Refuse the doctor in the clinic. Does the patient have the right to choose a doctor in the clinic

anonymous , Man, 35

Hello! In our polyclinic, the neurologist often changes, and each new one is worse than the previous one. We have a couple of dozen sites, a rather large area is serviced, respectively, to a single neurologist, an appointment for 2-3 weeks in advance. I have had neurological problems since childhood. The last time the neurologist did not read what the previous one wrote, nor look at the results of the examinations, he simply asked briefly "where does it hurt?" Without even looking at me, he wrote osteochondrosis lumbar spine and all. Although, previous doctors, I was already diagnosed with this. At my request to appoint examinations (X-ray, MRI, ultrasound), he said that now there is no nurse to write them out. It turns out, now again wait 3 weeks before the next dose. I told the therapist about my last visit to the neurologist and asked for a referral to another medical institution where the neurologist is not so busy, she just grinned and confirmed that his nurse was really on sick leave and offered to wait until she went to work. Still, do I have the right to request a referral to another doctor from another medical facility? Or even transfer to another clinic? Because, to be honest, our polyclinic is very inferior to many others in our city in terms of the number of doctors, availability of appointments, etc.

Hello. In accordance with the Federal laws on the basics of protecting the health of citizens (Article 21) and compulsory medical insurance of citizens (Article 16), citizens of the Russian Federation have a guaranteed right to choose medical organization(MO) to obtain a permanent outpatient medical care within the framework of the state guarantee program. The right to choose a MO can be exercised no more than once in a calendar year. This right is exercised in the manner approved by the Order of the Ministry of Health and Social Development of the Russian Federation dated April 26, 2012 No. 406n. The regulatory procedure stipulates that in order to exercise the right to choose the Ministry of Defense, a citizen needs and is sufficient to apply to the chosen Ministry of Defense with an application containing the information provided for by Order No. , is obliged to inform the citizen about attachment within 2 days. That is, the right to choose MO is implemented in a notification (rather than permissive) manner. The right to choose a specific district (pediatrician) is subject to the prior consent of the doctor. If no doctor "agreed" the attachment is at the discretion of the administration of the Moscow Region. If the citizen who has chosen the MO does not live on the territory of the district service by the doctors of this MO, then he is not provided with medical care by a general practitioner () at home. Specialized medical care is provided to citizens within the framework of the program of state guarantees in the direction of attending physicians and in accordance with the procedures for providing medical care and routing patients in a particular region (paragraphs 13-15 of the Order of the Ministry of Health and Social Development of the Russian Federation dated April 26, 2012 No. 406n). Accordingly, the patient can exercise his right to choose a specialist in the necessary medical specialty only within the information provided to him by the attending physician about the possibilities of choosing from organizations that have the necessary resource capabilities and have the obligation to accept a "foreign" patient on a doctor's referral. At the same time, the “broadness of choice” in a number of regions, for objective reasons, is limited to one single organization and one doctor. In your particular case, the replacement of a neurologist or an entire medical organization does not guarantee the quality of providing you with the necessary medical services in the future. The doctor's refusal to give you a referral to another is probably due to objective reasons (which I have indicated above). In order to resolve the problem, I would recommend that you file a written complaint about the quality of neurological care provided to you with the insurance company that issued you compulsory medical insurance policy, also ask the insurer to protect your rights to quality medical care in the CHI system. An application (complaint) is submitted in free form and must be considered within 30 days.

Current Russian legislation secures for each patient the right to choose a doctor and medical organization. And, for sure, there are citizens who want to use this right.

If many people have a more or less clear idea about paid clinics, then with budgetary institutions, many questions arise: where to go, what documents to collect and whether they can refuse to attach to another clinic.

And, as a result, ignorance of the rights gives rise to doubts, uncertainty about the correctness of their actions or decisions.

For a complete understanding of the situation, one should refer to the current legislative acts.

In accordance with Art. 21 of the Law of the Russian Federation of November 21, 2011 No. 323-FZ “On the Basics of Health Protection ...” (Law No. 323-FZ), a citizen has the right to choose a medical institution.

By order of the Ministry of Health and Social Development of the Russian Federation dated April 26, 2012 No. 406n, the “Procedure for the choice of medical care by a citizen ...” (Order No. 406n) was approved.

