Proposition 51K3012

Projet de loi relatif à l'indemnisation des dommages résultant de soins de santé.

General information ¶

Submitted by

PS | SP MR Open Vld Vooruit Purple Ⅰ

Submission date

March 22, 2007

Official page

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Status

Adopted

Requirement

Simple

Subjects

liability health care profession doctor medicine medical error damage damages insurance

Voting ¶

Voted to adopt

Vooruit Ecolo PS | SP Open Vld MR VB

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Discussion ¶

April 12, 2007 | Plenary session (Chamber of representatives)

Full source

(The Minister enters the half-circle)

I greet you, Mr. Minister. Mr Goutry, you are given the word for the report and subsequently for your speech. Then I will determine the order of the speakers.

Mr. Speaker, Mr. Minister, as a rapporteur, I will first present the report.

It was a rather impressive and important point. 3012, draft law on the compensation of damage caused by health care, joined with a draft law on the insertion of an article 1383bis into the Civil Code which clarifies that a person’s birth cannot be considered as a damage, joined with a draft law on diagnostic and therapeutic accidents, joined with a draft law on the compensation of abnormal damage related to medical care, joined with a draft law on the issue of safety and health standards for care institutions and establishing a compensation scheme for patients who are victims of hospital infections, in total 4 draft laws and 9 draft laws.

of these legislative proposals.

Mr. Tante, I will talk about this during my discussion, given that the various applicants have, of course, also given an explanation each time.

Mr. Speaker, the committee discussed this draft at its meeting on 27 March. We received the texts on 23 March, and we held the discussion and vote on 27 March. I regret – which is also stated in the report – that such an important bill was submitted so late. This way of working actually makes it impossible, I noted then, to deliver good legislative work.

Mr Drèze joined my comment. The President then proceeded to the division between Article 78 of the Constitution and Article 77 of the Constitution. The draft law is divided and part of it falls within the scope of Article 77. The rest shall be subject to Article 78.

The committee made that decision to divide the committee on the condition that the rapporteur would issue a single report, that the committee members would hold one vote on the whole draft and that two texts adopted by the committee would be drawn up, which would be submitted to the plenary session. Then there will be two articles 1 for both bills, with each article having a separate headline.

Finally, there is the bill to establish a faultless liability scheme for medical accidents and establishment of a fund for medical accidents. This was document 51/2013. It was added to the bill currently being discussed.

The second part of the report is the introductory presentation by the Minister of Social Affairs and Public Health, Mr Demotte. The Minister of Social Affairs and Public Health notes that the principles of the draft law have been discussed for years, both in Parliament and in the civil society. It aims to compensate victims of medical accidents, regardless of whether or not they are the result of an error. The discussion of that text provides an opportunity to put an end to the accumulation of misfortunes. The Minister explained that today in Belgium in less than five of the hundred damage cases the victim is subsequently compensated. More than 95% of victims of medical calamities do not actually receive compensation. The Minister argues that it is unacceptable that one could not defend himself after physical suffering caused by a doctor or healthcare provider. The Minister highlighted that on the other hand, we also often hear about absurd situations, in the United States, for example, where more and more doctors have stopped their activities due to the increasing number of courts and the associated increase in insurance premiums.

For every 20,000 transactions, there would be only one medical error in our country. The risk of medical errors is in our country, according to the minister, 0.005%. He thus pointed out the good quality of our medicine, with as a result also few medical mistakes.

Nevertheless, many victims often have the impression that, if they become the victim of a medical error, they will never succeed in proving that mistake. Damage is established, but it is very difficult for a patient to prove that a particular doctor made a mistake. What do we, ordinary people, know about medical interventions? It is often very difficult for a patient to prove that the doctor made a mistake. The minister says that victims who initiate a trial are faced with a large inertia of the court, among other things because systematically expertises are used. The judge says he can’t judge because it’s about medical issues and appoints an expert. This often takes a long time and costs a lot of money. There are many actors involved, hence the complexity of the case.

The Minister also explained that the jurisprudence appears unfair to him and the patients, especially when the Brussels Court of Appeal considers "that the fact that other surgeons, even numerous, would act in the same circumstances in an identical manner, does not give the character of caution to the acts that were made and where they remained in default." The result is that the doctor gets the impression of being prosecuted by a repressive justice. There is a remarkable difference here from the claim of liability of other professional practitioners, such as lawyers, notaries or bankers.

The minister further explained that, even in Belgium, estimates show that in 1988 11.5 percent of Belgian women gave birth with a cesarean section. In 2004 this was 18 percent. The minister says that a caesarean section is applied quickly because of the safety aspect. Doctors no longer take risks. This also leads to a substantial increase in the number of legal proceedings and a regular increase in insurance premiums, which can be ⁇ high. These could, according to the minister, amount to more than 5,000 euros for a specialist.

Everyone is aware of the wipes of the U.S. regulation on professional liability, the minister said. We must make sure that it does not go so far in our country and we must anticipate that evolution that is already taking place.

There is also an explanation given by the Minister to an important article, colleagues, which will surely come back in the discussion, namely the famous article 1382 of the Civil Code. The Minister has stated that if one ⁇ ins the application of the civil procedure, of Article 1382 which can induce both criminal and civil law, and at the same time one also establishes a fund, as in France, where the two systems exist side by side – one can go to the court and yet appeal to the fund – that would lead to difficulties.

What difficulties. First, the ethical level. A patient who suffers damage does not know whether the damage is due to accident or error. The new faultless system would have fewer resources because the premiums for the classical civil liability insurance would have to be paid further. Thus, the flat-rate amounts that the new system could allocate could be lower.

Second, by allowing persecution – the two systems side by side, the Fund and Article 1382 – one would not hinder the further development of a preventive medicine. The legal context would remain uncertain.

The next argument that the Minister cited was that even the transparency of the information and the actions in this way would still not improve. It is difficult to get the data from the insurance institutions. The fact that doctors are increasingly at risk of persecution will also not encourage them to be more transparent, and the cases of friendly settlement will never be known.

A prevention policy requires maximum knowledge of the problem. It is not sufficient that the Fund is notified that an appeal has been filed. It belongs to the priorities of the Minister of Public Health to be able to have a genuine, reliable and complete overview of the practices in force in Belgium. These data are essential to implement the preventive measures and, more generally, to respond to the demands of the population, both in terms of patients and healthcare professionals.

The abolition of the application of Article 1382 of the Civil Code is therefore indeed beneficial for the patient. In this way, the patient can indeed return to a unique and simple system that ensures a fair and quick compensation. In short: the minister says that the abolition of the application of Article 1382 is indeed beneficial for the patient.

The draft law should also enable the medical staff and other healthcare providers to continue to fulfill their duties in a serene manner by ending the growing risk of civil prosecution while ⁇ ining the application of the deontological rules.

Colleagues, I pay quite a lot of attention to the report because we received the texts very recently. The meeting lasted very long. I assume that many colleagues do not even realize what important draft and combined bills are being discussed here. Therefore, I will take the time to present the report in extent.

I am now on page 10 of 52.

The compensation of the victim may be awarded for any accident resulting from the care provision. The victim will therefore no longer have to prove the fault of the healthcare provider but will only have to prove that he has suffered damage as a result of a healthcare provision. He must therefore no longer prove the error, no longer the cause, no longer the causal relationship, but only prove that damage has been suffered.

After all, it is necessary to remove the compensation for medical damage – still according to the minister – from the common law sphere. On the one hand, this can sufficiently guarantee that both the government and the victims obtain all relevant information on medical accidents in the institutions and practices. On the other hand, this makes it possible to break the existing trend that leads to defensive medicine.

The fact that compensation is removed from the common law sphere – I see lawyers spitting their ears – does not mean that the provider escapes all responsibility. The proposed mechanism will in no case give the healthcare providers impunity, since a recourse at the criminal level always remains possible. After all, the victim can still take criminal proceedings and appear as a civil party. Nevertheless, the compensation that these steps may lead to is limited, so that only the new system provides compensation to victims; objectively it is clear that healthcare providers are the most qualified professionals with criminal justice, since their acts quickly constitute criminal offences.

I would like to make a small correction to my report, Mr. Speaker: I need to make an improvement here. On page 10 it should actually be stated: “Objectively it is clear that the healthcare providers are the professional practitioners who most come into contact with criminal justice”, and therefore not “will be considered”. This is obviously a mistake in my report on page 10 in the fifth paragraph of the Dutch text. In French it is correctly represented.

The established mechanism nuances the immunity of doctors and healthcare providers on the civil level. Indeed, it is intended that, in the event of a serious or intentional error by the healthcare provider, the body that will have compensated the victim may turn against the healthcare provider or the healthcare institution concerned to recover the amounts paid. In addition, the victim will be able to join that profession in order to obtain full compensation for the damage incurred.

On theoretical level, in many fields, such as in the system of occupational accidents, the application of Article 1382 of the Civil Code is avoided. The Minister also pointed out the analogy between this fund and the application of Article 1382 as applied to occupational accidents.

In addition, many healthcare providers are employees – nurses, doctors in university hospitals – and in that capacity they already enjoy a system in which they are not personally liable for errors committed in the exercise of their functions. Also here again, Mr. Speaker, on page 11 in the first paragraph a typing error as I assume, but it may be better to correct them immediately. It must be stated: “In that capacity they already enjoy a system...” The word “of” must therefore be mixed here. In French it is correct, because it says, “Ils bénéficient déjà d’un régime”. Therefore, the text is OK.

The Fund will have a complete database of therapeutic accidents and will therefore be able to draw attention to dysfunctions. Within the framework of its prevention assignment, it will ensure that the measures are effectively implemented internally or disciplinary. Furthermore, the functioning of the insurance system in itself guarantees an evolution of the premiums depending on the frequency of damage. This implies that the premiums will evolve completely transparently, depending on the number of payments that the insurer must make for the same provider.

The transparency on medical accidents, which will be made possible by removing compensation from common law, will be a much more effective incentive for the prevention of medical accidents by providers and institutions than the maintenance of the current system.

This is the third time I have to make a text improvement. This happens when texts are processed too quickly. With all respect for the services, but too fast work, of course, leads to careless work. One knows another by himself. On page 11, in the fifth paragraph, it is stated: “because the compensation” – single – “is removed from the common law”. The word here is plural. Therefore, a correction must be made. It must be: "because the compensation is deleted from the common law." If I look at the French text, it is true. That must be preserved.

Finally, the new system of faultless liability – says the minister – can only be financed if all insurance premiums currently paid by providers and institutions will also serve for the financing of that new system.

The establishment of a fund will also be a major step forward for health policy. After all, following the example of what is the case in England, the establishment of such a fund will give a clear view of the therapeutic accidents occurring in our country. Depending on the trends one will perceive, it will be possible to partially anticipate and thus avoid the mistakes of the past.

The Minister continues his general explanation, which he gave on Tuesday 27 March in the Committee on Social Affairs, chaired by Mr Mayeur and in the presence of sufficient members. With respect to the patient, that choice guarantees a single point of contact and a harmonised management of the application. The Fund is the best guarantee for the government that it will have a genuine, reliable and complete boardboard regarding the common practices in our country. These data are essential in order to take the necessary preventive measures and, more generally, to meet the needs of the population and again in respect of both patients and health professionals.

Specifically, the proposed system can be schematically presented as follows. I don’t have powerpoint here, as in the committee. The patient who believes that he is a victim of compensatory claims addresses the fund. This examines the application and sends it to the competent insurer. In any case, the insurer handles the file, but it is free to recover the possible compensation paid later, in whole or in part, from another insurer. This is called subrogation in technical terms.

The insurer decides to intervene or refuses such intervention on the grounds that no damage could be established. He shall submit his decision in the form of a proposal to the applicant, who has a time limit to submit to the insurer and the fund his comments on this proposal. Finally, the proposal of the insurer, together with the comments of the claimant, are transmitted to the fund.

Here I would actually have to question linguistically whether the verb should be single or multiple, colleagues, because it says “the proposal of the insurer together with the complainant’s comments to be transferred to the fund”. I think it should be “to be” and in the report it says “to be”. If one decomposes the sentence, I think that the first piece of the sentence is single and thereafter the verb goes. After the comma, a piece of the sentence is added. That could justify that the verb here would be used in the plural. Here, however, I come across a node, because I do not know whether the report is linguistically correct, because it states “the insurer’s proposal, together with the complainant’s comments, is transferred to the fund”. I think it should be “be transferred to the fund”. We are in the final phase of our legislature. There will not be much time for correction. Per ⁇ it is better to ask for language advice. The President agrees that we ask for linguistic advice. This must be suspended, Mr. President.

I am pleased that a number of colleagues will continue to follow, because it is an important report on an important topic, which we have worked on from early morning to very late evening. Some colleagues have not reached the end, but it has been a long meeting. It was very exhausting, very exhausting, too for you. You are always very faithful and accurately present, but that evening you were equally charged and special for you, because I know that the matter is at your heart like no other, I make the report so comprehensive. I heard you on the radio last week. You have an outstanding place in Antwerp and as a result you will be stuck in time and you will probably not have been able to review the report during this busy period, colleague Avontroodt.

The proposal of the insurer together with the comments of the claimant shall be transmitted to the Fund. The Fund speaks on the file and in case of disagreement with the insurer between these two institutions both an arbitration procedure and an appeal against the decision of the college of arbitrators are possible.

In these last two hypotheses, the claimant already pays the amount due without contest, pending the decision of the panel of arbitrators or of the court.

Mr. Speaker, I must note that, this time on page 12 in the fourth sentence – colleagues, you will probably follow with –, it says: “collega of arbitrators or of the court”. I look at the French text, where “collège” stands. I assume that “collega” is not the correct translation of “collège” and that it must be in the conscious place in the text “college”. Do you agree with this?

I would like to consult the Chairman on what we should do with this kind of improvement. Is it enough that I report them here on the tribune?

Mr. Speaker, the problem is that the overall design was discussed at an incredible speed, completely disproportionate to the importance of the design. For the fifth time now, I find a mistake in my report.

Colleagues, I apologize for this. I also have only two hands and one head and can only do what I can.

Mr. Speaker, the question is, of course, whether it is sufficient for me to add the corrections to the report on this floor every time?

Absolutely absolute . They will be included in the report of the current meeting. So there is no problem.

Mr. Speaker, therefore, is it not necessary that we suspend a moment and go to the services to correct the report?

The report is a document that informs the Chamber about what has happened in the committee.

Mr. Speaker, (...) through the services. We currently have no view of the proposed text corrections.

This is my size from before!

What is your opinion, Mr. Goutry?

It ambitious me. As a journalist, I cannot do more than to offer you my sincere apologies.

Mr. Speaker, I have taken on the difficult task of drawing up the report of the work on the day of such a meeting, on which everything must happen suddenly, until late evening. I did not ask for a second reading.

There is still time for that.

We have given the trust to the services, which have never shamed our trust. I also do not make any judgment about the services.

Do you already have an answer to my question?

However, as a rapporteur, I can only note what I hear. I try to make my report. If there are errors in the report, I can only point to it for the sake of honesty.

Colleagues, I have a certain professional fidelity, as you will know after 15 years. My professional integrity requires me, among other things, to deliver good reports. We used to write them by hand. Now they are drawn and we are assisted by the services. However, I still think that preparing a report is a ⁇ important activity. I still do not understand that so many colleagues refer to the written report and do not even make the effort and have the professionalism to come here to defend their report themselves, as I do right now.

Mr. Goutry, you are all the more right, because ultimately the Chamber and not you decide on the final text.

The Chamber decides on the text of the law. The text of the report is the responsibility of the rapporteur and is approved by the committee.

This is not about the report. It is about the text of the draft.

This is decided by the room.

This is what the Chamber decides. We agree on this. Not the services of the Chamber decide on the text of the draft. They may make a proposal, but it is up to the House to make a decision on the proposal.

At this point, the proposal of the services of the Chamber is missing. In this regard, the services of the Chamber have not proposed any text corrections.

Therefore, you must listen to the rapporteur. I think this is not the case.

The word is to the rapporteur. If you do not speak, you cannot listen.

That is right, Mr President. Without language or sign, one hears nothing, says an old proverb.

Colleagues, I would like to apologize once again and I hope that you can show your understanding. I have done what I could with this report but you can see in what context one can be worn. In the long run, it will be a risky occupation to report here in such circumstances. I would like to say that.

The victim may eventually appeal against the joint decision of the insurer and the fund. In that case, the court shall decide on the existence of the damage and, where applicable, on the amount of compensation to be paid. In cases where the healthcare provider is not insured, a Joint Guarantee Fund will be created by analogy to what already exists within the automotive sector.

Again a linguistic problem, colleagues, on page 13. Finally, we are launching a new word here, a common guarantee fund. If I read it in the sense as it stands, I read that we are going to create a Common Guarantee Fund. I do not think this should be written with major letters. If one says that one establishes a statutory common guarantee fund, that one “statutes” it, then that is a name, then it acquires its own statute, and then I think that one should write this with large letters. From my limited knowledge as a rapporteur and knowing that the services have been seized in speed by the overwhelming work of the last few weeks, I am here on page 13 again with a linguistic problem. The sixth already.

It comes with the insurance company (...). This should be with a major letter. If one reasoned analogously, it should be an insurance company with a large letter. If one writes a small letter, one must also write a common guarantee fund with a small letter. It is not yet a own name. We leave this in the middle.

As regards the financing of the projected scheme, the Knowledge Centre – rightly with large letters, its own name – has drawn up three reports for the Health Care, allowing it to estimate the total cost. The sources of funding established by the future law are – according to the minister, I am still at his explanation... I have to give the explanation of the applicants of the bill, then the discussion, the article-based discussion, the votes, etc. You can see that it is, in any case, an important design.

The sources of financing are as follows: an annual allowance charged to the State, an annual allowance charged to the RIZIV budget and the contribution of the healthcare providers through the premiums paid to the insurance institutions. That contribution shall have as its upper limit an amount to be fixed by the King, taking into account the stability objective of the premiums paid by the healthcare providers.

Mr. Speaker, in this way I cannot report here.

Mr Minister, please

Madame Tilmans, not only do you call, but you also disturb the Minister and Mr. The Mayor! A little respect for the speaker.

The [...]

by Mr. Goutry is right to make mistakes notice!

Mr. Mayeur is, of course, right; it is so far in the Dutch-language texts.

I always followed the French language text.

The French text is OK.

I always compare the two texts.

... ...

For me, that is no longer a problem. Neither for you, I think.

Mr. Speaker, can I ask you a simple question, colleagues?

You are bilingual. I am fortunate to be with you with the many bilingual people in the Room.

Colleagues, can I ask a simple question?

