On August 8, 2016 I requested Terveystalo – a private medical service provider with one medical center located at Albertinkatu 16, 90100 Oulu, Finland – to send me a printout of the log file of my medical records via regular mail. The log file should show who has accessed my medical or customer information and when since my first visit to the center. Below is a non-literal translation of their response dated September 29, 2016 sent via regular mail. The punctuation aims to follow the original text in Finnish.
[start of the letter, the original letter in Finnish with my contact information covered is available here: 160929 Terveystalo]
Dear Tero Auvinen,
The log file you have requested from Terveystalo is ready, in order to give it to you, we must confirm your identity.
Regarding the timing of confirming your identity and giving you the log file you can contact,
the person in charge of quality Anu Revonoja (tel. 010 345 3040) or quality manager Sanna Lämsä (tel. 050 533 3117)
With kind regards,
[end of the letter]
When requesting the log file in person at the center on August 8, 2016 there appeared to be no reason why the printout of the file could not be sent to me via regular mail. During my first visit to the center on June 13, 2017 I was given another letter dated July 20, 2016 which does not include a printout of the log file. During my second visit to the center on the same day no further letters addressed to me could be found. I requested the center once again to send me the printout of the log file via regular mail. As of July 10, 2017, I have not received a response from Terveystalo, although some of the apparently relevant employees appeared to be working rather than on vacation on, for instance, June 14, 2017.
According to my privacy settings none of my medical information should be visible to any other individual except the doctor who has produced such information. This appears to have been the case some years ago: I was told by a doctor that he is not able to see any information on whether I have visited any other doctor at the center before. Among other potential peculiarities associated with the center, the actual information-handling practice appears to have changed. During a visit on August 2, 2016 doctor Tuomo Jääskeläinen was reportedly able to see my medical records over the period of several years. The center has confirmed that the relevant privacy setting has not been changed. They were actually or allegedly not able to explain why my medical records appeared to be accessible to unauthorized individuals.
According to the patient ombudsman of the local healthcare center (Mirva Makkonen, Hanhitie 15, Oulu, Finland) in connection with a partly different issue, it is not possible to select an overall blanket prohibition that would prevent a private medical center from passing on some medical records to a national database (www.kanta.fi) – at least in a form that would not be potentially accessible by other users of the database in case a customer, patient or targeted individual cannot entirely prohibit the creation of a national registry of personal medical information by, for instance, “cartelist”, “conspiratorial” or “cultist” alleged or self-declared authorities – due to the “complex organizational structures of private medical service providers”. Apparently the customer has to wait until a private medical service provider has passed on information relating to a specific visit or procedure to the national database and prohibit access to each and every data entry on a case by case basis after the information has already been made accessible through the national database. In other words, the alleged or self-declared authorities or “government” in Finland do not appear to regard it as feasible, desirable or necessary to require private medical service providers to implement either sufficiently simple organizational structures or advanced information systems to prevent access to medical records through a national database based on an explicit customer request to do so.
For some medical procedures, Terveystalo appears to be the sole external service provider to the Oulu University Hospital. A customer who visits the local public health center and is subsequently referred to the Oulu University Hospital might be referred by the Oulu University Hospital to Terveystalo for procedures which cannot be performed within a reasonable time frame at the Oulu University Hospital. The Oulu University Hospital does not at least in some cases obtain the customer’s consent for such referral to Terveystalo or inform the customer beforehand: the first contact informing the customer about such referral may come from Terveystalo. Patient ombudsman Hilkka Manner at the Oulu University Hospital did not appear to be able or willing to explain upon request how the hospital’s choice of sole external provider for some medical procedures might be successfully contested. The public health care system in Oulu is using as the sole external service provider a private corporation which does not follow its own privacy policies and cannot even explain why such policies are not in practice followed by its staff and information systems despite unchanged customer privacy settings. Yet the public health care system in Oulu appears unable or unwilling to explain how a customer might challenge the choice of a clearly inappropriately or illegally acting sole external service provider or whether Terveystalo’s inappropriate or illegal activities might be significant enough to either require the public health care system to autonomously terminate its contract and prosecute Terveystalo or essentially amount to willing and knowing complicity by the public health care system in the inappropriate or illegal activities of Terveystalo.
According to the patient ombudsman of the local healthcare center, every potential channel for communications or complaints on inappropriate or illegal medical record management practices may involve the creation of additional databases consisting of the communications or complaints and potentially documentation that might be enclosed or attached to such communications or complaints. The receiving alleged or self-declared authority apparently decides whether the matter is entirely or partly confidential – although clearly never reliably private. In other words, any potential attempts to promote privacy through any official channel might merely create additional databases or achieves, including but apparently not limited to the information which was to be destroyed or made inaccessible in the first place. The responses which might in theory be obtainable through such procedures might often be non-binding or clearly inappropriate or insufficient as potential remedies rather than constituting genuine remedies for the harm suffered and penalties for the offences or violations committed.
This is what a toenail looks like after a small surgical procedure performed by doctor Petteri Kenttä (last name translatable as “Field”) at Terveystalo potentially on April 15, 2014 to remove a part of an ingrown nail.
The procedure involves the utilization of some type of chemical to prevent re-growth of the removed part of the nail. Presumably identical procedure was previously performed elsewhere with no apparent side effects. The appointment at Terveystalo was made for the explicit purpose of re-performing the same surgical procedure which had been previously done elsewhere. The doctor suggested removing the entire toenail rather than re-performing the same procedure once again. Once the patient declined the offer, the doctor reminded once again after injecting the local anesthetic that the patient could still change his mind until the local anesthetic would have had the desired effect and the procedure could be started. Apparently the removal of an entire toenail does not involve the utilization of any type of chemical to prevent re-growth of the removed nail. While the medical consensus may well be that nothing needs to be done to the toenail, might the change in the nail’s composition have been caused by the surgical procedure? If yes, might such a change have been foreseeable before the procedure and avoidable by removing the entire nail?
It does not appear to be possible to record entire medical examinations or procedures in order to, for instance, be able to prove that at some point in time no specific type of visible internal bodily damage existed despite specific visible symptoms or that no damage – internal or external – has been caused during such examinations or procedures.