

To fulfill this obligation the Health Insurance Fund of Macedonia announced a call for this category of insured persons and urged them to make re-registration of health insurance by submitting a Statement for revenues for the previous year between 3rd February, 2014 and 31st March, 2014.

Otherwiseif they did not obey this obligation, on 1st April 2014 the insured would face suspension of their health insurance. During the last year, many Roma people faced suspension of health insurance after 31st March 2013 due to a lack of information about the need for filing the Statement for revenues. Therefore, in order that citizens not face such consequences again, ROMA S.O.S., in addition to offering free legal assistance for filing the required Statements to the insured, organized field activities in Prilep and Bitola throughout the month of March.

DSCN46301. In Prilep the field activity was conducted in three days in three different locations in the Roma settlement “Trizla” so that the insured who hanot fulfilled this obligation could have their statements of income completed.

– The first field activity was conducted on 19.03.2014, by setting up a stand  in the place called Sred Selo. The required statement for revenues was completed for 14 people in total who after wards were directed to the regional office of the Health Insurance Fund of Macedonia to submit them.

– The second field activity was conducted on 20.03.2014 in the place called Mexico, where statements of income were completed for 9 people. In this part of the settlement the majority of citizens who visited the stand had submitted statements for revenues before.

– The field activity in Prilep ended on 21.03.2014 by setting up a stand in the place called Debarca, and the statement for revenues was completed for13 citizens who afterwards were directed to the regional office of the Health Insurance Fund of Macedonia to submit them.

From these activities, the total number of completed statements for revenues for holders of health insurance was 36, resulting in a total number of 99 people covered (including members of families).

100_09612. In Bitola the field activity was conducted in two days in three different locations in the Roma settlement “Bair” through home visits to families to whom flyers were handed out with informative content about the obligation of filing the Statement and the consequences for them as insured if they did not submit a Statement for revenues by 31.03.2014.

– The first activity was conducted on 19.03.2014, in the area of the streets “Kozjak” and “Ljubojno” where the citizens mostly were informed and aware of the need to submit the Statement for revenues. The 40 families that received distributed flyers were informed about the obligation of filing the Statement and it was pointed out to them to do so by 31st March in order not to face suspension of health insurance on 1st April.

– The field activity in Bitola ended on 20.03.2014 in the region of the Petocna Voda, where 60 families were given leaflets. A great part of the population was not informed and did not understand the need for filing the Statement. They were not informed where to submit it and what they face if they do not submitit by 31.03.2014. Field assistants explained the procedure to them and the specific consequences they will face if they do not meet the deadline were clarified.

This way, 100 families from the Roma settlement Bair were included and informed about fulfilling the obligation to the Health Insurance Fund of Macedonia.

Photographs of the activity

December 2013

Public discussion on “Health insurance for all citizens” was held

18.12.2013

infografik“Who should citizens obey to exercise their right to health insurance?”

 Association ROMA S.O.S. from Prilep today organized a public discussion on “Health insurance for all citizens” in the hotel Holiday Inn, whose goal was to actualize the challenges that citizens face in accessing the right to health insurance.
The focus of the discussion was the obligation of people with lower incomes who are unemployed to submit Statement of income (which ensures lower income for the previous year of 96,600 denars) in the process of re-registration of health insurance on front of the Health Insurance Fund of Macedonia each year in February-March, and is regulated by the Law on contributions for mandatory social insurance.

Slika_2Nesime Salioska, executive director of ROMA S.O.S. stated: “Considering frequent amendments to the legislation, non unified practice in implementation of the legislation, inadequate informing of the citizens about changes in the procedure for exercising the right, and complex administrative procedure that imposes additional obligations on citizens to submit documentation, a category of people who are facing obstacles in the approach is recurring. That is the case with filing the Statement.”

Tanje Trenkoska, jurist of the association ROMA S.O.S. stated: “Since 2009 we have current government policy according to which every citizen of the Republic of Macedonia should have health insurance. However, up to date the regulations in this part are changed 10 times. With the last change of the Law from 25.01.2013, on the basis of which the Health Insurance Fund of Macedonia announced a Call for submitting a Statement, 107,021 insured who failed to file a Statement faced a potential termination of the health insurance in April 2013, which directly led to:

  • compensation for using health services and supply of medicines up to 100% of the cost,
  • prohibition for using orthopedic devices within 6 months,
  • additional administrative costs for obtaining personal documentation needed for re-exercising the right to health care as for the first time.

