Case III CK 546/03

The plaintiff, a hospital, entered into an agreement for in-patient healthcare service with the defendant, a regional health fund. The contract did not include a provision that the services provided by the Anaesthesiology and Intensive Care Unit (“ICU”) be contracted separately, but did provide that the amount to be paid by the defendant constituted the entire amount owed to the plaintiff. The plaintiff wrote a letter to the defendant stating that the payment of services performed by the ICU had not been regulated by the letter. In 2001, an addendum to the agreement was put in place to bill the defendant for these services separately.

However, no agreement was reached as to who would be responsible for the payments incurred for 40 patients treated in the year 2000 in the ICU. The plaintiff proceeded with a lawsuit in the Regional Court. On November 20, 2002, the Regional Court ruled in favour of the plaintiff for the full amount. The Court’s ruling was based on the theory that, as the agreement did not regulate payment for treatment by the ICU, the defendant’s responsibility arose from Article 405 of the Civil Code. However, the Regional Court did not preclude contractual liability and also noted that the defendant should perform its contractual obligations “not only with respect to its content but also in a way that corresponds to its social-economical purpose and the rules of social conduct,”(p.2) which, in this case, meant securing healthcare services within its available financial resources.

The Court of Appeals also found for the plaintiff, but reasoned that Article 405 was not the basis for liability. In the opinion of the Court of Appeals, the healthcare services were covered under the agreement.

The defendant appealed the decision to the Supreme Court.

The Court concurred with the Regional Court that the disputed services were not covered by the agreement, so that liability should be based on Art. 405 of the Civil Code. The Court noted that, in any case, if the defendant’s obligations flowed from the agreement, the Civil Code and other relevant regulations would help define the content of such obligations as the healthcare system was regulated by law.

The Court determined that healthcare providers had an unconditional obligation to provide services in life-threatening situations. Thus, in order to determine the legality of the contract in dispute, the Court must consider the proper balance between the obligation to deliver life-saving healthcare and payment for such costs, which the Appellate Court had failed to do.  With reference to a case determined earlier that year, the Court noted that certain relevant regulations did not establish the defendant's obligation to pay for such healthcare services; however the plaintiff had charged that such a conclusion would be incompatible with other relevant provisions of the Civil Code. Therefore, the Court remanded the case to the Appellate Court to determine the relationship that the agreement in dispute had with the relevant provisions of the Civil Code.

“Art. 7 of the Healthcare Institutions Act of 14 October 1991 (consolidated text DziennikUstaw 1997, No. 104, item 661 as amended) and Art. 30 of the Act on Practicing as a Physician (consolidated text DziennikUstaw 1998, No. 64, item 729) place healthcare providers under an absolute obligation to provide services in life-threatening situations. These obligations are unconditional and they precede the limitations resulting from agreements on healthcare services (cf. the judgment of the Supreme Court of 5 September 2000, case file No. III CKN 365/03, unpublished).” P3

“Tymczasem art. 7 ustawy z dnia 14 października191 r. o zakładachopiekizdrowotnej (tekstjedn. Dz. U. z 197 r. Nr 104, poz.61 zezm.) I art. 30 ustawy z dnia 5 grudnia 196 r. o zawodzielekarza (tekstjedn. Dz. U. z 198 r. Nr 64, poz. 729) nakładająnaświadczeniodawcówbezwzględnyobowiązekświadczeń w raziezagrożeniażycia. Obowiązkitemającharakterbezwzględnyiwyprzedzająograniczeniawynikające z umówoświadczeniazdrowotne (por. wyrokSąduNajwyższego z dnia 5 sierpnia 200 r., II CK 365/03 nie]publ.).” (p.3)

“Therefore, to make a decision on this case it was necessary to determine the relationship between the obligations of rendering life-saving healthcare services and financing of their costs. The Supreme Court in its judgment of 25 March 2004 (case file No. II CK 207/03, unpublished) expressed an opinion that neither the provisions of the Act on General Health Insurance nor Art. 7 of the Healthcare Institutions Act or Art. 30 of the Act on Practicing as a Physician do not give grounds to establish the defendant's obligation to pay for such healthcare services.” P3

“Dlarozstrzygnięciasprawyistotnabyławięcrelacjamiędzytymiobowiązkamitj. udzielaniemświadczeńratującychżycie a sfinansowaniemichkosztów. SądNajwyższy w wyroku z dnia25 marca 204 r., (I CK 207/03 niepubl) wyraziłpogląd, żeaniprzepisyustawy o powszechnymubezpieczeniuzdrowotnym, ani art.7 ustawy o zakładachopiekizdrowotnej, aniteż art. 30 ustawyo zawodzielekarzaniedająpodstawyskonstruowaniaobowiązkustronypozwanej do zapłatyzategorodzajuusługimedyczne.” (p.3)