EESTI PATSIENTIDE ESINDUSÜHING
ESTONIAN PATIENT ADVOCACY ASSOCIATION
ACTIVITY REPORT
2005
EPAA has operated in 4 different modes during 2005:
- Provided individual advocacy services and advice to clients
- Advocated on behalf of patients’ rights in systemic level to change the legislation and policies
- Carried out strategic litigation to change the practice in Estonia
- Provided information through lectures, seminars and publications
Some of the details about those actions have been provided as follows.
1. Client advocacy services
EPAA provided advocacy services totally for 1883 clients in 2142 issues in 2005:
-1766 clients were advised and supported to act as self advocates
-366 individual cases were dealt with EPAA’s active role
-40 court cases were assisted and/or initiated by EPAA
-29 issues were advocated in systemic level
The services were provided by 3 lawyers and 3 patient advocates within 4 offices of EPAA in Tallinn, Tartu, Viljandi and Pärnu. The clients asked help from EPAA from all regions of Estonia.
Client advocacy services were co-financed by:
-Estonian Ministry of Social Affairs
-Estonian Ministry of Justice
-Baltic American Partnership Program
2. Systemic advocacy issues and actions
Violations of human rights in psychiatric long-term institutions of North-East Estonia
EPAA got several complaints about bad quality of care home services in North-East Estonia (with mostly Russian-speaking population). EPAA carried out a monitoring visit to North-Eastern institution to get a evidence of the situation and to have more facts in exerting more pressure on respective institutions to deal quality supervision in those facilities.
1) EPAA visited the following North-Eastern social care homes and institutions in June, July and August, interviewed the clients as well as the staff and made inquiries about the situation and working order:
- Social Board of Narva town government
- Primary Rehabilitation Reception in Narva
- Narva Rehabilitation Centre and Daycare
- rehabilitation department of Narva Hospital
- long-term care department in Narva Hospital
- psychiatry department of Narva Hospital
- Narva Dosshouse for homeless
- Kohtla-Järve Care Home for the Aged
- Social care home “Sügis“
- NGO Avinurme Care Home and Hospice
- Iisaku Care Home
- Narva-Jõesuu Care Home
- Aa Care Home
- Jõhvi Care Home
In all those institutions, the representative of EPAA divided written materials about the rights of residents and paid the attention of the staff on the possibilities of taking residents’ rights more seriously.
2) In September a written review of the visits was compiled of the information gathered on spot where the problematic questions were pointed out.
The main problems were:
-unnecessary restrictions of care home residents free movement and freedom of religion - residents are restricted to leave care home to go to shop, to city, to church or to praying house.
-violation of right to correspondence - residents’ letters are opened without the consent and without the presence of a resident
-lacking possibility to appeal - residents simply does not have money for envelopes, stamps ao to send a complaint however there is a law that obligates care facilities to pay for this. It appeared that the staff was not aware of this law.
-violation of privacy - mail staff search and strip female residents, delimited space in most care homes, lots of rooms are overcrowded
-inaccessible buildings - inclined planes and elevators were missing in several places, making physically disabled people in a “trap”
-the staff violates the legal acts and human rights well knowing that this is wrong
-unfounded limitations to clients' freedom of movement - detention used as a punishment
-involuntary detention in some care homes which is legally unsubstantiated (actually this is deprive of freedom without a court decision)
-problems with getting dental care (because the clients have to pay for it for themselves which they cannot afford)
-problems with getting general and special health care
-the care homes provide the clients with a place to be and food, but all the other needs of people are not provided (in most places there are no possibilities for spending free time, training or communication with outer world etc)
-rehabilitation services are not offered to clients at all
-no Russian information provided, although most clients are Russian-speaking
-lack of individual approach - people of different ages and diagnosis are mixed
-lacking staff in care homes - the clients are left without necessary care
-major shortcome of trained staff
-some care homes need repairs badly
-some houses are totally unsuitable for providing care home service
-the contents of care service is not defined in the contracts, the service fees are inequal
-local governments are not interested in the quality of care service for which they pay
-lack of adequate supervision over the situation in care homes
3) In July 1 - Social commission of the parliament was informed of the bad quality of care and about the human rights violations in those institutions.
4) In July 7 - EPAA sent a letter of notification to the ministry of social affairs about the situation in care homes of North-Eastern Estonia
5) July 11 - the Legal Chancellor was informed of the violation of human rights in care homes with special attention to the situation in Aa care home. The Legal Chancellor did not answer the letter, but paid a control visit to a care home in autumn, where he found several violations of human rights. An article was published in the daily newspaper Eesti Päevaleht on the use of an inhuman detention room detected in course of the visit of the Legal Chancellor.
