PART I CHANCELLOR OF JUSTICE AS NATIONAL PREVENTIVE MECHANISM During the reporting year, the Chancellor still found cases of unlawful restriction of the liberty of nursing care recipients and problems with the nurse call system. Besides these problems, the Chancellor also found significant shortcomings in obtaining consent for the provision of nursing care services, in ensuring human dignity and in overcoming the language barrier. 8.1. Restricting the liberty of persons PART II Locking of a door of a ward restricts the liberty of persons in it without a legal basis. A latch or a key on the outside of the doors of wards can be arbitrarily used to lock a door from the outside by the staff as well as by other patients. Therefore, the Chancellor proposed to remove such locking devices and ensure that the doors of all the wards can be easily opened from both the inside and outside. PART IV In four of the institutions providing nursing care services88 the Chancellor ascertained a risk of restriction of the liberty of service recipients, as it was found that in these institutions it was possible to lock patients in the wards. During the inspection, latches89 or similar locking devices which could be opened only from the outside (the so-called „butterflies“,90 keys on the outside91) were found on several doors. In some institutions it was found that some wards were locked regularly for the night, so that the patients in them could not leave on their own.92 Doors in some wards also lacked an (inside) handle.93 PART III 8.1.1. Locking of doors of wards In the reply to the Chancellor, one of the institutions94 did not find the Chancellor’s proposal justified but still removed the locking devices from the doors of the wards. 8.1.2. Unlawful mechanical fixing The use of means of restraint during the provision of nursing care services still continues to be a serious problem.95 In one institution, guidelines for mechanical restraint had been adopted96 and during the inspection visit one patient’s arm was fixed to the bed. The guidelines did not specify whether physical restriction of the freedom of movement takes place only during the performance of a medical procedure or also later. In two institutions97 there have been cases where a patient was tied to the bed with the consent of their next of kin. Restraining of patients during the provision of nursing care services is not allowed (except for the duration of a medical procedure).98 To avoid unlawful restriction of the liberty of persons, 36 88 See the inspection visits to Sillamäe Hospital Foundation (case No 7-9/130437), PJV Nursing Care Foundation (case No 7-9/140101), Pärnu-Jaagupi Care Home Foundation (case No 7-9/140001) and Kilingi-Nõmme Health and Care Centre Foundation (case No 7-9/131307). 89 See the inspection visits to Sillamäe Hospital Foundation (case No 7-9/130437) and Pärnu-Jaagupi Care Home Foundation (case No 7-9/140001). 90 See the inspection visit to Kilingi-Nõmme Health and Care Centre Foundation (case No 7-9/131307). 91 See the inspection visits to PJV Nursing Care Foundation (case No 7-9/140101) and Pärnu-Jaagupi Care Home Foundation (case No 7-9/140001). 92 See the inspection visit to Pärnu-Jaagupi Care Home Foundation (case No 7-9/140001). 93 See the inspection visits to Pärnu-Jaagupi Care Home Foundation (case No 7-9/140001) and PJV Nursing Care Foundation (case No 7-9/140101). 94 See the inspection visit to Pärnu-Jaagupi Care Home Foundation (case No 7-9/140001). 95 See the 2012 inspection visit to Tapa Hospital Ltd (case No 7-9/130295). 96 See the inspection visit to East Tallinn Central Hospital Ltd (case No 7-9/131500) and 2012 inspection visit to Jõgeva Hospital Foundation (case No 7-9/130302). 97 See the inspection visits to Kilingi-Nõmme Health and Care Centre Foundation (case No 7-9/131307) and PJV Nursing Care Foundation (case No 7-9/140101). 98 To comply with §  20 of the Constitution, fixation should be immediately terminated upon the completion of the procedure which necessitated it. See the inspection visit to East Tallinn Central Hospital Ltd (case No 7-9/131500).