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Urgent dental care of a severely disabled patient was neglected

Parliamentary Ombudsman Petri Jääskeläinen issued a reprimand to an oral surgery specialist in Kanta-Häme Central Hospital and the Hospital District for neglecting to arrange urgent oral health care for a severely disabled patient.

The Parliamentary Ombudsman found that this negligence caused the patient unnecessary pain and suffering that cannot be conpensated by a reprimand alone.

He proposes that the Joint Municipal Authority of Kanta-Häme Hospital District compensate the patient for the violations of the patient's fundamental and human rights. The Joint Municipal Authority shall report to the Parliamentary Ombudsman on measures it has taken by the end of the year.

The patient lives in a nursing home and has been diagnosed with a severe intellectual disability, an autistic disorder and a developmental disorder affecting speech and language. The patient cannot talk and express pain verbally. The complaint was filed by the patient's sister, who acts as their guardian.

Failure to assess the need for and provide care

The assessment of the patient's need for care failed in many respects. A health centre doctor referred the patient to the central hospital for dental care provided under general anaesthesia on 7 August 2013, but specified the urgency class of the referral as over 30 days.

On the basis of the referral, the dental specialist at the central hospital put the patient in the queue for non-urgent treatment, which meant waiting for an unspecified period of time. This could not be done under the law, and the doctor should have informed the patient's guardian of the point in time when treatment would be available.

The doctor should also have taken into consideration the symptoms recorded in the referral letter and organised an appointment urgently, especially as a dentist had not been consulted about the patient's status.

As the patient experienced more severe pain, another health centre doctor drew up an urgent referral. Only after many and varied steps did the patient receive dental care under general anaesthesia in the health centre on 19 September 2013. After this, they felt less pain, and the use of strong painkillers could be ceased. 

Negligences caused unnecessary suffering

Parliamentary Ombudsman Jääskeläinen finds that the patient needed urgent oral health care, and as a result of a failure to provide this care, the patient was subjected to unnecessary pain and suffering.

- The patient's rights to indispensable care and adequate health services enshrined in the Constitution were not implemented. Neither was the patient treated with human dignity, which is also guaranteed under the Constitution.

According to the Parliamentary Ombudsman, the information provided by the nursing home staff about dental pain experienced by the patient should have been better taken into account better when assessing the patient's need for care.  Among other things, the patient had resorted to self-harm by hitting their head against the wall.
 
Inconsistent dental care under general anaesthesia

In its statement to the Parliamentary Ombudsman, the National Supervisory Authority for Welfare and Health Valvira noted that the arrangements for dental care under general anaesthesia in Kanta-Häme Hospital District are fragmented and inconsistent. The services offered are also limited, and acute needs cannot be responded to.

In his decision, the Parliamentary Ombudsman stresses that municipalities or joint municipal authorities managing a hospital district have had an obligation to organise round-the-clock emergency facilities providing urgent oral health care as referred to in the Health Care Act since the Act entered into force, or as from 1 May 2011. The Parliamentary Ombudsman has on several occasions drawn the attention of health care authorities to this fact.

The full text of Parliamentary Ombudsman Petri Jääskeläinen's decision no 4915/4/13 (in Finnish).
Further information is available from Principal Legal Adviser Kaija Tanttinen-Laakkonen, tel. +358 (0)9 432 3377.