Patients in Cyprus can still find themselves caught between two hospitals with no clear responsibility for their care, according to a report by Patient Ombudsman Marios Charalambides that identified systemic gaps in referrals and transfers within the national health system, GeSY.
The Ombudsman's office examined 23 standard patient referral and transfer scenarios and found that the existing framework could allow violations of patients' rights in 12 cases. In six others, the outcome depends on whether a critical procedural step is completed correctly, while only five scenarios were deemed fully compliant with legal requirements.
The report identifies a key gap at the point where responsibility for a patient passes from one medical institution to another. While legislation requires continuity of care to be maintained, it does not clearly define when responsibility is formally assumed by the receiving institution or who remains accountable until that happens.
According to figures from the Health Insurance Organisation (HIO), around 380 hospital admissions each month, or 1.4% of the total, involve patients being transferred from another medical institution. However, there is no record of how often hospitals refuse to accept patients, how long transfer delays last or how frequently disputes arise over which provider should take responsibility.
Critical decisions made by telephone
Among the main shortcomings identified is the fact that referrals, acceptances and refusals are often made verbally or by telephone, without written documentation.
The report notes that even where relevant rules exist, the HIO had to issue reminders in both 2024 and 2026 to reinforce providers' obligations.
The HIO's current referral protocol covers only seven categories of emergency cases that cannot be managed by the initial provider. Transfers after admission, complications arising from previous medical procedures, ambulance transfers and issues relating to the availability and responsibility of treating physicians remain outside explicit regulation.
The report also highlights the absence of a central register of available hospital beds, making it impossible to verify claims that no beds are available at a particular institution.
At the same time, there is no authority empowered to resolve, within hours, disputes between providers over who should assume responsibility for a patient.
The Ombudsman also drew attention to patients with more complex medical needs, whose care is more costly. While the report does not identify discrimination in any specific case, it says the current system lacks all the safeguards needed to prevent such a risk.
Written acceptance before transfer
The Ombudsman recommends that no referral or transfer be considered complete unless the receiving institution provides written acceptance identifying the person assuming responsibility for the patient.
Until such acceptance is given, responsibility should remain with the institution where the patient is being treated or to which the patient initially presented.
The recommendations include an immediate HIO circular, mandatory written requests and referral forms for every transfer, and the recording of every refusal, including the time, reason and name of the responsible official.
The report also calls for clearly defined responsibility for the treating physician, including the appointment of a substitute during periods of absence.
Further proposals include the appointment of an HIO coordinator with the authority to issue binding decisions within hours when two providers disagree, the creation of a central bed registry and measurable monitoring of transfers, delays and the time required before final responsibility for a patient is assumed.
The report is not a finding into any specific case, does not identify individuals responsible and does not assess the medical appropriateness of individual decisions. Instead, it highlights a systemic problem whereby patients can be left without a clearly designated responsible provider while institutions dispute who should take charge of their care.
