Author: Tetiana Palamar

Guardianship and custody are established to secure personal non-proprietary and proprietary rights of a full-grown person whose health status does not permit them to exercise their rights and perform duties; guardianship and custody are terminated in case the person’s civil capacity is renewed.

The right to guardianship and custody

The law secures the right of an individual recognized as incapable or whose civil capacity is restricted, to guardianship or custody.

The restricted civil capacity of a person 

A court may limit the civil dispositive capacity of an individual if that person:

1) is suffering from a mental disorder that has a significant impact on their capacity to understand the meaning of their actions and/or control them;

2) abuses alcohol, drugs, toxic substances, gambling, etc., thus putting himself or herself, his or her family, and other persons whom he/she is legally obliged to maintain, in challenging financial circumstances.

A petition to limit the civil dispositive capacity of a person can be submitted by his/her family members, guardianship and custody authority, drug addiction, or mental health facility.

The legal consequences of an individual’s civil dispositive capacity restriction 

• Individuals with limited civil dispositive capacity are placed under guardianship;
• An individual with limited civil dispositive capacity may carry out only minor domestic transactions independently;
• Transactions involving the disposal of assets and other non-minor, non-domestic transactions may be carried out by a person with limited civil dispositive capacity only with the consent of their guardian. Refusal by a guardian to consent to a non-minor, non-domestic transaction may be appealed against by a person with limited civil dispositive capacity before an agency of tutorship or guardianship or before a court;
• A guardian manages the receipt and disposal of wages, pensions, educational grants and other income on behalf of a person with limited civil dispositive capacity;
• A guardian may give written authorization to an individual with limited civil dispositive capacity to allow him/her independently to receive and dispose of his/her wages, pensions, educational grants and other income. 

Requirements to guardians and custodians 

• Only an individual with full civil dispositive capacity can become a guardian or a custodian.
• A guardian or a custodian is appointed primarily from family members or related persons, with consideration given to their personal relations with the individual and the capacity to perform the duties of a guardian or a custodian. An individual can be assigned one or several guardians or custodians.
• An individual cannot become a guardian or a custodian if: this individual is deprived of the parental rights which have not been renewed; the individual’s conduct and interests are in conflict with the interests of the individual in need of guardianship or custody.
• The guardian is obliged to take care of the person under care, to create the necessary living conditions for him/her, ensure his/her care and treatment; take actions to protect the civil rights and interests of the person under guardianship (take care to ensure availability of the necessary medications and care, establish proper living conditions, represent his/her interests). 

The procedure of appointing guardians and custodians for full-grown persons 

• A guardian (custodian) for an incapable individual (an individual with limited civil dispositive capacity) is appointed by court upon request of the guardianship and custody authority.
• A request to appoint a guardian to an individual recognized incapable, can be submitted to court both by the guardianship and custody authority, and by the individual willing to become a guardian.
• The guardian is a legal representative of the individual recognized incapable.

Dismissal of a guardian or a custodian 

• The court, if it has appointed the guardian or the custodian, or the custody authority upon the individual’s request, relieves the individual from the powers of a guardian or a custodian. The court or the guardianship and custody authority review the request for one month. The individual continues performing the duties of the guardian or the custodian until the decision to relieve the individual from the powers of the guardian or the custodian is adopted or until the term of one month since the submission of the request is over, if the request has failed to be reviewed during this time.
• The court, if it has appointed the guardian or the custodian, or the custody authority can relieve the individual from the powers of a guardian or a custodian upon request of the individual under guardianship.
• The guardianship and custody authority at their own initiative, upon request of the person under care, governmental or civil organizations, and based on reasonable petitions of any person can initiate the procedure of relieving the individual from the powers of the guardian for failure to duly perform his/her duties.
• The court may relieve the individual from the powers of a guardian or a custodian upon petition of the guardianship and custody authority in case of failure to perform his/her duties, violation of the ward’s rights, and in case the person under care is placed to a school, health facility or a social protection facility.

