The issue of the implementation of health services remains unchanged, since the legal bases were not amended in any way in 2015. The construction of the emergency centre network received a lot of attention and criticism, since its presentation in public was inadequate. Individual municipalities, public institutions and also individual citizens submitted complaints and proposals to the Ombudsman and expressed their concern that response times in emergencies would be longer, which could endanger citizens’ health and lives. The Ombudsman submitted queries to the Ministry of Health, and on the basis of its reply assessed that the procedure or reorganisation of emergency medical services was suitable, since it permitted the participation of the public and all interested parties. Therefore, we did not discover any violations of human rights or fundamental freedoms, or an incorrectly conducted procedure with regard to the activities of the Ministry. We highlighted the Ombudsman’s expectations that the comments and proposals of municipalities, health institutions and the citizens for whom these services are intended would be taken into account in the preparation of the final concept. We also repeated the opinion that a preliminary notification of the public of reasons for amendments and their basic content is essential for the enforcement of any qualitative amendments, whereby the publication of draft legal acts on the website is not sufficient, and direct forms of presentation must be organised, and in particular replies to issues and dilemmas that are raised must be provided. 2.12.3 L  jubljana University Medical Centre ignores the Ombudsman’s queries Similarly to our criticism of the management and work of the Ministry of Health, we can also assess the situation in the largest health institution in Slovenia, Ljubljana University Medical Centre. Problems with finding a management body are clearly displayed in communication with the public and individuals, who see this institution as a public service. We emphasised several times that a prompt reply may frequently prevent further problems and complications, including the dissatisfaction of users who recognise an encroachment upon their dignity in the ignorance of the authorities. In March 2015, we received letters from the Pulmonary Hypertension Association of Slovenia and the Cystic Fibrosis Association of Slovenia, which described the intolerable treatment conditions of patients in both associations. According to both associations, the conditions described were endangering patients’ health and lives and had to be remedied immediately. The public was also informed about the poor conditions, and the Minister of Health explained in her reply to the associations that the issue had to be dealt with by the management of Ljubljana University Medical Centre. After receiving the complaints, we immediately asked the Director of Ljubljana University Medical Centre to state his position regarding the claims of both associations, and explain when and how the management of Ljubljana University Medical Centre would remedy the situation and ensure suitable treatment for all patients. Since we did not receive a reply for over six months, we submitted an urgent letter to Ljubljana University Medical Centre in November, which also received no reply. At the beginning of 2016, we sent another urgent letter to the new management of Ljubljana University Medical Centre and stressed that ignorance of letters received is disrespectful to those who contact a public institution, particularly when they point out conditions for which the management of the institution is directly responsible. Complainants who are concerned about the health and lives of their loved ones deserve at least a prompt reply. We explicitly notified the management of Ljubljana University Medical Centre that their unresponsiveness to the Ombudsman’s queries is disrespectful and is considered an obstruction to the Ombudsman’s work on the basis of paragraph four of Article 33 of the Human Rights Ombudsman Act. We thus proposed that the responsibility for unfounded delays in drafting replies in the discussed case be established in a prescribed procedure and that such conduct be sanctioned accordingly. improve channels of communication would be taken in cooperation with the institution’s management. At the beginning of 2016, we agreed together with institution’s management on a method of communication which would prevent further discrepancies. Example: The Medical Chamber of Slovenia delays a procedure and violates human rights A legal representative of a company who asked the Ministry of Health to issue a permit to perform a health-care activity wrote to the Ombudsman because the relevant procedure for issuing the permit was still underway, since by law the Ministry had to obtain the opinion of the Medical Chamber of Slovenia. In the procedure before the Chamber’s Professional Medical Committee, it was supposedly established that the applicant for the permit was using treatment methods which did not comply with medical practise, so the case was submitted to the Chamber’s arbitration board. The applicant’s representative emphasised that the applicant had not been informed of the content of the alleged complaint over his work or information about the current status of his case. The Ombudsman notified the Chamber that the provisions of the General Administrative Procedure Act must be observed when issuing permits for the implementation of health-care activities, which also determines the (instruction) deadlines for the issue of a competent authority’s decision. The statutory deadlines in the relevant case had already expired and we proposed to the Medical Chamber of Slovenia that the procedure be accelerated and to the Ministry of Health that the decision be issued as soon as possible and the procedure completed. We believe that when the Chamber issued its opinion according to Article 35 of the Health Services Act, it should have issued its opinion within the deadline (60 days), and the opinion did not require a decision by the arbitration board if the contentiousness of the treatment method had already been determined by the relevant Committee. Otherwise, the Chamber would be obliged to observe the deadline of two years from the violation, as per Article 43 of the Rules on Organisation and Work of the Arbitration Board of the Medical Chamber of Slovenia (Pravilnik o organizaciji in delu razsodišča Zdravniške zbornice Slovenije). in our opinion, such a situation would constitute an unacceptable delay in the procedure, since, on the basis of the provisions of a general act, the Chamber would actually be obstructing the work of the competent administrative body, which must be based on the Constitution and law (paragraph two of Article 120 of the Constitution of the Republic of Slovenia). Irrespective of the substantive decision of the Ministry of Health, which is not known to us, we assessed that decision making in this case took unreasonably long (approximately 18 months) and therefore was a violation of the principle of good administration and the complainant’s right to equal protection of rights arising from Article 22 of the Constitution of the Republic of Slovenia. We believe this to be an example of a systemic deficiency, i.e. dependence of a state authority’s decision making on acquiring an opinion from a professional association, which prevents the administrative body from making a correct and timely decision. We expect the new Health Services Act to contain amendments which prevent such violations of human rights. 2.12.4 Patient Rights Act The Council of Ljubljana University Medical Centre discussed our complaint and determined that the poor communication had been due to an administrative complication, and ensured that the measures needed to In 2015, we also organised a joint meeting with all advocates of patients’ rights, where we discussed certain open issues relating to their work. The Ombudsman assesses their work to be very beneficial and necessary, and the Ministry of Health should enhance its cooperation with them. Due to the anticipated amendments to legislation, the Ministry should also examine proposals to extend their work to the field of compulsory health insurance. Advocates of patients’ rights already frequently deal with issues encountered by patients when claiming rights deriving from compulsory health insurance. Our attention was drawn to decisions of the Health Insurance Institute of the Republic of Slovenia which are sometimes difficult to understand, the unregulated 128 ANNUAL REPORT OF THE HUMAN RIGHTS OMBUDSMAN OF THE REPUBLIC OF SLOVENIA FOR 2015 ANNUAL REPORT OF THE HUMAN RIGHTS OMBUDSMAN OF THE REPUBLIC OF SLOVENIA FOR 2015 129 2.12 HEALTH CARE AND HEALTH INSURANCE 2.12 HEALTH CARE AND HEALTH INSURANCE 2.12.2 Health Services Act