In Lithuania, an increasing number of injured patients are turning to healthcare institutions and judicial authorities for protection of their health interests when their health is damaged by the actions of a nurse or doctor. A person bringing an action against a healthcare institution for damages caused by the fault of its staff in the provision of healthcare services must prove the unlawful acts, the fact and extent of the damage, and the causal link between the unlawful acts/omissions and the damage caused. Persons providing medical services must act as professionals in their field of expertise and follow the principle of best endeavours. In determining the amount of damages, the courts analyse whether the actions of the person liable for the damage meet the requirements of the standard of conduct required of them, and it is therefore necessary to analyse the inappropriate actions of medical professionals in order to prevent the recurrence of such actions in the future and to avoid compensation for material and non-material damage. Patients’ rights and obligations in Lithuania are enshrined in the Constitution of the Republic of Lithuania (1992), as well as in other laws and sub-legislative legal acts. Article 53 of the Constitution provides that: ‘The State shall take care of the health of the people and shall guarantee medical assistance and services in case of illness’. Currently, the basic rights and obligations of patients are defined and enshrined in the Law on the Compensation of Patients’ Rights and Damages to Health of the Republic of Lithuania (1996, new wording as of 1 March 2010). This law sets out the main provisions on compensation for damages. Lithuanian and foreign authors have written on non-pecuniary damage caused to patients and other issues of legal liability of medical professionals. Sriubas (2013) has analysed relevant aspects of patients’ rights related to the provision of quality services to them and mainly deals with the peculiarities of compensation for damages and the concept of quality health services. Gudukienė Gudukienė analyzed the determination of guilt in personal injury cases (2015). . The peaceful settlement of disputes arising between healthcare institutions and patients has been analysed by Langys and Tvaronavičienė (2016). Bjorksten et al. (2016), analysed cases in which complaints about nurses’ actions were taken up and damages assessed. Bezerra, K.C.H. (2013) analyzed difficulties among users of Psychosocial Care Centers (PCCs) in accessing Family Health Units; and mental healthcare training for primary care professionals. The process of medicationalization goes beyond the professionals’ practice and forms the main demand of PCCs users.
The study found that the evaluation of the nurses’ actions depends on the extent of the harm caused. The socially sensitive profession of medical professionals’ responsibility has been the subject of Nedzinskas and Nedzinskienė (2017). Patients’ compensation and the problematic aspects of nurses’ actions and the judicial model of compensation for patients’ damages have been analysed in detail by Morkūnaitė (2017). Wallis (2017) has written about the compensation of damages to injured patients. Stirblienė (2019) analysed the most relevant case law on compensation for damage caused to patients’ health. Šivickaitė-Moldarienė and Juodkaitė-Granskienė (2022) looked into the scientific-practical competence of a forensic expert performing deontological expertise. Pallocci et al. (2023) have written about the ethics of medical professionals and the informativeness of patients regarding the research they conduct. The integration of artificial intelligence into healthcare and the significant implications for the doctor-patient relationship in terms of harm caused have been reported by Solaiman and Malik (2024). Markowitz and Smith (2024) conducted research on unsafe practices and poor quality care and on the inappropriate prescribing, dispensing and administration of drugs or medicines when patient harm occurs. The main steps in the assessment of professional liability and the possible new medical and legal problems that may be encountered by the expert in the analysis of malpractice cases were reported by Terranova et al. (2024), who suggested that a new expert on the assessment of professional liability cases in the healthcare workforce is likely to be needed. However, there is a lack of scholarly work in Lithuania on the theoretical and practical aspects of the legal liability of healthcare professionals. Therefore, in this article, we will examine the legal regulation of the legal liability of medical professionals and the problems of case law in relation to damage caused to patients’ health.
Theoretical and practical aspects of healthcare workers’ legal responsibility for harm caused to patients’ health.
The purpose of the article is to analyse the responsibility of healthcare workers for harm caused to the health of patients.