In Ukraine, the Law “On preventing tuberculosis disease” is in action. This law provides for state guarantees of measures aimed at preventing the dissemination of tuberculosis (Article 4) and sets forth the requirements for arrangements of medical care provided to patients with tuberculosis (Article 10). The medical services on TB diagnostics and treatment are covered by the Program of Medical Guarantees – the list of medical services guaranteed to patients by the Government. Under the Program of Medical Guarantees, TB patients are entitled to the following free services: laboratory and instrumental tests; outpatient and inpatient treatment; drugs from the National list of essential medications and drugs procured at the central level at the cost of the public budget.

What you need to consider

Starting from April 1, 2021, medical care for tuberculosis is provided under two state-guaranteed benefit packages, with a specific list of procedures defined for each package. To receive the service, one needs to select a facility contracted by the National Health Service of Ukraine (NHSU) for the provision of such services.

 The scope of free TB medical services which must be provided by health facilities includes:

1. Under benefit package “Follow-up and treatment of children and adults with TB at primary healthcare level”: directly observed treatment, monitoring, supervision, patient psychosocial support, including:
   1. Dynamic monitoring of the health status of people with tuberculosis (TB).
   1. Laboratory tests, including: 
2. Full blood panel;
3. Blood chemistry profile, bilirubin and fractions, creatinine, urea, uric acid;
4. Whole blood glucose or serum glucose;
5. Collection and transportation of biological samples for bacteriology tests;
6. Referral of TB patients to secondary (specialized), tertiary (highly specialized) care facilities for diagnostics, treatment of concomitant diseases aggravated by TB, or other services including medical rehabilitation.
7. Under benefit package “Outpatient and inpatient diagnostics and treatment of children and adults with TB”, including:

• Dynamic monitoring of the health status of people with tuberculosis (TB) at the outpatient treatment stage;
• Performing a broad range of required laboratory tests to confirm the diagnosis and monitor treatment progress;
• Performing the required instrumental investigations;
• Developing TB treatment and follow-up plan, including elaboration of an individual treatment plan for the outpatient / inpatient treatment stage, taking into account the patient’s concomitant diseases.

For the full scope of services under this benefit package, please access the NHSU website and select the specification under the relevant benefits package.

Conduct of the patient if healthcare providers solicit payment for medical service or refuse to provide the service.

• First of all, approach the chief physician of the healthcare facility, preferably with a written report (complaint), demanding to remedy the violation of right to free medical care under the relevant benefit package, referring to availability of public funding received by the healthcare facility for provision of such services. The complaint must be duly registered, with an incoming registration number assigned.
• If these efforts were not successful, you need to file a written report (complaint) to the oblast health department complaining about absence of response by the chief physician and demanding to remedy the violation of the right to healthcare. The healthcare department must duly register the complaint and respond to it. In fact, this is usually enough to correct the situation. 
• If the client remains unsatisfied, he/she can approach the National Health Service of Ukraine (NHSU) and submit a complaint using the online form on the NHSU website. 
• If a healthcare provider unreasonably refuses to provide medical care or solicits payment for the services covered by the NHSU under the Program of Medical Guarantees, this is a breach of the contract between the National Health Service and the facility. Usually, NHSU does not ignore such messages and may take measures up to terminating public funding provided to the health facility. Therefore, the administrations of health facilities try to avoid such complaints and prevent conflicts.
• The client has the right to file a complaint in court.

REAct was approached by an OST program client asking for support in receiving drugs. After the woman was discharged from a TB dispensary, she contacted her local narcologist to continue her OST. The doctor was reluctant to switch her to unsupervised OST intake, looking for excuses: suspicions that she has forged her discharge certificate, absence of proof of her TB diagnosis, etc. The claim that NHSU has contracted his facility for treating a definite number of clients and he was unwilling to take more as “he’s not paid for that” was another excuse.