However, paragraph 1 of the said Procedure provides that primary medical (pre-medical) health care is carried out directly on the principle of attachment to a certain territorial area.

This means the formation of sites with services for groups of people. People are assigned to the appropriate site based on the territory of their residence, work or study.

The sites are approved by the head of the institution, taking into account that the principle of accessibility of receiving services is not violated.

In particular, the number of patients per unit of workers is taken into account. The recommended indicators are contained in clause 18 of the Regulation approved by Order of the Ministry of Health of the Russian Federation of May 15, 2012 N 543n.

For example, 1,700 people should be observed at one therapeutic site in a city, and 1,300 citizens in a village.

If, for objective reasons, the necessary indicators are not achieved (in some regions there is a shortage of patients at the sites) and for citizens to use their rights to prefer one or another institution, it is allowed to attach persons who do not belong to the territory of the medical institution. institutions.

It is possible to implement your choice under certain conditions:

1. You can choose an institution only in the subject where the person lives. Exceptions are some categories (military, convicts).
2. Only an adult is entitled to replace the organization.

The rights of minor or minor children, as well as incapacitated citizens are represented by their parents or guardians.

To select a medical institution, you need to follow certain procedures:

• draw up a written application and present it to the organization where you would like to be registered;
• having received the document, the polyclinic sends this information to the institution where the person is registered within two days;
• the latter checks the veracity of the information provided and, if the information provided is correct, informs the organization that accepted the application, also within 2 days;
• within two days, the applicant is informed about admission to a medical institution;
• then, within three days, the information is sent to the insurance company and the former honey. institution.

Correspondence between organizations may be carried out by post or by electronic means. The citizen is notified by any accessible ways: in person, in a telephone conversation, using postal services, by e-mail.

For a correct understanding, it is worth noting that the principle of choosing another medical institution by the applicant implies its automatic detachment from the organization where it was observed earlier. That is, it is impossible to be registered in two different institutions at the same time.

Contents of the application for choosing a medical organization

The document must indicate:

• full name and location of the addressee;
• FULL NAME. chief physician of the organization to which the document is addressed;
• information about the applicant (gender, age, where he was born, what citizenship he has, passport details, place of residence);
• CHI policy number and the name of the insurer that issued the policy;
• information about the medical institution where the applicant is served.

When submitting an application at the same time, you must present the original documents:

• the passport;
• OMS policy.

A complete list of documents is enshrined in clause 5 of Order No. 406n. It depends on the status of the citizen. For example, a refugee needs to provide a certificate, and stateless persons need a residence permit.

The contacting person should be told which specialists provide primary care in the institution. He is also notified of the number of people who have chosen a particular health worker, indicating the territory served by him when calling at home. This information may affect right choice specialist.

Having chosen the right medical institution, the patient can also choose a doctor, but in this case, the legislation has limited the choice (Article 21 of Law No. 323-FZ).

A person has the right to make a choice only in relation to:

• local therapist;
• area pediatrician.

The patient can choose a specialist on his own, but on a mandatory condition - the doctor must give his consent (Article 70 of Law No. 323-FZ).

If a citizen has decided to opt for another specialist, the head physician is obliged to help him in exercising this right, according to the Procedure, approved. Order of the Ministry of Health and Social Development dated April 26, 2012 No. 407n (Order No. 407n).

The doctor in some cases has the right to refuse to serve the patient, if such a refusal is not associated with a threat to his life. In this case, the manager takes measures to select another specialist for the patient from among the employees of the clinic.

And here the point is not even that the doctor is too lazy to treat the patient. Basically, such refusals are related to the high workload of the doctor or the remoteness of the patient's residence, and the employee, understanding his official duties and assessing the real possibilities, will not risk taking on an additional person for service, risking not providing him with assistance at the right time, since there is disciplinary responsibility for this but also criminal.

Therefore, when deciding to replace medical staff, you need to act reasonably and consider these circumstances. There are, of course, situations based on personal relationships, but these are separate isolated situations.

How is the replacement of a doctor

The attending physician can be replaced for the following reasons:

1. If a citizen has decided to replace a doctor, he must contact the head of the organization with a written request. He must also state the reason.
2. Having received the application, the head physician informs about which specialists work in the institution.
3. Based on the information received, the applicant can decide who he would like to be observed.

The choice of a specialist should be approached responsibly.

