From: =?Windows-1252?Q?M=E4rt_Mikkal?= <mart.mikkal@meliva.ee>
To: "info - AKI" <info@aki.ee>
Subject: Re: Vastus selgitustaotlusele 
Date: Tue, 3 Nov 2026 15:34:25 +0200
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Tähelepanu! Tegemist on välisvõrgust saabunud kirjaga.
Tundmatu saatja korral palume linke ja faile mitte avada.

Tere,

aitäh Teile väga põhjaliku vastuse eest. Teie vastuse viimases kolmes
lõigus olid vastavad laused:

"Ravisuhte lõppemine ei välista iseenesest varasema teenuse kvaliteedi
hindamist, kuid varasem ravisuhe ei anna tähtajatut õigust patsiendi
edasist ravi jälgida"

"AKI hinnangul ei ole põhjendatud tuletada üldisest kvaliteedi tagamise
kohustusest õigust kõigi varem ravitud patsientide edasiste terviseandmete
süstemaatiliseks kontrollimiseks."

"Tüsistuste ja ravi tulemuslikkuse kohta teabe kogumiseks saab kliinik
kasutada vähem riivavaid meetmeid, näiteks patsientidelt tagasiside
küsimist või patsiendilt selleks eraldi nõusoleku võtmist"


Terviseministri 23. oktoobri 2024. a määruse nr 44 „Tervishoiuteenuste
kvaliteedi ja patsiendiohutuse tagamise nõuded“ (RT I, 29.10.2024, 1)
kohaselt on teenuse osutaja kohustatud:

§ 3. Üldnõuded tervishoiuteenuse osutaja tegevusele tervishoiuteenuste
kvaliteedi tagamisel ja parandamisel
(1) Tervishoiuteenuse osutaja vastutab patsiendile osutatava
tervishoiuteenuse kvaliteedi eest oma organisatsioonis ning on kohustatud
tagama käesolevas paragrahvis kirjeldatud meetmetega teenuse vastavuse
vähemalt arstiteaduse üldisele tasemele ja reeglitele teenuse osutamise
ajal.
(2) Tervishoiuteenuse osutaja on kohustatud viima oma organisatsioonis
ellu tõenduspõhiseid tegevusi tervishoiuteenuse kvaliteedi ja
patsiendiohutuse parandamiseks ja tervishoiuteenuse osutamisega seotud
riskide vähendamiseks ning koostama ja avalikustama regulaarsed
kokkuvõtted kvaliteediga seotud tegevustest ja eesmärkide saavutamisest.

Seda Võlaõigusseaduse (VÕS) § 762 kohaselt peab tervishoiuteenuse osutaja
teenust osutama tervishoiutöötajate üldiselt tunnustatud arstiteaduse
taseme järgi teenuse osutamise ajal ning vastavalt sellele hoolsusele,
mida temalt tavaliselt oodatakse.




Minu poolt välja toodud määrus ja seadus paneb kvaliteedi tagamise koorma
tervishoiuteenuse osutaja õlgadele mis on õige. Viis kuidas me seda saame
tagada on tegelikult järjepidev seire tüsistuste tekke osas , mis puudutab
kirurgiat. Nagu ma esialgses pöördumises tõin välja, siis patsientidelt
tagasiside saamine on keeruline. Iseseisvalt tehakse seda harva ning
asutuse poolt oleks see kulukas ning ebaefektiivne.  Lisaks võib
patsientide arusaam tüsistustest erineda - peale operatsiooni valu on
ootuspärane kuid keegi võib seda pidada tüsistuseks. Ja sarnaselt võidakse
öelda, et esines küll valu kuid ei mainita, et tekkis peale operatsiooni
infektsioon, mis vajas antibiootikumi ning oligi selle valu põhjuseks.

Ma olen täiesti nõus, et tähtajatult patsiendi edasist ravi jälgida pole
õigustatud. Eelkõige meid huvitab vahetu postop kulg kuni 30 päeva. Kas
selline lahendus oleks AKI vaatenurgast lubatud, kui operatsiooni
nõusoleku lehele võetakse allkiri , mis lubaks tutvuda lõikus kuupäevast
alates kuni 30 päeva täitumiseni patsiendi edasise ravi dokumentidega ? Me
saame nõusolekus ka täpsustada milliseid andmeid me vaatame (perearsti
vastuvõtt , emos käik, analüüsid, retseptid . kuid me ei vaata
psühhiaatrilisi või asjasse mitte puutuvaid dokumente. Näiteks kui
patsient on käinud ortopeedilisel lõikusel käe piirkonnas, siis meil ei
ole põhjust uurida järgnevat günekoloogilist haiguslugu) ja kes neid
vaatab.




