Proposals of the Official School of Doctors of Barcelona (CoMB)

Considerations of the School of Doctors in regard to the previous public query at the elaboration of a project of decree of modification of the Decree 151/2017, of 17 of October, for which establish the requisites and the guarantees tecnicosanitàries common of the centres and sanitary kicks and the procedures for his permission and registry.   Since the COMB value very positively the initiative of elaboration of this project of decree of modification of the Decree 151/2017, of 17 of October, for which establish the requisites and the guarantees tecnicosanitàries common of the centres and sanitary kicks and the procedures for his permission and registry, at the effects to improve the efficacy and efficiency of the relative procedures at the sanitary permissions that this regulates, and also, the will of consensus and dialogue for part of the Department of Health to cry at taking part in his modification at the agents implied. It treats of a necessary modification and, that definitely, has to be an advance that will contribute a main juridical security, so much for the interested affected by the Decree, for the same sanitary centres, how for the Department or for the same professional Schools that orient and advise the professionals implied. Of the possible alternative solutions proposed by the Department, share that the option at tracking more effective is the normative option. At this sense, make you arrive some observations everything expecting that they can be #take# into account and reflected at the writing of the Project of modification of the Decree: 1. Juridical security. 1.- The sanitary centres and medical queries, since before the onset of the procedure of administrative permission, have to can meet all the requisites and documentation at contributing, at function of the concrete characteristics of each centre or query. Therefore, the requisites, that some already collect at the Decree, if have to complete , has to make with an instrument reglat normativament, to attain the predicable juridical security at every procedure. In any event, this instrument has to be flexible, modifiable and actualitzable, when was necessary, but always with the aixopluc minimal normative. 2.- At the effect to give juridical security at the citizens and at the sanitary professionals in regard to the figure of the Manager Assistencial, would be convenient: • That at the document of application of operation of the sanitary centre included a document of responsible statement signed by the professional designated by the charge of Manager Assistencial of the centre with his functions and the corresponding acceptance of the charge. • That it enable a more agile procedure in order that can communicate the modifications at the charge of Manager assistencials of the centres. • That it include the identity of the professional that has the charge of Manager Assistencial at the public registry of centres authorised, identity that has to be public and accessible. 3.- #Make# possible that the Department can exert his functions of check, surveillance and control with regard to the unauthorized centres that carry out a sanitary activity for part of persons without sanitary degree or without sufficient sanitary degree, posing at risk the health of the citizens. Of chord with the article 24 of the Law 14/1986 of 25 of April, General of Health, the public or private activities that, directly or indirectly, can have negative consequences for the health, will be subjected by the competent organs at the limitations of administrative nature, of chord with the basic rule. Likewise, the article 26 enables at the sanitary authorities at adopting the sizes that consider pertinent as a suspension of the activity or shutdown or those that consider sanitàriament justified. At this sense, the own drafted of the Decree collects as a primordial purpose the establishment of the minimal requisites for the security and quality of the assistance loaned at the citizens to develop at conditions of security and quality the sanitary activity. And at the chapter V, referent at the check, surveillance and control of the debentures foresees that the competent General Address can order the ban of activities or closure of the centres or sanitary kicks that do not have the prescriptive permissions, as well as the suspension of his operation until they do not amend the defects or conform the requisites demanded by reasons of health, hygiene or security. Splitting of these premises, consider that would have to include at the Project of modification of the Decree the possibility that the Department could also act against those unauthorized centres that carry out a sanitary activity for part of persons without sanitary degree or without sufficient sanitary degree, posing at risk the health of the citizens for reasons of health, hygiene or security and that, at a lot of cases, make advert as a centres of alternative medicine inducing at error at the citizens at the belief that treats of a duly enabled centre for these practices. At these cases, the Department would have to agree the sizes cautelars pertinent and besides, if it detected the commission of a possible crime, make the corresponding communication at the judicial authorities. That is to say, in the same way that the Department can shut centres authorised where do not work sanitary professionals duly titled for the kick that loans , with more reason, could order the shutdown cautelar of unauthorized centres that realise sanitary practices without personnel no titled or without sufficient sanitary degree. The size cautelar of shutdowns is of immediate effects, unlike the chords that can take at judicial headquarters of nature cautelar or condemnatory much more dilated at the time, and that saved of flagrant cases, is not as effective in regard to the laws that pretend protect.   B. Solutions addressed to achieve a main celerity of the performances. 1.- We consider that the procedure of permission of the medical queries or sanitary centres that do not realise invasive procedures or minimally invasive, can simplify modifying the document of application of permission regarding the responsible statement that already contains , where include the statement of fulfillment of all the requisites foreseen by the rule, that will have to be accredited contributing the corresponding documentation, so that, once presented, the titular of the query or centre can induct the professional activity of provisional form, while it do not have of the definite resolution of permission, previous the timely check, if that's the case. It is necessary to append, that the technical project regarding the installations of the centres or queries have been crafted by a competent technician duly collegiate (architect/at, engineer/at, architect/at technician, engineer/at technician) that offers an appearance of sufficient juridical veracity to set up the activity of the centre or query, without damage that the administration can realise the comprovació that it correspond. at case that consider it necessary. In addition, at the case of the medical queries, at virtue of the Agreement of collaboration subscribed among the Department and the Council of Schools of Doctors of Catalonia (CCMC), for the delegation of determinate functions of sanitary permission of medical queries, since the CCMC already verifies previously the fulfillment of the requests of the applications of permissions managed emitting the corresponding technical report not linking on the fulfillment of the requisites that establish at the rule of app, and on the documentation contributed. This would be a mode to eschew the delays of the procedures, that the same Administration recognises at the memory of the project, with independence of the resources that can destine . Ara well, nevertheless, out convenient that, with this purpose, the Administration also endowed of more resources at this field. Concurrently, it would be necessary to include at the project of modification of the Decree, at the size that was possible, the requests that would have to conform the medical queries at the effects that the sanitary professionals are connoisseurs of his debentures and to speed up the processing and advice for part of the Professional Schools. 2.- For the rest of centres that do not carry out a minimally invasive activity, proposes the introduction of Entities Collaborators of the Administration (ECA) with the purpose of verification and control of the conditions and legal requests at the applications of permission of the more sanitary centres complex at the effect to reduce the administrative charges at the Department and celerity at the resolution of the records. 3.- Improve the internal procedure of management of the permission and establish uniform criteria for the resolution of the records of chord with the criteria that establish for the Department. 4.- Alternatively at all the previous, establish the positive silence at the procedures of the sanitary administrative permission for the suppositions that do not resolve in the terms established such and how already makes at other communities.  The article 24 of the Law 39/2015, of 1 of October, of the common administrative procedure of the public administrations establishes the positive silence as a general rule at the procedures inducted on request of the interested removed of the supposition that the resolution estimatòria awarded contrary laws at the juridical arranging or affected the general interest. This modification would reduce the administrative charge so much for the sanitary centres how for the Department, would eschew the economic damages that suffer some sanitary centres at the processings that lengthen at the time, giving also a juridical security at the patients.   Dr. Sònia Miravet Jiménez Secretari of the Joint of Governance