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The NPM team of the Ombudsman finds serious violations in psychiatric clinic within UMBAL Sveta Marina in Varna
9 August 2024
Team of the National Preventive Mechanism with the Ombudsman Institution carried out an unannounced inspection at the psychiatric clinic within the University Multidisciplinary Hospital for Active Treatment (UMBAL) Sveta Marina in Varna where a patient lost his life following a fire last Monday (5 August).
The experts’ inspection found many violations that affect the rights of the mentally ill individual placed in UMBAL Sveta Marina for the purpose of a forensic psychiatric examination.
First, during the fire the patient was immobilized (tied) in disregard for the basic requirements of Ordinance No. 1/28 June 2005 concerning the procedure of the enforcement of measures of temporary bodily restraint on patients with verified mental diagnoses. That is, the room in which the patient was immobilized is not subject to video surveillance and he was not continuously watched on so as to comply with the prescriptions of Art. 11 of the Ordinance.
The problem concerning the enforcement of Ordinance No. 1/28 June 2005 has been repeatedly brought up by the Ombudsman, both in the National Reports of the National Preventive Mechanism and in special reports – the latest one was brought to the attention of the 49th National Assembly.
The National Ombudsman Institution holds the view that the Ordinance in question conflicts with the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment and with the European Convention for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment of the Council of Europe. In connection with this, it has been repeatedly recommended to the Minister of Health to draw up a code about the enforcement of the coercive measures “immobilization” and “isolation”, which code clearly indicates for how long and how often patients can be isolated and immobilized within a period of 24 hours, and specifies the justifications for such measures to be applied.
Second, the inspection found that the Male Ward of the First Psychiatric Clinic within UMBAL Sveta Marina in Varna is heavily understaffed. At the time of the accident, one nurse and one orderly only were on duty. In total, one medical doctor was available for the four psychiatric clinics within UMBAL Sveta Marina and he was not in the clinic in question at the time of the fire.
Since 2014, the Ombudsman Institution has been sounding the alarm in its annual reports like the National Preventive Mechanism (NPM) about the problems concerning the financing of the government-operated psychiatric care and the application of medical standards. The institutions within whose competence the matter lies remain under the obligation to find a long-term solution to the serious problems that arise from the bad conditions such as space and equipment and staff recruitment for the psychiatric care.
The Ombudsman Institution has repeatedly warned that these problems directly affect and violate the rights of both – the patients placed in these mental health institutions and their staff.
In the inspections in the last ten years, the Ombudsman repeatedly emphasized the need to reconsider and adjust the budget of all psychiatric hospitals as a matter of urgency, taking into account the inflation processes that occur in the country. In connection with this, the Ombudsman made a recommendation that the 2020-2030 National Strategy for Mental Health of the Citizens of the Republic of Bulgaria should focus on the encouragement of the recruitment of a greater number of medics whose specialty is psychiatry and child psychiatry.
In previous inspections alike, the Ombudsman has made recommendations to the Ministry of Health to revise the Rules of the Organization and Operation of the Inpatient Psychiatric Care Hospitals, in particular the number of staff, in order to improve staffing and guarantee undiscriminating health service for all mentally ill inpatients in the government-operated psychiatric hospitals.
Third, the isolation facilities at the First Psychiatric Clinic within UMBAL Sveta Marina in Varna are not equipped with a fire alarm system, despite the instructions issued by the controlling authorities.
Since 2019, the Ombudsman Institution has constantly alerted the Minister of Health about the need to have a codified requirement for the fixing of smoke detectors for the needs of fire alarm as a criterion for the quality of health care in order to improve the security of patients with mental diagnoses. A recommendation to the same effect was made to the Minister of Health again in 2023. Always the reply was that the Ministry of Health would provide funding for fire alarm systems if it could afford that by the end of the year. It is evident from the findings of the inspection in the First Psychiatric Clinic within UMBAL Sveta Marina in Varna that this commitment of the Ministry of Health has not been met.
All the findings of the inspection are to be presented in a report to contain recommendations to the competent institutions.
MEDIA COVERAGE ON THE ISSUE:
https://clinica.bg/29770-kup-narusheniq-v-psihiatriqta-vyv-varna
https://duma.bg/ustanoviha-tezhki-narusheniya-v-psihiatriya-sled-smart-na-patsient-n295049
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