To determine the theoretical aspects of the legal responsibility of healthcare workers;
To analyse the legal responsibility of healthcare workers for harm caused to the health of patients in Lithuanian court practice.
The methods used for the study are the analysis of literature and legislation, and the case studies of court decisions.
Ensuring that patients’ rights are adequately protected and enforced requires not only the creation of an appropriate legal framework, enshrining patients’ rights in law but also the promotion of information dissemination and a strong role for informed patients. It is based on patients’ insights and experiences that better management and quality of healthcare services can be ensured. Only by being aware of their rights and obligations will patients be able to properly express their consent to treatment, cooperate and communicate with their doctor and demand high-quality healthcare that meets their needs, thus achieving the best possible treatment outcomes. The need to promote the active role of the patient in the healthcare system is also highlighted at the international level. The Organisation for Economic Co-operation and Development (OECD) has pointed out that ensuring transparency in the health system requires a transformation of the role of the patient, placing patients at the centre of the health system and thus making them equal partners OECD (2017). In this context, the state has a duty to design a system that properly communicates the rights and obligations that patients have. Unfortunately, now, there is still a lack of accessible and comprehensible general information in the language of patients in Lithuania, not only on their rights but also on the functioning of the healthcare system.
Lithuanian courts have repeatedly noted that a medical worker is equal to a civil servant, ‘the case law of the Court states that the head of a private enterprise or other employee (medical worker) may be equal to a civil servant, but such a conclusion must be reached after assessing not only the formal compliance of the position held with the elements referred to in Article 230 of the Criminal Code of the Republic of Lithuania (hereinafter—the CCL) but also the significance of the acts committed by him/her for the civil service or the public interests. The acts of a person entitled to act on behalf of a healthcare institution in relation to fraud in the provision of healthcare services are liable to undermine the entire healthcare system of the State and to undermine confidence in it, which is to be regarded as a breach of the public interest. The court noted that nurses are treated as civil servantss (Judgment of the Court of Appeal of Lithuania of 18 July 2018 in criminal case No. 1A-284-483/2018).
A review of foreign experience shows a low level of litigation, as most countries’ healthcare systems focus primarily on mediation, where an impartial mediator mediates between the parties. Third-party mediation is more neutral than administrative mediation and superior to bilateral negotiations. Resolving medical disputes through litigation is not only resource-intensive but also costly, complex and highly adversarial. Mediation is one of the most effective ways to mitigate the conflict between doctors, nurses and patients and to resolve disputes. As people become more aware of the protection of their rights, they are increasingly willing to have a relatively neutral third-party organisation to coordinate and resolve conflicts and disputes to ensure a fairer outcome.
Healthcare institutions in different countries are implementing various measures to help doctors avoid errors and reduce the risk of adverse events. However, it is not always clear which ones are appropriate, applicable and effective for Lithuanian hospitals. A doctor or nurse, like everyone, sometimes makes mistakes. Errors occur in the diagnosis of illness, in the performance and interpretation of tests, in the prescription of medicines, in surgical interventions and procedures, in patient identification, in the management of medical records and so on.
Lithuania, one of the first Member States of the European Union before it became a Member State, adopted the Law on the Rights of Patients and Compensation for Damage to Health in 1996. With good legal education of the public, every citizen of the Republic of Lithuania is aware of his/her rights and how a violation of these rights is related to his/her rights as a patient to turn to the healthcare institutions.
According to Article 23 of the Law on Patients’ Rights and Compensation for Damage to Health of the Republic of Lithuania of 1996 (new wording as of 1 March 2010), a patient has the right to lodge a complaint with the personal healthcare institution in which he/she believes that his/her rights have been violated, not later than 1 year from the date of becoming aware of the violation of his/her rights, and not later than 3 years from the date of the violation of his/her rights, unless the patient has suffered damages as a result of the violation. Complaints can be made directly or remotely. The complaint shall specify the rights of the patient which he/she considers have been violated by the healthcare institution, the circumstances justifying the violation and the patient’s demands for the violation of his/her rights to be remedied.