The general procedure is not acceptable in all cases. Some persons can only be served in a certain order.

These citizens include:

1. Residents of closed-type territorial entities (ZATOs), as well as territories with unfavorable conditions in terms of physical, chemical or biological indicators. The list of such territories is approved at the legislative level. Thus, such settlements were approved by Decree of the Government of the Russian Federation of 05.07.2001 No. 508. For example, ZATO - the city of Mirny, the Arkhangelsk region, the village of Voskhod, the Moscow region, etc. The specifics of medical care for such persons are determined by Decree of the Government of the Russian Federation of July 26, 2012 No. 770. Medical assistance to citizens for such persons is provided free of charge from among the Federal Medical and Biological Agencies (FMBA) located in the area where such persons live or work. RF GD dated August 21, 2006 No. 1156-r approved organizations served by the FMBA of Russia.
2. Soldiers, conscripts, contractors. Their service is carried out according to the rules of Art. 25 of Law No. 323-FZ. Depending on their status, they can count on medical services in departmental health care institutions or in accordance with Art. 21 of Law No. 323-FZ.
3. Persons suspected of crimes or convicted citizens who are kept in specialized institutions receive medical care in institutions of the criminal and executive system (Article 26 of Law No. 323-FZ).

Interpretation of Art. 21 of Law No. 323-FZ allows us to consider that a patient can be treated free of charge only if he has a valid CHI policy.

In this regard, many may have a reasonable question, is it possible to exercise such a right in a paid clinic?

Law No. 323-FZ does not directly provide guidance on the choice of specialists or the organization itself when a person pays for services. However, this was not correct, because any system in the state should give a certain choice to people.

A citizen who wishes to receive honey. service for money he is free to choose the appropriate organization and, consequently, a particular doctor. Legislative norms do not restrict citizens in this. As a rule, word of mouth, reviews, recommendations about the clinic and their staff, as well as the cost of services, play a role here.

Turning to private clinic, the consumer is offered to conclude an agreement with all the ensuing conditions. And here the principle of freedom of transaction applies (Article 421 of the Civil Code of the Russian Federation), which does not allow any coercion.

Thus, if the patient is not satisfied with the clinic, he can safely go to another one. This is a kind of freedom of choice.

The rights of insured citizens under compulsory health insurance

Getting free help is directly related to the fact that physical. the person must be an insured subject under compulsory medical insurance. Because otherwise, it will be problematic to use gratuitous services. Three subjects are involved in the relationship to receive medical care: individual, medical authority and insurer.

The legal status of such entities is regulated by the Law of the Russian Federation of November 29, 2010 No. 326-FZ “On Compulsory Medical Insurance ...” (Law No. 326-FZ).

Article 15 of Law No. 326-FZ indicates which entities can carry out activities within the framework of compulsory medical insurance.

These include:

• organizations;
• individual entrepreneurs.

The important thing is that they must be in the appropriate registry.

The legal status of such persons is fixed in Art. 16 of Law No. 326-FZ:

1. Get free help.
2. Services are provided on the territory of the Russian Federation and the specific subject where the insured person lives.
3. Choice of insurer.
4. Choice of medical institution and doctor.
5. Obtaining complete information about the services provided by polyclinics, hospitals.
6. Protection of the rights of the insured. This is a very important point, since not everyone knows that in case of violation of rights in the field of medicine according to the state. warranty, you can contact the insurance company specified in the policy. The functions of the insurer are reduced not only to the issuance of an insurance document, but to upholding the violated rights of the insured.
7. Compensation for damage caused to persons by both the insurance company and the medical organization. There is a lot of court practice in disputes about improper provision of services.

It should be recalled that all these rights are available to persons who are members of the CHI system.

Confirmation of this status is the CHI policy, which is issued and changed in the prescribed manner.

When choosing a medical organization, you need to inquire about the existence of an agreement between it and the insurance company indicated in the medical policy. Otherwise, a refusal may follow.

Bringing mandatory information to citizens

Carrying out activities in the field of free medicine, such entities must necessarily bring to their serviced information about the medical institution itself, about what services it directly provides, as well as about the staff of specialists indicating their qualification characteristics.

Information is posted on information boards, near the registry. In addition, the law obliges to place this information on the organization's website.

What medical assistance is available

In accordance with the legislation, assistance in medicine is divided into types, conditions and forms.