Heade soovidega
Märt Mikkal
Uroloog/ Operatsiooniploki vastutav arst
Meliva AS
Rävala pst 5, Tallinn
 <http://www.meliva.ee/> www.meliva.ee



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style=3D"font-size:9.0pt;font-family: &quot;Segoe =
UI&quot;,sans-serif;mso-fareast-font-family:&quot;Times New =
Roman&quot;;color:#212121"> <strong>T=E4helepanu! </strong>Tegemist on =
v=E4lisv=F5rgust saabunud kirjaga.<br>Tundmatu saatja korral palume =
linke ja faile mitte =
avada.<o:p></o:p></span></p></td></tr></tbody></table>
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<style type=3D"text/css" style=3D"display:none;"> P =
{margin-top:0;margin-bottom:0;} </style>
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Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; =
font-size: 12pt; color: rgb(0, 0, 0);">
Tere,</div>
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Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; =
font-size: 12pt; color: rgb(0, 0, 0);">
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</div>
<div class=3D"elementToProof" style=3D"font-family: Aptos, =
Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; =
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ait=E4h Teile v=E4ga p=F5hjaliku vastuse eest. Teie vastuse viimases =
kolmes l=F5igus olid vastavad laused:&nbsp;</div>
<div class=3D"elementToProof" style=3D"font-family: Aptos, =
Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; =
font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class=3D"elementToProof" style=3D"font-family: Aptos, =
Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; =
font-size: 12pt; color: rgb(0, 0, 0);">
&quot;Ravisuhte l=F5ppemine ei v=E4lista iseenesest varasema teenuse =
kvaliteedi hindamist, kuid
<b><u>varasem ravisuhe ei anna t=E4htajatut =F5igust patsiendi edasist =
ravi j=E4lgida</u></b>&quot;</div>
<div class=3D"elementToProof" style=3D"font-family: Aptos, =
Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; =
font-size: 12pt; color: rgb(0, 0, 0);">
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<div class=3D"elementToProof" style=3D"font-family: Aptos, =
Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; =
font-size: 12pt; color: rgb(0, 0, 0);">
&quot;AKI hinnangul <b><u>ei ole p=F5hjendatud</u></b> tuletada =
=FCldisest kvaliteedi tagamise kohustusest =F5igust
<b><u>k=F5igi varem ravitud patsientide edasiste terviseandmete =
s=FCstemaatiliseks kontrollimiseks</u></b>.&quot;</div>
<div class=3D"elementToProof" style=3D"font-family: Aptos, =
Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; =
font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class=3D"elementToProof" style=3D"font-family: Aptos, =
Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; =
font-size: 12pt; color: rgb(0, 0, 0);">
&quot;T=FCsistuste ja ravi tulemuslikkuse kohta teabe kogumiseks saab =
kliinik kasutada v=E4hem riivavaid meetmeid, n=E4iteks patsientidelt =
tagasiside k=FCsimist v=F5i
<b><u>patsiendilt selleks eraldi n=F5usoleku =
v=F5tmist</u></b>&quot;</div>
<div class=3D"elementToProof" style=3D"font-family: Aptos, =
Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; =
font-size: 12pt; color: rgb(0, 0, 0);">
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</div>
<div class=3D"elementToProof" style=3D"font-family: Aptos, =
Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; =
font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class=3D"elementToProof" style=3D"font-family: Aptos, =
Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; =
font-size: 12pt; color: rgb(0, 0, 0);">
Terviseministri 23. oktoobri 2024. a m=E4=E4ruse nr 44 <span =
style=3D"font-weight: 700;">
=84Tervishoiuteenuste kvaliteedi ja patsiendiohutuse tagamise =
n=F5uded=93</span> (RT I, 29.10.2024, 1) kohaselt on teenuse osutaja =
kohustatud:&nbsp;</div>
<div class=3D"elementToProof" style=3D"font-family: Aptos, =
Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; =
font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class=3D"elementToProof" style=3D"margin-right: -100px; =