A patient with a complaint concerning the protection of his/her violated rights related to the accessibility and quality of personal healthcare services has the right to address the State Service for Accreditation of Health Care Activities under the Ministry of Health, concerning the protection of his/her violated rights related to the issues of compulsory healthcare insurance—to the State Patients’ Insurance Fund under the Ministry of Health, concerning the protection of his/her violated rights related to the compliance of personal healthcare services with the bioethical requirements—to the Lithuanian Bioethics Committee. The patient shall have the right to apply to the institutions referred to in this paragraph only if he/she disagrees with the decision of the healthcare institution where he/she considers that his/her rights have been violated, following the examination of his/her complaint, or if his/her complaint has not been accepted by the healthcare institution for examination. In these cases, the patient also has the right to apply directly to the courts and to challenge before the courts the actions or omissions of the authorities referred to in this paragraph in the handling of his/her complaint (Figure 1).
Public authorities against whom patients can complain about a violation of their rights (simplified model, compiled by authors).
A patient whose rights have been violated thus has ample opportunities to protect his or her rights by contacting the various state institutions that protect patients’ rights.
From 1 January 2020, the patient’s health damages will be reimbursed by 18 July 2019. The Law on Patients’ Rights and Compensation of Health Damage of the Republic of Lithuania No. I-1562, amending Articles 2, 7, 8, 13, 20 and Chapter V of the Law on Patients’ Rights (the no-fault liability model for healthcare institutions), as amended by Law No. XIII-2377. Article 24(1) of the Law on Patients’ Rights provides that a patient who wishes to obtain compensation for damages must, in accordance with the procedure laid down in, apply to the Commission, which is a mandatory pre-judicial body for compensation. Pursuant to Article 24(6) of the Law on Patients’ Rights and Compensation for Damage to Health, compensation shall be granted if the Commission establishes that the patient’s health has been harmed during the provision of personal healthcare services and that the harm is not unavoidable. The Commission shall decide on the compensation of damages without assessing the fault of the healthcare institution and the healthcare professional who caused the damage. According to Article 2(91) of the Law of the Republic of Lithuania on Patients’ Rights and Compensation for Damage to Health (1996) (there is no such article) (new wording as of 01.08.2024), unavoidable damage is damage to the patient’s health, which is related to the provision of personal healthcare services, but which has been caused due to the circumstances which the personal healthcare professional and/or the personal healthcare institution could not foresee, control and/or prevent. The criteria for unavoidable damage shall be established by the Government of the Republic of Lithuania. It should be noted that Article 13 of the Law of the Republic of Lithuania on Patients’ Rights and Compensation for Damage to Health (1996, current wording as of 1 August 2024) was supplemented after the ruling of the Constitutional Court by providing that the right to compensation for non-pecuniary damage is also available to other persons who are bound to the patient by a particularly close and intimate relationship. The closeness and closeness of the relationship between the deceased patient and these persons is a matter for the Commission for the Determination of Damages to the Health of Patients (Figure 2).
The process of patient complaints for the damage to health (simplified model, compiled by authors).
Summarising the theoretical regulation of the legal liability of medical personnel, we can state that currently there are sufficient laws and other legal acts regulating the legal liability of medical personnel for the damage caused to patients, both in Lithuania and in some other countries. One of the main pre-trial investigation bodies for damages is the Commission under the Ministry of Health.
In the court practice, the most common issue in nurses’ liability cases is that of establishing causation in all cases. Causation exists where a person had a duty to do something, to act in some way, but failed to do so, and such conduct, which was inadequate to the factual situation, contributed sufficiently to the occurrence of the damage, either by directly causing the harmful consequences or by creating the conditions for such consequences to occur. Even in the absence of actual causation, legal causation may be established and may be sufficient to impose civil liability (Stirblienė et al., 2019: 35).