What is particularly concerning is that 120, 255 people who managed to file a Statement are not aware that by signing the form they bear criminal liability for giving false information if after processing the data, IRS determines income higher than shown. In February-March IRS has no record of the exact amount of income of citizens and does not issue any certificates.
Most citizens are not informed about this obligation on time by what “they allow themselves” to be confronted with the stated challenges. This requirement is contrary to the Constitution and confirmed by the decision of the Constitutional Court on 14.11.2012 which abolished submitting Statement by citizens, because it is authority (obligation) only of the state institutions.”

Slika_1Renata Deskoska, prof. PhD in Constitutional Law and Political System stated: “Parliament of the Republic of Macedonia allows gaining back a decision that was abolished, which is not a unique case. Namely, a year ago in November 2012 a resolution that abolished the decision for unemployed people with lower incomes to submit a Statement was made and the Constitutional Court in its reasoning emphasized that it is the responsibility of the IRS, not an obligation of the citizen. It is sad that after two months of the decision of the Constitutional Court there are changes in the Law that are not essential but only with modified terminology. It is called “cosmetic” change i.e. the same statement is being reintroduced only the part “in the current year for realized net incomes in the previous year” is added. Thus, the obligation for the citizens remains, and in such situation the minister who has suggested the decision by which constitutional decision is not respected should bear political responsibility, and that obviously is not his intention. This way the role of the Constitutional Court is being devaluated. Unfortunately, citizens who are facing this problem have no choice nor opportunity to exercise their right because it is the institution that should act to change the Law.”

Vaska B . Mustafa, deputy Ombudsman stated: “It was found that citizens’ requests and Ombudsman’s requests and interventions by the authorities, especially the Ministry of Health, have not been processed on time, which impedes the citizens in realization of their rights of health care and health insurance.
Ombudsman initiated a proceeding and indicated to the competent institutions of the legal obligation to full implementation of the decision of the Constitutional Court. The problem remains and the Constitutional Court is notified to alert and undertake certain measures about this issue, but we are still waiting a response.”

  1. Emilia Bozinovska, representative of the Health Insurance Fund of Macedonia stated: “Unemployed people who have lower incomes are divided in two categories:
    Insured people that as a family have realized income in 2012 that does not exceed 96 600 denars per year,
  2. Insured people that as a family have realized income in 2012 that is greater than 96 600 denars per year, but not more than 183,576 denars only in a case when in the last two months they have realized total income less than 16.100 denars.

These two categories of insured people filed a statement of income for the previous year that as a form is posted on the web site of the Health Insurance Fund of Macedonia. Also information for filing a statement is published in all printed and electronic media.

Re-registration in the Health Insurance Fund of Macedonia continues after the expiration on 31st March, but in that case the insured person has a cease in the health insurance.”

The discussion among the participants, where the associations that work on the promotion and protection of human rights and health care were the most numerous, finished with the following conclusions:

  • Disrespect of the constitutional decision is a classic example of arbitrariness and abuse of the citizens’ rights, for which the ones who are responsible should bear political responsibility,
  • Immediate adoption of amendments to the Law on Contributions for Mandatory Social Insurance is needed, according to the decision of the Constitutional Court, in order to ensure the governance of the legal system in the Republic of Macedonia,
  • People who have already faced or will face suspension of health insurance for failing to submit a Statement in the procedure for re-registration, may initiate litigation to protect their rights,
  • Ombudsman needs to actualize the abuse of law in the public and thereby to contribute to the effective protection of citizens, taking into account legal responsibilities in handling,
  • According to the single window system, direct cooperation between the Health Insurance Fund of Macedonia and the IRS should be provided, and by ex officio information for the revenues of citizens will be supplied,
  • To improve the mechanisms for informing the citizens about changes in the procedure for exercising their right, especially between marginalized groups and persons with lower education,
  • To prolong the Call of the Health Insurance Fund of Macedonia for re-registration of the health insurance in the period when the IRS will have processed the data for income of the citizens which would prevent misrepresentation of the amount of income and bearing criminal liability for giving false information,
  • Associations have agreed to launch an initiative to collect 10,000 signatures and submit them to the Parliament of the Republic of Macedonia, if the competent authorities do not undertake the necessary measures to amend the Law.

