About this Summary
This summary was created with the help of artificial intelligence (AI) to help readers quickly understand the key points of the article.
It has been reviewed by our editorial team before publication. For complete information and full details, please read the full article.
- The report reviewed 23 typical scenarios and found 12 could breach patient rights, while only five operated as required by law.
- Key problems include unclear responsibility before transfer completion, with the report stating phone calls or verbal directions do not count as referrals.
- The report says critical decisions are often made over the phone, while referrals, acceptances and refusals are frequently not documented as required.
- The Ombudsman recommends written, named acceptance before every transfer and an on-call coordinator to resolve provider disputes within hours.
Gaps in Cyprus’ patient referral and transfer procedures can, in some cases, leave patients “in the middle” without a clearly responsible healthcare provider, according to a report by the Office of the Patient Ombudsman.
The report, titled “The Patient in the Middle, Between Medical Centres”, examines 23 typical scenarios involving patient referrals and transfers.
According to its findings, 12 of the scenarios allow for patients’ rights to be breached under the current framework, while in another six, the outcome depends on whether a single procedural step is completed correctly.
Only five scenarios, the report says, operate as required by law.
Who is responsible for the patient?
The main gap concerns responsibility for the patient until a transfer has been completed.
Although the law requires a medical institution approached by a patient either to provide treatment or arrange their transfer and admission to an appropriate facility, the report says it does not clearly establish when the process is considered complete or who remains responsible in the meantime.
“A phone call is not an assumption of responsibility, and a recommendation to ‘go somewhere else’ is not a referral,” Patient Ombudsman Marios Charalambidis says.
“When providers disagree, the patient must already be receiving care and not be waiting for the dispute to be resolved,” he adds.
When patients are left ‘in the middle’
The report examines scenarios ranging from the transfer of patients already receiving treatment and arrivals at emergency departments to disagreements between medical institutions and the role of the treating doctor.
Three key elements are identified in cases where the process works as required by law: written documentation, confirmed acceptance by the receiving institution and a clearly designated person responsible for the patient.
“Where even one of the three is missing, the patient is left in the middle,” the report states.
The report also notes that the Health Insurance Organisation’s referral protocol covers seven categories of emergencies at emergency departments, while the relevant legislation applies to all patients.
Among the situations not covered by the specific protocol are complications following procedures, transfers of patients already admitted to a facility, ambulance transfers and the role of the treating doctor.
Critical decisions are made ‘over the phone’
The report also raises concerns about how referrals, acceptances and refusals are documented.
According to the findings, “critical decisions are made over the phone”, while referrals, acceptances and refusals are often not recorded, even when the rules require this.
The Health Insurance Organisation has had to remind providers of or tighten relevant rules at least twice, in 2024 and 2026, according to the report.
A particular problem arises when two medical institutions disagree over who should take responsibility for a patient. The report says there is no body with the authority to decide within a few hours which institution should take over, leaving the patient waiting.
Around 380 patient transfers each month
Around 380 patient transfers take place each month, according to the report.
However, refusals, delays and disagreements are not recorded separately.
There is also no central record of available hospital beds, meaning it is not possible to effectively verify claims that no bed is available or assess whether such claims are justified.
The report also raises concerns about more complex patients. It says that when reimbursement does not reflect the actual cost of treating complex cases, there may be an incentive to transfer them to another institution.
The report clarifies that it did not identify discrimination in a specific case, but warns that the system “does not have safeguards to prevent it”.
Patients’ rights at risk
The gaps identified affect several rights protected under Cyprus’ Patient Rights legislation.
These include the right to continuity of care and cooperation between providers, care within a reasonable timeframe, transfer only with acceptance by the receiving institution, referral and guaranteed transfer in emergencies and at emergency departments, equal care without adverse discrimination, and the right of patients and their families to receive information and participate in decisions.
Call for written acceptance before every transfer
The Patient Ombudsman’s central recommendation is the introduction of a clear rule that no referral or transfer should be considered complete without written, named acceptance by another appropriate medical institution.
Until that written acceptance is provided, responsibility for the patient should remain with the institution to which they initially turned, according to the proposal.
Acceptance by the receiving institution should be “explicit, written and named”, including the time and the name of the person responsible.
“A recommendation, phone call or verbal agreement is not enough,” the report states.
The Ombudsman also recommends a written request and referral document for every transfer, the recording of every refusal with the time, reason and name of the person responsible, named responsibility for the treating doctor and a mandatory replacement when the treating doctor is unavailable.
On-call Health Insurance Organisation coordinator proposed
The recommendations also include creating an on-call Health Insurance Organisation coordinator with the authority to decide within hours which medical institution should take responsibility when providers disagree.
The Ombudsman is also calling for a central bed availability register, accurate declarations of each provider’s capabilities, a review of reimbursement for complex cases and measurable oversight, including indicators tracking the time required for a patient to be taken over by another provider.
The report’s central objective is to ensure that there is always at least one responsible organisation and one responsible person, preventing responsibility from being passed from one provider to another.
The report does not constitute a finding concerning a specific case, does not name individuals responsible and does not assess the medical correctness of decisions.
Also read: Child benefit: These are the revised amounts
For more videos and updates, check out our YouTube channel
