At the request of the Parliamentary Committees on Labour and Social Policy and on Health, Ombudsman Velislava Delcheva sent an opinion on the draft law amending the Health Act.

22 July 2025

At the request of the Parliamentary Committees on Labour and Social Policy and on Health, Ombudsman Velislava Delcheva sent an opinion on the draft law amending the Health Act.

The opinion highlights that over the years the Ombudsman has identified a number of systemic problems related to the rights of psychiatric patients, one of the most significant being the application of extreme coercive measures to patients without a system of control.

Attention is drawn to the fact that the most serious case qualified as torture since the beginning of the Ombudsman's mandate as NPM is the fire that occurred on 2 October 2023 in the State Psychiatric Hospital in Lovech, during which a patient died.

The Ombudsman then found that on the day of the fire this patient had been isolated for 9 hours and had been immobilised, i.e. tied to all four limbs, for almost 6 hours. This is the reason why he died during the fire.

"The immobilisation happened nearly a month after he was admitted for treatment. This, in turn, suggests that after the treatment he received, the acute phase of his disease was brought under control. Moreover, he was accommodated in a so-called 'soft room', which allows patients to do everything and move freely without risks and without difficulties for the caring staff. It is evident in this case that instead of the soft room being used as a gentle and safe place for isolation, it was used as a 'punishment room' and the patient was immobilised in it," the public defender writes in her opinion.

Another significant problem identified by the Ombudsman is the violation of Ordinance No. 1 of 28 June 2005 on the procedure for the application of temporary physical restraint measures for patients with established mental disorders.

"According to Article 11(2) of the Ordinance, a patient who is subject to a temporary physical restraint measure shall be continuously monitored by nurses designated by the doctor, who shall change every hour. It is evident from the case that there was no continuous monitoring of the patient during the immobilisation," the NPM team states firmly.

In addition, the Book of Measures Taken for Temporary Physical Restraint identified a number of cases where patients were assigned several consecutive isolations and several immobilisations on the same day or on consecutive days. Particularly drastic was the case of a patient diagnosed with vascular dementia who, from 30 September to 2 October, had been isolated a total of 5 times for 6 hours each and immobilised 2 times for 2 hours each.

“It should be stressed that Ordinance No. 1 of 28 June 2005 on the procedure for the application of temporary physical restraint measures to patients with established mental disorders contravenes the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment and the Council of Europe Convention for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment. The Ombudsman considers that it is inhuman and degrading treatment or humiliation for a patient to be tied up for hours on the same day and isolated, as was found during the inspection at the State Hospital in Lovech. The Ordinance does not stipulate if once a measure of immobilisation (tying) has been imposed for 2 hours whether this means that 5 minutes after the measure has expired the patient may be tied up again an unlimited number of times. Similarly, when a person has been isolated for 6 hours, it is not stipulated how many times this measure may be extended for another 6 hours. In practice, a person can be isolated every day for 15 days almost without interruption of the measure," the opinion says.

In it, the Ombudsman Institution once again urges the Ministry of Health to revise the ordinance in question, including to draw up a protocol for the application of the coercive measures of "immobilisation" and "isolation", in which it is clearly noted for what duration and how often patients can be isolated and immobilised for a period of 24 hours, as well as to specify the grounds on which these measures are applied.

Another significant problem mentioned in the Ombudsman's opinion is the lack of a legal redress mechanism and other systemic deficits. Emphasis is placed on the Public Statement on Bulgaria of 4 November 2021 of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT). In its concluding observations, the Committee then noted that in its previous reports it had taken due account of the repeated assurances given by the Bulgarian authorities that action would be taken to improve the treatment of persons detained in psychiatric hospitals and social institutions.

"At the same time, the findings of the 2021 visit have once again highlighted the serious and long-standing problems that have not been systematically acted upon. This state of affairs demonstrates a continued lack of action by the Bulgarian authorities on most of the major shortcomings and on the implementation of the Committee's specific and repeated recommendations over many years. The CPT is of the opinion that action along these lines is long overdue and a fundamental change in the approach to the overall issue of mental health care and social care in institutions in Bulgaria is needed," the opinion stresses.

It also draws attention to the fact that in March 2023, the CPT again inspected two psychiatric hospitals in Bulgaria, where it found that violence against patients by staff continued. The Committee considers it a serious failure that the Ministry of Health has failed to stop these unacceptable practices.

"On 23 November 2023, the National Assembly adopted a decision to set up an Ad Hoc Committee to examine the violations of the rights of mentally ill patients found in Bulgaria by the European Committee against Torture and the Ombudsman of the Republic of Bulgaria and to propose legislative changes to guarantee the equal rights of Bulgarian citizens as provided for in the Constitution of the Republic of Bulgaria and the conventions to which the Republic of Bulgaria is a party. Among the tasks of the Committee are: to place at the forefront of the National Strategy for Mental Health; to guarantee respect for the rights of patients; to discuss and propose the abolition of the institution of mental institution; to take the necessary steps, in cooperation with NGOs and medical experts, to ensure the deinstitutionalization of mentally ill patients and respect for their personal choice. The Ombudsman, as the NPM, has proposed to this Ad Hoc Committee legislative changes that address the rights of mentally ill patients," the statement adds.