You are the last.

From the French text. The same goes for the Flemish.

Mr. Goutry, or you want to draw it in length. Do it, you have that right. It would still be regrettable. You are currently working on your report for 21 minutes. I only assume that you are working on it. The point. What do you say?

This is the report. I am guessing. I said nothing. (Discussions in the semiconductor)

Let Mr. Goutry report.

Once someone gives a verbal report, it may be noted and it may be honored by the President.

We did not interrupt Mr. Goutry, Mr. Speaker, for the sake of clarity. You did that.

I have asked questions.

You know it and yet you do it.

I should have known that.

This is of course because several journalists have not been present. He compensates and I have no problem with that.

I have understood. All those who referred to their report will be compensated by Mr. Goutry. Mr. Goutry, you are a compensator.

Thank you, Mr. President, that is a beautiful name.

Mr. Speaker, I know that you are very concerned with the prerogatives of this Chamber, that you want to be the image of it, you are usually also, sometimes sometimes not, and that you are on solid and quality work.

I don’t think I should be ashamed because I am here proposing a report on a bill that has enormous consequences for the people. We are talking here about the coverage of medical damages incurred by patients, who are usually in a very difficult situation. The bill has been debated for eight years.

Now that was passed in one day, along with four bills, of which I had to report. I now realize that I could have done this inaccurately. That is why I now allow myself to present a thorough report here, in the Chamber. If it was too late, you should have started earlier. For me, this afternoon was also at two o’clock. I have not asked to do my work here at ten to nine in the evening. I would have preferred to be home for a long time.

In any case, I assume that the mistakes will be improved every time and that in this way we will get a better report.

Based on the estimate, dixit the minister, based on the estimate cross speed... Tenens, that’s weird. Based on the estimate of cross-speed established in the reports of the Knowledge Centre... Les sources de financement actuelles permettent, dans l'estimation "vitesse de croisière"... Something is wrong here. Page 13, fifth paragraph. Mr. Speaker, I would like to ask... It is a long sentence. If I need to improve it here on site, it will take another five minutes longer, and I absolutely want to ensure that the report remains consistent. But we will have to compare this here with each other, because the Dutch-language sentence in the report is not correct.

As long as that estimate is not exceeded, there will be no change in the current ratio of the sources of money listed in the previous paragraph that will finance the scheme, and no new sources of financing will be used.

Finally, the new scheme becomes credible only if it provides for a fair compensation, taking into account moral damage, assistance from third parties, and so on. However, for budgetary purposes, flat-rate amounts and/or ceilings should be established.

I continue on page 14 of my report, for the colleagues who follow.

On the basis of the principles set out in this law, those amounts and/or upper limits shall be determined by royal decree.

This text can meet a well-known social need, and at the same time the system is supported by a sound financing arrangement.

Here I have a problem, linguistic, colleagues, on page 14, in the third paragraph. Follow me, Mr. Van Parys, you who know French well.

"The text fundamentally revises the principles of the law of responsibility in medical matters." "The text allows both to meet a social need known to all and is guaranteed by a system" In het Nederlands staat er: "wordt gestut".

The [...]

and insured.

and insured. and guaranteed. "Gestut" does not mean that one is also guaranteed, on the contrary. "Gestut" means that it stays standing for the time being. Whether it will end well or not, nobody knows. If one pulls the stut away, everything falls back into one. So much is clear.

"Garantir" and français and "stutten" in Dutch are not the same, Mr. President. This is stated in the report.

We can all read.

The [...]

The [...]

I am increasingly ashamed of my report.

The following sentence begins: "Il permet de mettre un terme". In Dutch: "With this text can be set paal and perk". Permit a term? and difficult.

Extremely important information can also be collected to improve the medical practice. In other words, this text guarantees that every fellow citizen gets the assurance of being better cared for. Here is the Minister’s explanation.

Now I will move on to the next chapter in my report. We still have to comment on it, of course. This was the Minister’s report.

In the next chapter we will get the presentation by the proposers of the bills.

I will begin with Mr. Benoit Drèze of the CDH, who points out that the CDH has long sought the creation of a fund for medical accidents. He notes that there is an evolution in the approach to compensation for medical errors. The legislative proposals submitted in this regard in the past stipulated that the system of common law continued to exist, in addition to the arrangement of a specific fund for the compensation of medical damages. The draft currently discussed has chosen one single way of compensation for the damage, namely through a fund, and no longer civil law through Article 1382.

Currently, civil liability is based on the principle of error, damage and causal relationship between them. This scheme is not adapted for application in the field of medical liability. Therefore, it is often very difficult for patients to receive compensation. Less than 20 percent of the victims sought compensation from insurance institutions, Drèze said. Along the side of the healthcare providers, this has resulted in a large number of additional examinations being carried out to prevent accidents from occurring. This brings a huge cost to the community and raises the fear that the miscarriages currently occurring in the United States would also arise in Belgium.

In addition, the premiums that the insurance institutions demand from the healthcare providers are increasing.

On page 15, paragraph 2, colleagues, there is again a small typing error. In the report, the division of the word "insurance institutions" takes place behind the letter "g" and not behind the letter "s". I think that the splitting should take place behind the letter "s", so,"insurance"-split sign-"institutions". It is also important to improve the text.

I think Mr. Goutry is reading his report.

I agree with you, Mr. President.

To summarize, Mr Goutry?

I will make a summary, Mr. President.

I read the report with you!

Mr. Speaker, let us admit that the rapporteur reads his report, even if it is painful! But listening to the rapporteur’s comments on his personal mistakes is even more! His reading should end at some point. Mr. Goutry, we forgive you. We take note of the mistakes you made in this report. It is not serious. We understood the essential. So we can go to the debate on the bill. This seems to me much more interesting! We will not want you. You have made many mistakes. It is not serious! Now, let’s go to the debate!

Colleagues, for all clarity, I have already apologized three times for my report, but I have also had the correctness to say what it is about. If one receives texts on Friday, a whole Bible thick, about a complicated legislation, and one must discuss them on Tuesday until 10 o’clock in the evening and then make a report, which is submitted for discussion today, then you can never blame me for some misconduct or inaccuracies.

I had the courage to write the report. I might have better not done it, as Mr. Mayeur says. Colleagues, you may not know that there is even a co-rapporteur, Ms. Raemaekers. She is not here.

She will come to help you.

I have to do the work here alone.

I think she will be happy with you as soon as she is here.

( ... ) : [...]

I have already done it. She will come and she will remove Mr. Goutry.

So I have to win time until she is here! That is where it comes down. I need to win time until my co-rapporter is here.

I was asked to take time so that the co-rapporter could arrive.

I would like to refer to the Rules of Procedure, as Mr. Mayeur asks whether Mr. Goutry has the authority to complete the report here. The Rules are very clear on this. It does not provide any restrictions, Mr. Mayeur.

The [...]

I never want to be a journalist again.

I will not report anymore. I would think twice.

The reporter publishes his report in his own way. But the report was also signed by Mr. Goutry. So I suspect he read it before he signed it.

Yes, but not in this form, not in this printed form.

Mr. Speaker, either you wrongly gave Mr. Mayeur the word – because he does not invoke the Rules of Procedure or anything else. I would like to know what the title he asks for the word here is. Let us know why you give him the word.

He is the chairman of the committee and has signed the report.

We agree, Mr. Speaker, to wait for the arrival of the co-rapporteur, to allow her to judge whether Mr. Goutry gives the correct version...

There was a protest because there was no reporter. Now you have one of the two and you are not yet satisfied.

Yes, but we cannot argue that Mr. Goutry does not refer to his written report. And if...

Colleagues, first of all, you should imagine that the rapporteur should polite ask whether he is allowed to present his report.

Second, we go here to a Parliament that does not bother to bring forward its reports. We are going here to a Parliament that would preferably approve everything as soon as possible, go home and be away from it. To such a parliament we go here!

Well, then I tell you: I am ashamed. We have fallen low! If that is the Parliament in 2007, we have never been deeper. I have been here 15 years. I’ve never experienced it happening this way: no more respect for reports, no more respect for rapporteurs, just rinse it through, good or bad, check it well, and go home! If that is the way of working in this Parliament, Mr. Speaker, then I would not like to sit on your chair. I would rather be here to try to present my report!

Ladies and gentlemen, apologize to me. That wasn’t good for my heart, already so tired of all the work of the last few weeks, including this report.

Mr Drèze cited examples that should demonstrate that a regulation is strictly necessary. Test-Santé magazine published the results of a survey of 834 people who ⁇ a medical liability case.

Of the 88 cases brought before the civil courts, 72% had not yet been settled. Such cases take at least 7 to 8 years.

The amounts of possible damages would still be discussed in the course of the discussion – which follows later in the report – because the bill provides for barricades and ceilings for the fees.

Medical accidents are...

The [...]

Do not interrupt!

I am not interrupting.

What are you doing? When you talk, you interrupt, right? Come, let Mr. Goutry present his report.

Yes, but...

No, you are not a reporter. Mr. Goutry is a reporter!

At least I want to understand it.

Myheer Tant, I have the pretension not. This is the flibustery in full!

If you do not contradict me...

I admire your French language knowledge.

Sur les montants des "indemnistaions"....I can not even read that, really true.

But Mr. Goutry will read it. Mr. Goutry, keep reading.

If you can’t read it properly, you can also read the translation.

You have accused Mr. Mayeur of intervening without being given the word. You do the same and I say: Mr. Goutry, continue with your report. And Mr. Goutry remains hanging.

I asked you what the title was, based on which...

I have said that Mr. Mayeur has signed the report, in his capacity as chairman of the committee. And Mr. Goutry has also signed.

But the question has i dus niet aan mijzelf gesteld, voorzitter. The French text must be read.

You need to read what you can read.

It is really unreadable.

Mr Van Parys, I admire your knowledge of the French language. The report was signed by the reporter.

You are very affectionate about the French language, as we have confirmed lately. I would like to read the French text for the President of the Commission.

“We’ll be back again” during the discussion on the amounts of the “indemnities”.

These are printing errors!

It should be read “we will come back again” and “indemnities”.

A little respect for the French language, please!

Mr. Van den Eynde, coming from you, I can understand that.

For the first time, the Dutch is correct.

Mr. Goutry, do you bring your report or not?

Do not be distracted by your colleagues. Bring your report.

Mr President, colleagues and colleagues,...

Mr Goutry, you have signed the report. So you are responsible for it.

There are two people who laugh at the room’s services. This is not acceptable!

Do you take yourself for whom? Your report is unfortunate!

And you moquez the services of the room! The Minables!

One of the conditions is respect for the rapporteur. This means that he must be able to deliver his report.

Mr. Goutry, I instruct you to continue reading your report.

Ladies and gentlemen, there are two important comments that I have to formulate from this speech.

First, it is not because I find a mistake in my report that I criticize the services of the Chamber. In the long run, one must no longer establish a mistake out of fear that one would criticize the services of the Chamber. What does that mean now? Everyone can make a mistake. I will not throw a stone at anyone. I’m just fixing the mistake.

Dean, you do not have the word. Mr. Goutry, keep going. This is not a way of working. If it continues like this, it is the clearing of the Room. Mr. Goutry, please continue.

What we do now is pure time saving, because we are on vacation.

I think you are right if I listen to some. Go ahead, Mr Goutry.

If the service of the Chamber feels affected by this, I am inclined to seek the advice of the secretary. He represents this service.

It has been enough now. Let us be serious. I do not want the room to be made ridiculous.

Mr. Speaker, you do not regret me, but you have embarrassed me, because you have already held me accountable for the report three times. You say, “Together with the President you have signed it.” In the long run, we will therefore have to insure ourselves against the accountability of the rapporteur. This fits very well in this design, because this is about the faultless liability scheme. I would then propose that also rapporteurs be held liable without error and therefore not be placed in a procedure. You constantly say, “You have signed this and so it is yours and the mistakes also come from you.” I think this is actually extensive.

The amounts of possible damages will still be discussed in the course of the discussion, as the draft provides for barricades and ceilings for the compensation. Mr Drèze considers that the amounts proposed in the draft law are too low.

The healthcare providers are also not satisfied. There is a possibility that more and more processes in liability are being strained. This threatens the relationship of trust between the patient and the healthcare provider.

I would like to remove a whole piece of the report, Mr. Speaker. I cannot otherwise. I am already going to the last part of Mr. Drèze’s intervention. He says that this bill aims to generalize the compensation for all victims who need it, while limiting the compensation for reasons of fairness and financial feasibility in an objective and reasonable manner. We must ensure that the funding remains affordable. Several solutions are possible to reduce, to a more or less reasonable extent, the financial risks associated with the new scheme.

Then I’ll leave a whole piece out of page 17, because otherwise we won’t get there. At the end of the intervention, Mr. Drèze. Unlike in the case of occupational accidents, it is intended to disconnect from any activity, in the first instance of the insurance companies. The premiums are then directly deposited into the fund which manages both the collection of the amounts and the redistribution of the amounts to the victims who meet the conditions for compensation.

As regards the management of the fund itself, Mr Drèze has three options. First, the possibility of a completely new public fund appears to have to be rejected. Second, if the management was handed over to a consortium of private insurers, it would meet the criterion of know-how. However, the convergence of the public and private sectors is not so obvious. Third, the original method that seems most interesting at this stage consists in entrusting the management of the fund to the insurance institutions. Regardless of how the fund is managed, Mr Drèze says, the various responsibility mechanisms must be provided in any case. I will finish with the speech of Mr. Drèze. I sweep over pages.

The CDH doubts the opportunity for private insurance companies to participate in the system. Therefore, the health funds should participate in the consideration, establishment and management of the fund.

It is a bit difficult, but I would like to ask for a small correction here. It is no one to harm. I take it on my account. I apologize again. In the word on page 19 for chapter 4 there is, however, in French "à la réflexion". In Dutch there is “reflection”. Thinking is not an existing Dutch word. This should be consideration or consideration. However, thinking seems to me to be a contamination. I would therefore like to make a correction here. It stands on page 19, §3, two sentences for chapter 4.

I come to the general discussion, on page 19, point A, the questions of the members.

Ms. Avontroodt believes that it is important that this draft law be put forward for discussion. This bill comes at the demand of the sector. She would like to make three comments. Mrs Avontroodt has questions regarding the recommendations of the Knowledge Centre, which prepared three reports. In the draft law, however, the hospital infections are integrated. This is also very important for patients, ⁇ taking into account the prevalence and incidence of hospital infections.

These are not written mistakes, but difficult words. However, in our committee it happens that we use them.

Ms. Avontroodt says the most important thing is that of these, 5000 infections could be avoided and that, in addition, the mortality of 852 people could be avoided. The Knowledge Centre’s 2006 report contains a recommendation that the estimate of 0.8 victims per thousand inhabitants is slightly lower than the figures we see in Sweden and Denmark.

Finally, Ms. Avontroodt notes that one should not create a large and difficult state structure for the implementation of this project. She believes that the design offers a good solution in this regard. There is also a small typing error here. It should be “good solution” and not “good solution”. This is on page 20, § 5.

Mr Daniel Bacquelaine is pleased that the bill is now being submitted for discussion. He himself, together with Mrs. Avontroodt, already submitted a proposal on this subject in 2003. Already with the approval of the law of 22 August 2002 on the rights of the patient, it is requested that in addition to this law there would be a regulation on the compensation of medical...

... ...

Please do not interrupt the reporter.

... ...

No, Mr. Tante, I am sorry. The reporter publishes his report. He can read that. He is on page 21. It is, of course, an invitation to nominate journalists from the opposition.

The [...]

You have nothing to say about it. The reporter continues.

The [...]

The President makes a serious warning. He said that he never nominated reporters from the opposition.

I did not say that. I am fixing.

So we know what we have to do. I think it’s quite a tough statement that the president says: never again a reporter from the opposition.

I did not say that. You are like some people: you read much faster than I think.

The draft responds to the concerns of both patients, doctors, hospitals, and anyone who advocates the defense of the public interest.

... ...

No, absolutely not. I have nominated the opposition in my own committee.

Even in a tripartite, will you continue to support that principle, with all the authority you possess?

I am not Madame Blanche.

This is an important point!

I am not Madame Blanche. I have to say: I like Lady Blanche, but I am not Madame Blanche.

I am the last one who wants to do it hard, but I find it surprising that the chairman of the House says that you see where you end up if you let someone from the opposition report! Because I read the report faithfully and accurately, I am dismissed. Imagine yourself!

... ...

I hope it. If you hear my comment later – this is just the report – then I don’t think, Mr. Van der Maelen, that you will find the still parliamentary work of the upper board. on the contrary.

The speaker believes that in the draft...

Mr. Goutry is working for 49 minutes.

The [...]

( ... ) So I would be silent, colleague Van der Maelen.

In the absence of content. The [...]

I do not know what kind of game they want to play. Mr. Goutry, you are now working on the report for 49 minutes. There is no time limit. You can keep doing it quietly, but then I don’t want you to be interrupted.

Mr. Van der Maelen challenged me. He says I don’t know much about the content. Well, I planned to talk about the content for a quarter or twenty minutes. I will later do that a little more broadly to prove to him that I also know the substance.

The speaker was of the opinion that in the draft the right choice was made by opting for a single form of compensation. The current procedure is difficult and long. Therefore, it would not provide a solution to reintroduce such a complicated procedure. The proposed procedure also provides for the possibility of appealing to the court if there is a disagreement about the existence of the damage. Mr Bacquelaine further stated that it would be inappropriate that the preconceived mode of financing of the system should be changed in order to compensate for the damage resulting from hospital infections. Mr. Bacquelaine believes that aesthetic treatments are fully justified. When treatment has significant aesthetic consequences for a patient, it should be possible to solve this problem. However, the term aesthetic intervention needs to be better defined as well as the manner in which these interventions are performed. Mr Bacquelaine was pleased that the Perruche judgment was taken into account in accordance with his Bill No. 90.

Furthermore, the speaker noted that the draft is rather a framework law but that the possible new forms of financing should be discussed in the legislative chambers.

Finally, Mr Bacquelaine recalled that the rest homes do not fall within the scope of the draft law. This could undermine the principle of equality.

Finally, Mr. Bacquelaine decided that he was very pleased that this design could be discussed and that the damage to the patient could be compensated within a short period of time without any further adverse costs.

Mr Koen Bultinck of the Flemish Belang pointed out the ever-increasing number of cases of damage. We must avoid coming to American conditions. Therefore, it is important that the project that is currently discussed be submitted for discussion. The faultless liability has already been dealt with several times in the Chamber. Mr Bultinck also recalled that when the Act of 22 August on the Rights of the Patient was adopted, it was promised that a law on the faultless liability of doctors would also follow.

