Parliament Allows Nurses and Midwives to Run Their Own Practices

The National Assembly allowed doctors' assistants, nurses, midwives and rehabilitation therapists to set up a new type of medical treatment establishments. Passing amendments to the Medical Treatment Establishments Act on second reading, the MPs resolved that a medical treatment establishment can be a stand-alone entity in which medical specialists provide medical and healthcare services, manipulations and disease prevention on their own. They can perform healthcare and medical activities in a patient's home when the patient's condition requires that.

A group healthcare practice may be run by a commercial corporation or a cooperative established by doctors' assistants, nurses, midwives and/or rehabilitation therapists who have at
least three years' experience in the respective field and are registered in accordance with Article 40 of the Medical Treatment Establishments Act. Such registration will be carried out by the CEO of the Executive Agency for Medical Supervision.

The organization, activities and internal order of group healthcare practices will be regulated by rules endorsed by the manager of the respective medical treatment establishment.

The BSP for Bulgaria parliamentary group objected to the amendments. A controversy broke out among the MPs about how to regulate the scope of the work of medical specialists and who should pay them. Health Committee Chair Daniela Daritkova (GERB) explained that the amendments will regulate types of services which are already being provided by nurses, doctors' assistants and rehabilitation therapists. This will ensure proper control, she noted.

The National Assembly also resolved that state and municipal hospitals and cancer centres should apply financial activity standards which include rules for setting the wages of medical staff in accordance with the Labour Code.

Furthermore, the approved amendments set administrative penalties for medical treatment establishments. An establishment which delays or fails to provide information to the National
Council on Prices and Reimbursement of Medicinal Products about a medicine whose therapeutic effect is being monitored, will incur a pecuniary penalty of 500 to 1,000 leva. A second offence will carry a penalty of 1,500 to 3,000 leva. The size of the
penalties depends on whether the offender is a sole proprietor or a legal entity.

Georgi Mihailov (BSP for Bulgaria) disapproved of a requirement for the above-mentioned type of information to be provided within 24 hours. He argued that the information system is still
very cumbersome, which creates a possibility for administrative manipulation of medical treatment establishments.

The Council of Ministers will be in charge of designating, on a proposal by the Health Minister, a state-run medical treatment establishment to provide medical services to officials
travelling domestically or abroad under the National Service for Protection Act and leaders of international organizations and institutions visiting Bulgaria.

The transitional and final provisions of the approved Act Amending the Medical Treatment Establishments Act also entail changes to the Transplantation of Organs, Tissues and Cells Act. One of the changes consists in expanding the scope of persons who may express a will to donate, by adding collateral relatives up to the fourth degree, including relatives by adoption, but not earlier than three years after the adoption.

Other provisions regulate swap transplants. Put simply, a swap transplant is a barter of organs between two families who fail to find a compatible donor within their own kin.

The Executive Agency for Medical Supervision will exercise control over the import, export and exchange of organs.

The new legislation further regulates the import of transplant organs from third countries under agreements signed with Bulgaria, and organ exchange with EU member states and
Switzerland.

Exporting transplant organs to third countries is allowed when there are agreements which expressly define the terms and procedures for export, but only if there is no matching
recipient in the European Union, the European Economic Area or Switzerland.

The export of tissues and cells, including egg cells, sperm cells and zygotes (fertilized egg cells), is allowed on condition that domestic demand for such tissues and cells has
been met and the receiving institution is duly recognized in the  respective country.

Source: BTA