Health Board seeks stronger powers to curb unsafe medical practice

Estonian officials have limited powers to stop doctors from using methods that do not follow evidence-based practice, ERR reports. A bill under development would give the Health Board more authority to restrict individual medical workers.

The issue has arisen at a family medical centre in Haapsalu, where patients of family doctor Piret Mets have reportedly continued to see Dr Martin Ruumet. The Estonian Association of Family Doctors considers his methods potentially dangerous to patients. The local newspaper Lääne Elu reported on the problem two years ago.

After receiving patient complaints, the Health Board opened an oversight proceeding, which has since ended. The board’s head of health services, Külli Friedemann, told ERR that, to her knowledge, the medical centre ended its employment relationship with Ruumet during the proceeding. He remains listed in the health workers’ register. Although he is not named on the centre’s website, ERR said it had received reports of recent cases in which patients still saw him there. Friedemann said she did not know the current situation at the centre.

Friedemann said the Health Board investigates healthcare providers, such as medical centres, rather than individual doctors. In Estonia’s health system, an employer is responsible for a doctor’s work, including how services are organised, what guidance staff receive and the quality of their work. She said patient feedback is important when concerns arise.

Under the current system, if a provider ends its employment relationship with a doctor under scrutiny, the Health Board no longer has grounds to continue its investigation, Friedemann said. She said the board cannot rule out that a doctor has changed their practice following an oversight order, but further proceedings or new reports may be needed to establish whether problems continue.

Friedemann described cases involving doctors who provide ineffective or non-evidence-based care as rare, but did not give a number. She said the same names can recur in cases where a doctor’s views become more extreme.

Amendments to the Health Services Organisation Act being prepared in the Riigikogu, Estonia’s parliament, would allow the Health Board to suspend a doctor’s or nurse’s registration in the health workers’ register. So far, this has been possible only with court approval or for a short period.

The proposed changes would also let the board assess more than formal requirements when granting healthcare providers a licence. It could consider how a provider plans to ensure staff competence, service quality and patient safety.