The event was the final activity of the citizens’ initiative supported by the National Democratic Institute for International Affairs of Macedonia, and in cooperation with the Foundation Open Society Macedonia and associations KHAM – Delcevo, SUMNAL – Skopje, H.E.R.A. – Skopje, NRC – Kumanovo, ESE – Skopje and Macedonian Anti-Poverty Platform.

Photographs of the activity

November 2013

ROMA S.O.S. in a meeting of the Network of Associations for protection from discrimination discussed the way of realization of the rights of social protection

23.11.2013

new-picture-7Association ROMA S.O.S. as part of the Network of associations for the protection of discrimination1 on 22nd November 2013 in Prilep, organized a coordination meeting among the members to consider the way citizens exercise their rights to social protection as well as identifying potential existence of systemic discrimination in the procedure.

Out of 55 people, members of the Roma community in Prilep, who were offered free legal aid in 2012 and 2013 in exercising and protection of the right of constant welfare and right to allowance for assistance and care of another person, 15 people were rejected by the Decision of the SWC – Prilep. Reasoning suggests that the Expert committee for providing findings and opinions on the incapacity for work found that they do not meet the terms of rights.2

At the meeting with the rejected applicants the same day it was concluded that some of those people had applied for the realization of any of these rights for the first time, and some of them had previously used the required right but it was terminated in the process of rebuilding the documentation or after two months of use. Therefore the question arises, how the person who is assessed as incapable of work, after two months is assessed as able to work without an explanation for the changed situation?

The findings pointed to two problems that applicant/beneficiaries of rights were facing:

1.Expert committees for providing finding, assessment and opinion on the inability to work, after fling the request by the person, prepare the finding solely on the basis of the submitted medical documentation in the absence of direct examination which often contradicts the actual and real condition of the applicant.

2.MLSP does not respond to appeals by the applicants in the statutory period of 60 days which does not give them right to protection of persons in the proceedings i.e. does not allow re-consideration and determination of the factual condition in these individuals, as well as the opportunity to submit new requirement for exercising the right of social protection.

In some cases MLSP has concealed so much that from 2012 until today they have not received a written response to their complaints, and the same people are left without the ability to use benefits of the social protection.

ROMA S.O.S. sees the systemic discrimination in the inefficient system for realization and protection of the rights of social aid provided by the Law on social protection and Regulations that are governing procedures, when a particular group of applicants are put at a disadvantage in exercising their rights.

Therefore, and in accordance with the conclusions of the meeting with the Network, future actions have been announced in the area of (1) defining the needs of legal reforms for establishing equal practices in procedures and work of the Expert Committee and (2) initiation of proceedings in front of the Commission for protection from discrimination and the Ombudsman to determine whether there is ground for systemic discrimination in the existing system of social protection and legislation.

__________________________________________
1The Network for protection against discrimination aims to develop strategic advocacy in cases of discrimination by filing cases in front of the Commission for Protection against discrimination and domestic and international courts. The development of domestic practice is encouraged by providing free legal aid in strategic cases of discrimination. The Network was established in December 2010 by the following organizations: Foundation Open Society – Macedonia; Association for health education and research (HERA); HOPS – Options for healthy life; Helsinki Committee for human rights of the Republic of Macedonia; Association for emancipation, solidarity and equality of women in the Republic of Macedonia (ESE); Roma Organization for Multicultural Affirmation ROMA S.O.S. Prilep; Coalition “Sexual and health rights of marginalized communities” and the National center for support of persons with intellectual disabilities – PORAKA.

2Centre for social work in these proceedings is authorized to make Decision based solely on the opinion given by the Expert Committee and is not authorized to act differently.

Photographs of the activity

ANNOUNCEMENT – Free legal aid for 65 citizens in realizing the right to health insurance and social protection

21.11.2013

soopstenieAssociation ROMA S.O.S. from Prilep as part of the informal network of authorized associations for free legal aid uses the Law on free legal aid in the past two months have offered aid to unemployed citizens with lower incomes to exercise or prolong the right to health insurance. Additionally, ROMA S.O.S. was helping users of social assistance to rebuild the documentation to extend the law, and helped the citizens to rebuild the documentation for permanent financial assistance and one-time financial assistance.

Namely, due to the requirement of the Health Insurance Fund of Macedonia (HIFM) and the obligation of citizens to file a statement of income for the period from 1st January to 31st March 2013, a large portion of the population with low level of education in Prilep, mostly Roma by ethnicity, have missed the deadline and lost the right to health insurance. ROMA S.O.S. has helped the citizens to complete and submit the complete documentation to re-exercise their right to health insurance.