Moreover, Article 10 of the Law on Patients’ Rights and Compensation for Damage to Health of the Republic of Lithuania provides that, in case of reimbursement of damages from the account, the right of recourse against the person who caused the damage and/or the personal healthcare institution where the person who caused the damage is employed shall not be acquired, except if the damage was caused intentionally, and also if the person who caused the damage was drunk or under the influence of medicines, drugs, or any other intoxicating substance. Thus, according to this regulation, it can be argued that healthcare institutions and medical staff are no longer liable and have no obligation to pay benefits, except in the exceptional cases of recourse provided for by the law.
In Lithuania, when investigating and prosecuting criminal medical cases involving the liability of medical professionals for injuries or death caused to a person, forensic (deontological) experts are used to determine whether the medical professional chose the appropriate treatment methods, correctly diagnosed the underlying condition and performed all the necessary and appropriate actions for the situation. These types of investigations are known as deontological examinations, which determine, among other things, whether a person was injured or died because of a medical error. Thus, a forensic expert who has carried out a deontological examination provides a conclusion based on specialised (medical) knowledge, which directly determines the medical outcome of a criminal case.
In our case study of Lithuanian court practice, we will look at the criminal, civil and labour cases heard by the courts and the verdicts and judgements handed down in them, as listed in Table 1.
List of court cases selected (Source: https://www.infolex.lt/tp/)
| No. | Case |
|---|---|
| 1. | Supreme Court of Luthuania of 15 July 2023, criminal case No. e3K-3-24-421/2023 |
| 2. | Supreme Court of Luthuania of 4 January 2023, criminal case No. e3K-3-43-313/2023 |
| 3. | Supreme Court of Luthuania of 8 January 2022, criminal case No. e2-720-587/2022 |
| 4. | Supreme Court of Luthuania of 20 October 2023, criminal case No. 1A-107-334/2023 |
| 5. | Supreme Court of Luthuania of 18 July 2018, criminal case No. 1A-284-483/2018 |
| 6. | Supreme Court of Luthuania of 22 September 2022, criminal case No. 2A-797-459/2022 |
The legal liability of healthcare professionals in Lithuania is criminal, civil and disciplinary.
On 15 June 2023, the Supreme Court of Lithuania heard a civil case No. e3K-3-24-421/2023, in which the interpretation and application of the provisions of the Law of the Republic of Lithuania on Patients’ Rights and Compensation for Damage to Health (LPRC) (which entered into force on 1 January 2020) governing the state’s obligation to compensate for the damage to the patient’s health caused by a healthcare institution was decided. The applicant asked the court to order the defendant, the Republic of Lithuania, to pay EUR 3,223 in respect of material damage and EUR 15,000 in respect of non-material damage suffered because of their mother’s death. The applicant submits that the patient was treated in a healthcare institution which failed to comply with the essential requirements of health safety legislation and that the patient was infected with COVID-19 disease and died. In its claim for compensation for pecuniary damage, the applicant sought compensation for the costs of burying their mother. The claim for non-material damage was based on the close and intimate relationship that the applicant had with their mother. The Court of First Instance upheld the action in part. In deciding on the amount of the material and non-material damages to be awarded to the applicant, the court considered the fact that the healthcare services were provided during a special period, when an epidemic was declared in the country and throughout the world. The court considered that the damages awarded to the applicant could be reduced and awarded EUR 5,000 in respect of non-material damage and EUR 1,000 in respect of material damage. The Court of Appeal annulled the judgement of the Court of First Instance and adopted a new judgement dismissing the applicant’s action. The court concluded that liability for damage to a patient’s health arises only if it is established that the healthcare institution has acted unlawfully and that the breaches committed have a legal causal link with the damage caused. The Court of Cassation annulled the judgement of the Court of Appeal, reversed the judgement of the Court of First Instance by increasing the compensation for pecuniary damage awarded to the claimant by the State to EUR 3,223, and remitted the part of the case concerning the compensation for non-pecuniary damage to the Court of Appeal for a fresh hearing. The Court of Cassation held that the Court of First Instance had