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Yrkeslegitimation inom hälso- och sjukvården - En studie av återkallelseinstitutet i förhållande till offentligrättsliga principer

Klintberg, Fredrik LU (2021) JURM02 20211
Department of Law
Faculty of Law
Abstract
There is a presumption that holding a professional license within the health care sector guarantees that the health care practitioner has the appropriate competence and personal qualities that are required for the specific medical profession. A health care practitioner (e.g. a medical doctor) who is no longer considered to be suitable to perform health and medical services shall, in accordance with chapter 8 article 3 of the Patient Safety Act (in Swedish patientsäkerhetslagen 2010:659, PSL), have their professional license revoked by the Medical Responsibility Board (in Swedish Hälso- och sjukvårdens ansvarsnämnd, HSAN). The purpose of this protective measure is not to punish the individual health care practitioner, but to guarantee that... (More)
There is a presumption that holding a professional license within the health care sector guarantees that the health care practitioner has the appropriate competence and personal qualities that are required for the specific medical profession. A health care practitioner (e.g. a medical doctor) who is no longer considered to be suitable to perform health and medical services shall, in accordance with chapter 8 article 3 of the Patient Safety Act (in Swedish patientsäkerhetslagen 2010:659, PSL), have their professional license revoked by the Medical Responsibility Board (in Swedish Hälso- och sjukvårdens ansvarsnämnd, HSAN). The purpose of this protective measure is not to punish the individual health care practitioner, but to guarantee that the public trust in the health care is not damaged. However, revoking the professional license raises a conflict between the public interest of protecting the patient safety and the interest of the individual of keeping his or her professional license. The specific grounds for revoking the license are serious incompetence, serious crime, and otherwise deemed unsuitable for the profession. The interpretation of these grounds leave room for discretionary assessments, by allowing the law enforcing authority, HSAN, to do an overall assessment of all the circumstances that are held against the health care practitioner. Arbitrary decisions must be counteracted, and HSAN must therefore consider if the specific purpose of the legislation (patient safety) will be achieved by revoking the professional license in the specific case – simply put, if the interpretation of the law is appropriate.

The purpose of this thesis is to demonstrate the applicable law concerning revoking a professional license within the health care sector, as stated in chapter 8 article 3 of PSL, and how the interpretation thereof, by HSAN, relates to principles of public law. An empirical study was conducted over a series of decisions taken by HSAN, which revealed specific circumstances for revoking the professional license. The assessment of the specific circumstances and the interpretation of the specific grounds for revoking the professional license, have been analyzed in relation to the requirements set out by the principles of legality, objectivity and proportionality. Due to the fact that revoking a professional license is considered to be a serious measure against the health care practitioner, the current law imposes a high burden on the authorities to prove the specific circumstances (full evidence) and that they do exist at the time of review by HSAN. The empirical study illustrates a variety of circumstances that HSAN must assess in relation to patient safety. The purpose of the legislation is clear to the law enforcing authority and the empirical study illustrates how HSAN focuses on the circumstances that are relevant and are considered to pose a threat to patient safety. Although the specific grounds leave room for discretionary assessments, the trends that have been demonstrated through the empirical study do indicate a consistent interpretation of the law, in regards to the professional license being revoked in line with the stated purpose. (Less)
Abstract (Swedish)
Yrkeslegitimationen inom hälso- och sjukvården anses utgöra en garanti för att den enskilde yrkesutövaren besitter den kompetens och de personliga egenskaper som krävs för yrket i fråga. En yrkesutövare (t.ex. en läkare) som inte bedöms vara lämplig för att få fortsätta sin yrkesutövning ska enligt 8 kap. 3 § patientsäkerhetslagen (2010:659), PSL, få sin legitimation återkallad av Hälso- och sjukvårdens ansvarsnämnd (HSAN). Denna skyddsåtgärd vidtas i syfte att bibehålla förtroendet för hälso- och sjukvården i stort – inte för att straffa den enskilde yrkesutövaren. Tillämpningen av återkallelseinstitutet aktualiserar dock en konflikt mellan allmänintresset av att säkerställa patientsäkerhet och den enskilde yrkesutövarens intresse av att... (More)
Yrkeslegitimationen inom hälso- och sjukvården anses utgöra en garanti för att den enskilde yrkesutövaren besitter den kompetens och de personliga egenskaper som krävs för yrket i fråga. En yrkesutövare (t.ex. en läkare) som inte bedöms vara lämplig för att få fortsätta sin yrkesutövning ska enligt 8 kap. 3 § patientsäkerhetslagen (2010:659), PSL, få sin legitimation återkallad av Hälso- och sjukvårdens ansvarsnämnd (HSAN). Denna skyddsåtgärd vidtas i syfte att bibehålla förtroendet för hälso- och sjukvården i stort – inte för att straffa den enskilde yrkesutövaren. Tillämpningen av återkallelseinstitutet aktualiserar dock en konflikt mellan allmänintresset av att säkerställa patientsäkerhet och den enskilde yrkesutövarens intresse av att få behålla sin yrkeslegitimation. De specifika återkallelsegrunderna är grov oskicklighet, allvarlig brottslighet, samt på annat sätt uppenbart olämplig för yrkesutövningen. HSAN, som rättstillämpare, ges utrymme för skönsmässiga bedömningar genom att det ska göras en helhetsbedömning av samtliga omständigheter som läggs den legitimerade yrkesutövaren till last. Med hänsyn till den enskilde yrkesutövarens intressen ska godtyckliga myndighetsbeslut motverkas. HSAN måste således bedöma om det uttalade syftet (patientsäkerhet) går att uppnå i det enskilda fallet genom att återkalla legitimationen – helt enkelt om rättstillämpningen är ändamålsenlig.

