The next of kin (or parents) of a client (or son) who died as a result of suicide have demanded that the GGZ institution provide all information regarding this incident, including the issue of two PRISMA studies. This concerned both the investigation into the death of the client and the investigation into the death of another client at the same mental health institution. The mental healthcare institution has submitted parts of the client’s medical file – insofar as they relate to the death – as well as parts of the calamity report that the healthcare institution believes are relevant. This did not include the two PRISMA studies. However, the next of kin also wished to obtain these PRISMA investigations on the basis of Section 843a of the Code of Civil Procedure (Rv).
The legal basis for this claim is Article 843a Rv, which allows for data to be claimed in which a party, in this case, the next of kin, has a legitimate interest. The central question in this procedure is therefore: how does Article 843a Rv relate to the provisions in the Wkkgz in which the confidential nature of the internal incident register is regulated (see, in this context, among other things, Articles 7 and 9 of the Wkkgz).
Internal incident register: scope confidential nature
Article of the Wkkgz generally prescribes that a healthcare institution must set up a quality system. Part of the quality system is the internal incident register. The quality system works properly if a reporter or the care provider can safely report an incident within the care institution. Also known as the so-called VIM system (‘safe reporting of incidents’). If there is no safe reporting, and the reporter is therefore insufficiently protected, the idea is that the willingness to report is insufficient in practice to be able to effectively control, monitor and improve the quality of care within the healthcare institution. The quality system then does not work properly.
In order to achieve the aforementioned protection of the reporter, Article 9 paragraph 6 of the Wkkgz stipulates that data in the internal incident register cannot be used as evidence in civil, criminal, administrative, and disciplinary proceedings, except for data relating to a calamity* and violence in the care relationship. Also, a disciplinary measure, an administrative sanction, or an administrative measure cannot be based on the data in the internal incident register. Paragraph 6 stipulates, deviating from the above rules, that the exception applies to criminal law that the data in the internal incident register may be used as evidence if they cannot reasonably be obtained in any other way.
Pursuant to Article 10 paragraph 3 of the Wkkgz, the client, the (legal) representative, or the surviving relative(s) do have the right to information about the nature and circumstances of an incident (including a calamity). However, this does not include concrete documents or documents. In practice, the healthcare institution can therefore suffice with a discussion of the nature and circumstances in a conversation.
In short, the data in the internal incident register is confidential, except for data relating to a calamity, violence in the care relationship or criminal evidence (with the associated conditions). But what does the exception ‘unless … ‘ mean in practice?
Court and Court of Justice
Both the court and the Court of Appeal have rejected the request of the next of kin for inspection and/or a copy of the PRISMA investigations. Both authorities are of the opinion that Article 9 paragraph 6 of the Wkkgz would be violated if a healthcare institution was required to provide access to or copies of the PRISMA investigations pursuant to Article 843a Rv. In addition, Article 10 paragraph 3 of the Wkkgz does not provide a basis for providing the reports, because this only pertains to the right to information about the nature and circumstances of an incident.
High Council
In cassation, the Supreme Court, therefore, considers the question: how does Article 843a Rv relate to the provisions in the Wkkgz in which the confidential nature of the internal incident register is regulated? For that reason, the main discussion is how the exception in Article 6 paragraph 9 of the Wkkgz should be interpreted. Does the exception, except for data relating to a calamity or violence in the care relationship, mean that data in the internal incident register that relate to a calamity or violence in the care relationship do not fall under the protection of Article 9 paragraph 6 of the Wkkgz and are therefore subject to Article 843a DCCP? can be viewed?
The Supreme Court ruled that this exception for calamities and violence in the care relationship is solely intended to enable the Health and Youth Care Inspectorate (IGJ) and the care institution (as an employer) to take measures against the care provider involved. In that case, data from the internal incident register that relate to a calamity can lead to further investigation by the healthcare institution or the IGJ and the data can be used in a procedure, for example, a disciplinary procedure from the IGJ or a dismissal procedure from the healthcare institution. or employer. Others than the IGJ, the Public Prosecution Service (OM), and the healthcare institution, therefore, have no right to inspect the data in the internal incident register, including PRISMA reports. The exception does not apply to “others”, including next of kin.
The importance of the proper functioning of the system of safe reporting for the purpose of monitoring the quality of care has been confirmed by the Supreme Court. This control, monitoring, and improvement of quality would be undermined if the request of the next of kin would be granted via Article 843a Rv because the reporter can no longer report safely and the willingness to report may therefore be reduced.
PRISMA investigation/calamity report
This judgment concerns the PRISMA investigation. This should be distinguished from a calamity report (and, of course, from the medical file). After all, the calamity report is not part of the internal incident register. The PRISMA study does. The present judgment of the Supreme Court pertains to the PRISMA investigation.
