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Yes. Doctors may bear responsibility for incorrect consultations based on negligence in providing services.

Rare

Plaintiff must prove the illegality of the actions of the medical worker, i.e., his or her direct violation of the requirements of the relevant regulations governing the provision of medical care.

They are very detailed and would take a long time to read.

Dexis Partners is preparing one.

Yes.

Not so long as the final decisions are in the hands of the doctor in Ukraine. Responsibility for the quality of care will be borne directly by the Attending physician of the pertinent medical institution. Consultations are of an advisory nature, and the methods of treatment of the patient depend on the attending physician. That is, the role of a consultant is ancillary, subordinated to the priority of the attending physician.

Yes. The necessary condition for a doctor to be held liable for his professional activity is a direct connection between the doctor’s acts and harmful effects of such acts on the patient’s health and life. Under Ukrainian law, it is difficult to prove that there is a causal link between the actions of the person sued and the damage caused, because the human body’s response to medical intervention is not always unambiguous.

A forensic medical examination establishes or refutes the existence of such a connection. If the damage is attributable to individual characteristics of the patient’s body or was caused by the patient’s actions (non-compliance with the doctor’s recommendations, e.g.), the doctor’s liability is excluded. It is possible to recover funds for damages only if the negligence of the medical worker is proved. The mere fact of a patient’s health deterioration (or even death) during treatment is not grounds for imposing civil liability on a medical institution in Ukraine.

The amount of compensation in each case is set by the court. To calculate the amount of material costs, the patient must submit to the court the relevant documents (e.g., pharmacy checks).

The law does not provide for an upper or lower limit on the amount of non-pecuniary damage. Usually the court takes into account: the amount of monetary damages; the severity of physical and moral suffering; the nature of the reduction of abilities or deprivation of the opportunity to function; the culpability of the person who caused moral damage; and other circumstances that had a significant impact on the situation. The requirements of expediency and fairness are also taken into account.

Yes.

The amount of compensation differs significantly from the practice of American courts. The predominant amount of compensation is 10-20 thousand hryvnias (about $329.82 to $659.73) in case of damage to health and up to 100 thousand hryvnias (approx. $3,385.54) if the doctor’s actions led to the patient’s death.

Provide explanations and give recommendations, but do not make a diagnosis and do not prescribe treatment. This way the US provider will not bear responsibility as an Attending physician does.

If you communicate with Ukrainian providers independent of the coalition, and in doing so you use a website, post a limitation of liability clause (known as disclaimer) on the website and/or in the application forms. A patient should be acquainted with the mentioned disclaimer before the consultation begins.

No. The disclaimer referred to here is for use only by a US provider who elects to offer services to Ukrainians independent of the coalition.

Yes, as long as it accurately reflects the relationship between the two parties.

Our website contains general medical information. Any information we provide cannot be considered as advice you should follow. The medical information on our website is provided without any guarantee of recovery. You should not rely on the information on our website as an alternative to medical advice from your attending physician. If you think you may be suffering from any medical condition, you should consult with your attending physician and visit him without delay. You should never delay visiting a doctor, ignoring medical advice, or stopping medical treatment because of the information on our website.

You understand that, owing to the limited nature of communicating with the interactive features of our website, any assistance you may receive through such features may be incomplete or may be misleading. Any assistance you may receive in connection with any other active features of our website is not specific advice and should not be relied upon without further independent confirmation and precise investigation by the attending physician. Nothing in this disclaimer will

• limit or exclude any liability for death or personal injury caused by negligence;

• limit or exclude any liability for fraud or fraudulent misrepresentation;

• limit any obligations in any way not permitted by applicable law; or • exclude any obligations that cannot be excluded in accordance with applicable Ukrainian law.

The patient needs to review the website and project type. Understanding and agreement can be documented with a check-box or pop-up to receive confirmation. Because it relates to healthcare, a check-box would be the better solution.

No.

Yes.

VSee purchased insurance ($1M/3M) for This American Doc from The Doctors’ Insurance Agency against tort liability for HCPs providing care abroad through Aimee. A volunteer who registers at ThisAmericanDoc will get coverage. Note: a doctor need not register individually; VSee can do bulk registrations. As with the waivers, however, at this writing this coverage does not extend beyond Aimee-affiliated professionals. The Doctor’s Insurance Agency certificate of coverage covers only “This American Doc, Inc.,” and not individual physicians.