Types of medical care:

• primary health care;
• specialized medical care;
• Ambulance;
• palliative care.

Conditions for the provision of medical help:

• outpatient (in the clinic, at home);
• not at the location of the hospital building (the place where an ambulance was called, an ambulance);
• in a day hospital (under observation during the daytime);
• in a hospital (under round-the-clock supervision).

Help forms:

• emergency (when there is a possibility of death of a person);
• urgent (with an acute, sudden, unexpected illness, but if at the same time nothing threatens a person’s life);
• planned (if the patient's health does not deteriorate during the delay of treatment).

The provision of this type of service includes preventive and diagnostic measures, as well as treatment of diseases. In addition, it involves the observation of women in the situation and the implementation of measures to prevent epidemics.

This type of assistance is organized mainly on a territorial basis, that is, close to the place of residence, labor activity or patient education.

This assistance is divided into:

• pre-medical (it turns out to be paramedics, that is, personnel with a secondary education);
• medical (turns out to be doctors);
• specialized (provided by specialists of a certain narrow focus).

Primary care can be provided:

• in an outpatient setting;
• on the territory of the patient, if he lives in a remote area (not an ambulance);
• in a day hospital;
• in the office emergency care, which can be temporarily organized, for example, in horticultural and summer cottages.

Such assistance is provided by medical specialists.

It also includes preventive measures, diagnostic measures and treatment of diseases. However, unlike primary care, it requires special techniques, modern technologies and subsequent rehabilitation. Therefore, such assistance is provided in a hospital setting or in a day care facility, so that it is possible to observe the course of the disease to the maximum.

High-tech assistance is also referred to as specialized assistance. Its feature is the use of unique, complex methods of treatment, the use of robotics and various techniques at the gene level.

You may need a referral from your GP or pediatrician to get specialized care. Also, the patient can seek help on their own. In this case, he has the right to choose a specialist and a medical institution.

In the implementation of assistance in a planned mode, the therapist gives a referral to a specialist. In case if needed help can be provided in several medical institutions, the attending physician must inform the patient about this so that he can independently select a specialist.

Getting urgent or emergency medical care

This need usually arises when chronic diseases suddenly aggravated, or the person fell ill and the malaise flowing into acute form. Also, the service may be needed in case of poisoning or injury, when urgent intervention is needed.

In some cases, it is necessary to evacuate the victim, which is possible using an ambulance.

Basically, such forms of assistance are provided in stationary conditions, because in most cases it is necessary surgical intervention and patient monitoring.

Palliative care is a comprehensive medical intervention to relieve a terminally ill person from pain and improve his life.

Such cases include, for example, malignant tumors, progressive diseases. Appropriate care, food, transportation to and from medical facilities, anesthesia are prescribed for them.

Orders of the Ministry of Health of the Russian Federation dated April 14, 2015 No. 193n, No. 187n approved the relevant rules for such assistance for the adult population and children.

Assistance is provided in the clinic or in the hospital.

The choice of a medical institution or a doctor is made dependent on the type of assistance.

Primary health care.

Article 21 of Law No. 323-FZ establishes for a citizen the right to choose honey. organizations once a year, not more often. The exception is when the place of residence changes.

In the same institution, patients can choose a doctor - once a year.

Such provisions were most likely established in order to prevent abuse of rights by consumers of services. Since there are such categories of dissatisfied people who are ready to change the clinic or specialist almost every few days. In this case, the law also protects the rights of doctors.

Specialized medical care in a planned manner.

To get help, you need to get a referral from your doctor. It should be noted that if there are several medical institutions providing the necessary services, the doctor must notify the patient about this.

Emergency and urgent care.

Since these types of assistance are provided online, there are no fixed deadlines for selection. Because you need to act immediately.

A citizen can apply for help personally by choosing an institution. In this case, most likely, the institution will not be entitled to refuse to provide assistance, given the moral component, as well as the medical oath.

Help can be sought by calling an ambulance. Departure time special brigade is established by the relevant regulations approved at the legislative level. In this situation, the choice of institution will depend on who will be ready to receive the victim.

Palliative care.

The attending physician, after an appropriate diagnosis, issues a referral to the patient for assistance.

How to defend your rights in case of refusal

In most cases, clinics or specific specialists are reluctant to take on new persons, as this is not financially justified, but increases their workload.