correctly applied the rules of assessment of the evidence and had come to the reasonable conclusion that the damage caused to the patient’s health during the provision of healthcare services could not be classified as unavoidable and must therefore be compensated. To examine the specifics of the civil liability of medical institutions in more detail, it is worth reviewing the ruling of the Court of Cassation of 4 January 2023 in civil case No. e3K-3-43-313/2023. The applicant stated that she had undergone a total hysterectomy (removal of the uterus) in a medical institution. The defendant’s staff made mistakes in the form of mechanical damage to the rectum during the operation, which was not diagnosed in time. The applicant was diagnosed as having a medium level of disability and a reduced capacity to work. The Supreme Court of Lithuania stated in this case that in assessing the actions of a doctor and deciding on the question of his fault, the standard of a doctor’s actions must be applied, i.e. his actions are not assessed according to the standard of a reasonable and careful person, but according to the standard of a reasonable and careful professional. The assessment of whether a doctor’s action was lawful or unlawful, according to the above standards, must be made on a case-by-case basis. In assessing whether there has been an unlawful act, the question of whether, in the individual case, the patient has received quality healthcare must be answered. In deciding whether fault is a condition for civil liability, it must be assessed whether the healthcare provider acted as a qualified professional in his field, in accordance with the knowledge of medicine and other sciences, the rules of professional ethics and recognised medical practice, the provisions of the legislation governing the provision of medical services, and whether his actions complied with the standard of an honest, reasonable and careful professional and the standard of best endeavour. The Court of Cassation has stated that the actions of doctors must be assessed by the court in terms of the process and not the result, i.e. whether, in the particular situation, the medical services were rendered with the utmost diligence, by taking all possible and necessary measures and by exercising those measures in a careful, diligent and skilled manner.
In the decision of the Kaunas Regional Court of 8 July 2022 in civil case No. e2-720-587/2022, non-pecuniary damage was awarded for damage to the patient’s health during the provision of personal healthcare services, because of a fracture of both ankles caused by a fall when the patient was trying to get out of the bed independently. The patient, unable to move independently and aware of this, attempted to stand up independently without the assistance of medical staff at 9.30 a.m. on 26 July 2020, which led to a fall and injury. The nurses failed to ensure safe conditions for the patient and to anticipate the risk of falling. The circumstances established in the case and the documentary evidence submitted allow a reasonable conclusion to be drawn that the staff of the Public Health Institution (Data is sensitive) breached a general professional duty by failing to take sufficient individualised preventive measures to avoid possible damage to the applicant’s health, even though they had foreseen such a risk, and that such actions of the third party must be regarded as an unlawful failure to act (Article 6.246 of the Civil Code). It was at the time of the fall that the edge of the applicant’s bed was not raised, and there is therefore no reason to conclude that there are circumstances which exclude the defendant’s civil liability. In the court’s view, the applicant’s representative has proved in the case the unlawful acts (omissions) of the hospital providing nursing services (Articles 177, 178, 185 of the CPC). The court awarded the victim the non-pecuniary damage of EUR 3000.
In another case, the plaintiffs’ mother, E.B., was admitted to Kaunas Clinics at 19:21 on the same day for injuries sustained in a road traffic accident (data not published). After examinations, she was urgently admitted to the Department of Thoracic Surgery ((data not provided)). The medical records of the Kaunas Clinic documented that E.B. had lost consciousness, complained of chest and left hip pain, and nausea. Her general condition, according to the medical records, was satisfactory, oriented, with pale skin and mucous membranes, and rhythmic heartbeat. Diagnosed as (data not provided). On (data not published), the patient complained of abdominal pain and nausea. On (data not provided), the patient received an injection of the narcotic analgesic (data not provided) 100 mg/2 ml i/m. E.B. was found in the ward (data not provided) with no signs of life. Resuscitation was applied. In the absence of a response to resuscitation, the patient was pronounced dead.