padding-right: 100px;">
<div id=3D"para3" class=3D"elementToProof" style=3D"margin: 0.5em 0px =
0px;">
<div class=3D"elementToProof" style=3D"text-align: left; text-indent: =
6px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, =
Calibri, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<b>=A7 3. =DCldn=F5uded tervishoiuteenuse osutaja tegevusele =
tervishoiuteenuste kvaliteedi tagamisel ja parandamisel</b></div>
</div>
</div>
<div class=3D"elementToProof" style=3D"margin-right: -100px; =
padding-right: 100px;">
<div id=3D"para3lg1" class=3D"elementToProof" style=3D"margin: 0.5em 0px =
0px;">
<div class=3D"elementToProof" style=3D"text-align: left; text-indent: =
6px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, =
Calibri, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
(1) <b><u>Tervishoiuteenuse osutaja vastutab patsiendile osutatava =
tervishoiuteenuse kvaliteedi eest oma organisatsioonis</u></b> ning on =
kohustatud tagama k=E4esolevas paragrahvis kirjeldatud meetmetega =
teenuse vastavuse v=E4hemalt arstiteaduse =FCldisele tasemele
 ja reeglitele teenuse osutamise ajal.</div>
</div>
</div>
<div class=3D"elementToProof" style=3D"margin-right: -100px; =
padding-right: 100px;">
<div id=3D"para3lg2" class=3D"elementToProof" style=3D"margin: 0.5em 0px =
0px;">
<div class=3D"elementToProof" style=3D"text-align: left; text-indent: =
6px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, =
Calibri, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
(2) <b><u>Tervishoiuteenuse osutaja on kohustatud viima oma =
organisatsioonis ellu t=F5endusp=F5hiseid tegevusi tervishoiuteenuse =
kvaliteedi ja patsiendiohutuse parandamiseks</u></b> ja =
tervishoiuteenuse osutamisega seotud riskide v=E4hendamiseks ning =
koostama ja
 avalikustama regulaarsed kokkuv=F5tted kvaliteediga seotud tegevustest =
ja eesm=E4rkide saavutamisest.</div>
<div class=3D"elementToProof" style=3D"text-align: left; text-indent: =
6px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, =
Calibri, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class=3D"elementToProof" style=3D"text-align: left; text-indent: =
6px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, =
Calibri, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
Seda V=F5la=F5igusseaduse <span style=3D"font-weight: 700;">(V=D5S) =A7 =
762</span> kohaselt<b><u> peab tervishoiuteenuse osutaja teenust osutama =
tervishoiut=F6=F6tajate =FCldiselt tunnustatud arstiteaduse taseme =
j=E4rgi</u></b> teenuse osutamise ajal ning vastavalt sellele =
hoolsusele,
 mida temalt tavaliselt oodatakse.</div>
<div class=3D"elementToProof" style=3D"text-align: left; text-indent: =
6px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, =
Calibri, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class=3D"elementToProof" style=3D"text-align: left; text-indent: =
6px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, =
Calibri, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class=3D"elementToProof" style=3D"text-align: left; text-indent: =
6px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, =
Calibri, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class=3D"elementToProof" style=3D"text-align: left; text-indent: =
6px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, =
Calibri, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class=3D"elementToProof" style=3D"text-align: left; text-indent: =
6px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, =
Calibri, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
Minu poolt v=E4lja toodud m=E4=E4rus ja seadus paneb kvaliteedi tagamise =
koorma tervishoiuteenuse osutaja =F5lgadele mis on =F5ige. Viis kuidas =
me seda saame tagada on tegelikult j=E4rjepidev seire t=FCsistuste tekke =
osas , mis puudutab kirurgiat. Nagu ma esialgses p=F6=F6rdumises
 t=F5in v=E4lja, siis patsientidelt tagasiside saamine on keeruline. =
Iseseisvalt tehakse seda harva ning asutuse poolt oleks see kulukas ning =