Mr Bultinck requested more information on the financing of the Fund for Compensation for Damages in Healthcare Accidents. Healthcare providers, RIZIV and the insurance sector will be responsible for funding the Fund. Mr. Bultinck also argued that the chief physician, Mr. Moens, wrote a letter to the Prime Minister asking for guarantees that if the RIZIV is to provide funding for the Fund, this should not have any impact on the application of the budget objectives for the Medical Corps as we ultimately do global management in social security. The speaker noted – I am still referring to Mr. Bultinck – that the figures cited vary greatly. The Cabinet of the Minister assumes that on the basis of the figures used for 70% of the complaints the damage will be compensated.

The inclusion of hospital infections in the bill will result in a huge increase in cost. Mr Bultinck wondered whether, in the given circumstances, it would be appropriate to include the hospital infections in the draft. According to him, the State Council also has comments on the introduction of a number of ceilings and exemptions. The State Council says the minister will have to justify why exemptions are introduced.

Furthermore, it is not clear whether the bill currently discussed also applies to the problem of medical errors in rest and care homes.

The [...]

Mr. Tant, Mr. Goutry presents his report. I ask for respect for the reporter.

Mr. Goutry, do you want to continue? You will not get me from my horse.

On page 25, rapporteur Goutry points out that the manner in which the draft law should be treated should not lead to the creation of an inaccurate system.

I am also a reporter. I suggest that I bring the other half of the report.

That is excellent. You are galant, Mr Goutry.

I accept this with pleasure. I suggest that I finish my piece, up to page 30. We had agreed so too. Sorry, from the page.

What was the appointment? I want to know them.

There were no agreements. I suggest that we each give half of the report.

Half of the 47 pages is 23.5.

I would like to start on page 25.

Mr. Goutry, be galant with the ladies.

Mr. Speaker, I can already tell you that we will not be satisfied with the fact that Ms. Raemaekers refers to her written report.

Ms. Raemaekers will do what is usually done: bring a summary of the written report. Agreements are agreements.

Mr. Speaker, if my co-rapporteur does not give the same energy that I have given as a member of Parliament, I think I should also give the rest of the report. I think the room is right. I will then, of course, ask the word in the general discussion.

Mr Goutry, thank you for the first part of the report. Co-reporter, you have the word for your report.

Mr. Speaker, I will continue with the report and I will do it in my own way. I will start on page 25.

Rapporteur Luc Goutry points out that the way the draft law should be treated should not lead to the establishment of an inaccurate system. For the purpose of applying the law, proof of the damage will still have to be provided and it will also have to be proven that it was unforeseeable and not a normal consequence of the delivered act. The speaker agrees that a solidarity fund is being established to prevent doctors from being attacked. Mr Goutry recalls that in October 2006, on a day of study on the faultless liability of doctors, no preliminary draft law was yet available.

Another important point is that the RIZIV is an important partner in the financing of the Fund.

Mr Goutry, however, points out the danger that in this way an injury scheme would be introduced into the social security system.

( ... ) : ( ... )

Lord, you can do it, but, as I have already said, I do it in my own way.

In this case, it is actually an insurance matter. Only TestAkkup formulated comments to the bill. Other sectors did not have time to do so.

Mr Goutry considers that the €93 million provided for the establishment of the Fund is insufficient. The KCE also considers that, without taking into account the infectious diseases, the fund will need approximately 140 to 150 million euros. MRSA is also, according to Mr. Goutry, a problem that is underestimated.

The procedure as set out in the Fund, both in terms of procedure and arbitration, is not comparable to the court. The proposed system is very fast, but this is partly at the expense of the procedures. The design also does not specify in detail how the procedure should be initiated by the patient. What effect will in such a case be given to the claims for damages that would be submitted under the present draft law? The draft stipulates that the damage is compensable unless it is foreseeable, involves a foreseeable risk or is a foreseeable side effect. There is no additional information available to Members of Parliament concerning the direction the Minister intends to take in the definition of the aforementioned provision.

Furthermore, the text does not indicate whether the patient can still intervene during the procedure.

Can the patient be assisted? Can he apply for an expert for the insurance or for the fund? The KCE report states that 20% of hospital accidents are caused by falls. Such damages will also be directed to the Fund. Therefore, it will be very important that it is clearly displayed what falls precisely under the application of the law.

The speaker is of the opinion that the committees for Justice and Business should at least have given their opinion on the aforementioned issue.

Mr. Goutry puts his questions together as follows.

What happens if the same patient reports an injury multiple times? What are the exemptions? Which maximum for damage cases does the Minister think? How does the Minister motivate that Article 1382 of the Civil Code can no longer be invoked for medical injuries? In most countries, such as in France, the double regime still exists. What application procedure will the patient need to carry out? Are costs associated with this? What costs are associated with this? Who will control the Fund? How will the Fund be financed? What about economic and non-economic compensation? What will be the staff composition of the Fund? Was the know-how of the hospital funds currently managing the damage files used for the simulation of the possible number of dossiers? What is a serious and intentional mistake? What happens to rest houses? What happens to transferred MRSA from hospital patients to rest homes? Will the paid amounts be taxed? What if the benefits are combined with social benefits? Will it be possible to ask for storytelling interests? Will a bonus malus system be applied?

The speaker considers it important to draw up an annual report on the implementation of the law.

Mr. Goutry concludes that he believes that a good system should be established.

According to Chairman Yvan Mayeur, the present bill responds to a social need. In the case of a medical error, the patient’s aspiration to be compensated is justified. The present draft law is therefore a necessary supplement to the law of 22 August 2002, in order to enable an effective sanction of the rights of patients, while giving the practitioners the freedom they need. Hospital infections are discussed in the bill.

Mr Benoît Drèze agrees with the objectives of the draft law, but he finds a number of shortcomings that should be addressed. Many of the concepts used in the bill are vague or will be further defined in an implementing decision. The speaker therefore asks whether it is possible to describe the damage that will be reimbursed by the Fund in a positive way.

The State Council regrets that the bill does not apply to institutions that are not hospitals. The Council of State also points out the uncertainty concerning the scope of Articles 4 and 5. Since the King is charged with determining the exemptions and the maximum amounts of the fees, it is difficult to figure out what benefit the bill will actually have to the patients. Which company will accept to cover a risk that will have nothing to do with the individual liability of the insured?

Ms. Muriel Gerkens is pleased with the submission of the bill, but she regrets that it happened so late. For the sake of prompt implementation, the added bill provides only for the financing of the fund by the State. Can the Minister explain the financing mechanism by which the proposed fund will be established? Apparently, the government bill provides for a simultaneous action of the fund and the insurer. The speaker is concerned about the coordination of the actions of the two payment institutions. Is there no risk that the payment periods will be extended?

Ms. Magda De Meyer is pleased with the submission of the bill. The establishment of a compensation fund will enable more reliable statistics on medical accidents to be ⁇ ined and will prevent the unnecessary fear that some patients have. The speaker welcomes the fact that the government has chosen to take as a model the system currently in force in Sweden.

Then followed the responses of the Minister of Social Affairs in the committee. First, as regards hospital infections, an additional €7.5 million has been provided for the quality of care policy. The rest and care homes should be consulted with the Communities. Second, as regards funding, the figures communicated to the committee members are derived from an estimate of the Federal Health Care Knowledge Centre based on data from Assuralia. Third, as regards future costs, an increase in costs cannot be ruled out. Fourth, aesthetic interventions fit into the framework of health care. It would be appropriate to go beyond what the present text stipulates. In this regard, a number of legislative proposals are pending. The Minister urges them to be discussed. Fifth, Article 7, fourth of the draft law covers the serious and intentional errors and the dispositive is clear. A list of the serious errors for which a legal action may be brought shall be given.

Sixth, the procedure and the relations between the fund and the insurers. The fund will be the only point of contact for the patient.

Seventh, abnormal damage. The risks set out in Article 5 correspond to a more precise definition of damage that cannot be compensated. In those cases, the victim must prove the abnormal nature of the damage.

The eighth is monitoring. The Fund for Compensation for Accidents in Healthcare will have to operate under the supervision of the Minister of Health. It will be a state service with separate management, as provided for in Article 12, § 1, of the draft law.

Ninth, assistance to the victims. The victim has the right to assistance throughout the procedure. It may request that such assistance be provided by a person of its choice.

Third, the concerned healthcare providers. The healthcare providers concerned by this bill are those referred to in Royal Decree no. 78 of 10 November 1967 on the exercise of the health care professions.

I come to the replies.

Mrs Yolande Avontroodt is not convinced that it is appropriate to set up a different arrangement for the rest homes and the rest and care homes. Minister of Social Affairs and Public Health Rudy Demotte is in favour of the extension of the scope of the draft law under discussion. This, however, requires an agreement between the federal and community governments.

Mr. Jacques Germeaux considers that even if the origin of the nosocomial infection is difficult to establish, it is therefore still not non-existent.

Mr Benoît Drèze would like to receive a more precise budget note from the government. According to the Minister of Social Affairs and Public Health, the projected budget is based on a study by the Federal Knowledge Centre for Health Care. The budget predetermined in the study of the Federal Knowledge Centre for Healthcare is not 124 million euros, as Assuralia claims, but 153,9 million euros.

Mr Luc Goutry, the rapporteur, asks whether the amount currently paid by the insurers will now be borne by the Fund. Minister of Social Affairs and Public Health Rudy Demotte reminds that part of the costs estimated by the Knowledge Centre is already covered by the RIZIV. The budget takes this into account and therefore only includes the difference between what is already covered and what will be covered in the future.

Mr Koen Bultinck regrets that the Minister does not act decisively with regard to the stability of the medical insurance premiums. This is a guarantee requested by the medical organizations. Minister of Social Affairs and Public Health Rudy Demotte refers to page 12 of the Memory of Explanation, which clearly indicates the will of the government in this regard.

Mr. Jacques Germeaux refers to the Swedish scheme.

I come to the voting.

The articles are adopted with ten votes and two abstentions. The committee agrees on a number of technical improvements. The entire draft law, as amended, is adopted with nine votes and three abstentions.

Thank you, Ms. Co-rapporteur

They are included in the general discussion, and I propose an order: the gentlemen Goutry, Bacquelaine, Bultinck, Mayeur, Mrs Avontroodt, the gentlemen Drèze and Verherstraeten and Mrs De Meyer. I didn’t have anyone from the SPF. Then I will try to place Mrs. De Meyer after Mrs. Avontroodt, I will see.

[...] the word takes, depends on what is said here, of course.

We have already lost a little time. I am not inclined to change much, after what I all (..)

You don’t have to change anything, you have to apply the rules.

U kent het reglement, mijnheer Tant. Read article 17, §3, in kom mij een geschreven voorstel doen met 50 handtekeningen. Voor de wijziging van de agenda hebt u 50 handtekeningen nodig, mijnheer Tant. Or there is consensus.

Mr. Goutry, you have the word, unless you give up.

Would you like to read that article?

I have it yesterday in the French, that speelt no role, I can it also in the Dutch questions. “The order of work can not subsequently...”

Yes, but in Dutch.

I will ask the Dutch regulation.

You are no longer just the president, but we are.

The translation is, of course, by the services. Article 17, paragraph 3. Sir, you can also read. The agenda may subsequently be amended only by a vote held on my initiative, or of the Government, or by a vote held on a motion submitted in writing and supported by a third of the members of the Chamber. So will be.

Mr. Goutry, you have the word. It will be so. Mr. Goutry, you are neglecting the word?

Are you applying to the Rules? Just do it. Please read .

In our Rules of Procedure it says: "The so submitted to the Chamber for approval..

The agenda has been approved. We are working on the basis of an approved agenda, at the beginning of the meeting, comprising exactly - I repeat - 26 points, as you see here, and that order can only be changed by paragraph 3 of Article 17. So is it. (Protest by Mr Tant)

That is over. The order is established. Mr. Tante, you know it as well as I play that paragraph 3. Our agenda was established at the beginning of this meeting with the points I added to it, unanimously approved by the Chamber by consensus. I can only deviate from it in three conditions and you must fulfill those conditions.

Mr Goutry, you have the word and you know the speaking time in the general discussion.

How much time do I have?

Mr. Goutry, you have 30 minutes. You should not use them, but you have them.

And the speaking time of Mr. Annemans, which he gave me?

The speaking time of Mr Annemans is for Mr Annemans. I don’t want to take away anything from the VB.

He put his time at my disposal.

That might decorate him, but that doesn’t interest me.

Mr. Speaker, Mr. Minister, Ladies and Gentlemen, I have a difficult task. I must try to convince Mr. Van der Maelen, a very eminent Chamber member, who in many areas is very occupied and very documented, from this vulnerable place that I know something about this too.

I was not able to convince him, the rest, that I am a good rapporteur, that I have followed the case well, and that I have worked all day to bring that report here. Now I have to convince him that I know something about it too. I will do my best for that, Mr. Van der Maelen.

It depends on how fast of mind he is. If he understands it quickly, I can also go a little faster.

Mr. Speaker, ladies and gentlemen, dear colleagues, I must address you, Mr. Speaker, because you have repeatedly told me during this legislature that this is not a way of working. You have supported me in every program law, in every draft, backing me, literally and figuratively. You said it was right what I said, that you shared my opinion.

On Friday, a draft will be sent with a Bible from the State Council, with the amended draft. On Friday, a text of 80 pages with an extensive opinion from the State Council will be sent to the Chamber members, with a modified draft. On Tuesday, discussions will be held until the finish. It is considered appropriate that the opposition makes comments in the committee. One does culpabilizing and says that one must look at how good it is and that it must be approved.

Mr. Speaker, I have repeatedly asked that you take your responsibility and that you protect the House and the opposition so that they can also do their democratic parliamentary work well. You have always said that you will not bear it anymore, that it is not a way of working.

It happened again, this time with a very important design for very many people. It is about sick people, about patients who become victims of significant medical damage and who need to be able to recover it in the form of compensation. Colleagues, we have had exactly one weekend time to study this, along with our study services. Not to mention that we could have asked someone for advice.

Mr. Goutry, I am not going to answer this, but your first amendments mark the date of 27 March. That was three weeks ago.

Mr. Speaker, I’m talking about the fact that we get the texts on Friday and discuss this in the committee on Tuesday. That there are now three weeks until the plenary session, we have not much more to do about that.

It would have been better to have three weeks between the texts and the committee meeting. At least we could have done a good job. For me, it could take only a week before it came into the plenary session. That is not the point. The point is the reverse.

All the colleagues of the majority – and I find that so nonsense – say that it is right, that I am right, and that this is not a way of working. They also ask numerous questions and they also find no way to do it. At the moment we continue on that for a moment and get the chance to do it in public so that everyone knows it, they crawl into their shell.

Then they give the impression that we are here just to waste our time. Well, if you think I have a goat, at 21.43 pm in the evening, to waste my time on this speaking chair, I can assure you, colleagues, that I have much better things to do.

What my colleague Luc Goutry says is obviously important. Furthermore, I would like to emphasize that on that Tuesday, we were put on an entirely unacceptable pressure: the meeting began at 10:00 and could only be extended until 19:00. The case had to be closed the same day.

In the early hours of the morning, Mr. Goutry and myself, to, foot by foot, defend our amendments and examine our articles, were accused of doing flibustery and not wanting to finish the same day. Now, we finished, and we voted at 18.45, but at charge. It was not a quality work. You will also find, in the course of the evening, that the text we are going to vote on – unless smart amendments are submitted – has imperfections that we will regret later.

Mr. Speaker, you might judge that the opposition asks a lot of questions. Of course it is so. We are not part of the majority consultation and do not have the texts months in advance.

What was very striking, for which I call all my colleagues to testify – those who have the courage to say otherwise should come here to tell it – is that the majority has asked nothing but technical questions and this all day long about a design by which we create in the patients the expectation that with this everything is arranged. I tell you from the beginning: nothing is settled with this. It is a shame that this will create many false expectations in patients who think they can go to the fund with medical damage and will be compensated.

When this fund will ever see the light of life, colleagues, is when the 41 implementing decisions of this draft will be approved and published in the Official Journal. Only then will that empty box be filled and that rough building will become a house. Well, when will it be? The next three weeks? Forget it ! Next year there will be no fund that is still operational. Meanwhile, thousands of people will live in the belief that they are now covered against medical damage. I find this very dangerous what is happening here and want to distance myself absolutely from it, no matter how much I am in favor of the system. In this way to be with us, with the Parliament, with the patients, that I think is actually an electoral stunt but with a very high danger value. That you take out an electoral stunt with something to laugh with, I will laugh with it. That you make an electoral stunt on the people’s cap, I find it destructive for this Parliament. This is what I wanted to say.

in conjunction with it. We once made the effort, colleagues, to look at something, because we are blamed that we are indeed trying to demand with all clarity what belongs to us. The Rules of Procedure allow us to do so, and the majority must undergo it. That majority has put so much pressure on us over the past few years that we are no longer used to conducting a serious debate.

You know, colleagues, that under the Dehaene government for 14% of the drafts the high urgency was asked. Under the first government Verhofstadt was that 28%, under the second government Verhofstadt is that 38%. What should all this serve? To prevent a proper debate in this Parliament. Then you would blame us for bringing this to the attention of the people! You will have to go through this, go-go or not go-go: it is the last possibility that remains to us. You should be ashamed, you all and the President. 14% versus 38%, which is just a third. Mr. Bacquelaine, that’s just a third or three times under your government. Then there is a chairman of this house who speaks about the revalorisation of Parliament and who makes highlights, acclaimed by all of you. Well, the result is what it is.

Mr. Goutry, you have a quiet time. If we are prevented from speaking, then we will also draw the conclusions, be sure.

Intellectual honesty has its rights from time to time. Maybe not for you. You have approved the draft agenda. I then interrupted you, Mr. Speaker, asked for the word and pointed out the fact that we felt that the draft related to civil security should be able to be discussed at a useful time. You then committed yourself that this could happen. You hoped that we would all go through it in silence. If you are intellectually honest, then we are still in Article 17 second and not third, but you do not attract anything from it, because you must be the servant of this majority. That is the great achievement, the service you have proven to the operation of this institution. Thank you very much, President, and say that to your voters.

Mr. Goutry, you have the word.

Mr. Speaker, Mr. Minister, colleagues, I try to tell and make clear – I have already done this in the report, because all the sentences I have read were important – that the patient becomes the victim of the medical damage, when he becomes the victim of a medical accident, whether or not of a medical act, because there can also be intentional involvement. All possibilities are open, it can be both criminal, civil, avoidable and inevitable.