What should be done in such cases:

1. You need to approach the chief physician of the health facility with a written report (complaint) demanding to remedy the violation of the right to receiving free OST services. The complaint must be duly registered, with an incoming registration number assigned.
   1. At the same time, you can call OST hotline to report about the situation and to ask for support in ensuring OST. OST hotline has experience in responding to clients’ calls, the contact information of responsible people in this field in the regions and can be engaged to improve the situation.

If a narcologist says that it is impossible to register a person for the OST program referring to some alleged limits of the number of patients, you need to know the following.

• A health facility receives public funding for provision of certain services covered by relevant benefit package. In this case, it is the state-guaranteed benefit package “Treatment of persons with mental and behavioral disorders caused by opioid consumption with the use of substitution maintenance therapy drugs.”
• First of all, you need to verify the claim of the narcologist through the official NHSU website. Click on the “Signed contracts” item in the menu on top of the page. You will be forwarded to the page with links on the left. Click on “Contracts with specialized health facilities” and select your oblast from the list. Then select the health facility and click to download the contract between the health facility and the NHSU for provision of healthcare services to population under the program of medical guarantees for 2021. The service we are looking for is listed in the annexes to the contract.
• If the number of patients is defined (e.g., 37), this does not mean that the healthcare provider will reject you. On the contrary, during contract validity period, the parties may review and modify the planned cost of medical services. Each health facility receives public funding for more than one benefit package which means a certain balance range to ensure possible reallocation between the packages.
• And more to that. According to the previous plan of the Ministry of Health to expand OST coverage to 5% of the estimate number of opioid drug users, significant quantities of OST drugs were procured. This means that OST drugs are available, stored in warehouses at oblast level, so a health facility can request additional quantity of drugs should a need arise (the number of an OST site patients exceeds expectations). This is based on the Ministry of Health order on need-based reallocation of OST drugs in line with a relevant institutional procedure.

This ensures legal grounds to demand registering the client for the OST program in this health facility.

• If the efforts mentioned in paragraphs 1 and 2, were not successful, you need to file a written report (complaint) to the municipal or oblast health department about absence of response by the chief physician and demanding to remedy the violation of the right to healthcare. The healthcare department must duly register the complaint and respond to it. 
  • At the same time, you can approach the National Health Service of Ukraine (NHSU) and submit a complaint using the online form on the NHSU website. Usually, NHSU does not ignore such messages and may take measures up to terminating public funding provided to the healthcare facility. Therefore, the administrations of health facilities try to avoid such complaints and prevent conflicts.

In Ukraine, a special Law of Ukraine “On preventing diseases caused by human immune deficiency virus (HIV) and on legal and social protection of people living with HIV” is in action. This law provides for state guarantees of testing to detect HIV infection (Article 4), and for the right to free provision of antiretroviral drugs and medications to treat opportunistic infections (Article 15).

What you need to consider 

Starting from April 1, 2021, medical care for HIV is provided under the state-guaranteed benefit package “Diagnostics, treatment and follow-up services for people with HIV (and suspected HIV).” To receive the services, one needs to select any healthcare facility contracted by the National Health Service of Ukraine (NHSU) for the provision of such services. Alongside AIDS Centers, these can be oblast and city hospitals for communicable diseases, TB care facilities, drug treatment centers, and other healthcare settings.

Medical services delivered free of charge to people living with HIV or with suspected HIV based on their medical needs, include:

• Testing for human immune deficiency virus and counseling at every stage of testing;
• Required laboratory tests, including:

• Total blood count;
• Complete urinalysis;
• CD4 Cell count;
• Plasma HIV RNA (viral load) testing;
• Proviral DNA and HIV serology;
• Cord blood investigations;
• PCR in children for early HIV diagnostics;
• Testing for HBsAg, HCV antibodies;
• Blood chemistry profile (creatinine, transaminase, glucose);
• CrAg test;
• Urine LF-LAM test for TB;
• Testing for sexually transmitted infections;
• Other laboratory tests based on the needs of the patient.

