Ombudsman Velislava Delcheva wants lawmakers to drop a part of the changes to the Health Act that would let an automated system pick out "risky" decisions of the medical assessment boards TELK and NELK and send them for review. She says so in her opinion on bill No 52-653-15-16, the ombudsman's press office said.
Instead, Delcheva proposes that the system work only on clear rules that a person has set and approved, with no artificial intelligence and no self-learning algorithms.
The disputed text is the new paragraph 9 of Article 108a. The ombudsman's proposal does not touch paragraphs 7 and 8 of the same article, which MPs passed at first reading. The bill is due for a second reading.
Under the text, if the system finds a high risk in the work of TELK, the case goes to NELK. If the risk is in the work of NELK, people authorised by the health minister will look at it.
The ombudsman says an AI system that looks for anomalies carries a high risk of discrimination against people with rare diseases and with severe or multiple disabilities. Delcheva believes such cases could be flagged as "suspicious" just because they are unusual. People with the most complex health conditions could then be checked far more often than others.
She insists the assessment should look at the experts' decisions and the medical records, not at people's personal traits or behaviour. The type of illness alone, and a person's address, should not count as signs of risk.
The ombudsman points out that the new paragraph 9 does not set the criteria for high risk. It is also unclear what data will be processed, or how people can challenge the result of the automated assessment. Delcheva says this opens the way for a parallel out-of-court procedure that does not fit the current rules for oversight and appeal of expert decisions.
At present, the medical assessment bodies can cancel, change or review wrong decisions on their own only within three months of issuing them.
Delcheva wants mandatory assessments of the impact on fundamental rights and personal data protection before the system is introduced. The methodology should be drawn up after consultations with organisations of people with disabilities. It would be approved after opinions from the Commission for Personal Data Protection, the ombudsman, the National Social Security Institute and the National Council for People with Disabilities.
The ombudsman says the two-month deadline in the bill is not enough to adopt the rules, develop and test the system and carry out the impact assessments. She therefore proposes that Article 108b take effect only after the methodology is approved and the assessments are ready.
Delcheva also wants parliament's health committee to ask the Commission for Personal Data Protection for an opinion before the second vote.
The ombudsman says the aim of her proposals is better control over medical assessments, without legal uncertainty for people with disabilities and without an algorithm replacing the judgment of the medical assessment bodies.
In early October, minister Ivan Demerdzhiev announced at a briefing at the Council of Ministers that operations were coming over how TELK decisions are issued.