Living with diabetes: your rights at the clinic, the health plan and work

It is the bill of rights for people living with diabetes in Puerto Rico (24 L.P.R.A. §§ 347-347f). The Legislature adopted the International Diabetes Federation’s text and turned it into local law, organized in four blocks: the right to care, the patient’s responsibilities, the right to information and education, and the right to social justice. Its premise is that people living with diabetes have the same human and social rights as those who do not, and that they can be partners with health providers and government in managing the condition.

Every person living with diabetes who is a user or consumer of health services and facilities in Puerto Rico, regardless of whether the provider is public or private, and without distinction by race, color, sex, age, religion, origin or ethnic or national identification, political ideology, present or future physical or mental disability, medical or genetic information, social condition, sexual orientation, or their ability or form of payment. The information and education rights extend to parents or caregivers when the person is a minor or dependent.

• Living with diabetes and being a user or consumer of health services or facilities in Puerto Rico.Verified against the official source

• Your medical record or the request to obtain it: the law recognizes the right to individual access to your records and other relevant information upon request, and to have it shared.

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   Step 1: Know what the right to care covers

   Article 3 recognizes the right to receive an early diagnosis and access to affordable, equitable treatment and care regardless of race, ethnicity, sex or age, including access to psychosocial care and support; to receive reliable and regular advice, education and treatment under evidence-based practices centered on your needs, whatever the setting where you receive care; to benefit from community activities and education and prevention campaigns; to high-quality services during and after pregnancy and childbirth; to high-quality services during childhood and adolescence; to adequate transition care as the illness evolves and age changes; and to continuity of adequate care in emergency or disaster situations.

2. 2

   Step 2: Use the right to information and education

   Article 5 gives you — and your parents or caregivers if you are a minor or dependent — the right to receive information and education about diabetes, including how it can be prevented, the advantage of early detection in high-risk people, how it can be managed effectively, and how to access clinical and educational resources; to receive high-quality self-management education, in groups or individually, at diagnosis and whenever needed, integrating clinical, behavioral and psychosocial aspects; to be part of the assessment, planning and implementation of your care and health goals; to receive reliable information on the names and dosages of any therapy and medicine, their actions and possible side effects and interactions; and to have individual access to your medical records.

3. 3

   Step 3: Claim the accommodations at work and at school

   Article 6 spells this out more than people expect: you have the right to be treated fairly at work and in your professional advancement — meaning being allowed to eat your food during the periods you need, to tend to your various symptoms, to use your glucose monitor or inject insulin when necessary, and to have the people you interact with daily oriented on correct management, health emergencies and how to support you when hypoglycemia or hyperglycemia occurs. You also have the right to the reasonable accommodations needed in preschool, school, university and extracurricular activities, social clubs and the workplace; and to be authorized the necessary and reasonable time to attend medical appointments, plus the time and privacy to measure and administer your medicines in a clean, safe setting.

4. 4

   Step 4: Do not accept being denied coverage over the condition

   Among the social justice rights, Article 6 expressly includes not being discriminated against when applying for health insurance coverage, and obtaining at affordable prices the medicines, insulin, devices and advanced, recent technologies for self-managing your condition. It also recognizes the right to access healthy food options at establishments of public use and access.

5. 5

   Step 5: Know your responsibilities too

   The law is one of rights and responsibilities, and Article 4 lists the latter: sharing with your health provider information about your current condition, the medicines you use, allergies, social environment, lifestyle and other information relevant to determining the right treatment; complying with the agreed care and treatment plan and adopting, implementing and monitoring healthy behaviors as part of self-management; sharing with your provider any problem with the recommended treatment plan, including any barrier to implementing it; and informing people you trust and interact with regularly about your diabetes, correct management, health emergencies and how they can help you when hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar) occurs.

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   Step 6: If you are denied, the forum is the Patient Advocate

   Article 7 gives responsibility for implementing this law to the Office of the Patient Advocate, created under Act 77-2013, which shall adopt and issue — in coordination with the Departments of Health and Education — the necessary regulation, including the mechanisms for filing, processing and resolving complaints and grievances. That is the forum the law itself designates for claiming when a provider, facility or insurer fails to comply.

The Office of the Patient Advocate is the agency responsible for implementing this Charter and establishing the complaint and grievance mechanisms, in coordination with the Departments of Health and Education. If the problem is with your health plan — a denied medicine, an unapproved treatment — we also have specific guides for that route. If the matter is at school, the applicable law is different and covered in our guide on diabetes in the school setting.

• Believing diabetes gives no right to a reasonable accommodation at work: the law expressly recognizes it, including time to eat, measure and administer insulin.
• Accepting having to check your sugar without privacy: the law recognizes the right to time and privacy to measure and administer medicines in a clean, safe setting.
• Not asking for self-management education: it is a right at diagnosis and whenever needed, in groups or individually.
• Not requesting your medical record: you have the right to individual access and to have the information shared upon request.
• Accepting a coverage denial over the condition: the law recognizes the right not to be discriminated against when applying for health insurance coverage.
• Thinking the law only applies to public hospitals: it covers public and private providers alike.
• Taking the complaint to the wrong agency: implementation and complaint mechanisms belong to the Office of the Patient Advocate.
• Forgetting the Article 4 responsibilities the law itself places alongside the rights.

These are the government pages this guide is based on.

• Oficina del Procurador del Paciente (OPP)

  Procurador del Paciente

  bvirtualogp.pr.gov