National Preventive Mechanism Directors noted that all their needs should be included in the tender list. If they fail to include every single necessary item in the tender list, they will be forced to arrange another tender that requires additional expenses. At the same time, it is absolutely impossible to identify all needs of the establishment one year earlier. As one of the directors mentioned, the tender system is not adequate in certain cases, for instance, in case of serious damages of heating system, as the tender procedures necessary for renovating the system shall take at least two weeks and meanwhile the patients shall have to stay in the establishment without heating. As stated by another director, the procurement system prevents them from purchasing products from local farmers. This practice damages interests of local economy as well as of patients’. For instance, tender procedures actually allow the establishments to buy frozen meat and fish only, while it is clear that the quality of such products is much lower than of those available at local markets. STATE CONTROL Control over the utilization of financing is an innovation requiring submission of medical information (form IV100/a) of every patient to the Social Service Agency. Doctors clarified that within 24 hours of patient’s admission to the establishment the information on the patient – first name, last name, personal number, case number, and code of preliminary diagnose, shall be communicated electronically to the Agency. They also stated that in case of very minor inaccuracy the doctor is subjected to fine. Together with electronic documentation, Form IV-100/a is be submitted to the Social Service Agency on a monthly basis; together with other information, this form includes precise diagnosis of a patient. Doctors in the establishments do not know who has access to this confidential information. Such system of control clearly infringes confidentiality of information on patients’ health as recognized by Georgian legislation and international standards. The Council of Europe Recommendation of 2004 stipulates: “All personal data relating to a person with mental disorder should be considered to be confidential. Such data may only be collected, processed and communicated according to the rules relating to professional confidentiality and personal data protection.“55 The same article specifies that the conditions governing access to that information should be clearly specified by law.56 State Regulation Agency for Medical Service of the Ministry of Labour, Health and Social Affairs carries out government control over the patient-based financing system. The latter triggers doctors to violate laws and not to allow voluntary patients to leave the facilities. The doctors are well aware that, on the one hand, the voluntary patient may leave the facility freely upon request and on the other hand, they might be hospitalized voluntarily or non-voluntarily within several days that shall be considered as re-placement; the latter constitutes a violation and the facility has to return finances to the state. The mentioned problem once again highlights inadequacy of control system, even more so the aim of such mechanism is to control finances and not to check the quality of treatment. National Preventive Mechanism considers that existing case-linked financing system is not adequate and does not reflect the needs of persons with mental disorders as well as of relevant establishments. It follows from the afore-mentioned that the State is unable to establish adequate system of financing and quality control being in line with the rights of patients, confidentiality principle and does not trigger medical personnel to violate the law. 55 56 Rec(2004)10 art. 13, para. 1. Ibid, para. 2. www.ombudsman.ge NPM Report