Chancellor of Justice: Systematic problems found in nursing care services

Last year, advisers to the Chancellor of Justice made eight inspection visits to various nursing care establishments in Estonia. The inspections revealed that in several of these, patients may be held in locked rooms without reason and treated without appropriate consent and their dignity may not always be guaranteed.

Although the advisers to the Chancellor of Justice did not see anyone being held in locked rooms when they checked the nursing care establishments, the Chancellor of Justice finds that bolts and other locking devices that can only be opened from the outside as well as doors with their handles removed suggest that the fundamental rights and freedoms of people may be restricted in an impermissible manner. After the inspection visits made in 2013, the Chancellor of Justice made proposals for the removal of locking devices to e.g. Sillamäe Hospital, Kilingi-Nõmme Health and Care Centre, Pärnu-Jaagupi Care Home and PJV Nursing Care.  

Another problem found in several of the nursing care establishments visited by the advisers to the Chancellor of Justice was the lack of evidence that the appropriate consent had been obtained for the treatment of e.g. certain patients suffering from dementia. Obtaining the appropriate consent was a problem in Kallavere Hospital, Kilingi-Nõmme Health and Care Centre and PJV Nursing Care. Deputy Chancellor of Justice and Adviser Nele Parrest said that the appropriate consent of the patient or their representative is extremely important, as it gives the health service provider the right to intervene in issues concerning the patient’s body. Obtaining consent from a dementia patient who is unable to make adequate treatment decisions about themselves cannot be considered as granting of informed consent, as the person does not understand what is going on or what the consequences might be. 

In a situation where the immediate provision of nursing care services is not necessary for the protection of a person’s life and health, consent must be obtained from their legal representative. The legal representative cannot be a close person who has not been granted the rights of a guardian by the court. If there is no legal representative, the persons close to the person or the local authority should request the appointment of a guardian from the court. In such a case, the court will assess whether the patent is able to make adequate treatment decisions concerning themselves despite their dementia. The lack of an impartial opinion creates the threat that the patient will be labelled as suffering from dementia behind their back and be deprived of the right to decide whether to receive any treatment, and what kind of treatment to receive. Judicial practice indicates that courts are able to make rulings promptly in cases concerning the appointment of guardians.

The inspection visits made by the Chancellor of Justice to nursing care establishment last year also gave rise to suspicions that the dignified treatment of patients may be a problem in certain establishments. For example, the inspection of Kallavere Hospital revealed that patients are fed in haste, communicating with Russian-speaking staff is a problem for Estonian patients and little attention is paid to the provision of leisure activities. Patients in PJV Nursing Care also complained that they had nothing to do. The visit to PJV Nursing Care revealed that asking for help is disapproved of, dementia patients eat the food of others and sleep in the beds of other patients (laying down next to them).