So far, a patient, first of all, has to attack the doctor, which is not easy for a patient, because he may still need the doctor. He must, secondly, attack the doctor in the medical field, which for a patient, as a non-medical, is almost unstarted work. Third, he should hope for the cooperation of the attacked doctor. It is almost excluded that it will be available to determine the damage. For this, he must carry out a whole procedure. Nowadays, there is hardly a single patient who receives compensation.

What does this majority say now? In addition, it is supported by us. We support the principle that a patient can be indemnified without fault and that, in other words, the cause should no longer be indicated, the doctor should no longer be confounded, and there should no longer be a causal link between error and damage, to be proved by the patient, which is almost impossible. From now on, he will have the opportunity to go to a fund, to sign up and to try to prove his damage. He will get a proposal for that. The fund mediates and the patient should no longer attack the doctor. The fund will subrogate against the doctor. I would like to give a double applause. It can count on a house-wide majority. Anyone who would not support this principle would have to be crazy and can’t agree with the people.

So far there is no disagreement.

Mr. Minister, regarding the purpose and purpose of the bill, there can be no difference between the majority and the opposition. Every good-thinking, good-thinking man will advocate a faultless system in which a patient must only prove the harm, which for the patient should be a feasible thing, if he can resort to another doctor, who advises him in that. No one can resist that the hard work, the subrogative work, the offensive work are then done by the fund, which in turn regulates it. This is an excellent principle.

However, I will very much regret you, Mr. Minister, if a story of prostitution is spread in the newspapers in the coming days, as if the patients are now saved, because there is now a fund for error-free medical liability. I will take you on it, if you dare to make advertising for it, because I do not think it is correct. The fund does not exist today. What did you do, Mr. Minister? You put the rough construction. That is your merit. You have melted the walls and you have placed a roof on them.

However, the house is not windproof, not waterproof, let alone it would be furnished. This means that the house is uninhabitable. The minister actually bought the land, put the house on it and made a start. He has shown his good will. The majority has shown their goodwill to do something about the problem. For the rest, that house is a rough building where people will later be invited to live in. Then I will protest. I would say that the construction is there and that it is a good start. Before you allow people to live in a house, you must make sure that it is habitable. This is not the case at all today. That disturbs me in this design.

I see it happening already. The next few days will be round. I see people walking to the public houses to say that a fund has been established that patients will always and everywhere be compensated for medical damage. This will only happen in rare cases. There will be a lot of legal implications and complications from this.

What is a serious mistake? What is a deliberate error? Was it avoidable? Was it not inevitable? Who will do the expertise? Who will arbitrate? Who will make a damages proposal? Will there be a franchise? Will there be a ceiling? Where will the funding of this fund come from? Nothing about that. Questions have been asked, but we do not get any answers, as evidenced by the report I have presented here. I did not get any answers to all these questions. Then claiming that we now have a fund that will help people and compensate them does not go. I will struggle with this, because that is not true.

My opinion is that this is very dangerous. There are many false expectations opened towards a very vulnerable group, namely patients who have medical injuries. There is not even a procedure defined as to how a petitioner will have to direct his petition to that fund. This is not even foreseen. Should it be accompanied by a medical certificate? What should such an objection be? What evidence must be provided? A patient is given 30 days of consideration when he receives a proposal. What are his means of defense? What if the deadline is exceeded by the patient? There is nothing arranged for this design that is full of holes. It is a design that rammes on all sides.

I will prove to Mr. Van der Maelen that I am not standing out of my neck to talk. I will ask a whole series of questions. You will undoubtedly know the design and the text and it adorns you that you show interest in this important topic. I will ask questions here and I expect an answer. How can you expect us to vote or approve if we don’t even get an answer to our questions?

If the Minister does not respond to our questions, I invite the majority to help answer the questions also on the speaker’s seat. That is the meaning and purpose of a debate, so that soon after the conclusion of the discussion of the draft we can all together say to the people that we have designed a good system.

In that case, I will participate. If the system is okay and I can verify that, I will go with you to the patients to defend the system. Now I keep myself on the ground. I will only be able to respond when I have the answers to my questions.

First, what will happen if the same patient repeatedly reports an injury with or without a causal link? I have already asked that question. What was the answer to that? No answer !

Secondly, what are the exemptions – the franchise therefore – to which people will be subject? A patient, when insuring himself, must know in advance how much the franchise is. What are the maximum amounts of damages? What does the Minister think in this regard? The Minister replied to me: "The damages suffered are in principle fully reimbursed." However, he added that the King can set the franchise and the maximum ceilings.

What do patients know? We also know that the King can fix the franchise. This is stated in the design. I would like to know in advance whether a large franchise will be working with. That makes a difference. If someone suffers damage and learns that the first 5,000 euros are not covered, what kind of insurance do we have?

Third, how does the Minister motivate the use of Article 1382 of the Civil Code? The Minister stated that for the aforementioned article was chosen. If a patient now suffers medical damage, he can respond in two ways. He may, first, invoke Article 1382 which stipulates that, when a person inflicts damage, he is obliged to compensate for the damage. This is stated in Article 1382.

Mr Van Parys, I am not a lawyer, but I think it is so in the conscious article.

This can happen on two levels. Compensation can be claimed in civil law, as well as in criminal law, as strikes and injuries can come along. In the second case, the prosecutor may have to open a file, whether or not with the involvement of an investigative judge. In less extent, the patient will open the procedure himself. The society will procure by way of speech against the one who committed the mistake. Until today, a patient, if he suffers injury, can therefore defend himself by means of Article 1382 of the Civil Code.

What does the design say? I hope you fully understand the scope. The draft stipulates that when a patient chooses to receive compensation through the Fund, he will automatically and definitively renounce the appeals set out in Article 1382. Consequently, he can no longer claim civil damages for the damage incident.

However, the patient makes his choice for the fund at a time when he does not know whether his file will be recognized, how much compensation he will receive, and what franchise and maximum apply. Nevertheless, he must make a choice, which is definitive, irrevocable and irreversible. After all, once he chooses the fund, he can no longer go to the civil court.

Well, I agree with Test-Buy, yet not the first the best magazine – for you use that quite often from a socialist angle – which says about it that you want to do a test with regard to the principle of equality. People are deprived of remedies in a definitive and irreversible way, because they are made to choose in advance, without knowing what the compensation will be, and they are excluded from the possibility of subsequent civil defence against them. This is a strange method of work. In France, there is also a system of faultless liability. What has been done there, colleagues? Both systems have been allowed to exist side by side. The patient invokes the fund and receives compensation. If he is rewarded, the shirt is off for him. If he or she considers that he or she is not compensated or insufficient, he or she may still apply to civil law and initiate a civil procedure based on Article 1382. This is the French system. Several consultants have told us that this should be the case in Belgium.

However, the minister does the opposite and the majority follows him. The draft may soon be approved by the majority. This means that patients from now on, when they choose the fund, will be excluded from civil proceedings. There are enough lawyers in the room. Is this really an evidence that we can simply decide in one, two, three? I have received some legal advice on this issue. Most lawyers are very reluctant in this regard. It is said that, when there is full clarity in advance and a commitment to compensate for the damage, one could still drop the civil procedure, and then again. The jurists refer to the French system and say that it is much better to allow the two to exist side by side. That can’t hurt, right? What is the benefit for the patient? Why does he not appeal to civil liability?

Because the fund will be able to help him faster. That is right, Mr Mayeur.

The [...]

Mr. Mayeur, one could say that, but I think that is a serious claim. There is a legal system of compensation through Article 1382 in civil law, but one wants to establish a different system because it does not work. The law, the system does not work. This is a heavy determination.

Second, even if it works less well – because the causal relationship, the error must be demonstrated; this is a difficult procedure – one should still be able to maintain the double system. One could tell the patient that if he wants to be treated quickly, he should choose the short procedure and the fund. If it turns out that the compensation is insufficient, then you would still have to be able to go to the civil court to obtain the rest of the compensation. With this design, this is no longer possible.

First, Article 1382 as such does not work in practice in terms of compensation. That is why there is consensus on creating a compensation fund.

As for the option that would have consisted in leaving the choice between the compensation fund and the article of the Civil Code, we obviously thought about it. But what have we been answered? That it was unpaid, and therefore that a procedure choice had to be made. That’s why we chose the compensation fund – that’s all!

This is not the first time that a provision of the Civil Code that does not produce a desired effect for the population is amended. This is not extraordinary serious!

If it is in the interests of people, it is a good measure!

That remains to be proved!

Excuse me, but I feel like I know the subject better than you. We discussed it in the committee. We mention that it does not give us full satisfaction and we are developing a system that is more satisfactory than the existing system. It is not scandalous to change an article of the Civil Code if one considers that it is not efficient enough to help the population!

Then you’d better adjust the civil law, frankly.

The problem is indeed that the whole procedure before the civil court may be subject to improvement. However, this fund has yet to prove its solidity, also in terms of the resources it has at its disposal, and especially in terms of the “sufficiency” of the compensation it receives.

A theoretical system, Mr. Mayeur, always works better than an existing system, at least in theory. The practice is often different and we are therefore not convinced, and I fear that Mr. Goutry is right. You assume that what you invented is the ideal system. The question is whether it will be so, but I add to you as a socialist: if people have to choose between the one and the other systems, then, if they are simple people, they will primarily choose the money that they should receive in the short term, and not the substantial compensation, because they often in the high urgency need the means in question. In this way you are developing a two-speed system, Mr. Mayeur.

Mr. Goutry, you should not keep your speech during the interruption.

It is obvious that we all seek to improve the situation of patients, especially those who are victims of medical accidents. What disturbs us, members of the CDH, is the hybrid nature of the private and public management of the system.

We do not yet know the royal decrees, Mr. Mayeur, but we presume that the agreement you have made with the liberals will do the good part to the insurers. You yourself have asked questions with me in the commission on the financial reserves of the insurers. I will explain it in more detail soon.

We cannot at the same time serve the people and fill the pockets of the insurers. I ask you to meditate on this point.

I will be brief at this stage of the discussion because it will still be long.

It should be noted that the argument argued by Mr. So much is unlikely, or even impossible. Today, 95% of people who would have tried a procedure do not succeed. Those who are already less qualified in terms of legal or financial assistance do not have access to it. They are disgusted and do not go to the end.

I don’t want to hear here in the tribune or in the banks that the system we offer is ideal. This is not what Mr. The Mayor said. Nevertheless, this system brings an improvement compared to the existing situation. At the moment, the system does not work. When 95% of the complaints fail, it is a scandal for democracy!

Colleagues, please make a small effort, despite being late, to remain intellectually honest. I have said the following, and I will continue to say it. If there comes a fund that is here now, which is not a rough building, but a well-equipped home, of which I know all the instruments, of which I know where to light, of which I know it is fully habitable, that all people have the security, the guarantee, that they are served in a good and correct way, then I am prepared to say: let us choose that fund. That was my position from the beginning. I started by saying that we are naturally for it.

But in the long run, the next thing will emerge in Parliament. They say, you are for, so you can no longer be against, whatever it looks like. The fact that you say you’re for means that you won’t be against anymore. Well, there is still a big difference between holding a discourse about such a thing and then the effect in the facts, the juris, and providing a closing financial system so that people can be guaranteed to receive compensation. The tendency in the committee was that one would do it this way, that one found it a good system that one could not oppose, and that there should not even be free time to discuss it. Mr. Bacquelaine literally told me that I would not be against it anyway and that I would not begin to criticize it anyway. That means, in a way of speaking, that if one orders a house, furnished with a key on the door, one must be satisfied with a rough building. I would like to know who would accept that. No one would accept that! This is what is being discussed here in Parliament.

I have a fourth question. What application procedure will the patient need to carry out? Are there costs associated, for example? In what way? Within what timeframe? By what means? The answer was, “No answer.”

The fifth question. Who will control the Fund? The fund will, according to the Minister, have to operate under his supervision. It shall be a state service with separate management, as provided for in Article 12, §1. We already know something: it will be a state service with separate management.

I asked the Minister who would arbitrate. The Minister spoke of arbitration. In the text, there are even two arbitrators, and if it does not, a third arbitrator will be added. It is like with football. I asked the Minister who were the persons who were given the authority to arbitrate. I have not received a response to this.

What is the role of the health funds? The victim has the right to assistance throughout the entire procedure and may have that assistance provided by a person of his or her choice. That is the summary answer I received from the Minister when I asked him about the powers of the insurance institutions.

The eighth question I asked the minister was what information would be given to the patient. I have not received a response to that.

My ninth question was: what is “predictable and normal damage?” what is “unpredictable and abnormal damage?” People need to know what this is, abnormal damage? What is unforeseen damage? The Minister has answered me – be careful: “The domain of therapeutic activities as such includes a portion of risk...” – when one does medicine – “... which must be taken into account. Not everything goes well. That risk should not be confused with the known side effects of this or that therapy that do not raise liability issues.”

In short, the minister says: science is science, missing is human, mistakes can happen. You cannot claim compensation for things you cannot do anything about, things that are not intentional mistakes. very correctly . But then he says, “The focus here is on abnormal risks, something that is generally not expected.” I don’t know if there are still legal practitioners who follow, but so we made a definition of “an abnormal risk,” in the design terminology. The Minister gives in response to the question: “What is an abnormal risk?” That is a risk that is not generally expected.

This is a general risk... Is it legally defined, colleagues? Do you find that enough to say to a patient: “Sir, you have abnormal damage?” That patient will say: “Yes, I think I have abnormal damage.” “Is it damage” – one should then ask – “which “is not generally expected?” That one should ask the patient. Will he know that, you think? Will he know if he can expect that damage generally or not? Who, to the hell, can answer this?

Are these things defined in a law? How else can one insist on the patients that someone is unfailingly liable, and whether they will be able to get compensation? The poison is apparently in the tail, because, says the minister, “In those cases the victim must prove the abnormal nature of the damage.” he must prove it, but he does not actually know what to prove, because that “abnormal damage” is not defined. It is a notion, a connotation that is inserted into the design, but without further definition.

I asked the Minister: How will the Fund be financed? Where will the money come from? It only states who will participate in the fund. So, what does the Minister do in his draft? He says, we have found three who will pay for it. And you must be satisfied with that, the Parliament must approve it. The RIZIV will pay, the government will pay, and the insurers will pay. How much will one pay, how much will the other pay? These are not questions for now, they are questions for later, we do not deal with them. Now accept the law, and then it will come by itself, as everything comes by itself.

That is quite a way of doing! Would you feel safe as a patient, Mr. Van der Maelen, if you can claim compensation from a fund which today at the time of approval is not known how it will be financed and to what extent the various partners will contribute to that financing? In other words, is there a guarantee for this? Who says that?

Or will we carry all the money that may have to come from the insurance, from the private, in solidarity through the social security? That is an important question. Several members of the majority have requested this. That was a very big concern. The Minister did not actually respond to this in real terms, but they have settled into it. He said, “You will see it. We will implement that. You trust in me.” This means that we must be able to tell people that we have a good fund.

How will the inflation of applications be avoided? What will be done with it? Are we going to a situation like in the State Council, where decisions are made with four years of delay? We cannot set deadlines. What is the enforceability of the deadlines set out in this draft? There is no enforcement. This will happen in 180 days. What is enforceability? I predict that this will go on the same street as in the Council of State, namely a ruling after three or four years. If we have to do this with people who suffer medical damage, then we are much better with the existing civil law regime. I accept a new arrangement, but it must be closing. She has to give me guarantees. Then I trust them and I want to approve them.

I asked the following question to the Minister. What about economic and non-economic compensation? How should we understand this? What are economic and non-economic damages? For example, is workability an economic damage? Is this fund residuair? If one is unable to work due to a medical intervention, the social security will pay you, as an insured. What will then happen? Will that fund then be residuair or will they subroge? We do not know this until today, because it is not defined in the design. Only one article states that there will be compensation for economic and non-economic damages. As if it is sufficient if it is not defined. No one knows if it is residuair, or it will be subrogated. That is not in it, it is not explained, it is not explained, it is not in the memory of explanation.

I would like to point out, by the way, that there are plenty of comments from the Council of State on this draft, and not the slightest comments. What will be the staff composition of that fund? Who will work in it? What kind of people? The minister says that it is being considered to hire medical staff and lawyers. How much, what, what kind, in what context? It is possible to call on external experts. He says it is primarily about officials who are already employed in Public Health. They will be able to carry out that work. The courts can’t, because there we have a bad service. But now that we will entrust it to Public Health, to the administration, with the same people, everything will succeed. I would like to see that.

Mr. Goutry, I took into account the fact that you were interrupted by Mr. Drèze, Mr. Tant and Mr. Mayeur, but you are now sitting, including the interruption, well above the 30 minutes of speech time normally given in the discussion of a bill or bill. Can I finish your question? I can tell you that I took the interruption into account.

Mr. Speaker, I have asked questions. I want an answer to my questions. Was the know-how of the medical funds used for the simulation of the possible number of dossiers? They manage the damage records. They know that. Has it been used? No answer .

Will there be expert work? With which and in what way? According to which procedure? No answer .

What about the burden of proof? That was a very inadequate answer. This has been observed by people who are better legally informed.

Another question I had asked was what is the key between the premiums that come from insurance and the contributions from solidarity. I also did not get a real answer. We will see it.

What is a serious and deliberate mistake? Which legislation is referred to in this context? Then the Minister talks about Article 7, fourth of the bill, which relates to serious and intentional errors. The minister explains this, but he does not say which legislation is referred to here, and he also does not define in any way what is a serious and intentional error.

Is the ball popular? If people are not interested in all the effort I do here, I would rather have them refresh themselves in the buffet.

I have asked what will happen to the rest and care homes. Several colleagues have asked the question. The same goes for Mr. Bacquelaine. They are excluded. However, the hospital infections are in the design and are compensated, as if a hospital infection occurs only in hospitals. Nothing is less true. After all, it has long been said that it is no longer a hospital infection, but a nosocomial infection. This is not localized. This happens just as well in a rest house as in a hospital. In a hospital you can get compensation, not in a rest home. Most people agree with it and consider it less important. For the time being, they approve this.

Mr. Goutry, do you want to decide? That would give me pleasure.

The question was whether the paid amounts would be taxed. No answer . What happens when benefits are combined with social benefits? No answer . Will it be possible to ask for story interests if the deadlines are not respected? No answer . Will there be a bonus malus system? Inadequate response .

Do you think it makes sense to discuss a design in this way? Do you think it makes sense to construct this way for patients who are vulnerable and who have suffered medical damage? Would you dare at this tribune later claim that you can handle it with honour and conscience, that you are convinced that this system is good, that it will work well? Do you dare to claim that all guarantees are available to be able to tell patients that they can be calm, that they are cared for, that they can apply and that they can offer compensation or not within a period of 180 days? Do you dare to claim this today? Second, when will this system be finished? When will the building be a residential building? Third, what will you communicate about this? These three questions worry me very much at the end of this discussion.