• Full medical follow-up of HIV-positive people (counseling, examination, administration of antiretroviral therapy, treatment of opportunistic infections and monitoring of progression of HIV-infection);
• Patient referral for secondary (specialized), tertiary (highly specialized) medical care, other healthcare services;
• Blood testing of infants born to HIV-positive mothers;
• Medical follow-up of infants up to 18 months of age born to HIV-positive mothers with diagnosis at the stage of confirmation;
• Counseling of families and relatives of people living with HIV.

In Ukraine, antiretroviral drugs must be accessible to every person with HIV and provided free of charge.

For the full scope of outpatient care services please access the NHSU website and select the specification under the relevant benefits package.

Conduct of a patient in case of solicitation of payment for medical services in a health facility or in case of refusal to provide the medical service.

•  First of all, approach the chief physician of the healthcare facility, preferably with a written report (complaint), demanding to remedy the violation of right to free medical care under the relevant benefit package, referring to availability of public funding received by the healthcare facility for provision of such services. The complaint must be duly registered, with an incoming registration number assigned.
• If these efforts were not successful, you need to file a written report (complaint) to the municipal or oblast health department complaining about absence of response by the chief physician and demanding to remedy the violation of the right to healthcare. The healthcare department must duly register the complaint and respond to it. In fact, this is usually enough to correct the situation. If the client remains unsatisfied, he/she can approach the National Health Service of Ukraine (NHSU) and submit a complaint using the online form on the NHSU website. 
• If a healthcare provider unreasonable refuses to provide medical care or solicits payment for the services covered by the NHSU under the Program of Medical Guarantees, this is a breach of the contract between the National Health Service and the facility. Usually, NHSU does not ignore such messages and may take measures up to terminating public funding provided to the healthcare facility. Therefore, the administrations of health facilities try to avoid such complaints and prevent conflicts.
• The client has the right to file a complaint in court.

Emergency medical care is provided in line with the provisions of the Law of Ukraine “On emergency medical care.” Refusal to insure transfer and acceptance of an emergency medical care call is forbidden, with liability imposed (Article 4).

Emergency medical care is medical assistance including urgent actions of healthcare providers aiming at saving and maintaining the life of a person in an emergency condition and minimizing the health consequences of such condition.

What you need to consider

• Emergency medical care called at 103 must be delivered to anyone free of charge regardless of the availability of declaration with a family doctor. No online referral is needed to call the ambulance. Calling 103 means that a person is having a medical emergency.

A medical emergency is a sudden deterioration of physical or mental wellbeing posing a direct and imminent threat to the person’s life and health or other people occurring as a result of a disease, trauma, poisoning or other intrinsic or external causes.

There are several categories of calls depending on the patient’s condition.

• A critical call means that the patient is in critical condition and needs resuscitation. Such condition is marked by absence of breathing, ineffective breathing, massive blood loss or hemorrhage.
• An emergency call implies that the patient is having a medical emergency marked by fainting or loss of consciousness, signs of acute coronary syndrome, signs of acute cerebral stroke, breathing difficulties, and other relevant signs and complaints.
• Non-emergency calls are the calls about patients who are not having a medical emergency and whose condition will not deteriorate for the delay in providing medical care, but such patients need to be assessed by a healthcare worker.

Emergency medical care is provided free of charge, including:

• On scene: in the street, in public places, at work, in various institutions;
• During transportation of the patient in need of emergency medical care, in response to the call of health professionals;
• Upon personal call to an emergency medical care unit by a patient in a life-threatening state.

In addition, emergency care teams must visit patients with COVID-19 in critical condition to assess the person’s health status, the need for hospitalization and to transport a person with suspected COVID-19 to a pre-defined hospital. If the COVID-19 patient does not need hospitalization, medical care and recommendations must be provided on-site.

The Law envisages liability for the following offense:

• Failure to provide on the scene paramedical and medical care without a valid reason or unjustified refusal to provide such care;
• Failure to provide an available vehicle for free transportation of a person in the state of medical emergency, to the nearest emergency room without a valid reason, or unjustified refusal to provide such transportation;
• Untimely provision of emergency medical care or obstructing provision of such care.

