According to NIK, binding regulations enable the development of comprehensive psychiatric care in Poland. However, the procedures related to the admission of patients without their consent or the use of coercive means towards them need to be enhanced immediately. NIK alarms that the hospitals systematically ignore the obligation to properly evidence such cases. The lack of relevant records may point to the breach of patients’ rights.
The instances of grave negligence in evidencing the admission of patients without their consent were observed in nearly all of the audited hospitals. Usually the documentation lacked: the approval by the Head of the Ward or the Ward Manager for the patient admission, the records confirming that the patient had been informed of the reasons for detention and his or her rights as well as the records saying that the patient had been made familiar with the treatment plan. NIK took under the microscope 64 medical histories of patients admitted to a psychiatric hospital based on the court decision. None of the histories contained information on notifying the patient of the hospitalisation causes or the planned treatment. NIK stands in a position that the lack of statutory obligation and the presumption that the court informed the patient of the reasons for admission to hospital without his or her consent may not excuse the lack of information given by the doctor.
The cases of using coercive means are also incorrectly recorded. The doctors fail to evidence examinations justifying the use or prolongation of coercive means. Basic information on the duration and type of the protection used is missing, as well as the records on short-term release (every four hours). It happens that coercion is ordered at once for 24 hours, which is against the law (instead for four hours, with an option to prolong these means after repeated medical examination).
NIK emphasises that careful documentation of medical history is of vital importance for the patients with mental disorders. Coercion represents the most drastic form of violation of personal inviolability. The Mental Health Protection Act clearly and rigorously determines the cases in which it may be applied. Diligent recording of such cases is at the same time a form of elementary, day-to-day control of observing patient rights. Therefore, the Supreme Audit Office claims that any gaps in the documentation may not be justified by inadvertence - this is how the doctors most often explained it to the auditors.
In the audited psychiatric hospitals and psychiatric wards an improvement was reported against the audit results in 2007, especially in terms of access to information as well as diagnostics and treatment of co-existing diseases. However, again a number of irregularities was identified, e.g. poor sanitary or fire protection conditions and overcrowding of beds in hospital rooms. As many as 70 percent of audited hospital rooms were not adapted or insufficiently adapted to the specific nature of psychiatric treatment. Even basic requirements were often not met: beds were not accessible from three sides of the bed (including the two longer ones), and the spaces between beds did not ensure free access to patients. A half of the wards were neglected: the walls were dirty, windows were not tight and water closets lacked toilet paper. In 50 percent of psychiatric wards the conditions were even worse due to additional beds which were placed even in the corridors and common rooms.
All patients requiring urgent hospitalisation were admitted on an on-going basis, even if there were no vacant beds. NIK signals, though, significant problems with planned admissions. The waiting lists happen to be alarmingly long. In extreme cases people have to wait nearly two years for the planned hospitalisation. For instance, at the addiction treatment ward in Babiński Specialist Hospital in Cracow it was 659 days. At the forensic psychiatry wards the waiting time ranged from 15 days (Psychiatric Hospital in Toszek) to as long as 726 days (Neuropsychiatric Hospital in Lublin).
The number of Commissioners for Rights of the Psychiatric Hospital Patients is still too small. Currently, there are 24 active Commissioners of that type, although there should be fifty of them. Only 35 percent of psychiatric hospitals have such Commissioners assigned on a regular basis. As a consequence, not all patients may use their help. There are many reasons for that, e.g. the lack of money for new FTEs and wages or too few candidates with adequate qualifications.