The next speaker is M. and Bacquelaine. We will then understand in the order, MM. Bultinck et Mayeur, Mmes Avontroodt et De Meyer, M. Drèze and Mr Verherstraeten, the second speaker of the CD&V group.

Mr Bacquelaine, your speaking time is a maximum of 30 minutes, but you are not obliged to use it fully.

First of all, I would like to say that I rarely heard from Mr. President. Goutry as bad faith as today. You can be both surprised and disappointed. Personally, I am only disappointed. The way Mr. Goutry has considered...

I would like to address this immediately. It was also present throughout the day in the committee. If we in Parliament make the effort to do our work well, to read the texts, to seek advice and to demand that legally concluding texts be drawn up for the population, then we are blamed for our bad will, unbelief in the cause and counteraction. You have to tell the people. I will do it in your place, rest assured!

Mr. Goutry, it is you who makes me a trial of intent!

Like everyone else, I have the right, and you have it too.

I think mr. Goutry, today in the plenary session at this tribune, was fundamentally of bad faith compared to what he said in the commission. I keep it. I am disappointed, although I am not entirely surprised. I will demonstrate this by a number of points.

Since the vote on patient rights in 2002, we all expected a law on medical liability without fault. It had also been agreed at the time that the law on the rights of patients should be somehow doubled or accompanied in parallel with a law on liability without fault. It was an implacable logic. It is clear that the more rights are given to the patient, the more the dialogue between the doctor and the patient is envisaged, the more it is necessary to go to the end of the chain. The end of the chain is to allow the patient to be compensated at a given time if he is the victim of a damage, whether there is a fault or not. This was the principle desired by all the groups in the Health Committee. The Patient Rights Act was to be accompanied, sooner or later, by a law on compensation for medical liability without fault.

We submitted a whole series of proposals on the subject. I myself submitted one with my colleague Yolande Avontroodt, in order to result in compensation for as many patients as possible.

by Mr. Goutry asked the question as soon as possible whether, in conclusion, it would work. This question can be asked for any bill, for any bill. Whenever a project is discussed, this question is obviously acceptable. Through this question, there is probably a bit of intent trial – as Mr. said. So – but, overall, I obviously cannot deny or avoid the question. In any case, I know that at the moment, the system does not work. We all know it! The majority of patients who suffer damage as a result of surgery or hospitalization are not compensated. This is the current system.

When one knows this reality, one can obviously only congratulate and rejoice at the establishment of another system, even if one does not attain perfection. It will not be achieved, of course, but it is impossible not to improve the current situation, as it is.

The [...]

These are not promises at all. This bill does not contain any promises.

I think you are wrong; you are already in the election campaign! No to? This is exactly what surprises me! Per ⁇ this is a somewhat backward campaign and, therefore, you are already talking about promises. These are not promises, but proposals and bills. This obviously has nothing to do with it.

Dr. Bacquelaine just said something that the minister also said, and which I find very dangerous. According to them, the current system is bad and does not work. Therefore, the proposal in question could only improve it. But I think that reasoning contains a dangerous element. By changing the legal system to result in a system of liability without fault, the latter must be able to compensate in all cases. Otherwise, the victim has no recourse. Now - we will demonstrate this as the work goes on and it will be even clearer in the application - there will ⁇ be a greater potential of compensation than today, but you risk creating a situation such that less than 50% of cases will be compensated, without any possible legal remedy.

Therefore, on the level of principles, your reasoning has a major flaw.

Not at all: the bill provides for possible remedies if the person is not satisfied and believes that his/her damage has not been taken into account.

In addition, I would like to return to the notion of “damage”. You claim that not all patients will be compensated. Of course, some damages are called “predictable”. If you had a notion of medical affairs, you should know it. I’m sorry, but I’m forced to say it: if you remove a lung from someone who suffers from a tumor, he naturally risks breathing much worse! It is true. But will you compensate respiratory failure as a medical damage? Of course not. Fortunately, his lungs were removed.

I’ll give you a second example so you can understand.

I am pleased that you cite an example yourself, since mr. Mayeur and the Minister have forbidden me to do so in commission. Therefore, your intervention allows me to provide others just recently.

I cannot let you say that. It is incorrect! The minister did not say that he was opposed to giving examples. He simply said that he did not want to limit himself, in the exhibition, to provide examples that would be taken as mere illustrations.

I do not want to lie in the plenary session.

Look forward to Mr. Dress. You will have the word soon. Leave the M. Bacquelaine express yourself; you will answer with additional knowledge.

If someone suffers from a gangrene in the foot, that he appears in the emergencies and that the only solution to treat him and avoid his death is amputation, it will be necessary to resort to this operation - of course! This is not a damage compensable by the Compensation Fund. The patient will be compensated as a disabled, disabled person - and this is normal. But this will not be the responsibility of the compensation fund. With a little goodwill, anyone can understand it and do a share of things to know when the fund comes into application or not.

The project is probably not perfect and I’m used to say that the best way to prevent a project from succeeding is to require it to be perfect. Albert Claude, the Nobel Prize winner in medicine, made this quote for the first time. He was eminently right! If one refuses to vote on a project until it is not perfect, I assure you that here, we would come home very early on Thursday. This applies both to the majority and to the opposition.

I think that a number of questions must be raised, including that of ⁇ ining or abolishing the system of civil liability. I had submitted a proposal that ⁇ ined both routes. And I confess to you that we have stripped our hair from the practical and technical feasibility of a system that preserved both paths. On the intellectual level, it is probably ideal, superior, but on the practical level, we realized very quickly that it was impossible. It was therefore practically left to the current situation, both for the length and complexity of the steps to be undertaken by the patient as well as for the judicialization and defensive medicine practiced by the doctors in relation to the application of Article 1382 of the Civil Code. In no way were the problems concerning patients and care providers solved. Here, the application of Article 1382 of the Civil Code in this matter is terminated.

In other words, the primary condition of compensation will no longer be the existence of a fault and a causal link between the damage and the fault, but simply the presence of an abnormal damage related to a health benefit or the absence of a health benefit.

As I said before, I will not repeat the same thing several times. Anyone who has a little notion of medicine knows what it is!

Since the compensation fund will benefit in particular from the collaboration of people who have a small idea of medicine, this should normally be the best. Maybe if there were only employees of Christian Mutualities, that would have created a problem! This will not be the case and we will probably be able to evaluate most of the damage.

This option is going in the right direction, I think. We know that in the current state, the procedure is very long and arduous. Proof of a fault is always very difficult to bring, as well as its causal link. The introduction of a new complex procedure would therefore have had no interest in comparison with the current situation.

The proposed system is simplified. Simple for the victim, but also much faster in its application. It necessarily involves a single and limited compensation. However, an appeal to the labour court is still possible in case of disagreement as to the existence of a damage and, where appropriate, the amount of compensation to be paid.

The second question concerns the problem of nosocomial infections. It was decided to incorporate this notion into the law, so it is true that it corresponds to an acute problem at present. You cannot deny it, you can avoid it. This must be taken into account. It causes a number of damage to many patients. Therefore, it was important to be able to predict it.

Of course, this measure has an impact on financing. You should not be fooled. The entry of nosocomial infections into the field of responsibility without fault probably involves an additional funding effort. This is the third question. Is this funding correctly estimated? The future will tell us. In any case, we wanted to introduce an amendment to the bill for the problem of financing. Indeed, if the latter is to be re-evaluated, the Parliament retains its word in relation to the sources of financing. Financing is currently planned according to the State/INAMI/insurance premiums paid by the providers. This is a balanced financing. A hundred million euros are expected. If it appears to be insufficient, it should be possible to re-evaluate it and eventually use other sources or at least amplify revenues compared to existing sources at the moment. We found it useful that Parliament could confirm the choices that would be decided by royal decree at that time.

The fourth question concerns aesthetic benefits. Should they be included in the text? The choice that has been made seems right. It is clear that during a cosmetic intervention, in the context of hospitalization, a damage may occur which was neither foreseeable nor “normal” and which ⁇ deserves compensation.

Fifth question: Should rest and care homes be integrated? Today, they do not fall within the scope of the law. The question will rest in the long run, especially as patients move from a rest home to the hospital and vice versa, sometimes very quickly and several times in a month. It is not always possible to say where the source of an infection that might have been contracted comes from. Is it the hospital that is incriminated or the home of rest and care? This is difficult to clarify. We are heading towards a zone of uncertainty. Certainly, the system will still need to be improved, by means of additional funding, that is undoubted.

I know you are collecting taxes in the same way you would eat croissants at breakfast, but not all of us are supporters of these practices! In our view, additional funding implies revenue to be found. I don’t know if you’re going to make donations for this purpose, but I find it demagogic to say “just fund more.” The point! There is no question about the sources of funding. It seems to me too easy!

Dr. Bacquelaine accuses me once again of demagogy. If he no longer knows what has been said, he falls into blasphemous words, and that is because he cannot replicate on the content. Until then, I will collect it.

But what he says is much worse. He says himself: you might want to get that all financed by the taxes, and so on. He does not know how the funding will go. He probably forgets that social security is also covered by taxes. It’s all the same, it’s all community money. He claims that, in our opinion, it will "drive" to the taxes. We are apparently in favor of tax increases because we demand clarity on the financing of the system. Amai, what reasoning is that? It does not mean intellectual honesty.

Mr. Goutry, as you know, we are in the phase of launching a new compensation system that provides for and is based on a financing of the order of 100 million euros by INAMI, by the State and by the premiums of the service providers. We are also trying to prevent these premiums from increasing indefinitely, which is one of the problems of the current system. Therefore, we must be reasonable in the scope of application. The question will arise sooner or later of the inclusion in the system of rest and care homes and all care institutions in general. But thankfully, let’s launch the system first, let’s see where we are in terms of funding. Once the system is launched, it will probably need to be supplemented.

The sixth question was about the notion of responsibility of healthcare providers. It was necessary to maintain a system of accountability, otherwise we would head to a series of accidents due not to a simple mistake but to a lack of caution. It was necessary that the incitement to precaution should also be inscribed in the law by the notion of serious fault and intentional fault. by Mr. Goutry is wrong to say that these notions are not defined: the law clearly states what is understood by heavy fault and intentional fault. If a doctor operates in a state of drunkenness, for example, it is not up to the community, to the national solidarity to cover the costs of a possible damage while the doctor would have put himself in a wrong situation in an inexcusable way. Therefore, these notions of heavy fault and intentional fault had to be ⁇ ined.

Finally, I am pleased that the judgment in Perruche, that French judgment on which I myself had submitted a proposal at the time, was taken into account. After the ruling of the French Court of Cassation in 2001, I had submitted a proposal aimed at palliating...

I only came to the secretary for help. If he no longer knows what to recommend, I can always help him a little, Mr. President.

Thank you, Secretary Tante.

The [...]

I return to the Perruche stop, which seems to me to be a ⁇ important notion for the analysis of this project. In 2001, I had submitted a proposal aimed at mitigating a certain legal deviation and to clarify in our legislation that the fact of birth alone cannot constitute in itself a prejudice. By accepting that a disabled person may be compensated because he was born disabled as a result of an error in prenatal diagnosis, the Court of Cassation had recognized that the mere fact of birth could constitute a prejudice. It was a large extension from a punctual accident.

The Court thus venture to compare the incomparable, namely the situation of the child after birth with the situation in which he would have found himself if he had not been born. This reasoning had at the time aroused some concern, or even some indignation and unbelief. We could not accept his postulate of departure or its implications. On the contrary, a society must give every person the opportunity to live a dignified life. The principle of solidarity must ensure the disabled person a place in our society, and their problem cannot be compensated by a completely biased legal reasoning.

This case-law also infringed the fundamental principle of equality between persons. In fact, it appeared from the judgment that the life of a disabled person was worth less than that of any other human being. Life is for us an essential good, and the value of existence cannot be conditioned by its quality. Our society cannot accept that a sort of hierarchy between human lives is organized.

All these considerations seemed, therefore, to fall within the realm of irrealism. Nevertheless, France – which is a country that had not used us to this kind of legal derivative – had committed this decision causing several problems.

I am therefore pleased that we have taken a position on this ethical issue that is heavy with consequences, in order to avoid unfortunate judicial decisions.

To conclude, Mr. Speaker, Mr. Minister, dear colleagues, we will support this bill, because we are convinced that victims of care benefits will be quickly and properly compensated without endured long and costly legal proceedings. Furthermore, I believe that this text will contribute to the proper exercise of the art of healing and avoid the deviations of defensive medicine. This is an increasingly prevalent problem, very widespread in the United States, but it also exists in our country. This practice leads to medical overconsumption and an increase in health costs, in terms of spending on delivering a diagnosis.

This provision will also prevent venturing into the excessive judicialization and in the unstoppable growth of insurance premiums related to the exercise of the art of healing. Regarding these issues, I would like to answer Mr. and Dresden. Whatever he thinks, the least happy in the system we put in place, from what I hear, are the insurance companies. Patients and patient associations, as well as healthcare providers, have received the text with great satisfaction. Insurance companies, on the other hand, are more confused and doubtful. In the patient-insurer-prestator triangle, they are not the most delightful part of this text.

Mr. Bacquelaine, insurance companies have doubts. As long as we do not have execution orders, we do not know exactly in detail how it will work. It is therefore logical that they continue to maintain the pressure to try to have the most favorable distribution key. It is as simple as this!

If we had allowed the system to persist as it currently works, we would very quickly enter into a system of increasingly large insurance premiums. This is clear to everyone. This is what exists in the United States and in other countries that do not have this system. If the system had been gradually abandoned, insurance premiums would have become increasingly important and unpaid by healthcare providers, who would have had to replicate this cost in particular on the operation of hospitals. So we were in a system that was becoming technically ungovernable.

We really had no choice: we had to improve the system. We chose the procedure that I think is most effective at the moment. It will probably need to be improved as soon as we have implemented it so that both patients and care providers and all healthcare institutions benefit from it, one in relation to the damage they may have suffered, another in relation to their working conditions.

Thanks to M. and Bacquelaine. Fellow Bultinck? Picked M. Mayeur and then Mrs. Avontroodt. I alter the languages. Mr Bultinck, you have the word.

Mr. Speaker, Mr. Minister, Colleagues, I think we at least agree, beyond all boundaries of majority and opposition, that the present bill is a very important bill. I think we cannot emphasize this enough. Also from our group you have heard very clearly that we regret in the first order that the minister wanted to write such an important draft so late in this legislature, almost as the last point, still absolutely on his account. This is human and politically understandable. Our group regrets the fact that at the end of the legislature, such an important draft will soon be chased by Parliament.

I will come to a second very important element, Mr. Minister. In this, we also support the fairly sharp criticism of some colleagues from the opposition, even though we are in this issue – colleague Goutry will later notice that from my speech – not always on the same line. There is and remains, of course, quite a lot of uncertainty about a number of practical issues, which still need to be settled in KB. I will later address the concrete question, Mr. Minister, you are still trying to provoke a number of technically interesting answers, even if it was only to get a concrete view in which direction the KBs will have a concrete effect. It would be good if we got a little more clarity on this issue today in this Parliament.

If we look at the dossier technically, Mr. Minister, we all make the same conclusion that at the moment we are all facing an increasing number of claims for damages and that this in the medical corps gives rise to very defensive medicine. That in itself is not good. Let us agree on this.

I have also said very clearly in my discussion in the committee that the Flemish Interest in no way – I repeat this today in the plenary session – wants to come to American states, in which all kinds of insurance companies earn rough money to organize all kinds of claims, provide compensation and so on. We reject this system. In this sense, we are also willing to look for another solution in a constructive way. In this sense, we say without any problem, from the opposition, that it is positive in itself that a draft of this level is finally presented.

It is good, colleagues, however, to remind for a moment of long-lasting times in this Parliament, when already at the passing of the Law on the Rights of the Patient, on 22 August 2002, the appointment was actually made. One had to eventually compensate the other in order to regulate that faultless liability legally. We continue to regret that this has left us waiting for so long. Therefore, it was more than time to make this work concrete now.

Mr. Minister, let’s go over the whole debate – which we have been able to conduct quite thoroughly in the committee for a part – even if it was only to get some additional clarity on a number of questions.

The first important point of discussion with the Medical Corps was, of course, the entire problem of funding of the Fund for compensation for damage caused by accidents in healthcare. We all know that there are three parties involved, the healthcare providers, the RIZIV and the insurance sector. The main fear of the Medical Corps was – and is probably still – that this could occasionally lead to a drastic increase in professional liability premiums. Mr. Minister, you have responded quite clearly to this in your responses in the committee. In that sense, I belonged, as far as this part theme was concerned, to those who were somewhat reassured.

It would be good if you could confirm once again in your answer today that there should no longer be any uncertainty in that area and that it is not intended that these insurance premiums would be pushed even higher, and that we can indeed give the medical corps the guarantee that there will be punch and punch. It would not be unnecessary to hear that confirmation again in the answer you will give later in this plenary session.

The second point of discussion, on which the Medical Corps – in part correctly – asked for guarantees, concerns the following problematic question. If the RIZIV must intervene, will it affect our budget objective, specifically the medical corps, but will it, in other words, affect the budget in relation to honorary wages? This has also been said in the committee, and we have taken note of that piece of clarity. However, it would not be bad to reaffirm that additional clarity in this plenary session, and to say that therefore it may not be the intention to finance the Fund from the honorary budget, but that the resources for the Fund actually come from the overall RIZIV budget.

It remains open for a bit, Mr. Minister, if we see what your cabinet has explained in this dossier very concretely. It would be intended to be able to move to a scheme that would eventually be able to reimburse 70% of damages. I am making another attempt, Mr. Minister, because there have been no concrete answers in the committee. Can you guarantee that 70% of damages will be reimbursed? After all, 70% is ⁇ high compared to wax abroad already in force. I make a very explicit attempt, Mr. Minister, to obtain more clarity from you on that part, on which, even after the answers in the committee, uncertainty persists.

However, the numerical debate continues to hang and there remains a lot of uncertainty. From your cabinet one has continued to talk about grosso modo 80 million euros, when it comes to the whole problem of the cost sector that we need to be able to finance this fund, while one at the Knowledge Center had very clear about grosso modo 140 million. In the insurance sector – which in part of course also has its importance – one spoke of a cost of 240 million. It would be good to have more clarification on this subject. Even though the Knowledge Centre has confirmed in its second version of the study that it is confident in terms of its assertion and its calculations, it would be good to get additional clarity on this subject today.