Conduct of a patient upon refusal to provide emergency medical services.

• Based on the urgency of the situation, you need to urgently call the hotline of the oblast health department. In some regions, there are special hotlines for emergency medical care. You can also call the Ministry of Health hotline at 0-800-505-201 and government hotline at 1545 to report unjustified refusal to provide emergency medical care and the need in receiving such care.
• If these efforts were not successful, you need to contact the oblast health department and submit a written report (complaint) demanding to hold the healthcare workers liable for violating the right to receiving medical care. The oblast health department must duly register the complaint and respond to it.
• If the client remains unsatisfied, he/she can file a complaint to the Ministry of Health or to court. An appeal to court is possible regardless of the institutional vertical review of the acts of the healthcare worker.
• If any consequence of the refusal to provide emergency medical care or of untimely provision of emergency medical care to the patient in need of such care, occur, you can file a complaint to the National Police of Ukraine based on Art. 139 of the Criminal Code of Ukraine for an unreasonable failure to provide medical care by a healthcare provider obliged to provide such care if he healthcare provider is aware about the severe health consequences of such failure for the patient.

Inpatient (hospital) medical care is the healthcare of tertiary (highly specialized) level provided in line with Art. 35-3 of the Law of Ukraine “The fundamentals of the legislature of Ukraine concerning healthcare”. Inpatient medical care is care provided upon hospitalization. This may include medical care requiring or not requiring any surgical interventions.

Hospital care is free for patients in case:

• there is a referral from a family doctor or an attending physician;
• a patient is brought to the hospital by emergency care brigade;
• a hospital patient is referred from another clinical department or health facility;
• a patient seeks hospital care in an emergency condition.

To receive the service, you need to select a facility contracted by the National Health Service of Ukraine (NHSU).

What you need to consider 

Starting from April 1, 2021, patients who do not need surgical treatment, are delivered care under the package “Inpatient care to adults and children not requiring surgical interventions”. The majority of hospitalizations fall under this package. Under the Program of Medical Guarantees, patients are also entitled to free surgeries performed by health facilities contracted by the NHSU for “Inpatient surgeries.”

Which free services are included in the package of inpatient care not requiring surgery?

Hospitalization under the benefit package of inpatient care does not require surgical interventions, including prevention, diagnostics, treatment (including medication therapy), complicated pregnancy care, and medical rehabilitation in the acute period.

Under this benefit package, patients are entitled to the following free services:

• initial examination;
• necessary laboratory tests, including full blood panel, blood chemistry profile, rheumatoid factor and CRP tests, urinalysis, and other laboratory tests, based on the needs of the patient.
• Performing necessary instrumental tests, such as endoscopy, CT, MRI, X-ray, sonography, and other tests, based on the needs of the patient.
• Pain relief at all stages of diagnostics and treatment;
• Medication therapy;
• 24-h nursing and medical attendance;
• Medications included in the National list of essential medications.

Which free services are included in the package of inpatient care requiring surgery?

This benefit package includes all the services covered by the package above, plus:

• Surgical operation with anesthesia;
• Post-operative patient monitoring, pain relief and further medication therapy.

The full scope of services covered by the inpatient care benefit package is available on the NHSU website. Please select the specification under the relevant benefits package.

How to find out which free services are provided by a certain health facility?

This information is available on the official NHSU website. Patients can access Section “Signed contracts on provision of healthcare services to population” and find out which services are provided by any healthcare facility contracted by NHSU under the Program of Medical Guarantees. The table lists the contracted facilities. You can filter the information using the filter panel on the left, and after selecting the facility, click on the “Service group” title above the table to see the groups of services the facility is contracted by NHSU for.

Conduct of a patient if a healthcare provider solicits payment for hospital care or refuses to provide care.