Although the rights of citizens are enshrined at the legislative level, but often, in practice, people are faced with refusals.

Someone, not being guided by the legislation, agrees with the arguments of the registrar regarding the impossibility of observation in this institution, since citizens do not belong to the service area. And someone, even realizing the violation of their rights, simply does not know what to do next.

Where to go

Where to go for help:

• health authorities;
• health insurance institutions;

In case of refusal to choose under Art. 21 of Law No. 323-FZ, statements of claim demanding that the defendant be obliged to perform certain actions are filed with a court of general jurisdiction, a district or city court (not a world court).

The lawsuit is filed in court based on the location of the defendant, that is, the organization that refused.

The law does not contain the exact form of the claim, the main thing is to adhere to the requirements of the law regarding the details of the application.

The claim must show:

• the name of the judicial body;
• FULL NAME. the plaintiff and the organization, indicating their addresses;
• rights violation;
• regulatory justification;
• proof of;
• request to the court;
• list of attached documents.

From the defendant in court, all the expenses of the plaintiff incurred by him in the case under consideration - postage, paid state duty, representation services (lawyer, lawyer) can be recovered. You can also file a claim for non-pecuniary damage.

The claim is subject to consideration in a court session, in which all persons of the process participate. Other interested parties, such as OMS authorities, may be involved in the case.

The court interrogates the parties, examines all the evidence and issues a judicial act. If the outcome is positive, the defendant has the right to appeal. After that, the decision is considered to have entered into force and is subject to execution.

Since the defendant has information about the judicial act issued, a second appeal to the organization is not required. The defendant must voluntarily comply with the requirements of the court. Even if its representatives did not participate in the process, a decision in absentia is made and sent to the address of the defendant.

However, it is better to worry and re-apply to the head physician, presenting a judicial act, since the case can be left to chance.

If the decision is not executed voluntarily, it is necessary to resort to a forced solution of the issue by contacting the bailiff.

Judicial practice on the issue covered in most cases develops in favor of citizens. For example, the following judgments can be cited.

Case No. 2-4638/2017 (District Court of Arkhangelsk).

The citizen filed a lawsuit against the budgetary health care institution on imposing the obligation to take her for service. At the same time, she indicated that she was suffering diabetes and is currently observed in the clinic at the place of her registration, but there are no necessary doctors. She filed an application with the defendant, but she was refused due to the excess of served persons by one full-time specialist. Also, the reason for the refusal was the fact that the woman lived in a territory that did not belong to the service area of ​​​​honey. institution.

The court considered the defendant's arguments untenable and pointed out that Regulation No. 543n does not contain such grounds for refusal as the territorial principle.

The claim was granted. The clinic was obliged to register the patient and provide her with the necessary services.

Case No. 6445/2016 (Angara City Court).

The woman asked the head doctor of the treatment center to be assigned to the service in this institution. However, she was denied this. The head of the organization motivated the refusal as follows, the institution has a staff turnover, congestion and lack of staff.

The court did not accept such arguments of the defendant, considering them not based on the law.

The judgment was rendered in favor of the plaintiff.

In some cases, it is not the citizens themselves who apply to the courts. Their rights are protected by supervisory authorities.

It's confirmed court decision.

Case No. 2-3623/2016 (City Court of Anapa).

The prosecutor filed a lawsuit in the interests of citizens and asked to recognize as illegal the inaction of the city hospital, expressed in the failure to provide information on the website of the institution about doctors and their qualifications. This was revealed as a result of the audit. Thus, according to the prosecutor, the rights of potential consumers of services are violated, since they cannot fully exercise the right to choose under Art. 21 of Law No. 323-FZ.

The court agreed with the plaintiff and ordered the hospital to place the relevant information on the hospital's official website on the Internet.

There are also negative judgments. However, these are individual cases and the courts in such disputes take into account all circumstances.

For example, in one of the civil cases, the position of the court was different than in those described earlier.

Case No. 2-4206/2017 (District Court of the city of Chelyabinsk).

The plaintiff filed a lawsuit demanding that she be registered in a clinical hospital. She indicated that she was not attached to any institution, but needed medical assistance. The defendant objected to the claim, referring to the fact that the woman does not belong to the hospital in terms of territory. In addition, the number of people served, so exceeds the established standards. The woman was assigned to another hospital in the city for observation.