Neither CTeL nor Telehealth4ukraine provides insurance of any kind.

If a Ukrainian patient sued a foreign doctor, litigation would be very difficult, as it would be necessary to send summonses abroad and get confirmation of receipt. Online litigation in Ukraine is not yet operational. All documents should be legalized in the defendant’s country. That is, such a lawsuit would be extremely time- and money consuming, with but a low chance of winning.

It is extremely unlikely that a foreign doctor will be sued. In fact, this is possible only in case of gross disregard for professional standards, a clear violation of medical protocols and the patient’s willingness to incur high costs of litigation.

In the case of pure consulting without making a diagnosis and prescribing treatment, such a risk is absent.

Yes. A healthcare professional may be held criminally liable for failing to perform or improperly performing his or her professional duties as a result of negligent or dishonest treatment, if this has resulted in serious consequences for the patient. A difficulty the prosecutor faces in all criminal cases against doctors is the impact of a significant number of evaluative concepts (in particular, the inability to unambiguously determine whether a doctor’s actions were appropriate or inappropriate, whether in full or superficially performed by a health worker, etc.).

To convict, the prosecutor must show that the defendant could at least either foresee the possibility of socially dangerous consequences of his own actions or should have foreseen them.

Criminal liability of a doctor in Ukraine is limited to cases of obvious neglect of professional duties – usually in the form of a direct violation of medical protocols, which the doctor has been acquainted with on receipt. In other cases, the corpus delicti (concrete evidence of a crime, such as a corpse) is absent. Therefore, cases of bringing doctors to criminal responsibility in Ukraine are very rare.

Clinician to clinician.

In Ukraine, such service may be provided only by doctors who have a Ukrainian medical education or legalized foreign diplomas. Therefore, there are three ways to provide care to Ukrainian patients directly:

1. Engage doctors with diplomas acknowledged in Ukraine, or

2. Cooperate with a Ukrainian medical institution and provide consultations on behalf of it, or

3. Provide online consultations.

Yes, but the process is very difficult and time-consuming.

Yes, clearly with respect to in-person care by a foreign provider. According to the Order of the Ministry of Health, “On the involvement of foreign medical workers in the provision of services to victims of martial law” from 2/26/2022 No. 383, foreign doctors may be involved in medical assistance in Ukraine. Until the state of war in Ukraine is at an end, there are no restrictions.

Yes: https://zakon.rada.gov.ua/rada/show/v0383282-22#Text

In pertinent part, the Order says:

Order of the Ministry of Health of Ukraine dated 26.02.2022 № 383: “On the involvement of foreign medical workers in providing assistance to victims of war under the applicability of martial law”

… in connection with the imposition of martial law in Ukraine in accordance with the Decree of the President of Ukraine of February 24, 2022 № 64/2022 “On the imposition of martial law in Ukraine,” in order to ensure timely, continuous assistance to victims, the minister of health of Ukraine ORDERS:

1) Heads of health care institutions during martial law:

….

4. if there is a necessity, to ensure the provision of medical care with the use of telemedicine with the involvement of foreign medical professionals who meet the requirements for professional education and qualifications of the country where the relevant medical worker works, in compliance with personal data protection legislation.

Order 383 remains in effect.

Statutes are higher authorities, with higher power, than MOH orders. The order remains binding, however, until a statute says otherwise.

Yes.

Yes. This order protects both Ukrainian healthcare institutions and foreign consultants.

Yes. “Medical assistance” can be construed broadly.

Yes. Counsel at Dexis Partners have concluded that the same principle applies to medical services provided on a remote basis. Moreover, the representative of the Ministry of Health of Ukraine, Sergiy Ubogov, Director General of the Directorate of Medical Personnel, Education and Science of the Ministry of Health of Ukraine, also confirmed this conclusion over the phone. As of 13 May 2022, written confirmation pending.

The Director General reports directly to the Minister of Health.

Yes. This is possible, but unlikely.

Yes. We can interpret “victims of martial law” as meaning “Persons who became victims because of the war.” Dexis Partners believes “victims” of war can be interpreted broadly.

Foreign medical workers can be interpreted broadly to include broad range of specialists and licensee groups.

Yes.

Yes.