6) In September 6 EPAA met representatives of the State Audit Office and made a suggestion to audit the quality and efficiency of care home service as well as the use and reasonability of their fees
7) In September 16 an article was published in the daily newspaper about alcohol problems gaining command of life in care homes
8) In September 20 another article on the same theme was published in a local newspaper Põhjarannik
9) In February 29 EPAA contacted the leading specialist dealing with protection of the disabled in North-Eastern Estonian county government who claimed that there is no supervision over the staff needs in local care homes and their adequacy to requirements, but there are no resources to do get proper staff as well. The specialist was aware of violation of human rights in some care homes, explaining it with a fact that a representative of the Legal Chancellor Mr. Aljoshin had made control visits to some care homes and wrote no comments about any of those disadvantages there.
10) The Ministry of Social Affairs thanked EPAA for an additional supervision of care homes and informed that he has sent a letter to Health Protection Inspectorate as well as the local county government asking to solve the problems with a promise to inform EPAA of the results of the supervision.
Local governments are not interested in quality of care services that they pay for
Tallinn is buying care services outside Tallinn for 400 people, choosing the cheapest offer. The client is never contacted afterwards and therefore, there is no control over the quality of this service. This is becoming a tendency practiced by all local governments. EPAA wants local governments to carry out supervision over the quality of care home service and be interested in the life of their inhabitants after sending them to care home.
1) EPAA called the attention of Maardu social department to the violation of patients' rights in Aa Care Home and asked them as bookers of the service to control its quality.
2) EPAA contacted the commission body that sends people from Tallinn to care homes and called their attention to violations of human rights in Aa care home, asking the commission to contact the people they have sent there and check the quality of the service offered on spot.
3) On July 14 EPAA informed the case manager of Ida-Viru Pension Board about the situation of clients in care homes. The case manager was aware of the problems in the care homes under discussion and alleged that has tried to relocate people from those places.
4) On August 8 EPAA contacted an officer of the Social Insurance Board who is responsible for and keeps record on those people taken under detention to social care homes. EPAA found out that the board has no information about how many people have got or would need the service.
5) On September sends EPAA a request to State Audit Inspection to review the service quality within the care homes. State Audit Inspection carried out an inspection within Aa and Narva-Jõesuu Care Homes concluding a negative report with concrete recommendations to improve the service quality.
Illegal isolation of people in Aa and Narva-Jõesuu Care Homes
Locking people up to closed units and inhumane carcers as for the punishment based only on the care home director’s decision is clearly violating residents rights.
EPAA finds that such practice should end as quickly as possible.
1) EPAA sent letters to those care homes calling up to stop this practice immediately.
2) EPAA informed the Legal Chancellor about violations of human rights in Aa and Narva-Jõesuu care homes. Chancellor did not answer to this letter.
3) 7.10.05 sent EPE a new letter on the same matter to Legal Chancellor.
4) 14.10. replied legal Chancellor to EPAA describing his efforts in carrying out review
within psychiatric care homes.
Superficial work of court experts violates the rights of patients
In last two years, EPAA has testified the negligent and incompetent work of psychiatric experts in court cases concerning restriction of legal capacity. So far, EPAA has dealt with deficiencies of expert acts composed in Tallinn.
1) On Febr. 9, 2005 EPAA lawyer visited a court process in Tartu where a court psychiatric expert gave a stand. The same expert gave a stand about another EPAA client's case without informing and meeting the client. The superficial work of the expert was obvious. The positive side of the matter is that the expert was ready to renounce previously given stand.
2) On Febr 16 EPAA contacted the Ministry of Justice that is responsible for the organization of court experts’ work. EPAA was informed that the substantial work of court experts does not lie under the jurisdiction of the ministry.
3) On Febr 22 the Ministry of Justice recommended in an answer to EPAA to challenge the opinions of the expert in court process. The ministry admitted that there are no legal means to control the work of experts.
4) In February, EPAA started to look for independent experts for its clients. An agreement of principle was concluded with a Lithuanian psychiatrist. Also experts from Great Britain were ready to carry out expertise, but their fee is far to high for Estonian clients (250-300 pounds per hour).
5) On April 25 EPAA representative met court expert on psychology Mrs. Kompus to discuss legal competence of court psychiatric experts as well as the contents of the work. Mrs. Kompus stressed that the right to carry out expertise is given to those experts who have been included in the list of licensed court psychiatric experts filed by the Ministry of Justice and that health institutions do not have a right to carry out expertise and to get fees for it.