Medical staff may also face criminal liability. In another criminal case No. 1A-107-334/2023, the Panevėžys Regional Court of 2023, by its ruling of 20 October 2023, found D.S. guilty of a criminal offence under Article 229 of the Criminal Code of the Republic of Lithuania (hereinafter—the CC) and imposed a fine of 80 MGL (EUR 4,000) on her. D. S., while working as a nursing specialist, came to a call at the house of (data is sensitive) at (data is sensitive) in the period from 15 July 2021 at 21:00. 13 min. until 22:00 on 15 July 2021. 04 min. did not examine and assess the objective condition of A. Š. in accordance with her competence, did not assess the indicators of the necessity of necessary assistance, did not provide necessary medical assistance to the victim A. Š., did not transport him to the emergency ward of the hospital admissions of the personal healthcare institution, as a result of which the victim A. Š. died in the temporary detention cell of the Panevėžys County Chief Police Commissariat on 15 July 2021 at about 23:00. The Court noted that the criminal offence was committed in the field of work. The case file shows that at the time of the commission of the criminal offence, D. S. was a nursing specialist at (data is sensitive). It has been proved in this criminal case that Ms D. S. violated the requirements of the legislation referred to in the indictment and thus failed to perform her official duties due to criminal negligence, thereby causing serious damage to a natural person, because of the death of a person.
Klaipėda Regional Court on 18-07-2018. 1A-284-483/2018 and found guilty of criminal offences under the Criminal Code (fraud and abuse of office. In the case, D. P. abused her official position for pecuniary gain, which resulted in significant non-pecuniary damage to a natural person and to the State, and fraudulently acquired, for her own benefit, the following property: M. J. T., in her capacity as a member of the UAB ‘I. t.” as the director-medical epidemiologist, i.e. as a person equal to a civil servant, and responsible for the organisation of the activities of this company and the implementation of its objectives, between 1 January 2010 and 20 May 2015, at UAB”I. t.’ organised and provided vaccination services to patients on the premises of the company I. I. I., without having a licence from the institution authorising it to provide community nursing and family medicine services, and without having personal healthcare professionals (a community nurse, a family doctor and a paediatrician) to provide those services (online access at: https://eteismai.lt/byla/18942458035801/1A-284-483/2018).
In summary, criminal liability for nurses is only applicable in the case of an error that causes serious harm, and in practice is usually associated with the death or serious injury of the patient. In deciding whether nurses are at fault, it is necessary to answer the question of whether the medical services were in fact provided with the utmost care, diligence, attention and caution.
It should be noted that according to Article 154(2) of the Labour Code, if the damage is caused by an employee’s activity that has the characteristics of a crime, the nurse must pay full compensation. One of the conditions for civil liability as compensation for damage to the patient is unlawful acts (Article 6.246 of the Civil Code). The unlawful acts of a carer arise from the failure to fulfill a duty imposed by law or contract (unlawful omission) or from the performance of acts prohibited by law or contract (unlawful act) or from the breach of a general duty of care.