One of the following pain points, which remain standing, is whether or not hospital infections should be included in the bill, as it now predicts. I think we agree that if we really – and this is happening in this design – include hospital infections to a certain extent in the design, this will obviously result in a huge cost increase. Then we must ask ourselves whether it is appropriate to include hospital infections in the design by definition. Has the calculation of the resources and the budget provided sufficiently taken into account the high risk? Indeed, once we have included the hospital infections in the fund as it is now conceived, we must ensure that we can keep the calculations in the budget that we have prepared for it under control.

A third discussion point with the medical sector that remained partially open was the whole debate about whether or not to include a limiting list of serious medical errors. We expressly support the medical corps, which has expressed its satisfaction with the fact that the final version of the text, as it presents, has indeed included the limitative list of serious medical errors. It specifically concerns acts under the influence of alcohol and narcotic drugs and forbidden activities. That limiting list of serious medical errors is now definitively in the design. I think it is a good thing that this is finally settled.

Mr. Minister, one of the few institutions that we occasionally take seriously and seriously is the State Council. However, the State Council has made quite sharp comments on a certain number of aspects of the draft as presented here today. I would, of course, first refer to the observation of the Council of State concerning the possible risk of discrimination which could possibly arise between the victims of medical accidents and the other victims who cannot invoke this system. The State Council has explicitly pointed out the possible violation of the principle of equality. If we no longer apply Article 1382 of the Civil Code as regards civil liability in the practical implementation, this does indeed involve risks.

A second item to which the State Council has very explicitly commented in this draft, Mr. Minister, was, of course, the whole problem of the famous exemptions, the ceilings, the franchises that are provided. I am making an attempt today, Mr. Minister, to gain insight into how those franchises will look in practice. This must be resolved by a royal decree. Specifically, are you already aware of those franchises? How will these exemptions evolve? After all, it is not insignificant that in this view we get to the root of the situation.

I come to the next pain point. Mr. Minister, is the problem of medical errors in the rest and care homes resolved with these? This remains a sensitivity of our group and we will continue to repeat it. This is within the competence of the European Communities. Are the medical errors committed in RVTs and ROBs covered by the regulation? You answered in the committee that there is indeed a working group with the Communities. I would like to make an attempt today, Mr. Minister, even though I realize that this draft has theoretically not yet been voted by the House today and that it will probably be evoked by the Senate, to technically ask some questions about the course of affairs within that working group. Has the working group been formed? Has the Working Group been meeting? What is the first state of affairs in relation to the activities of that working group? In the whole debate on whether or not to include medical errors in relation to RVTs and ROBs, this element remains one of the crucial points.

Mr. Minister, the State Council – and this must be said – was about the design as it predicts, not really mild. The State Council had quite a few critical comments. He has spread his entire advice over 50 pages. When a respectable institution such as the State Council issues a 50-page opinion, we as members of Parliament should nevertheless make the minimum effort to read those opinions seriously and try to take some consideration in the legislative work.

Mr. Minister, I will give you some of the long list. The entire problem that remains unclear is what happens when the patient’s rights are not or insufficiently respected. The State Council makes it very clear that the deadlines for dealing with the Fund are quite short and that one can question whether they are indeed unrealistic. Does this not ultimately make the fund inoperable?

The State Council also had quite sharp comments on the part franchise and ceilings, as I said earlier. Grosso modo, however, the State Council made quite a few comments on the part of the funding of the system in substance.

Mr. Minister, the next element that I want to point out is very clearly the problem – we must put it in the right context – that the patient is not involved in the investigation in any way and at any time. The investigation, as it is now regulated, is conducted through the insurer, who eventually becomes directly the intermediary, who must settle the case through the fund.

The fact that the procedure at the Fund is no longer contradictory is and remains subject to debate. There is the double track that exists in France. Colleagues have referred to it. Here we choose very clearly for a clear track. That is a choice, that is a certain policy set that we push forward. One might have better – we must dare to make that comment – kept the double track as it exists in France, standing. There is – we must make this conclusion – a limitation throughout the whole system of franchises: there is no integral compensation for the damage, as the case is regulated in practice.

On the other hand – this is not insignificant – we as a group are very pleased that in a draft, which comes from a PS cabinet, in Article 5 is almost literally included a bill of our own group, Mr. Minister. I refer to the bill proposed by one of our colleagues to regulate the compensation granted in the case of liability for the origin and survival of human life.

Correctly summarized, it comes down to the following. Article 5 states that the origin and continued existence of human life and the fact of being born cannot give rise to compensation. We also say very explicitly that we see this as a positive element. A Flemish Interest Law proposal that is incorporated into a government draft, which does not happen every day. It is therefore a positive element that I must mention, that this is happening in practice today.

Mr. Speaker, I am going around. Mr. Minister, when I am asked what is the crucial attitude, ending stance or closing stance that the Flemish Interest Group will take, I say very clearly the following.

The political conclusion that we must draw from the present draft is that progress has finally been made in a file that has lasted too long. We have no problem with acknowledging that this dossier, and the design, as it is presented today, is indeed an improvement for the patients and for the doctors. However, I also tell you very clearly that this design still contains many uncertainties. There is still too much to be arranged through KB. In part, it is the merit of this design that there is finally a design and that there is finally – in this I differ in opinion with our colleagues from CD&V – a strange, positive evolution. Everyone agrees that the current situation could not continue. The current situation of medical errors is not a good thing. Patients now need a solution and compensation for the damage suffered. With this design, at least, it is provided with a very rough rough construction, which makes it possible that the scheme will be concrete via a KB. In this sense, we consider the present bill as a positive evolution, though too late, incomplete and not perfect. In itself, this draft is cautiously approached positively, because it could finally, after eight years of debate, offer a solution – I express myself very cautiously in the future time – to a very important problem, namely the problem of medical errors and the faultless liability.

Mr. Minister, you will find that at the final vote we will expose the positive evolution of this draft for a bit positively, but with the explicit question – we will remind you of it telkenmal – to provide very quickly clarity about the direction in which your KBs will go. In itself, it is a positive evolution that this design is there today. It comes too late, but at least it has the merit of being there. We will also demonstrate this positively.

Mr. Speaker, Mr. Minister, dear colleagues, the PS Group is delighted that we will finally vote on a bill that will allow compensation for patients victims of damage related to health care and medical acts.

This is a file, as other colleagues have said before me, which took time, which was already under the previous legislature and which finally comes to an end before the end of this legislature.

We have often and much discussed the nature and composition, the financing of the state body that would have to intervene in compensation and the modalities of compensation. It should be remembered that an important work has already been done by Parliament. This is evidenced by the numerous legislative proposals on the subject, as well as the hearings of experts – university professors, representatives of the insurance sector, doctors – which took place. It is by this work that the Public Health Commission opened this legislature since it is the first thing we did: a day of reflection on the problem of therapeutic disorders.

Among the parliamentary texts that had been deposited, there was, in particular, a proposal for a PS law aimed at solving the specific problem of nosocomial infections, which therefore occur in the hospital environment, which is done in part in the project that is submitted to us.

A second element of our bill, which aims to impose hygiene standards on hospitals, is not taken, but, through royal decrees or in a future legislature, this aspect can be addressed. In any case, we do not regret that progress has already been made on this subject in the text presented to us.

The subject that concerns us, therapeutic disorders, is important because it obviously affects people from the point of view of their physical integrity but also from the financial point of view. This latter aspect, even if you are in a medical setting, affects not only patients but also their loved ones in a significant way because judicial procedures, appeals have consequences and repercussions on the family and financial aspect, and this in the long term, too long term.

As I said, the current situation is far from satisfactory.

The press, the associations of patients and victims have often alerted us. We have read phrases such as “The patient is helpless” or “You find yourself completely alone” or “Without money, you get nothing.” “The doctors are trying to stifle the case,” titled some newspapers; “The medical environment is insensitive.” These are obviously unacceptable statements but it was the relay, ⁇ in a consumer defense magazine, of concerns that are very real and affect patients who have been confronted with problems, accidents, medical errors.

When a patient is a victim of a medical error, it is difficult for him to establish proof that the damage he has suffered was caused by the doctor or by the therapeutic act that he made. But the physical consequences, the economic and social damage that may follow, are not always or entirely covered by adequate compensation, it is the least that can be said, not to mention the human dimension of the drama that can be experienced by a patient and that compensation cannot alleviate.

We also know that the intervention of a doctor can fail without the doctor making a mistake. There is always a risk; medicine remains a random activity, at least partially, and doctors are subject to an obligation of means. Unfortunately, it is still not possible to contract an obligation of results.

In Belgium, compensation for healthcare-related damages can only take place at the moment if the patient can provide proof of a causal link between the fault in the head of the provider and the damage he suffered.

The legal recognition of patient rights in a particular text is a good thing. As the patient is a free individual capable of understanding and interpreting the pathology he is facing, the law on patient rights was voted under the previous legislature. But one aspect of this law had been omitted, to which our colleague Daniel Bacquelaine has alluded just recently: it is its indispensable corollary, namely the protection of medical practice. These two aspects are closely linked. Like him, I recall that we were promised in the previous legislature that a text would be deposited on the protection of the medical act. I am grateful to the government for doing so, although late in the legislature. Finally, the text is here. It is thus a promise to the members of the Public Health Commission who had quite rightly pointed out that the law on the right of patients would remain incomplete without a law that protects medical acts.

It is therefore important to emphasize that by the adoption of the Patient Rights Act, the doctor faced the mistake made during a medical act was very exposed. Now things can be balanced. Indeed, we cannot fall into a system like that observed in the United States, in which practitioners are constantly subject to pressure, threats of complaints, prosecutions in courts for possible medical errors or potential therapeutic accidents, the lawyer in the waiting room playing the role of oppression on the medical act and practice in hospitals.

This lack of protection in these countries leads to a form of defensive medicine, with some doctors and hospital institutions being pushed to perform acts or analyses not in the interest of the patient but to cover themselves and avoid being later blamed in the event of an accident.

It is important to counter the risk of seeing the doctor attempting to refrain from providing the necessary care or adopting a defensive attitude when giving care.

The Patient Law Act is only relevant if it is accompanied by a text protecting the practitioner from medical risk, from therapeutic accident. This is what we said in the previous legislature. Today we have reached a result. It should also be taken into account that otherwise, the relationship of trust between the doctor and his patient can also deteriorate. These deviations would not be without consequences on the financial level and on healthcare costs.

For us, therefore, it is important to allow fair compensation of the patient within a reasonable time, to allow doctors to continue their work serenely, to guarantee equal care and therapeutic relationship, not to hinder access to care for all. One of the essential tasks that a social democracy such as ours must fulfill is to provide those who are in a situation of vulnerability and dependence with the necessary guarantees of rights and certain legal certainty.

It is true that the Civil Code, even though it has been well thought out and works in many fields, today shows the limits of its efficiency.

I understand that in some environments – I heard the intervention of mr. Goutry – we are worried about changes. I would simply say that the change can only be beneficial to patients since the current situation is not effective in 95% of cases. I also read the criticisms formulated by the Christian Mutuality. Let us not condemn a priori a system we propose to establish when we know that it aims to replace a system that does not work – in itself, therefore, we cannot do worse than what exists today – and that it is also inspired by existing funds (employment accidents, occupational diseases). These funds work and compensate the victims. It is obviously not the same thing but it is inspired by a logic that exists for other subjects. I think this is the best guarantee that things will go in the right direction.

It is obviously not up to us – I will conclude with this point – to us legislators, as some have wanted in committees, to say what will fall into the fund or not.

I believe that it should be left to the people who will make up the teams of this fund the care to expert themselves whether a case falls within the compensation or not. They should also be able to establish their own case-law. We should not interfere in their work or make lists of cases that would be compensated and protected and others that would not. If we embark on that adventure, I fear not only that we are mistaken, but – in addition – that we are putting several patients in a situation of exclusion. This is neither your wish nor ours.

In general, we welcome the initiative taken by the Minister of Health and the Government. We truly hope that the opposition itself will understand and be able to support the logic underlying this project. I sincerely believe that it was designed in the interests of patients and the public, and that it is indispensable given the other legislation we have voted for.

The floor is yielded to Ms. Avontroodt. Then it will be the turn of Mr. Drèze, Mrs. De Meyer and Mr. by Verherstraeten. “It’s five o’clock, Brussels is waking up.”

Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker. I have divided it into three large sections in the committee and Mr. Goutry has read it thoroughly during the presentation of his report. In the end, this was very concise.

First of all. Mr. Mayeur, Mr. Bacquelaine has already mentioned this: it was indeed the completion of a question from this Parliament after we had passed a very important law during the previous legislature, in particular the Law on Patient Rights, as this is the natural follow-up of the Law on Patient Rights. The patients, the doctors and the government were asking party to determine the contours of a no fault insurance system. It is indeed at the fallout, at the end of the legislature, that a text was submitted. From our group, we are absolutely satisfied with this.

Of course, it is not a perfect law, not at all. In fact, at the beginning of my speech, I would like to refer to the end of it. There will ⁇ be an evaluation of this law after one, two or three years. Then the resem will ask questions that colleague Goutry has asked and which I think he himself cannot answer, or cannot indicate the direction in which sense...

... ...

No, Mr. Goutry, there are many proposals from many parties. I don’t think there was a bee from your party, unless I am mistaken.

With all respect – and that is a word you are very happy to hear – but you have had a very different debate in the committee. You have rightly asked a number of questions and pointed out a number of pain points. After that, I thought, I was listening attentively. If you read the report correctly, which I have done very explicitly, it was in a very different, even positive, sense. You have abstained. You did not vote against, but you abstained. This is of a different nature and, by the way, also with a different purpose than which this debate is conducted.

It is almost impossible to correctly discuss this issue. We behaved positively. I started by saying that we are for such a system.

I have begun to tell you that we absolutely believe that patients have a compensation for damages to be able to obtain a compensation for damages. Is dit voldoende als alibi om zomaar wat te maken in om het even wat in elkaar te flansen, met veel vragen in bedenkingen in without guarantees, noch over de financiering noch over de procedures? U neemt daarmee genoegen bij wijze van een resolutie die niet eens een wetsontwerp kan worden genoemd. Afterwards verwijt u us that we against would be. In that case, I don’t know what we’re talking about. I am very sorry.

This is the dishonesty of the debate. Either the design is good and it is done well, or it is not the case. It’s not because an architect says he will build your house well that you already have a good house. That is something very different.

Mr. Goutry, you have your opinion. I will respect them. At least let others refresh their memory. It is all not so long ago. You know it yourself well enough. We have known each other for a long time. You know it yourself well enough.

Mr. Minister, colleagues, there was a lot of discussion about the concept of “abnormal damage”. People involved in the medical sector know very well how thin and how fragile the border is between normal risks and normal, unavoidable side effects and what is ensured through the design, especially the abnormal damage.

The definition given by the Minister is not wrong. In the bill, it is very clear what abnormal damage is, what is covered and what is not covered. This is not the big trouble point.

The scheme provides for compensation for damages associated with a care provision but does more. It goes even further, not providing the care a patient could legitimately expect and – indeed – infections fall under the scheme.

I do not want to return here to the difficulties that arise around hospital infections. Mr. Minister, I pointed out very clearly that the aforementioned infections were not included in the study of the Knowledge Centre. That there is an unknown in this area is therefore correct. Nevertheless, I would like to repeat my plea, namely to have the Knowledge Centre also investigate the nosocomial infections in rest homes and in rest and care homes. Before we include the aforementioned infections in the law, we must be able to speak with knowledge of matters.

Part of the design is, by the way, based on the three different studies of the Knowledge Centre. I have made extensive references to the mentioned studies in the committee.

I will not return to the abolition of the application of Article 1382 of the Civil Code. My colleagues have already done that. The abolition is a clear choice related to the feasibility and transparency of the system, precisely to provide greater legal certainty.

That ⁇ does not mean – and I would like to emphasize this here in view of the quality of the system – that the impunity of the doctor does not prevent. That was one of the concerns that many colleagues had expressed.

The problem of the insurance of hospital infections can, in my opinion, ⁇ be monitored if the Knowledge Centre can also apply its knowledge and expertise there. Regarding the registration of hospital infections, it can be said that this is still only in children’s shoes. In this regard, we cannot predict where we are going. Prevention is needed and will continue to increase. Prevention will always be necessary. However, the cost of hospital infections in the future is completely unpredictable. Our president is not Madame Blanche, but I believe that none of us can be.

However, an important added value of the scheme is that for the first time we will get real sight, – Mr. Goutry, you mentioned very little about it – on proper registration, on all possible and impossible therapeutic accidents and hospital infections. I think it is good that that data collection is included in the design so that we can measure the quality of our institutions and the quality of our concerns in terms of output, which is the cure of diseases, and not in terms of finance or in terms of square meters and such more.

One of the problems is, of course, the funding of the fund. Mr. Minister, I have one concrete question. It might be useful in the context of Article 33... It is in it but the uncertainty remains and colleague Bacquelaine has already mentioned it. If one sector has big questions and may not be so sure, it is the insurance sector. One of the crucial conditions for us was that it should not be cost-inducing for the premiums and that those premiums for the doctors should not go up quickly. We belong to the area where this fear exists. If everything is reimbursed, it cannot be otherwise, they mean and say, than that the premiums would increase. The key to this is, in my opinion, however, in Article 33, which should be able to make it clear that the insurance is given that the premiums do not increase for the healthcare providers. This was an essential condition for us. It was, by the way, something that the Prime Minister also stated in the plenary session: that these would be the contours for the establishment of a “no fault” system. This is, of course, conditional, which is only possible if the part of the total damage burden that would be borne by the insurance sector is determined and limited.

This is a difficult question. There are so many words in Article 33. This is, of course, a crucial question that needs to be answered in the long run.

Ladies and gentlemen, I will leave it here. Open VLD will surely approve this. We did this in the committee too. We thanked the government for this effort, but for us, a review after three years is ⁇ desirable, both in terms of the amount of benefits and the budgetary cost of the system. I would like to advocate that the reporting and data collected through the Fund be made available as transparent as possible to the whole sector, both patients, providers and the government. I think we can all learn from that.

Mrs. Avontroodt, can Mr. Bultinck, who has been short, interrupt you?

I have one question for clarification, colleague Avontroodt. I see that your group insists on an evaluation. I think that in itself no one can have anything against it. The fact that the majority asks for an evaluation after a few years is in itself strange.

I think we could have made a better proposal than today. I just tried this in my speech. If the minister could show the direction he wants to concrete with his KBs, we would at least as Parliament get more clarity in which direction those KBs are going, and then it would be possible that we should not even leave behind the evaluation itself. I would rather have that today we get clarity about which direction the KBs are going.