Syftet med denna uppsats är att åskådliggöra gällande rätt kring återkallelseinstitutet i 8 kap. 3 § PSL, och hur HSAN:s tolkning och tillämpning därav förhåller sig till de offentligrättsliga principerna om legalitet, objektivitet samt proportionalitet. Genom en empirisk undersökning av HSAN:s beslut om återkallelse av legitimation konkretiseras vilka omständigheter som har åberopats och hur dessa har bedömts mot de specifika återkallelsegrunderna. Rättstillämpningen har sedermera analyserats i förhållande till de krav som uppställs genom de offentligrättsliga principerna om legalitet, objektivitet samt proportionalitet. Med anledning av att återkallelse bedöms vara en ingripande åtgärd gentemot den enskilde yrkesutövaren uppställer gällande rätt ett högt beviskrav, nämligen full bevisning, samt att prövningen av återkallelse ska göras mot de omständigheter som föreligger vid prövningstillfället. Den empiriska undersökningen åskådliggör en mångfald av åberopade omständigheter som HSAN sedermera måste bedöma utifrån ett patientsäkerhetsperspektiv. Syftet med lagstiftningen framstår dock som klart och tydligt för rättstillämparen och den empiriska undersökningen åskådliggör hur HSAN fokuserar på de omständigheter som är relevanta och anses utgöra ett hot mot patientsäkerheten. Trots utrymmet för skönsmässiga bedömningar så åskådliggör den empiriska undersökningen tendenser som tyder på en konsekvent rättstillämpning, i det avseende att skyddsåtgärden att återkalla legitimation vidtas i linje med det uttalade syftet. (Less)
Please use this url to cite or link to this publication:
author
Klintberg, Fredrik LU
supervisor
organization
course
JURM02 20211
year
type
H3 - Professional qualifications (4 Years - )
subject
keywords
Förvaltningsrätt, offentlig rätt, hälso- och sjukvård, yrkeslegitimation, återkallelse, patientsäkerhet, offentligrättsliga principer
language
Swedish
id
9044963
date added to LUP
2021-06-09 11:21:16
date last changed
2021-06-09 11:21:16
@misc{9044963,
  abstract     = {{There is a presumption that holding a professional license within the health care sector guarantees that the health care practitioner has the appropriate competence and personal qualities that are required for the specific medical profession. A health care practitioner (e.g. a medical doctor) who is no longer considered to be suitable to perform health and medical services shall, in accordance with chapter 8 article 3 of the Patient Safety Act (in Swedish patientsäkerhetslagen 2010:659, PSL), have their professional license revoked by the Medical Responsibility Board (in Swedish Hälso- och sjukvårdens ansvarsnämnd, HSAN). The purpose of this protective measure is not to punish the individual health care practitioner, but to guarantee that the public trust in the health care is not damaged. However, revoking the professional license raises a conflict between the public interest of protecting the patient safety and the interest of the individual of keeping his or her professional license. The specific grounds for revoking the license are serious incompetence, serious crime, and otherwise deemed unsuitable for the profession. The interpretation of these grounds leave room for discretionary assessments, by allowing the law enforcing authority, HSAN, to do an overall assessment of all the circumstances that are held against the health care practitioner. Arbitrary decisions must be counteracted, and HSAN must therefore consider if the specific purpose of the legislation (patient safety) will be achieved by revoking the professional license in the specific case – simply put, if the interpretation of the law is appropriate. 

The purpose of this thesis is to demonstrate the applicable law concerning revoking a professional license within the health care sector, as stated in chapter 8 article 3 of PSL, and how the interpretation thereof, by HSAN, relates to principles of public law. An empirical study was conducted over a series of decisions taken by HSAN, which revealed specific circumstances for revoking the professional license. The assessment of the specific circumstances and the interpretation of the specific grounds for revoking the professional license, have been analyzed in relation to the requirements set out by the principles of legality, objectivity and proportionality. Due to the fact that revoking a professional license is considered to be a serious measure against the health care practitioner, the current law imposes a high burden on the authorities to prove the specific circumstances (full evidence) and that they do exist at the time of review by HSAN. The empirical study illustrates a variety of circumstances that HSAN must assess in relation to patient safety. The purpose of the legislation is clear to the law enforcing authority and the empirical study illustrates how HSAN focuses on the circumstances that are relevant and are considered to pose a threat to patient safety. Although the specific grounds leave room for discretionary assessments, the trends that have been demonstrated through the empirical study do indicate a consistent interpretation of the law, in regards to the professional license being revoked in line with the stated purpose.}},
  author       = {{Klintberg, Fredrik}},
  language     = {{swe}},
  note         = {{Student Paper}},
  title        = {{Yrkeslegitimation inom hälso- och sjukvården - En studie av återkallelseinstitutet i förhållande till offentligrättsliga principer}},
  year         = {{2021}},
}