Health care professionals are required to record every incident of coercive restraint every time a patient is tied down. The employee in charge is required to explain why restraints were needed and how long the patient had to be restrained.
After a fighting for six months to get access to these logbooks through public information laws, VG digitized several thousand handwritten notes with the purpose of analysing the extent and use of coercion at psychiatric institutions in Norway.
Several of Norway’s leading legal experts and law professors in the field of coercion in psychiatric health care reviewed the justifications and concluded that the material exposed extensive statutory violations, questionable justifications for why restraints were used and serious discrepancies in how psychiatric wards and hospitals put coercion into practice. VG also revealed how the State control agencies that are tasked with ensuring patient rights, failed to do their job.
The origin of VG’s investigation was a story we published in March 2016 about a young woman who petitioned the court to release her from a psychiatric hospital so she could take her own life. VG’s journalists stayed in contact with the woman, learning that she had spent the majority of the last two years tied down in a bed at a psychiatric hospital in Oslo.
By investigating the difficult ethical issues in her case, the journalists wanted to figure out just how unique her story was. How often are patients being tied down and for how long?
VG contacted 102 institutions that are authorized to use coercion in April 2016. VG found that the hospitals failed to report about 1 out of 4 incidents of restraint. St Olav’s Hospital in Trondheim and the Møre og Romsdal Hospital Trust, among others, failed to report 80% of all incidents where belts were used to restrain patients.
We learned that hospitals are required to keep handwritten notes for each incident of coercion. The procedure has not changed in 170 years.
Information from patient journals are normally exempt from public disclosure, and many hospitals refused to hand the logbooks over, but VG fought for the right to review those records – and after three rounds of complaints with the national health authorities VG finally won; we were given copies of several thousand pages of information.
We digitized the logbooks and devised an analytics tool where the information could be divided into graphics and diagrams that show the times of year, weeks and days on which patients were tied down.
The final material contains the full coercion logs from 2015 for 14 psychiatric institutions, documenting 2538 incidents of coercion use against 996 patients. 640 incidents were considered unlawful or problematic by legal experts.
Effectively two journalists for two months to do the digitization, with help from one data scientist and one editorial developer to structure the dataset, analysis and tools development.
VG’s publications led to several national and regional investigations into how hospitals could reduce the use of coercion. All hospitals were ordered to review their previous coercion statistics and told to report accurate figures this time. There are plans to introduce a new registration system starting in 2017.
The Parliamentary Ombudsman, the Minister of Health and legal experts said VG’s journalistic efforts brought great concern for the rights of the weakest patient groups in our society.
The Minister of Health announced that he would like to reorganize the entire Control Commission system. There will be made modifications to their tasks in short term, and a full reorganization or shutdown in the longer term.
The Chief County Medical Officer for Oslo and Akershus Counties initiated two regulatory investigations based on VG’s findings, and many families talk about bringing their cases to the courts after learning the rights of their family members may have been violated.
1. Getting the data
While some institutions immediately understood the importance of being transparent about how they used physical coercion, some institutions systematically tried to undermine the release of the coercion logs and fought for several months to keep them secret. It took around half a year – and three complaints to the Ministry of Health – to establish that the logs should be made public under Norway’s freedom of information laws.
2. Manual work to digitize handwritten copies
Hard-to-read copies of the handwritten logs made OCR or automated digitization out of the question. The logs (around 10,000 rows of data) were manually digitized, cleaned, tagged to make analysis and publication of the database possible.