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Need for clear guidelines on the language in which patient records ara drafted


Ombudsman Petri Jääskeläinen believes that the Ministry of Social Affairs and Health should issue more precise guidelines on the language to be used in patient records. What the matter involves is the language rights of patients.

The Ombudsman adopted a position on the matter arising from a complaint by Svenska Finlands folkting (The Swedish Assembly of Finland). The Assembly asked the Ombudsman to examine the practice adopted by the City of Helsinki of always drafting patient records in Finnish. It also criticised a set of guidelines issued by the City to the effect that, inter alia, epicrises and medical statements need not be translated even if the patient is Swedish-speaking.

In the Ombudsman's assessment, the City of Helsinki Health Centre had not acted unlawfully in always drafting patient records in Finnish.

By contrast, the Centre's guidelines on translation into Swedish contained, in the Ombudsman's view, too many restrictions. He believes that the epicrises and doctor's certificates and medical statements given to Swedish-speaking patients must be translated into Swedish unless the patient has announced otherwise.

Patient's language rights the starting point

The relevant Act does not contain unambiguous regulations concerning the language in which patient records or other material relating to treatment are to be drafted. For this reason, the Ombudsman believes that the point of departure in assessing the question should be the general provisions concerning the patient's language rights.

Under the Primary Health Care Act, a health centre in a bilingual municipality must provide health services in both of the municipality's languages so that a patient receives treatment through the medium of Finnish or Swedish as he or she chooses. The Patient Act requires the patient's mother tongue to be taken into consideration in treatment to the extent that possibilities allow.

Helsinki can draft patient records in Finnish

Current legislation does not, in the Ombudsman’s assessment, require that patient records be drafted in the patient's own language. The Language Act does not regulate the internal official language of a municipality; instead, the municipality can act in the way that it deems most purposeful.

The City of Helsinki Health Centre defended its practice by pointing out that the City's internal official language is Finnish and that patient-related documents must be understandable in all of the units to which the Health Centre sends its patients. In addition, translation takes time and could endanger a patient's safety in urgent cases.

The Ombudsman finds that the grounds the City has presented in support of its practice are appropriate.

Epicrises and medical statements must be translated into Swedish

The right of patients to receive information on their medical records must be respected even if the documents have originally been drafted in another language, says the Ombudsman. This causes a need for both interpretation and translation.

The City of Helsinki Health Centre has taken these needs quite well into consideration in its guidelines in that extracts of patients' records are translated without this having to be separately requested. By contrast, referrals, epicrises and medical statements are not translated under the guidelines.

The relevant Act requires that an epicrisis be sent not only to the treatment units that need this document, but also to the patient. In the view of the Ombudsman, in bilingual municipalities the epicrisis must be sent to the patient in the national language that is marked as his or her mother tongue or language of transaction – if the patient has not announced that there is no need to translate it.

The Ombudsman regards the provision of medical statements as being included in a health centre's duties. Then the services involved must in a bilingual municipality be provided by the health centre in the language, Finnish or Swedish, that the patient has specified.

Clearer guidance needed

In Ombudsman Jääskeläinen's opinion, there is a manifest need in this matter for guidance by the Ministry of Social Affairs and Health.

In his assessment, what is involved in the final analysis is how patients' language-related fundamental rights are taken care of. He has drawn the attention of the Ministry of Social Affairs and Health to the fact that the Constitution requires the public authorities to ensure implementation of fundamental and human rights.

The Ombudsman has asked the Ministry to inform him, by 30.12.2011, what measures his decision has given rise to. The City of Helsinki Health Centre must likewise report on the measures it has taken by 30.9.2011.

Additional info will be provided by Senior Legal Adviser Håkan Stoor, tel. +358 (0)9 432 3366.