The court denied the woman's demands. When making a decision, the court took into account that at the time the citizen filed a lawsuit, her rights had not been violated. She was assigned to serve in another hospital. The woman herself also explained that it does not matter where she gets help, as long as she can do it.

Practice of the Courts of Appeal

Courts of appeal generally uphold decisions of first instance. In confirmation, you can submit the decision of the appellate instance.

Case No. 33-1492/2015 (Arkhangelsk Regional Court).

By the decision of the city court, the claims of the plaintiff were satisfied, in particular, the court decided to attach the patient to the service in the clinical medical Center. The defendant disagreed with the judgment and filed a complaint with a higher court.

However, the second instance agreed with the arguments set forth in the city court's decision.

In addition, in the case, the defendant was awarded compensation for moral suffering.

Supreme Court of the Russian Federation

Judicial act on the recognition of illegal certain regulations.

Case No. APL15-354.

The citizen in the case reached the Supreme Court. Her goal was to invalidate clauses 10, 11 of Order No. 406n, namely, she considered it illegal that it was not possible to be attached to two medical institutions at the same time and to have two patient cards. She argued her position by the fact that the parents live separately, and the daughter is periodically with her father, then with her mother. The rules established by law violate the principles of family law. In particular, about the obligation of both parents to monitor the health of children.

The Supreme Court left in force all the judicial acts adopted in the case, thereby not recognizing the points as illegal, indicating that they do not contradict the Constitution and current legislation. He also explained that the norms of the Family Code of the Russian Federation do not regulate relations in the field of medical activity.

Summing up, it should be noted that in modern reality there are quite a lot of people who want to replace a doctor or a medical organization. This may be explained various reasons, such as distrust of a particular specialist or a medical institution in general, unsatisfactory quality of services provided, or even a purely objective factor - a personal attitude towards a doctor. And the law in this situation is on the side of the citizens. However, when making such a decision, you should weigh the pros and cons. Since this step can literally affect health. It is necessary to take into account both the workload of the staff and the remoteness of the institution from the place of residence of the patient. After all, it is not always possible to get there on time, both independently and to the doctor, in case of calling him at home. Therefore, it is necessary to solve the problem rationally and deliberately.

Today, "RG" publishes an order of the Ministry of Health and Social Development, which approved the Procedure for assisting the head of a medical organization (its division) with the patient's choice of a doctor in the event that the patient requests a replacement of the attending physician.

The document is small, but important, because for the first time it clearly defines the mechanism for choosing the attending physician. In itself, this right exists in Russian healthcare for a long time, but it was always not easy to use it - the final decision depended largely on the location of the head physician of the medical institution, and sometimes, to be honest, on his character.

So, to change the attending physician when providing care general type(in a polyclinic, outpatient clinic, dispensary, hospital, etc.), you must write an application addressed to the head physician, indicating the reasons why you require it. Their document does not regulate in any way, therefore, there can be any reasons - from dissatisfaction with the style of communication to distrust of the doctor and his competence, from an inconvenient work schedule to a specific conflict. The head within three working days must inform the patient in writing or orally about what other doctors are in the institution and what their work schedule is. Based on this information, he makes his choice.

It is important that the transition to the doctor of your choice is subject to his consent. It is understood that he may refuse if, for example, he is overloaded with work.

In principle, the right to choose a doctor naturally follows from the civil rights and freedoms of the individual. However, like all our other rights, it also has limitations. This should not be forgotten when demanding your own.

expert opinion

Vladimir Porkhanov, Chief Physician of the Krasnodar Regional clinical hospital, corresponding member of the Russian Academy of Medical Sciences:

If the patient expresses such a wish, we, of course, try to satisfy him when possible. But if one doctor performs 8 operations a day, he will not physically be able to perform 9 or 10. I think there is only one way out: all hospitals should be good, and all doctors should be highly qualified and treat patients normally. Then you don't have to choose. And we are striving for this.

Oksana Denisenko, Deputy Chief Physician of the Moscow City Polyclinic N34:

For us, the desire of the patient to change the district doctor is not a problem. There are very few such applications, no more than 1-2 per year. The reason, as a rule, is that the relationship with the doctor did not work out. The issue is resolved immediately, the patient can go to any other doctor. The only restriction is that his local therapist will come to his house on a call, because the territorial principle of service is preserved.