Poročilo Varuha človekovih pravic Republike Slovenije o izvajanju nalog državnega preventivnega mehanizma za leto 2011 (še) po pošti. Ob tem bi PB Begunje morala upoštevati tudi zahtevo ZDZdr o obveščanju najbližje osebe, zakonitega zastopnika in zastopnika v štirih urah od sprejema pacienta. Zato smo predlagali, da bolnišnica nemudoma pridobi naslove zastopnikov, določenih po ZDZdr, in jih začne o sprejemih tudi takoj obveščati. PB Begunje je v odgovoru na predhodno poročilo navedla, da ima naslove zastopnikov. Vendar meni, da bi bilo obveščanje zastopnika (brez predhodne odločitve pacienta za enega izmed njih) neprimerno in celo v nasprotju z zakonom. Če si pacient(ka) zastopnika izbere, pa ga obvesti o vseh relevantnih postopkih. Pomisleki bolnišnice so sicer lahko utemeljeni. Vendar ob tem opozarjamo na določilo 7. člena ZDZdr, da lahko pacientu, ki si ne izbere sam zastopnika, tega določi najbližja oseba. Poleg tega menimo, da pri pacientih, ki si zastopnika kljub ponujeni možnosti (ob sprejemu v bolnišnico, lahko pa tudi pozneje) ne izberejo, lahko bolnišnica vseeno o pridržanju obvesti enega izmed zastopnikov. Namen zastopnikov je namreč predvsem skrb za pacienta in njegove pravice. Pacientu da informacije o njegovih pravicah, omejitvah teh pravic in posameznih postopkih. Če se pacient z obveščenim zastopnikom ne bo strinjal, mu ne bo podpisal pisnega pooblastila in se bo lahko za nadaljnjo pomoč obrnil na drugega (izbranega) zastopnika ali pa se pravici do njega celo odpovedal. O pacientkah, ki jih sprejmejo ali premestijo na polodprti oddelek (D1), PB Begunje ne obvešča sodišča. Vendar po zagotovilih bolnišnice na oddelek ni mogoče sprejeti nikogar, če še nima odločbe sodišča oziroma če v sprejem ne privoli. Pacientke ob tem obvestijo o polodprti naravi oddelka, poleg tega pa se morajo strinjati z namestitvijo. Čeprav je polodprti oddelek zaklenjen le ponoči, je s tem pacientkam vsaj v tem času omejena svoboda gibanja. Zato ta oddelek ohranja (vsaj delno) naravo oddelka pod posebnim nadzorom. Predlagali smo, da PB Begunje zagotovi, da so na ta oddelek nastanjene le pacientke, ki s takšno nastanitvijo pisno soglašajo oziroma o njihovi nastanitvi na oddelek pod posebnim nadzorom odloči sodišče. Bolnišnica na ta predlog DPM ni odgovorila. V PB Ormož oddelek za psihogeriatrijo šteje za odprtega, ker se vhodno-izhodna vrata ne zaklepajo. Vendar pa so nam hkrati pojasnili, da tamkajšnje paciente ustavijo in napoti nazaj vanj, ko ga želijo zapustiti. Zgodilo se je sicer že, da je kakšen pacient neopaženo »odtaval« z oddelka in so ga morali iskati. Zato razmišljajo tudi o uvedbi ‘varnostnih zapestnic’ in ‘preprog’ pred posteljami (ki zaznajo premikanje pacientov). Tako želijo vzpostaviti celovit varnostni sistem (kot so ga videli v podobnih ustanovah v tujini), pri katerem bi, ko bi pacient prestopil določeno mejo, zasvetila lučka. Osebje bi bilo tako vselej opozorjeno in bi poskrbelo, da pacientu ne bi uspelo oditi. DPM vztraja pri že večkrat izraženem razumevanju varovanega oddelka oziroma oddelka pod posebnim nadzorom. Kadar pacient oddelka ne more zapuščati po lastni volj, po našem mnenju ni mogoče več trditi, da mu dejansko ni omejena svoboda gibanja. V konkretnem primeru bi to veljalo tudi ob morebitni uvedbi elektronskih zapestnic. Bistvena okoliščina v omejitvi gibanja je dejanska posledica za stanovalca oziroma pacienta, ne metoda, s katero se ta doseže. Posledično to pomeni, da je treba takšen režim bivanja v bolnišnici urediti v skladu z Zakonom o duševnem zdravju (ZDZdr). Bolnišnica na to stališče DPM ni odgovorila. Posebni varovalni ukrepi (PVU) PVU lahko po ZDZdr traja največ štiri ure. Po štirih urah se ukrep ne more nadaljevati, temveč je treba pacienta odfiksirati in ga nato, če je treba, znova fiksirati. Takšna ureditev je po mnenju PB Begunje slaba. Odfiksirati je treba namreč tudi bolnika, za katerega je očitno, da je še vedno nemiren. S tem se izpostavlja nevarnosti poškodbe pacient in tudi osebje. Imeli so pacienta, ki je bil fiksiran trikrat po štiri ure. 38 Državni preventivni mehanizem v Republiki Sloveniji po Opcijskem protokolu h Konvenciji OZN proti mučenju in drugim krutim, nečloveškim ali poniževalnim kaznim ali ravnanju Implementation of the Duties and Powers of the National Preventive Mechanism in 2011 PB