ebaefektiivne.&nbsp; Lisaks v=F5ib patsientide arusaam t=FCsistustest =
erineda - peale operatsiooni valu on ootusp=E4rane kuid keegi
 v=F5ib seda pidada t=FCsistuseks. Ja sarnaselt v=F5idakse =F6elda, et =
esines k=FCll valu kuid ei mainita, et tekkis peale operatsiooni =
infektsioon, mis vajas antibiootikumi ning oligi selle valu =
p=F5hjuseks.</div>
<div class=3D"elementToProof" style=3D"text-align: left; text-indent: =
6px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, =
Calibri, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class=3D"elementToProof" style=3D"text-align: left; text-indent: =
6px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, =
Calibri, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
Ma olen t=E4iesti n=F5us, et t=E4htajatult patsiendi edasist ravi =
j=E4lgida pole =F5igustatud. Eelk=F5ige meid huvitab vahetu postop kulg =
kuni 30 p=E4eva. Kas selline lahendus oleks AKI vaatenurgast lubatud, =
kui operatsiooni n=F5usoleku lehele v=F5etakse allkiri , mis lubaks
 tutvuda l=F5ikus kuup=E4evast alates kuni 30 p=E4eva t=E4itumiseni =
patsiendi edasise ravi dokumentidega ? Me saame n=F5usolekus ka =
t=E4psustada milliseid andmeid me vaatame (perearsti vastuv=F5tt , emos =
k=E4ik, anal=FC=FCsid, retseptid . kuid me ei vaata ps=FChhiaatrilisi =
v=F5i asjasse
 mitte puutuvaid dokumente. N=E4iteks kui patsient on k=E4inud =
ortopeedilisel l=F5ikusel k=E4e piirkonnas, siis meil ei ole p=F5hjust =
uurida j=E4rgnevat g=FCnekoloogilist haiguslugu) ja kes neid =
vaatab.</div>
<div class=3D"elementToProof" style=3D"text-align: left; text-indent: =
6px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, =
Calibri, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div class=3D"elementToProof" style=3D"text-align: left; text-indent: =
6px; font-family: Aptos, Aptos_EmbeddedFont, Aptos_MSFontService, =
Calibri, Helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
</div>
</div>
<div class=3D"elementToProof" style=3D"font-family: Aptos, =
Aptos_EmbeddedFont, Aptos_MSFontService, Calibri, Helvetica, sans-serif; =
font-size: 12pt; color: rgb(0, 0, 0);">
<br>
</div>
<div id=3D"Signature">
<div style=3D"font-family: Aptos, Aptos_EmbeddedFont, =
Aptos_MSFontService, Calibri, Helvetica, sans-serif; font-size: 12pt; =
color: rgb(0, 0, 0);">
<br>
</div>
<div style=3D"direction: ltr; text-align: left; text-indent: 0px; =
margin: 0px 0px 10.6667px; font-family: Arial, Helvetica, sans-serif; =
font-size: 10pt; color: rgb(0, 0, 0);">
Heade soovidega&nbsp;</div>
<div style=3D"direction: ltr; text-align: left; text-indent: 0px; =
margin: 0px; font-family: Arial, Helvetica, sans-serif; font-size: 10pt; =
color: rgb(0, 0, 0);">
<b>M=E4rt Mikkal</b>&nbsp;</div>
<div style=3D"direction: ltr; text-align: left; text-indent: 0px; =
margin: 0px; font-family: Arial, Helvetica, sans-serif; font-size: 10pt; =
color: rgb(0, 0, 0);">
Uroloog/ Operatsiooniploki vastutav arst&nbsp;</div>
<div style=3D"direction: ltr; text-align: left; text-indent: 0px; =
margin: 0px; font-family: Arial, Helvetica, sans-serif; font-size: 10pt; =
color: rgb(0, 0, 0);">
Meliva&nbsp;AS&nbsp;</div>
<div style=3D"direction: ltr; text-align: left; text-indent: 0px; =
margin: 0px; font-family: Arial, Helvetica, sans-serif; font-size: 10pt; =
color: rgb(0, 0, 0);">
R=E4vala pst 5, Tallinn&nbsp;</div>
<div style=3D"direction: ltr; text-align: left; text-indent: 0px; =
margin: 0px; font-family: Arial, Helvetica, sans-serif; font-size: 10pt; =
color: rgb(0, 0, 0);">
<span style=3D"color: rgb(70, 120, 134);"><a =
href=3D"http://www.meliva.ee/" target=3D"_blank" class=3D"x_Hyperlink =
x_SCXW6008542 x_BCX8" rel=3D"noreferrer noopener" style=3D"color: =
rgb(70, 120, 134); margin: =
0px;"><u>www.meliva.ee</u></a></span>&nbsp;</div>
<div style=3D"font-family: Arial, Helvetica, sans-serif; font-size: =
10pt; color: rgb(0, 0, 0);">
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height=3D"66" style=3D"width: 66px; height: 66px; max-width: 648px; =
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