6) EPAA found out in one court proceeding that TallinnPsychiatric Hospital has presented an invoice with 48,000 EEK to the court for carrying out a psychiatric expertise. EPAA informed the judge that the persons who signed the expertise act had actually no right to sign the expertise and that the hospital is not inclined to deal with such procedures. EPAA stressed that there was no need to keep the client in the hospital for almost two months as the diagnose was not changed and no additional or important procedures were done. The judge thanked EPAA for the information and promised to discuss it with colleagues.
The right to marry during forensic treatment
It is not very common that people who are under forensic treatment express the wish to get married. At the same time, they have an equal right to get married as other incapable citizens. The forensic hospital was in a position that those people have no right to marry and did not allow their patients to marry. After the involvement of EPAA the hospital changed its standpoint and EPAA clients Aarne and Kristina are happily married now.
Violation of procedural safeguards in court processes restricting legal capacity and detaining smb into long-term closed psychiatric institution
However Estonian Supreme Court has ruled already more than 20 decisions deploring violations of procedural safeguards in those processes, the practice and the legislation have not changed much.
1) 5.05 EPAA started the preparatory work to present the applications to European Court of Human Rights collaborating closely with Mental Disability Advocacy Centre.
2) In the beginning of June 2 cases were added in the preparatory work.
3) 6.06. first case were sent to ECHR about client Mare
4) 10.12 second case was sent to ECHR about client Luule.
CPT report about the visit in 2003
1) 26.04.05 published Estonia the CPT Report of 2003. The report included much of this information that EPAA provided to CPT. Sections 85 - 125 describe very thoroughly human rights problems within Estonian psychiatric institutions. Estonia has not translated the report into Estonian. There are no links or any other information about this document in web pages of Ministry of Social Affairs and Ministry of Justice.
2) 27.04. published EPAA and MDAC joint press release to inform about the existence of this document. EPAA published the information about and link to CPT report in its web page.
3) In May the report was published in the web page of Estonian Legal Centre.
4) Council of Europe translated the report and the government response into Estonian and published those in their web page
Conflict of interest - Local government as a legal guardian
It is quite common practice in Estonia that local governments are appointed to act as legal guardians to incompetent persons. It is a clear conflict of interest because the local government should act as a supervision authority to legal guardians. It means that there is no kind of supervision to the activity of legal guardians and the persons’ rights are not adequately protected. The issue was brought up by EPAA in 2004 informing the problem to Ministry of Justice and initiating a client’s case in Tartu County Court.
1) 6.07 presents EPAA an application to Supreme Court to argue this issue in one client case.
2) 7. 12 ruled Supreme Court a positive verdict nr. 3-2-1-141-05 clearly stating that a local government cannot be appointed to act as legal guardian. It was first time while Supreme Court gave thorough analyze about the content of legal capacity and grounds to restrict this. Supreme court also mentioned that restriction of a person’s legal capacity is not justified only based to the person’s age, health condition, person’s habits or housing conditions. People who have problems in managing their everyday life should be helped with social services and not with eliminating those people from legal turnover - ruled the verdict.
Violations of human rights within the Law of Psychiatric Assistance
On 27.05.2003 asked EPAA with its letter to Legal Chancellor to start a procedure to abolish violating norms within the law. 12.09.03 agreed Legal Chancellor that the law violates Estonian constitution, but was not in the position to take steps to abolish this.
Two years later in 2005 the situation had not changed and the law was still in force. However the Law of Legal Chancellor gives him several options and means to abolish a law, he has not used this possibility.
1)6.04.05 sent EPAA a letter to Legal Chancellor to pay attention to his obligation to react within 20 days and to compel a legislative organ to change a law.
2)In his reply of 6.05.05 repeated Legal Chancellor his earlier position that he is not obliged to initiate mentioned procedure because Ministry of Social Affairs works on changing this law already 1,5 years.
3)10.05.05 sent EPAA a letter to Chair of Estonian Parliament appointing to the inactivity of Legal Chancellor.
4)23.05 contacted Parliament’s Commission of Justice and Commission of Constitution with EPAA and asked to send them prepositions to change the Law of Psychiatric Assistance. The deadline for the concrete prepositions was after 2 days that is obviously not enough to work out legally correct prepositions.
5)26.05 sent EPAA conceptual comments on the drafts to amend several laws that will change with the new Law of Civil Procedure. EPAA sent its critics concerning Law of Psychiatric Assistance, Law of Prevention of Infection Diseases, Law of Sterilization and Abortion and Law of Social Care. Several ground principles were pointed out and concrete violating points were appointed to. Unfortunately non of those comments were considered.