• First of all, approach the chief physician of the healthcare facility, preferably with a written report (complaint), demanding to remedy the violation of right to free medical care under the relevant benefit package, referring to availability of public funding received by the healthcare facility for provision of such services. The complaint must be duly registered, with an incoming registration number assigned.
• If these efforts were not successful, you need to file a written report (complaint) to the municipal or oblast health department complaining about absence of response by the chief physician and demanding to remedy the violation of the right to healthcare. The healthcare department must duly register the complaint and respond to it. In fact, this is usually enough to correct the situation.
• If the client remains unsatisfied, he/she can approach the National Health Service of Ukraine (NHSU) and submit a complaint using the online form on the NHSU website. 

• In case any questions regarding filing a complaint arise, call NHSU contact center toll-free at 16-77.
• If the client remains unsatisfied, he/she can file a complaint to court.

Specialized outpatient medical care is classified as secondary healthcare provided under Article 35-2 of the Law of Ukraine “The fundamentals of the legislature of Ukraine concerning healthcare”.  It commonly includes the services which a patient can receive without hospitalization (for example, in a policlinic).

Outpatient care is free for the patient upon referral by a family doctor or an attending physician.

Visits to the following specialist physicians do not require a referral from a family doctor:

•  Pediatrician 
•  Gynecologist 
•  Psychiatrist 
•  Dentist 
•  Narcologist 
•  TB physician 

A patient does not need a referral to visit his/her supervising physician.

Next, you need to choose any healthcare facility contracted by the National Health Service of Ukraine (NHSU) to receive the service.

What you need to consider

Starting from April 1, 2021, outpatient care is provided under the “Prevention, diagnostics, monitoring, treatment and rehabilitation in outpatient care facilities” benefit package. This benefit package includes the following services provided free of charge:

• Consultations by specialist physicians, including, for example, consultations by a surgeon, ophthalmologist, traumatologist, otolaryngologist, and treatment procedures, minor surgical interventions, tests and examinations conducted by these specialists. All these services are provided either in an outpatient clinic or in a day-stay center.
• Performing the necessary tests, including clinical and biochemical tests, such as complete blood count, blood type and Rh-factor test, blood chemistry profile, rheumatoid factor and CRP tests, RBC count, blood glucose, immunology tests to detect and control communicable and non-communicable diseases, complete urinalysis, etc.
• Performing necessary instrumental tests, such as X-ray, CT, MRI, sonography, endoscopy, electrocardiography, electroencephalography, ophthalmological tests, etc.
• Provision of medical care in day-stay centers.
• Provision of care to patients seeking care in trauma emergency rooms or in hospital admission rooms without further hospitalization.

For full scope of outpatient care services please access NHSU website and select the specification under the relevant benefit package.

It is important to remember that a patient is entitled to free laboratory or instrumental tests he/she is referred to if the healthcare facilities contracted by the NHSU for outpatient care, have the capacities to perform such tests.

How to find out which free services are provided by a certain healthcare facility?

This information is available on the official NHSU website. Patients can access Section “Signed contracts on provision of healthcare services to population” and find out which services are provided by any healthcare facility contracted by NHSU under the Program of Medical Guarantees. The table lists the contracted facilities. You can filter the information using the filter panel on the left, and after selecting the facility, click on the “Service group” title above the table to see the groups of services the facility is contracted by NHSU for.

Conduct of a patient if a healthcare provider solicits payment for outpatient care or refuses to provide care.

• First of all, approach the chief physician of the healthcare facility, preferably with a written report (complaint), demanding to remedy the violation of right to free medical care under the relevant benefit package, referring to availability of public funding received by the healthcare facility for provision of such services. The complaint must be duly registered, with an incoming registration number assigned.
• If these efforts were not successful, you need to file a written report (complaint) to the municipal or oblast health department complaining about absence of response by the chief physician and demanding to remedy the violation of the right to healthcare. The healthcare department must duly register the complaint and respond to it. In fact, this is usually enough to correct the situation.
• If the client remains unsatisfied, he/she can approach the National Health Service of Ukraine (NHSU) and submit a complaint using the online form on the NHSU website. 
• In case any questions regarding filing a complaint arise, call NHSU contact center toll-free at 16-77.
• If the client remains unsatisfied, he/she can file a complaint to court.