The events in Ruda Slaska led once again, primarily the media, to examine the possibility of the use of the so-called direct coercion of aggressive patients by medical staff . The legal provisions in this regard were incorporated into the Law of 19 August 1994 on the protection of mental health, hereinafter referred to as the Law on the protection of mental health. 18 sec. 1 of the law, the use of direct coercion by medical personnel is possible against persons who attack their life or health or public health or safety, forcibly destroy or damage nearby objects or severely disrupt or impede the functioning of a medical service organization providing medical services .
Services. However, what is extremely important, this provision contains both subjective and objective limitations. Subjectively, the use of direct coercion in the situations described above is possible only in relation to a person with a mental disorder, ie a mentally ill person (who demonstrates psychotic disorders), with mental retardation or who demonstrates other mental disorders. which, depending on the level of knowledge, are classified as mental disorders and the person needs medical services or other forms of assistance and care necessary to live in a family or social environment (section 3 (1) of the Public Procurement Act).
Transferring these considerations to the facts from the hospital in Ruda Сl, ska, it is necessary first of all to state that the available press reports, very rare, show that the aggressive person was a postoperative patient under the influence of strong drugs. Therefore, it seems that they can cause certain mental disorders that would give doctors the right to use direct coercion.
However, a much more complicated situation concerns the prescription of an objective nature and, in this sense, in the opinion of the author of the comment, the case of Ruda Slaska demonstrates again a serious ambiguity in the content of art. 18 OPSP The above provision allows medical personnel to use direct coercion against people with mental disorders only in the psychiatric departments of hospitals and organizational units of social assistance, as well as in addition during rescue operations.
In view of the above, it is doubtful whether it was possible, in the context of the Ruda Slaska incident, to use direct coercive measures on the part of staff. According to the author, yes, because the content of art. 18 PAP is not explicitly restrictive in this regard, and therefore the physician may apply direct coercion to patients with mental disorders who are treated in other wards. It is noteworthy that a similar position was taken by the
Ministry of Health in a letter of 31 May 2012, MZ-ZP-P-073-23541-1 / AB / 12, which was an answer to the Ombudsman’s question on human rights. patients on the regulations of the institution of direct coercion. At the same time, it should be clearly emphasized that in the same document the Ministry of Health recognizes the need to clarify these provisions in the volume discussed. Unfortunately, although more than two years have passed since the preparation of the above letter, there is no information about plans to amend the Mental Health Act.
It is worth noting that, in the opinion of the author of the comment, conducting a different legal assessment in the situation in Ruda Slaska and recognizing that medical staff cannot apply direct coercive measures under the conditions specified in the provisions of the Mental Health Act will not lead to criminal prosecution of staff. , especially criminal liability, because in this case the aggressive patient runs up the stairs, armed with a knife in the form of a kitchen knife and therefore seems justified the thesis that the medical staff intervening in
connection with such a patient will act in conditions of increased need and even the necessary protection and, therefore, institutions, the existence of which excludes criminal liability, in accordance with art. 25 and 26 of the Law of June 6, 1997 – Criminal Code, hereinafter referred to as the Civil Code. Staff will protect not only their lives and health, but also their patients.
However, the right decision was made – to call the police immediately. There is no information on whether this action was the result of strictly established internal rules or was a consequence of the development of events. All this leads to an extremely important conclusion – in every hospital a conflict situation can arise with the participation of an aggressive and armed person, not only a patient, but also a third person, so it is absolutely necessary to develop a procedure. adequate security.