The disciplinary liability of a medical staff member is governed by the Labour Code of the Republic of Lithuania. Therefore, the most common sanction is dismissal. The Klaipėda Regional Court of 22 September 2022, in case No. 2A-797-459/2022 (https://www.infolex.lt/tp/2108624), held that the dismissal of a head nurse was lawful for a serious breach of labour discipline. In the case, the Acting Head Nurse did not record a shortage of medicines. The Court noted that the shortage of medicines was recorded at 6 a.m. on 20 May by a nurse, Ms T.A., who had no medicines for the patients when she arrived at work on the morning of 20 May. Among other things, the head nurse was dismissed for disseminating information that was not true in relation to Ms A., creating ignorance, humiliation, a feeling of irrelevance, contempt for Ms A.’s work, failing to ensure a good and supportive working environment, expressing contempt for and denigrating the employee’s work, and spreading rumours. The Court points out that, according to the Instruction of Duties of the Chief Physician of the Klaipėda County Hospital, approved by Order No. P-30 of 29 January 2009, it is the senior nurse who is responsible for the timely provision of the ward with medicines and other means necessary for the healthcare process. The head nurse of the ward is responsible for recording, storing and dispensing medicines to patients and for the inclusion of surplus stocks, for controlling the shelf life of medicines, and for the timely transfer of unsuitable medicines from the ward to the pharmacy of the Klaipėda Republic Hospital. It pointed out that no one other than the senior nurse has the right or the possibility to order medicines from the pharmacy in order to ensure proper accounting of medicines, and that for that reason it is the sole responsibility of the senior nurse, and that the dismissal was therefore lawful. It pointed out that the fact that there are occasional shortages of medicines during on-call duty can in no way negate the fact that such shortages cause tension and stress for the nurses. Shortages of medicines and other supplies necessary for the healthcare process on the ward are not considered to be the norm and/or the normal situation on the ward. It also noted that the duty of the senior nurse to ensure that the ward is supplied with medicines and other supplies necessary for the healthcare process is not established for the sake of it, but precisely for the purpose of the proper and smooth provision of personal healthcare services to patients.
Thus, for a nurse to carry out his or her functions properly, he or she must be licensed. However, most of the cases reviewed in the case law concern senior nurses and their management. Inappropriate actions in terms of failure to control the quantities of medicines, inadequate documentation and inadequate supervision of the nurses themselves. Only in very few cases, in specific criminal cases, has the court sentenced a nurse to 1 year’s imprisonment for failure to perform his/her duties, 4 years’ imprisonment for qualified negligent homicide, 2 years’ imprisonment for negligent homicide and 2 years’ imprisonment for the combination of qualified negligent homicide and failure to perform his/her official duties. The courts impose a specific penalty on each nurse individually, considering mitigating and aggravating circumstances, the form and type of fault. Nurses are also subject to disciplinary sanctions such as revocation of their licence and dismissal. Unlawful dismissals are also noted, where the employer fails to comply with time limits for repeated breaches of labour discipline.
In Lithuania, amendments to the basic Law on Patients’ Rights and Compensation for Damage to Health of the Republic of Lithuania have made the procedure for appeals and patients’ rights to compensation for damage caused to their health fully clear.
However, there is a lack of deontological expertise in Lithuania, carried out by independent experts from other countries. Currently, deontological expertise in Lithuania is carried out by medical staff from the Vilnius Santara or Kaunas clinics, and this is where the lack of impartiality can be seen, because the same medical staff assesses the mistakes made by their colleagues, and most often states that there were no violations, except for cases that are already resonant.
An analysis of Lithuanian case law on the legal liability of nurses shows that the number of such cases in Lithuania is low. Nurses are usually only held liable in cases where there is a serious risk to the patient’s health or where a death has been reported as a result of inappropriate actions by nurses. It is likely that hospitals are reluctant to publicise cases of patient injuries and settle the cases with the relatives of patients or the patients themselves, without recourse to the courts. It is therefore difficult to analyse the specific legal liability that arises for nurses, as the courts apply it only in criminal cases. Nurses are usually subject to civil liability for inadequate patient care and errors.
With the new no-fault model of patient compensation, it becomes the personal responsibility of the carer to pay for the damage caused, both pecuniary and non-pecuniary. Nurses are liable to forms of disciplinary liability such as revocation of their licence and/or dismissal. It should be noted that in specific criminal cases, it is very rare for a court to impose a custodial sentence for failure to perform the duties of a nurse.