Additionally, the Ministry of labor and social policy has announced a call, which was announced by the media, and that requires the citizens who are users of social welfare in the period from 1st November to 30th November 2013 to rebuild their documentation i.e. to submit a new request to exercise the right to social assistance and to attach a photocopy of the ID. ROMA S.O.S. has helped 59 citizens, beneficiaries of social assistance, so that they have completed the needed documentation and directed them to relevant institutions.

Through the work of ROMA S.O.S. in the past two months easier access in the realization of human rights was enabled to a total of 65 citizens.

The six authorized associations that provide free legal aid requested from the Minister of Justice Involvement in the process of preparation of the Strategy for strengthening the justice

11.11.2013

baner_za_web_BPPThe six organizations that provide free legal aid, Macedonian association of young lawyers, National Roma Center – Kumanovo, Youth Cultural Center – Bitola, EHO – Stip, Izbor – Strumica and Roma S.O.S. – Prilep asked the Minister of Justice for active involvement in the process of preparing the Strategy for strengthening the justice (2014-2017).

Specifically, the associations require participation in this strategic document regarding the free legal aid and access to justice for poor and vulnerable categories of citizens. By incorporating the process of creating the Strategy, associations can substantially contribute to policy-making related to improving the access to justice in civil and administrative matters.

Additionally, involvement of associations in the process of preparing the policies is legal obligation of the public authorities under the Law on the organization and operation of the state administration, and liability that arises from the strategy for co-operation between the Government and the civil society (2012-2017).

The six associations that are authorized by the Ministry of Justice to provide free legal aid, according to the Law on free legal aid, are provided with financial and program support by the Foundation Open Society – Macedonia.

More details about the work of authorized associations you can get at www.pristapdopravda.mk

October 2013

Press-Conference

24.10.2013

pressENToday ROMA S.O.S. in the presence of associations from H.E.R.A. – Skopje, KHAM – Delvevo and NRC from Kumanovo, held a press conference to alert about the legal obstacles that obstruct the realization of the right to health insurance for unemployed people with lower incomes.

Namely, 50% of the unemployed people – beneficiaries of the Health Insurance Fund of Macedonia in April 2013 lost their right to health insurance for not submitting Statement of revenues for the previous year, a requirement that was abolished in November 2011 by the Constitutional Court.

Ministry of Finance, as a competent authority which was to respect the Decision of the Constitutional Court, applied it incompletely i.e. did not make appropriate amendments to the Law on contributions for mandatory social insurance by which it was supposed to eliminate this requirement for unemployed citizens.

During the press conference it was stated: “We require appropriate amendments to be introduced to Law on Contributions for Mandatory Social Insurance under which the Health Insurance Fund of Macedonia shall officially determine the income of unemployed people in the process of realizing the right to health insurance, which is in accordance with the Decision of the Constitutional Court”.

This will prevent future loss of health insurance for the unemployed and the motto of the Ministry of Health will be applied completely: “No person without health insurance” for which significant reforms have been adopted over the past years, and our associations advocate for as well.

1. What leads to this conclusion?

A pregnant woman gave birth in April 2013 at the department of gynecology and obstetrics in P.H.I. General Hospital Prilep and at the time of discharge from the hospital instead of joy she received shock – an invoice in the amount of 13,000 denars, cost of health service calculated for a person without health insurance. On the other hand, the same woman has received blue cards until March that year as a confirmation that she is insured by the Health Insurance Fund of Macedonia based on unemployment, under re-registration of health insurance in August 2012.

The same woman refers to ROMA S.O.S. for help and information about this situation in which it is determined that she has not filed a Statement of revenues in the Health Insurance Fund of Macedonia for that year for which the Health Insurance Fund of Macedonia is not entitled to give her health insurance.

During the same month and the next, ROMA S.O.S. registered another 280 similar cases after which the question arises:

How many people have lost their health insurance and thus lead to a situation to participate in 100% of the requested health service?

2. What is the response of the Health Insurance Fund of Macedonia upon this issue?

The response to the Request that we submitted to the Health Insurance Fund of Macedonia upon this question was as follows – by March 31st, (including March 31st) 2013 only 120,255 holders of health insurance in the territory of the Republic of Macedonia submitted a Statement of revenues of total of 227,276 registered insurers.