Begunje should also observe the requirement of ZDZdr concerning the notification of the person’s next of kin, legal representative and representative within four hours of admission. We proposed that the hospital immediately obtain the addresses of the representatives specified according to ZDZdr and begin to notify them promptly on the admission. In its response to the preliminary report, PB Begunje stated that they had the representatives’ addresses. However, they believe that notification of the representative (without the patient first selecting one of the representatives) would be inappropriate and even illegal. If the patient has chosen his or her representative, the latter is notified on all relevant procedures. The considerations of the hospital might be justified. However, we point out the provision of Article 7 of ZDZdr which states that a patient who does not choose his or her representative may be assigned one by his or her next of kin. Moreover, we believe that for patients who, despite having the opportunity to choose a representative (upon admission to the hospital or later), do not choose one, the hospital may still inform one of the representatives of the detention. The aim of the representatives is to take care of the patient and his or her rights. They provide patients with information on their rights, the limitations of these rights and on particular procedures. If the patient rejects the representative who has been notified, he or she will not sign the written authorisation and will turn to another (chosen) representative or even waive this right. PB Begunje does not notify the court of female patients admitted or transferred to the semiopen ward (D1). However, according to the hospital’s assurances, no one may be admitted to the ward without consent or without a court decision. The female patients are informed of the semi-open nature of the ward, and they must agree to be accommodated there. Although the semi-open ward is locked only at night, the patients’ freedom of movement is partially restricted. Therefore, this ward maintains (at least partially) the nature of a secure ward. We suggested that PB Begunje ensure that only patients who agree with such accommodation in writing, or when the court decides on their accommodation to the secure ward, be accommodated there. The hospital has not responded to this proposal of the DPM. In PB Ormož, the psychogeriatric ward is considered open, as the entrance is not locked. Nevertheless, they explained that female patients from this ward are stopped and returned when they want to leave. Patients have �wandered off� the ward without being seen, and a search had to be made for them. For this reason, the use of ‘safety wristbands’ and ‘carpets’ in front of the beds (which detect the movement of patients) are being considered. This would enable an integral security system (such as seen in similar institutions abroad) to be created, which would indicate by a flashing light when a patient crossed a certain limit. The personnel would always be notified and would prevent the patient from leaving. The DPM insists on the previously expressed understanding of a secure ward. When patients cannot leave whenever they wish, it is not possible to say that their freedom of movement is not restricted. In this particular case, this would hold true if electronic wristbands were introduced. The key circumstance in the restriction of movement is the actual consequence for the resident or patient, not the method of achieving restriction. In consequence, this means that this accommodation regime in the hospital should be regulated according to the Mental Health Act (ZDZdr). The hospital has not responded to this view of the DPM. Special protection measures (PVU) According to ZDZdr, PVU may last up to four hours. After four hours, the measure cannot be prolonged and the patient must be released and, if necessary, later restrained again. According to PB Begunje, this arrangement is bad. Even a patient who is obviously still restless must be released. Both patient and personnel risk injuries. They had a patient who was restrained three times for four hours. National Preventive Mechanism in the Republic of Slovenia under the Optional Protocol to the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment 39