60 npm annual report 2016 /observations and recommendations An electroconvulsive therapy room in Pitkäniemi Hospital (visit on 20 April 2016). Following the visit, the Ombudsman launched an own-initiative investigation of the following matters: – The Ministry of Social Affairs and Health was asked to clarify and issue a statement on how the consent of a patient’s legal representative to an important decision on treatment required under the Act on the Status and Rights of Patients can be obtained when the patient is unable to make the decision personally and has no family members or friends who participate in his or her treatment. – The Regional State Administrative Agency was asked to establish and issue a statement on whether restraining a patient over long periods had been appropriate. – Hatanpää Hospital was asked to establish how the contusions found in a patient’s arm had been caused. – Hatanpää Hospital was requested to provide information on the actions of the security guards on one of its wards. The neurological and geriatric psychiatry wards of Pitkäniemi Hospital The neurological and geriatric psychiatry wards of Pitkäniemi Hospital were informed of the Ombudsman’s view, according to which patients in both involuntary and voluntary treatment should, if they so wish, have access to outdoor exercise daily. Comment: A draft report on the visit was sent to the hospital for comments. The hospital reported that it had taken action related to many viewpoints contained in the draft. These viewpoints concerned such issues as more detailed monitoring of the patients’ outdoor exercise, placement of acute patients in single rooms, providing grounds for decisions to take patients in for observation as well as rectifying shortcomings observed in the seclusion room.