I have a problem with your convenience solution, in which we will evaluate the problem afterwards. I would rather see that today we are getting clarity about the state of affairs with regard to the KBs and the direction we are taking. Then that evaluation may even be positive after a few years. I would rather get clarification today and would rather not wait until we have to evaluate the matter within two years.

Mr. Bultinck, I have two answers to this. First, I would like to recall that you asked that question to the Minister whether there were already KBs or draft KBs and that the Minister responded negatively to them. So I think it was not possible.

Second, I see no contradiction in asking for a permanent evaluation of this system. I consider it the most normal course of affairs to put such matters on the website of the fund to be established and that that information is transparent and accessible. I really see no contradiction in that. I will explain my question here again. I think the review and step-by-step implementation of the law will be necessary.

Mr. Speaker, I make a small attempt of clarification for Mrs. Avontroodt. I did not ask the Minister whether or not there are implementing decisions. I am also aware that they are not there yet, because the law has yet to be passed. I have explicitly asked for the direction the implementing decisions will take, because that is important to know. If we know in what direction those royal decrees will go, this can reassure us. Whether there are implementation decisions or not, we have no message to that. I would like to know which direction they are going. I hope that the Minister will be able to answer this later.

I suppose you are asking this question to the Minister.

Mr. Speaker, my assertion that this is an empty box is backed up again. This text takes the level of a resolution and not a bill. It is confirmed here again. There are still 41 implementing decisions to be taken, for which there is no draft yet. These decisions are precisely a guarantee for the system, a legal certainty for the people. Then it is announced that a big breakthrough has been achieved, while this is a first small step. Mrs. Avontroodt, an evaluation is in the law itself. That is the only good that is in the law. There is an article in which it is stated that there must be an annual report. The rest is not defined.

Mr. Speaker, Mr. Minister, I will say at the beginning of the game the respect I feel for the work done and I understand well the options that have been adopted.

This is the “captatio benevolentiae”.

We do not share these options at all points, but we agree with the principle of responsibility without fault, which is a generation principle that appeared quite recently in Belgium. In fact, the legislative proposals before the one I submitted in 2005 were different. We are very pleased that the government has adopted this view.

I have to repeat here a clarification that I had already delivered in the committee. Nearly a year before the introduction of the proposal you are talking about, I had organized in collaboration with the Senate and the House a commission in which I had pledged in favour of this point of view. This principle is not revolutionary.

I was talking about parliamentary work. The earlier bills – it is logical, they date back to 2002, 2003, 2004 – adopted a different point of view than liability without fault.

It is false!

Since 2002, since the Law on the Rights of Patients!

And the debate that took place in committee in collaboration with experts dealt with the subject of "no fault". This is the work we have done.

And the debates, yes.

Anything of anything!

The project approved by the government is clearly a hybrid compromise, as it contains both a public and a private aspect. This is primarily what makes us troubled. That’s why I decided with Mr. Goutry and Verhaegen to resubmit the most important amendments. One of the issues is who manages the fund. We had proposed that mutualities should be stakeholders in their capacity as experts, such as insurers; in that they benefit from the trust of patients and in my opinion they have more; in that they operate for non-profit purposes and this difference is fundamental compared to private insurers.

To put the mutualities on their backs today, whether they dare to express themselves or not, is a disability that should not be underestimated in the execution, tomorrow, of the bill.

Insurers have the good part. First of all, at the level of the old reserves, nothing is said. I will return to this point through the amendment I am proposing again. The file is designed in such a way that the premiums are ⁇ ined; it speaks of the "significant contribution of public financing". It is not certain that compensations, which will be larger tomorrow than in the past, will compete with additional public funding. Therefore, it is not forbidden to think that the profits of insurance companies will be even greater than they already are today.

I will come, Mr. Minister, to another question concerning the details of financial movements. In commission, you have schematized the circuit of the file as such. This is stated on page 12 of the report. Here you describe, point by point, in a clearly comprehensible way, 7 steps of the path of the dossier. You add the notion of the joint guarantee fund and the possibility for the victim to be represented or accompanied.

After schematizing the file circuit, you have presented the five types of funding sources, namely:

an annual allowance to be borne by the State;

- an annual allocation to be borne by the INAMI budget;

- the contribution of healthcare providers through premiums paid to insurance undertakings;

the income from the subrogatory action;

the financial products collected from the amounts available to the Fund.

All this is on page 13 of the report and is quite clear at the level of principles. There is a discussion about the royal arrests. It is obviously quite logical that the arrested follow the law and that it is not the opposite. As the State Council has repeatedly pointed out, as well as several parliamentarians not only from the opposition, there is too much royal authorization. Some elements should be included in the law so that it can be seen more clearly. In particular, the Minister does not specify the concrete arrangements concerning the amounts of compensation and the portion of the premiums that will be allocated to compensation, to the coverage of administrative costs, to the benefit of insurers and to the reserves.

I am referring to the proposed amendments, which will not be repeated at this time. First of all, I am referring to amendment 2. I am delighted that it is partly taken into account by the Minister and his collaborators, as blood transfusion centers and clinical biology laboratories have been reintegrated into the scope. However, we regret – and we are not the only ones – that the same is not the case for rest homes, rest and care homes and for ambulances.

I note on page 34 of the report that the Minister proposes to amend the bill to allow the King to increase the coverage of rest and care homes if the Communities agree to increase that of rest homes. That would have been very useful. I expected that this tense perche would be followed – as was the case in other elements of the file – by one or more amendments of the majority. I think we missed an opportunity.

I hope that we will be able to make this improvement during its journey in the Senate, given that the matter is clearly discussed in the Senate, unless our amendment is voted today. In this case, there is no need to risk changing the text in the Senate.

On this point too, the Council of State has been extremely clear. The Minister replies, as I understand, that he did not want a different treatment of rest homes and rest and care homes. This does not justify the fact that we have not found the time, since waiting for this bill, to discuss with the federated entities to conclude a cooperation agreement.

Then comes our amendment no. 4 to article 2, which is necessary for subsequent amendments and which has the merit, in our opinion, to clarify what is meant by "medical accident". Furthermore, the State Council notes that the fact generating the damage is not defined, which leads to a certain fuzzy in the scope of application. Medical accident means any unintentional event causing harm and finding its cause either in a health care provision performed by a health care provider, in the absence of a health care provision that the patient could legitimately expect given the state of science, or in an infection contracted during a health care provision.

Then comes our amendment no. 19 to article 5 which has been the subject of discussions at the end of which we have not been reassured. The amendment concerns Article 5, § 1 in which it is proposed to replace the words "of normal and foreseeable risks or side effects related to the provision of health care" with the words "of side effects of the provision of health care which have not an abnormal character". I note that several majority speakers have used this expression of “abnormal risk” and that the minister himself has said, as is ⁇ on page 35 of the report, that “the therapeutic field by nature involves a share of risk that must be taken into account. This risk should not be confused with known side effects of this or that therapy which, in turn, do not pose problems of responsibility. What attracts attention is the abnormal risk, that is, that which is generally not expected, the criteria provided for in Article 5 corresponding to a more precise definition of the damage that cannot be compensated. In this case, the victim must prove the abnormality of the damage."

If this term (“abnormal”) is commonly used by everyone, I would expect to find it in the text of the law. I am surprised, especially since you, like us, refer to the French regulation. We should clear up this slight dispute with regard to the French reference.

I am referring to previous amendments in order to keep the order of the articles. I come back to amendments 6 to 14, which present nine concrete situations with precise compensation to respond to the request of the State Council to indicate in a more consistent way in the law how the victims will be compensated and which are inspired by the work of Pr. Fagnard, to which many of us have referred.

Mr. Mayeur, these amendments are inspired by what is happening at the level of the Labour Accident Compensation Fund while knowing that the context is different.

Amendment No. 6 refers to the situation of a victim who dies as a result of a medical accident and stipulates the compensation for funeral expenses that is granted.

Amendment No. 7 indicates the compensation granted to the rightful recipients of the deceased patient.

Amendment No. 8 specifies that the children of the victim each receive an equal pension equivalent to 15% of the basic income, without that the total may not exceed 45% of that income, with other precisions.

Amendment No. 9 stipulates compensation in case of total temporary disability.

Amendment No. 10 stipulates the compensation in case of partial temporary disability exceeding for six months at least the rate of 15%. I am grateful for the details of the compensation.

Amendment 11 takes into account the case of disability that is or becomes permanent and that exceeds the rate of 66%. In this case, for example, the annual allowance is 100%, calculated on the basis of basic income and the degree of disability.

Amendment No. 12 refers to the situation where the disability is or becomes permanent and exceeds the rate of 15% but does not exceed 66%.

Amendment 13 addresses the case of disability that is or becomes permanent and is less than 16%.

Finally, amendment 14 refers to the case where the condition of the victim absolutely and normally requires the assistance of another person. In this case, the victim may claim a supplementary allowance fixed according to the degree of necessity of such assistance, on the basis of the guaranteed average monthly income as determined for a full-time worker by a CCT concluded within the National Labour Council.

I am moving forward in the amendments and I am coming to amendment no. 20 to article 33. by Mr. Mayeur abstained in the vote on this amendment. I would have liked more conviction. This amendment specifically refers to the reserves of insurance companies. In fact, even the KCE (the Federal Center for Health Care Expertise)...

I expressed myself independently, but does your group leader follow your amendment? Is he aware of its significance?

I just heard Mrs. Avontroodt’s theory of abstinence regarding a bill that marks a rather pronounced attachment. He spoke of the abstention. and Goutry. I hear that mr. Mayeur abstains on an amendment submitted by the opposition, which must be ⁇ relevant. The fact that the majority supports an opposition amendment from the end of the lips will only make me listen with even more attention to Mr. President’s speech. and Dresden.

Mr. Wathelet, this reminds us of the training of our fathers!

Several speakers highlighted the evolution, which we want to stop just like you, towards a form of judicialization of medical accidents, with the consequence of an increase, year after year, of insurance premiums. Thus, these companies could develop within them abnormally high financial reserves compared to the risks incurred. On the one hand, the premiums increase according to the risks incurred and, on the other hand, because companies want to develop extremely large reserve funds. These could have been justified at a time when some cases actually cost companies very expensive, but there is enough time to think that there is no need to have such high reserves.

We thus shape a regime which I will characterize as universal with significant public funding. We can therefore ask ourselves, Mr. Mayeur, about the becoming of the reserves of the past. Could one eventually allocate a part of it to the fund now created, which will need a capital, a treasury? As for the part that may be left to companies, can it be taxed? In this regard, the bill is relatively silent. I hear the Minister say in the committee that such article will allow to intervene. However, I would prefer the amendment to be adopted. We would have a much clearer, explicit legal basis that could be activated without any reservation.

As a committee, I had withdrawn Amendment 21 following the Minister’s response (I refer to page 45 of the report). The Minister of Social Affairs and Public Health refers to Article 10, last subparagraph of his project, which provides for the possibility of individualizing the amount of the premium. The purpose of our amendment 21 is, according to the minister, already met by the draft.

I reviewed the government’s draft in detail, and as with the financial reserves of mutuals, I prefer to have a quite explicit text. With Mr. Goutry, we have therefore decided to reintroduce Amendment No. 21, which aims to add to Article 33, §2 between paragraphs 1 and 2, the following text: "The King may, by decree deliberated in the Council of Ministers, determine the modalities for the calculation of the premiums referred to in paragraph 1, in particular with regard to bonus-malus".

In fact, the new device carries, according to some, a risk of disresponsibility of service providers. In addition to the task entrusted to the Fund in the field of prevention, we propose to entrust the King with the power to settle certain arrangements for fixing the amounts of insurance premiums in the field of bonus-malus.

I have one last amendment.

I very much appreciate Mr. This is especially important because he supports his amendments. I have to take into account the others!

( ... ) He proposes his amendments.

Mr. Speaker, I could not have done it now and postponed it for later in the discussion.

It is obvious. by Mr. Goutry did it too.

We discussed this with Mr. Goutry and I would like to withdraw today the last amendment that aims to postpone the entry into force by one year.

I actually saw that you had changed the date in your last amendment.

If the other amendments are accepted, the amendment will be withdrawn immediately. In this way we will have the guarantee of a bill that we understand and which we find effective and clear. Today, especially with all royal habilitations, these are elements that should be included in the law. We are not reassured. Everyone knows that elections will be held on June 10 and then negotiations will follow. The current government will be in ordinary affairs until the formation of the next government. We are not convinced that by the end of the year, the government will be able to produce urgently high-quality royal decrees. We therefore prefer to protect ourselves from an unfortunate situation by proposing the entry into force on 1 January 2009 rather than on 1 January 2008.

With this in mind, I would like to make two further interventions which, in my opinion, bring an added value compared to what was discussed on the day in question on Tuesday in the committee. I have a note from a physician-advisory specialist in body damage assessment about this famous notion of “predictable risks.” As I said in the committee, it is confirmed that these terms "predictable risks" are part of the medical literature and that behind these two words, a lot of things are hidden. You cannot ignore them.

by Mr. Bacquelaine recently took the quite clear example of the ablation of a lung. He understood that we knew what was going to happen. I will take a few examples. It is not my intention to ask the minister in what cases there will be compensation but it is simply to prove that behind the terms "predictable risks" there are concrete situations.

First, perforation on colonoscopy is a frequently encountered situation that can sometimes lead to major consequences. Mr. Germeaux, you know this better than I do: the risks are about 0.2% of cases. This figure is much larger than for average risks in care benefits. In the case of associated polypectomy, the risks can reach up to 1.4%. This is not anodin. This type of risk is defined by the medical literature as predictable.

Secondly, radical prostatectomy is...

by Mr. Germeaux wants to interrupt you, “Doctor.”

We also had this discussion in the committee. You can find here for another hour all possible and impossible mistakes in medicine. Just go on. I will stay there until 7 a.m. tomorrow.

However, you are not correct in the comment we made at the time. You need to put it in your ears, Mr. Drèze, good medical practice exists. The medical practice is tested. If you go outside, you can simply be prosecuted. Just go on. For my part, you can list here hundreds of perforations of all possible. You are prosecutable, if you go beyond the numbers of good medicine. In that case, you are to be accused. This is outside of this bill. This is the other, classic procedure. I don’t think it’s the intention of listening here and today for hours. I do not think you are right, Mr. Drèze. You know that.

Parliamentarians have the right, before voting on a text, to hear different opinions in order to form their own opinions.

I find this especially short through the curve. Here it is said that anything that is not in accordance with good medical practices is serious intentional mistakes. All this falls under criminal law. Amai, we will get a lot of processes!

What are Good Medical Practices? Where are all those directives? What statutes do these directives have? These are usually scientific agreements that have no legal basis for the rest and that will always be qualified case by case by case by the court. What you say, I think, therefore, is a very large municipality, which has no legal basis.

by Mr. Dresde asked the same questions in the committee. I told him that I understood that these questions are being asked. But it is not up to the legislator to answer about the consequences of this or that medical act. It would be dangerous if we said that in such a case there would be compensation and not in such another. This is not our role. It is the responsibility of experts to address these problems. If tomorrow someone is compensated or not, because we would risk appreciating situations that are not within our legislative competence, and even our intellectual capacity, I think we would have rendered a very bad service to the population.

It is as if, to take the example of the Road Code, we discussed the precise circumstances under which a driver coming from the right must act. Again, this is not our role. We set the rules, and then the experts do their job.

The [...]

He was talking about politics.

Even as a left-wing man, I can understand this for the Road Code!

Mr. President, I would like to give Mr. Drèze another answer. Did Mr. Goutry also ask for the word?

I can give a concrete example of why and what it is about here. You might go with it. Because apparently, if I believe you and if I follow your reasoning, any mistake that could happen could be eligible.

However, other criteria are used. Mr. Goutry, that is not different in insurance medicine.

In childbirth, for example. There is not a single gynecologist in this country – fortunately – who can present a flawless course. Fortunately, a certain margin of problems is accepted. If the gynecologist exceeds that margin, then he is punished by increasing his insurance. If you require the maximum to be reached, zero mistakes, then that is not possible.

That is why this bill exists. If a gynecologist has done his business or his work well, and yet there is euphoria, then that must be reimbursed. That is nothing more than logical. However, if you want to name every exception and see compensation, depending on, then that is impossible, and that is also not the intention of this bill, not at all. You can continue, you can continue for hours. I think that what lives on the ground is very well regulated, and that we should keep it so.

Where there is malpraxis – let me use that word – there are other means available to combat it.

We have different examples in mind. We thought this would be considered in some cases and not in other cases. The cases we have in mind are not the same. This is what worries me!

Article 4 is clear: patients and their rightful recipients are compensated. Article 5 § 1 states that damages resulting from points 1, 2 and 3 are not compensated. I have no problem with the first two points. My opinion is about the third: "Normal and foreseeable risks or side effects are not compensated." The words “predictable risks” are used; but behind them is hidden a medical literature that you know better than me and that will pose problems tomorrow. I suggest you change these terms by taking back the qualificative that you yourself often use, which is the word "anormal". It’s as simple as that, I’m not going any further!

I do not interfere with the debate because it is a dialogue between parliamentarians. But they ultimately testify to the fact that the government’s attitude is justified.

On the question of predictable risks, I had the opportunity to speak in committee and Mr. Dress had the kindness to recite my words. I would like to emphasize that when we talk about predictable risks, we always do so based on the state of knowledge and the evolution of medical sciences and techniques. This means that if we take the risk of fixing a list tonight, it is necessarily in the state of current knowledge of science and technology. And this knowledge is not the knowledge of tomorrow or aftermorrow. It would be dangerous to have to change the law every time because the evolution of the scientific literature allows it. That’s why I think that borrowing from the royal decree is more interesting. This partly answers the question. Bultinck: For obvious methodological reasons, we could not go into the law until the finest detail, until the last carat.

Either there is a misunderstanding, or it is more complicated than that. We pursue the same goal as you. We simply use different terms, which we find more appropriate. That’s all, I say. And if I say it, it’s because there are people behind me who think so. I refer to a specialist counseling doctor – he’s not an idiot – and his colleagues. We will see tomorrow!

As for my last point, I could have addressed it in committee, but it took a little time to prepare it. By reviewing the text in detail, I wonder if problems do not arise at the level of the deadlines proposed by the bill.

I explain, you have to be a little careful.

If it is done chronologically, the applicant first introduces his file to the fund. The latter must accuse receipt within 15 days – I assume that these are calendar days – that is article 17, §4. If the Fund considers that the file is incomplete, it shall add to the receipt statement a request for additional information. The applicant has 30 days to respond. When the file is complete, the fund has 15 days to send the request to the insurance company concerned. The insurer then has 10 days to notify the applicant of his intervention. This is the first step.