Namely, in January 2013 the Health Insurance Fund of Macedonia (HIF) announced a Call by which they asked all unemployed and people with lower incomes, who are beneficiaries of the Fund, to make a re-registration of their health insurance by submitting a statement of revenues for the previous year, 2012, in order to retain this right. The deadline for filing the statement was from February 1st, 2013 to March 31st 2013.

3. What consequences did unemployed – beneficiaries of the Fund face?

Beneficiaries that were not informed were finding out about it at the time when they were accessing health services or had the need to buy medicines at the pharmacy when actually they “were informed for all procedures”: paying private prices for health services, inability to obtain necessary drugs from the positive list, completing the necessary paperwork and submitting a new Application for health insurance and waiting for their turn in front of the HIF together with 50 other people on average, at the same time when the health condition of the person or a family member was deteriorated and there was need of health care.

4. What did ROMA S.O.S. accomplish from April to date?

Having interest to find legal means in order to overcome this situation, ROMA S.O.S. considered the legislation and concluded that there flaws in the application of the relevant laws which led to situation like this. The findings obtained by ROMA S.O.S. are presented in the table.

However, what should be emphasized is the Decision of the Constitutional Court from 14.11.2012, by which citizens are not obliged to submit Statements of revenues in the process of realizing the right to health insurance i.e. the decision indicates the obligation of the Health Insurance Fund of Macedonia to check the amount of revenue for each insured through Public Revenue Office, as the competent authority.

According to this, ROMA S.O.S. finds that the Constitutional Court’s decision is not fully complied and applied by the Ministry of Finance, as an institution that is directly responsible for implementing this decision, so in order to hold accountable for respecting the Decision from 18.07.2013, interventions were submitted to the Ministry of Finance and Ministry of Health.

In addition, a petition was submitted to the Ombudsman to act in accordance with its responsibilities and to examine whether the Decision was fully implemented and executed, and Appeal to the Commission for Health at the Assembly of R.M to review the matter as well.

The initiative was backed by 6 NGOs from Macedonia that signed the documents: ESE-Skopje, KHAM-Delcevo, SUMNAL-Skopje, NRC-Kumanovo, H.E.R.A.-Skopje and Macedonian platform against poverty.

5. What is the attitude of institutions?

Responses upon submitted Complaints and Notification were received in September 2013 according to which the Ministry of Finance and the Ministry of Health do not recognize our perception as an obstacle in realizing the right to health insurance, although aware that the number of people who lost their health insurance because of failing Statement is great. Additionally they give an explanation that the submission of a Statement by the citizens once a year is not a big commitment.

In contrast to this view, the Ombudsman confirms the perception of ROMA S.O.S. and shows that there is no full implementation of the constitutional decision and therefore requires immediate adoption of new legal amendments.

July 2013

200.000 MKD compensation for damage of 63 year old Romani woman from Delčevo due to inadequate treatment

29.07.2013

Association ROMA S.O.S. inform you that has been brought the first positive decision regarding the 4 cases in which was initiated litigation in the past years which are supported in the court representation in front of the Basic Courts of Macedonia for violation of the rights of health care where patients Roma are damaged.
Namely, 63 year old Romani woman, S.F. from Delčevo, during fall from the stairs hurts her right shoulder and gained fracture, which was not adequately treated by the orthopedic doctor in PHI General Hospital in Kocani, after which the situation got worse. As a result, it ended with reduced function of the hand and need surgery for placement of artificial wrist.
Through the initiated court representation it is given a monetary compensation for the damage, through which the 63 years Roma woman accomplished the right to compensation as an internationally recognized right and provided with the European Charter of Patients’ Rights. By this, it can be provided an artificial wrist and perform surgical intervention which finally will allow S.F. to independently perform their daily living needs.

These positive decisions in the interest of damaged Roma, encourage Roma population to seek responsibility from health care providers, with aim to conduct a fair and confirmation of “the right to health for all without discrimination”.
Brief informatory for the course of trial and judgment you can find here.
In 2010 association ROMA S.O.S. formed a Legal department in the frame of the project “Health of Roma – basic human right” financed from FOSM, with aim to create strategic method through which violations of the right of health protection will be publicly an institutionally actualized. Through applying of the legal regulative it is required provision of equal access for Roma to the right of health protection.