It further specifies that tragic incidents continue to recur, and one of the Ombudsman's most important recommendations for legislative change, which is not included in the current draft law, is the creation of a single information system in which it is mandatory to record in real time every "immobilisation" and "isolation" from all psychiatric hospitals in the country. This system should link all psychiatric hospitals to the Ministry of Health, and the Ministry of Health should make publicly available, on a monthly basis, data on coercive measures applied in psychiatric hospitals in the country.

OMBUDSMAN'S RECEPTION-ROOM

• address: 22 George Washington str.,
  1202, Sofia
• phone: (+359 2) 810 6955; fax: (+359 2) 810 6963
• e-mail: priemna@ombudsman.bg

PRE

On July 29, 2025, the Public Defender visited the social housing located in Bolnisi, Sioni No. 1, where six families are currently living.

The social housing is located in the former building of the so-called mining chemistry, which was used to conduct chemical processes. The overall condition of the building is critical in terms of safety. The building has cracks, a collapsed facade, walls often get wet, there are signs of water coming from the ceiling, the sewage system is faulty, and the basement often floods.

As residents note and it is also visually noticeable, one of the main challenges in the building is dampness. Due to the exceptionally high humidity, there is an unbearable smell in the living rooms and the walls are blackened. The general condition of the rooms allocated to the beneficiaries is inadequate, the walls, floor and ceiling are damaged.

It is worth noting that, like the majority of other social housing facilities in Georgia, the facility located in Bolnisi does not have any administration. Thus, the relevant departments of the City Hall do not systematically monitor conditions in the facility or take effective, timely and efficient steps to eliminate the existing challenges.

La sottoscrizione delle sindache Bottamedi e Campestrin con Bernardi alla presenza di Soini

​​Sale a 140 il numero dei comuni trentini convenzionati con il difensore civico della provincia. L’avvocato Giacomo Bernardi, eletto nel ruolo dal Consiglio provinciale il 10 dicembre scorso, ha raccolto stamane le firme di Eleonora Bottamedi e Daniela Campestrin, rispettivamente sindache dei comuni di Andalo e Torcegno.

La sottoscrizione è avvenuta in presenza del Presidente del Consiglio provinciale Claudio Soini che ha sottolineato l’importanza del ruolo del difensore civico e dell’eccezionale opportunità di avvalersi di un servizio gratuito a beneficio dei cittadini e delle amministrazioni pubbliche. Un servizio prezioso, ha aggiunto Bernardi, svolto nell’ottica della mediazione e del confronto, per superare o placare contenziosi, nell’interesse della collettività.

Le sindache hanno detto di aver risposto volentieri all’appello alla convezione, lanciato nei mesi scorsi dal difensore civico, nella consapevolezza che il servizio risponda all’interesse delle loro comunità.

Mancano all’appello 26 comuni trentini.

Concepción Gimeno pide valorar la modificación de la Orden de 22 de marzo de 2004 de Sanidad para revalorizar el precio de 0,06 euros por kilómetro

La justicia de Aragón, Concepción Gimeno, ha emitido una sugerencia dirigida al Departamento de Sanidad en la que pide que se valore la modificación de la Orden 22 de marzo de 2004 por la que se aprobaron las ayudas por gastos de desplazamiento, manutención y hospedaje para pacientes de la Comunidad.

En concreto, la institución insta a la actualización de la cuantía prevista para gastos de desplazamiento, que actualmente se sitúa en 0,06 euros por kilómetro, o la revisión del modelo actual de determinación de dichas ayudas en aras a una mayor efectividad de la garantía de igualdad en el acceso a las prestaciones sanitarias.

Esta sugerencia responde a la queja de un vecino de Tarazona que solicitó la ayuda por tenerse que desplazar a Zaragoza para asistir a un especialista del que no disponía en su ciudad. En la queja muestra su sorpresa por que este precio lleve más de veinte años sin ningún tipo de revalorización.

En la resolución, la justicia de Aragón reconoce que el gasto que asume este paciente por el desplazamiento para recibir asistencia sanitaria especializada supera significativamente la cuantía recogida en la normativa. Además, hace referencia a que la variación del Índice de Precios al Consumo de marzo de 2024 a marzo de 2025 es de un 57,8%, según el INE, y a que, en otras comunidades como Galicia o La Rioja, el precio asciende a 0,15 y 0,16 euros el kilómetro, respectivamente.