The second step.

The insurer or fund can still request additional information to support their dossier. Each time, since it is not specified that this can only take place once, the applicant has 30 days to provide such additional information.

Article 19, §2, paragraph 2, provides that the period provided for in Article 24 is suspended for 30 days. It should be read “Article 23” and not “Article 24”. I will ask you to check that this is not a number error and if so, the reference to the Senate will allow to correct it. Furthermore, what do you mean, Mr. Minister, my colleagues, the terms "taking into account the periods of suspension"?

Does it mean that the suspension period should be added to 110 days or that it has already been taken into account and that it is a maximum period? If we look at the first hypothesis, the formulation appears to me nebulous. Speaking of the term “reserved” would seem more appropriate. If this is the second hypothesis, what is the difference between the first 30-day deadline that is not suspending and the second that appears to be?

The third stage.

Article 23, §2 provides that the applicant to whom a reasoned proposal is made has 30 days to submit his comments. He may request an extension of the deadline. It is then said that the deadline – but no maximum deadline is specified – of Article 27 is suspended during the extension. I think we should talk about Article 26. Once again, it needs to be checked. Furthermore, I formulate the same question on what is understood by “suspension period”.

The Fourth Stage.

It is provided that in case of disagreement, the fund and the insurer shall each designate an arbitrator who, in turn, shall designate a third person by mutual agreement to form a college (Article 35). However, it does not specify the deadlines within which such designations must take place. It is therefore assumed that this is within the 80 days provided for in paragraph 2. When you know the time it takes for a college designation (two months), there is a risk that there are only very few days left for the analysis of the file at the fund.

The fifth step.

Article 25, §2 explains to us that the collegium of experts has the task of reconciling the views of the fund and the insurer. He has for this to do, as the law says, a period of 80 days after the expiration of the period of Article 26. This article tells us about a period of 210 days, taking into account the periods of suspension. So, 210 plus 80 days, this gives us a total of 290 days of suspension. The college then notifies its decision...

In addition, knowing the terms and deadlines of current judicial proceedings, I count. We will then make the balance sheet.

The college shall then notify the decision to the fund and the insurer within 80 days and the insurer shall notify the applicant of its decision within the time limit specified in Article 26, which is 210 days. If the insurer gets there, he is very strong.

I have not done the same calculations as you. I find it interesting and your demonstration may be relevant. Assuming that your demonstration is accurate, in less than a year, a damage is compensated in the worst of cases. Do you know the timing of the current procedures?

Sixth and last step, Mr. Mayeur, Article 26 provides for a period of 210 days from the date of receipt of the full request for reparation. It should be noted that this clarification is not repeated in Article 23, which makes the period run from the day following the day after the accused receives the request for reparation. However, there is no accusation of receipt of the full request provided for by law. Article 17, § 4 does not include this precision. It provides for the acknowledgment of receipt of the request and paragraph 5 providing for the possibility of requesting additional information does not provide for a new acknowledgment of receipt. So what is the exact starting point of this deadline?

This is incredibly important. Mr Drèze now proves here – and whoever reads those articles comes to the conclusion – that an absolute problem of interpretation can arise when one reads the articles together and places the deadlines after one so that one comes to a much longer term beyond all deadlines. Mr. Mayeur says that this is still better than the current situation.

We are working here on a bill that must be very precise because it is about damages, it is about cents, it is about large bets. We do not know exactly how those deadlines run, but that is – according to the majority – still better than now, because now everything takes much longer.

In this way of making legislation, voluntarism is at the top. This is actually even less than the level of a resolution. When I hear all this, I find even one abstinence no longer enough. Unfortunately, one will interpret an opposing vote as if CD&V were against the system. We are for it on condition that it is a good system. What they are doing now is really folk licking, very dangerous.

I have finished with my comments. I think I have convinced my colleagues that we did not want to delay work artificially, but that we wanted to bring added value. We don’t pretend to be right about everything, but we believe that the debate between majority and opposition can be useful.

In any case, this issue has fascinated us all. Like everyone else, I have done a lot of work. I am very interested in its evolution.

I wish the next Minister of Public Health a lot of pleasure.

Mr. Speaker, Mr. Minister, colleagues, as sp.a, we are pleased with the present draft, because this draft actually has a very long path of suffering behind. What is stated in this text today has been promised to us for a long time. I have been working in this Parliament for a while, and we have been discussing what lies ahead for more than a decade, in particular to put an end to the big problems of patients who are victims of a medical error. It may be a shame for some people to hear that, but it is indeed the merit of this government and this minister to present this draft here in this legislature.

Of course, this is not an ideal design. I think, by the way, we should say in all humility that many non-ideal designs pass here. It would be awful if everything that happens here in the Room were ideal. In our view, it is a workable and pragmatic thing, with which we put an end to the great injustice that exists today. The many thousands of people, who are victims of a medical error each year, too often end up in a patch situation, so that 95 percent of them today can boast of no compensation. That is the reality.

The question is: who is the culprit? It is very difficult for the patient who is the victim of a medical error to find out who has done the mistake when he is in the hospital. Was it his own treating doctor, was it the surgeon, was it the nurse, was it the anesthetist? How can he prove who was specifically guilty of what? The healthcare provider is also not easy in the current situation. Like every human being, a healthcare provider also makes mistakes, but his insurance pledges him today to ⁇ not admit that mistake, as that could lead to huge claims. In fact, we are in a patch situation, which the current design is ending.

The patient has remained in the cold too often so far. Not only was he not financially compensated, which in itself was a big problem if he had suffered serious injuries as a result of a medical intervention. He suffered financially, but also morally he had great problems. Even morally, he could not even get satisfaction by a simple apology from the person who had treated him.

The present design is, in our opinion, not a vodje paper, as wrongly stated here, with a rather arrogant dedain. What is ahead is the result of a long debate with healthcare providers, insurance companies and patient associations, and based on a solid study by the Knowledge Centre to learn from the mistakes of other countries and to make a good budgetary estimate of what is ahead.

Hopefully there is now a quick and simple procedure, which will finally allow the victim to have the right to what belongs to him. In addition to a flat-rate compensation through the Fund, the victim can still go to court in the event of a deliberate mistake or a serious mistake.

Mrs. I sought to end your reasoning at a certain point, to give Mr. Goutry the word.

Please listen to what is being said here. I will immediately put the points on the i. This is a draft law, with a legal dimension, which deals with damages. It is not next to it or a little next to it. It is completely out of it or otherwise one will never be able to obtain his right. You say that you have worked on it for eight years, that all the texts have been discussed, that everyone has been able to say their thoughts about it, and that hearing was held. That is very correct. Seven years ago, in the year 2000, we held non-binding hearings. We talked a little about some great principles and about what we could do.

I ask you one question: has this text, which is presented today in Parliament, for which the approval is sought and which will therefore constitute the law, been discussed in hearings by organisations and opinions have been given on it? Yes or No? Or is this text the result of all those hearings? What guarantees that the text is correct? No one has seen this text, not even the RIZIV insurance committee, before parliamentarians got it under their nose. Now one pretends that this text I-know-not-which cenacles and commissions has passed. Nothing is less true. For me it is about the text, not about principles, about goodwill or about voluntarism. This is about legal facts and procedures. It is on it or next to it.

You are here to make a little shy and say that you still have something and that it will be much better now. You need to explain it to me. However, I warn you. If there are people with false expectations who will turn to the fund and then return with zero on the record, with a lot of disappointments, then I will send them to you.

Mr. Goutry, 95 percent of people have so far received nothing. I will send them to you.

I understand that it is a little frustrating for people in the opposition to see that one eventually finalises a ⁇ difficult point, on which various governments have cut their teeth. We have indeed achieved something. I have already said that it is not ideal. It is a new system. It must be tried. There are doubts about the franchise. You referred to the comments of Test Purchase. I think that Test Buy raises a number of justified concerns. How will the franchise work in practice? How will the interpretation of what is a predictable risk happen in practice? It is a new system, which is now being put on foot and which will need to be evaluated over the years.

It is important for us that the fund is there, that it will be installed and that, after a while of work, we will be able to make a solid evaluation of it and thus be able to see whether or not it should be updated. We believe it is equally important – colleague Avontroodt has also pointed out – that thanks to the fund and thanks to the fact that it will finally be installed, we will finally get a record of the medical errors in our country. Until now, this was absolutely not the case. We will be able to make an inventory of the most common mistakes and we will finally be able to set up a serious prevention policy. These are all especially great advantages of what is now ahead.

Although it is not the most ideal, we think this is an important step forward when we see where we come from, from a total lawlessness of patients, who so far could not get their story anywhere, neither financially nor morally. With this new fund, we are taking an important step forward. For us, this new fund is the closing point of the patient’s rights. Without the compensation as regulated here now in this fund, the patient’s rights were a bit of an empty box. This fund is for us the ultimate closing piece of the Patient Rights Act.

Mr. Minister, could you answer briefly, since you have already answered several observations?

I will limit myself to the comments to which I have not yet had the opportunity to answer.

I please please.

I will start with a note. What situation do we find today with regard to therapeutic hazards and medical errors?

Regarding only medical errors, we can reasonably say that we are aware of a unfortunately very high failure rate resulting from the complexity of procedures and the inability of people to find themselves in this deadlock. These are the reasons for the continuously repeated figure of 95% of people, unfortunately, spared in their requests.

The answer is even clearer, since this problem is absolutely not covered by our legal system. This is 0%.

What are we doing to remedy this? In the current system, we answer three questions relating to the notion of responsibility.

First of all, is there any harm? Can a person be identified as responsible for this damage? Finally, is there a proven relationship between the responsible and the damage? These different points are very difficult to demonstrate. This is the current situation.

But we get out of this situation, because we also want to embrace the alia. Similarly, we want to establish a "normation", i.e. a reference for compensation, which would depend on a fund. In case of proven liability for serious faults, it would be possible to pursue legal actions. I recall this, because some comments found in the press suggested that the abandonment of the double path in the sense of civil liability also imposed that of the judicial path in relation in particular to criminal liability. This is not the case.

I will come to the very specific question of the deadlines, posed by Mr. and Dresden.

I would like to answer it simply.

Within the seven-month period, must various extension and suspension be considered to be beyond the deadline or to be included in the deadline? They are extending the deadline. It is clear. The State Council itself accepted this formulation. I therefore propose to remain there. The explanation I just gave should remove any ambiguity.

Let me now answer the question of financing. I will be brief.

by Mr. Bultinck says I have to show in my cards and reveal my royal arrests. When he was absent, I said about another file that, given the scientific literature, it was difficult to establish in the law precise lists. I can make the same remarks. The royal decrees today cannot be commented in detail. I can nevertheless give you a few indications on one of the royal decrees, the one that falls under financing.

You know that the funding is roughly 100 million euros. The Federal Centre of Expertise had formulated different assumptions than those of Assuralia but let us agree and keep the figure of 100 million euros. What do insurance companies say about this number? They claim that approximately 34 million euros can be paid on the basis of current premiums. This means that you know at least the minimum range of insurer intervention. I asked the Kenniscentrum – I indicated it in the commission but I repeat it here – to re-evaluate this figure to check if it is realistic.

By deduction, what is made of reserves? This question was asked by several speakers. I would like to remind you of the right to which we are bound, Mr. President. These reserves are not the property of the State. It is the property of the insurance companies and more specifically of the insured. If the question should be asked, I will simply insist on one point. Keep in mind that ongoing and upcoming proceedings until the implementation of the new law must be covered by insurance companies. In other words, they still need funds today to meet demand.

This is very speculative as a question, if there was the demonstration that these reserve funds were not used altogether. I cannot myself answer for a reason of competence that will be understood by all members of this honorable assembly. When I was wearing another hat, that of Minister of Economy, I could have answered because it was the accounting law that would allow it. If you want an answer, you will have to ask the Minister of Economy, which you will still have time to do in the coming weeks.

Always about this ventilation, the government wanted to make sure it takes into account well-calibrated figures. If tomorrow, we could see that the coverage of therapeutic disorders in the broad sense of the term, medical responsibility was more important, it would be necessary to discuss it again, knowing that the government will not be to weigh more on the providers.

The following question is raised in relation to the disease-invalidity budget and the state budget: will we not play a cheat market in relation to service providers by amputating partial budgets that were dedicated to the fees of care providers to cover an extension of the amounts necessary to pay them? This question was asked by Mr. by Bultinck. The answer is no. Our intention is not to seek in partial budgets compensatory means for underestimated needs ab initio.

I also recall that the calculation method giving this amount of 100 million euros is as follows: we took the current amount of medical incidents and extrapolated this figure by incorporating therapeutic hazards, which gives a figure of 10,000 people. This is where the 70% intervene: they do not represent the entire population treated but the number of people among those 10,000 who could use the mechanism. To give you an idea, in the Nordic countries that also served as a reference to the estimate, this rate is 40%. It was intentionally overestimated. I said this to some of you.

For franchises, we have fixed in Article 6 of the Beacons Act. The franchises that will serve as a base are tagged. They were used to re-estimate the figures given by the Centre of Expertise. The latter also introduces these range for franchises and compensation in its estimates.

With regard to Article 13, the question arose of how we could involve mutualities. I recall that we obviously intend to ensure that mutualities, which are also patient unions, are associated. It is even planned that mutualities can, as such, accompany the patient throughout the procedure. Therefore, we can have the assistance of mutualities in representation throughout the procedure.

My last point is the question of Mr and Mrs. This is a delicate question. If you look at this from a legal perspective, the jurisdiction in relation to rest and care houses (MRS) is of the order of the federal level. We are responsible for the MRS. For rest homes (MRs), these are communities and/or regions, depending on whether you are located in the north or south of the country. Speaking like this, it appears almost like a sophism. But it is more complicated! In reality, these are not different institutions. Sometimes it is in the same room of one bed that is MR and another that is MRS. Imagine that we would take a disposition in relation to the MRS bed but that we do not have, as is the case today, the competence to take it for the MR bed. It creates an absolutely intolerable inequality. That is why we were blocked.

I called for a solution and we did not find it in the committee. Sorry but I tried. I hope that we will find, after consultation – which has begun for a long time – a solution with our friends of the Communities and Regions.

Here, Mr. Speaker, are the few points that I would like to highlight.

We spent more than four hours in this interesting debate.

Mr. Minister, of course, I have quietly waited for the answers to our questions. We asked 24 questions. You answered three. You said there is a socket of 94 million. That is absolutely inadequate. You also know that given only the costs associated with the hospital bacteria and the like, that will be far from insufficient. We had asked for the franchises in concrete situations. You did not respond to that. You mentioned in connection with the ROB’s RVTs that we live in a federal country. Of course we know that too. So you have 21 questions not answered on this very important matter.

Let us be clear, for us, the no-fault system is very important. It is even so important that we have always hoped that we would not have to discuss the text on the subject on a slump and then have to arrange everything later. I have listened carefully to the majority’s statements and I have only been able to find that there are more questions than answers. Maybe one will arrange the sister and otherwise one will arrange it so. Nothing is clear. It is said that before there was nothing and now there is something. This is, of course, a trap, and we should not enter it. It is a kind of trophy hunt, unfortunately on the cap of the help seeking, vulnerable patient.

Colleagues, I would also like to emphasize that we are at risk of being isolated in our country. Collega Goutry cited France, where the citizen can still turn to the court in emergencies regarding the no-fault scheme. Also the pioneering countries Sweden, Denmark, Norway and Finland have the double system, the combination of both systems. We also continue to insist on this, because we consider it fundamental. It is said that they were looking for it but did not find it. I am confident that the proposed scheme will now take away a lot of legal certainty for our patients.

It is unfortunate that the bill does not provide a structural solution. As I said, the budget is insufficient. There is also the risk of violating the principle of equality.

The current design has remained in place for eight years. I have heard from colleague De Meyer that there have been certain preliminary discussions. Well, we have seen nothing. As far as I know, no hearings have been organized; no information has been provided from the workplace. One will now try to print a text, whose formatting has dragged eight years, in eight hours. We held one committee meeting. We were surprised by the speed. As a result, we were actually unable to present a substantive explanation. That is why colleague Goutry had to speak here for a very long time today. This has only to do with the fact that they wanted to take us in speed.

However, all of this is not so important. The most important thing is that we actually leave the patient seeking help in the cold.

I am sure that the patient seeking help is the asshole of this. I hope that reason will come back, but I fear that this will not be the case. I also fear that we will have a law with a beautiful façade, as is often the case: the façade is polished, but there it is then left and the rest will be seen later. In legislation concerning insurance, we must be very punctual and correct: there it is very accurate and it must be calculated whether something can or not. Therefore, I am sure that this law will not pass the test of reality. Again, the majority has been warned: we cannot approve of this.

Colleague Goutry also says that we have held hearings on other topics. We can talk about this later in point 15.

Mr. Drèze, you respond, but do not start a new intervention, since you have intervened just recently.

These are two small points.

First, I would like to return to the discussion with Mr. Bacquelaine about the old bills. I checked: the only bill proposal before 2003 where the words "without fault" were present in the title came from his Senate colleague, Alain Destexhe. In this regard, in the proposal of Mr. Bacquelaine, although not mentioned in the title, is ⁇ mentioned in the device. However, I made an inaccuracy in my previous speech. In this proposal, the two regimes – the old and the new – remained together. On the other hand, in the draft government and in my bill, there is only the regime without fault.

In the old proposals, victims of medical accidents were oriented towards one or the other regime depending on whether the damage resulted from a medical fault or not. If such texts were a first step in the right direction, they left behind a fundamental problem, namely that the application of one or another regime depended on the existence or non-existence of a fault in the classical sense of the term – which everyone today agrees to denounce or, in any case, to estimate as outdated.

My second point, Mr. Minister, will also be my last word on this matter for tonight. You once again specified why you did not integrate the rest homes and the rest and care homes. I understand your reasoning. However, if a cooperation agreement could have been negotiated with the federated entities, I suppose you meant by this that the latter should finance the own share of their institutions. I think there will be difficulties in this area for a long time.

You can replicate, Mr. Minister, but quickly, because chaining the general discussions one after the other is not okay!

I would simply say that this is obvious. In a negotiation, everything has a cost. If we agree, we must necessarily do so in order of magnitude and cost.

Mr. Speaker, I had asked the Minister not to increase the insurance premiums for the providers. This also affects the overall burden on the insurance companies. I think there will also be some kind of restriction. I just give it with me. I think that is useful, because I think the question will also be asked in the Senate.