Unemployed persons and the right to health insurance

19.07.2013

A pregnant woman gave birth in April 2013 at the Department of gynecology and obstetrics in P.H.I. General Hospital Prilep and at the time of discharge from the hospital instead of joy she received shock – an invoice in the amount of 13,000 denars, cost of health service calculated for a person without health insurance. On the other hand, the same woman received blue cartons until March that year as a confirmation that she is insured by the Health Insurance Fund of Macedonia based on unemployment, under the procedure for re-registration of health insurance in August 2012.

S.I. refered to ROMA S.O.S. for help and information about this situation when it was determined that the same woman has not filed a Statement for incomes in the Health Insurance Fund of Macedonia due to which she was not entitled to realize the right on health insurance anymore and her status of insured person in the Health Insurance Fund of Macedonia has been terminated.

(in January 2013 the Health Insurance Fund of Macedonia (HIF) announced a Call with which they asked all unemployed and people with lower incomes, who are beneficiaries of the Fund, to make a re-registration of their health insurance by submitting a Statement of incomes for the previous year (2012) in order to retain this right. The deadline for filing the statement was from February 1st, 2013 to March 31st 2013)

During the same month and the next, ROMA S.O.S. registered another 280 similar cases after which the question arises: How many people have lost their health insurance and thus lead to a situation to participate in 100% of the requested health service?

The response to the Request that we submitted to the Health Insurance Fund of Macedonia upon this question was as follows – by March 31st, (including March 31st ) 2013 only 120,255 holders of health insurance in the territory of the Republic of Macedonia submitted a Statement of incomes of the total 227,276 registered insurers. In other words 50% of the unemployed who were insured by the Health Insurance Fund of Macedonia until March 2013, did not get their health insurance extended since April 2013.

What was worrying was the fact that these same people were not informed of this situation and were finding out at the time when accessing health services or had the need to buy medicines at the pharmacy when actually they “were informed for all procedures” – paying private prices for health services, inability to obtain necessary drugs from the positive list, completing the necessary paperwork and submiting a new Application for health insurance and waiting for their turn in front of the HIF together with 50 other people on average, at the same time when the health condition of the person or a family member was deteriorated and there was need of health care.

Having the interest of finding means to overcome this situation, ROMA S.O.S. came to the decision of the Constitutional Court from 14.11.2012 by which citizens are not obliged to submit Statements of incomes in the process of realizing the right to health insurance i.e. the decision indicates the obligation of the Health Insurance Fund of Macedonia to check the amount of income for each insured through Public Revenue Office, as the competent authority.

According to this, ROMA S.O.S. finds that the Constitutional Court’s decision is not fully complied and applied by the Ministry of Finance, as an institution that is directly responsible for implementing this decision. In order to hold institutions accountable for not respecting the Decision of the Constitutional Court, ROMA S.O.S. submitted Complaints to the Ministry of Finance and Ministry of Health on 18.07.2013.

In addition, a Complaint was submitted to the Ombudsman to act in accordance with its responsibilities and to examine whether the Decision was fully implemented and executed, and Appeal to the Commission for Health at the Assembly of R.M to review the matter as well.

The initiative was backed by 6 NGOs from Macedonia that signed the Complaints: ESE-Skopje, KHAM-Delčevo, SUMNAL-Skopje, NRC-Kumanovo, H.E.R.A.-Skopje and Macedonian platform against poverty.

Responses upon submitted Complaints were received in September 2013 according to which the Ministry of Finance and the Ministry of Health do not recognize our perception as an obstacle in realizing the right to health insurance, although aware that the number of people who lost their health insurance because of failing Statement is significantly high. Additionally they give an explanation that the submission of a Statement by the citizens once a year is not a big commitment for them.

In contrast to this view, the Ombudsman confirms the perception of ROMA S.O.S. and shows that there is no full implementation of the Constitutional Court’s Decision and therefore requires immediate adoption of new legal amendments.

As a result, ROMA S.O.S. in cooperation with the other associations plans the following activities:
1. To submit a Request for a consultative meeting with the Commission for Health at the Assembly of R.M in order to schedule a meeting to discuss the issue among MPs,
2. To organize a press conference in order to inform the public regarding the received observations and contradiction in the answers, and the consequences for the citizens of this situation. The same event will invoke the relevant institutions to take measures to legislative changes and remove obstacles that citizens are facing in exercising their rights according to the decision of the Constitutional Court.