Response to interpellation 2025/26:9 on patient safety in gynecological diagnostics and irreversible procedures
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerned patient safety in gynecological diagnostics and irreversible surgical procedures after women were operated on unnecessarily 1 2. SD argues that nationally binding stop rules and mandatory double reviews are required to ensure a minimum level and avoid unequal care 2 3. SD also requests an extended analysis after 2023 as well as coherent and dignified support with reasonable compensation for those affected 2 3. KD argues that the regions bear the responsibility for care and insurance processes 1 4. KD emphasizes that legislation should not hinder the profession's development or technical progress such as AI 5. KD does, however, concede that the compensation levels can be extremely low 4.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Sjukvårdsministern Elisabet Lann (KD)
Madam Speaker! Carita Boulwén has asked me if I intend to take measures to introduce nationally binding stop rules and requirements for double review in cases of serious diagnoses that can lead to irreversible surgical interventions, so that women do not risk having their uterus removed or other interventions performed on incorrect grounds. Carita Boulwén has also asked how I intend to act to ensure that those who have been affected by incorrect irreversible surgical interventions receive dignified support and compensation that is in reasonable proportion to the lifelong damage they have suffered.
All women should be able to feel safe with healthcare. That a woman has her uterus removed unnecessarily is something that must not happen.
Women's health and good health and medical care for conditions and diseases that primarily affect girls and women is an area that is highly prioritized by the government. To ensure further progress and patient benefit within maternal health care, childbirth care, as well as girls' and women's health, the government continues the initiative in the area. The continued initiative shall support the development of a strengthened and equal health as well as a more person-centered health and medical care for girls and women. The need for knowledge about conditions and diseases that primarily affect girls and women, both within specialized care and within primary care, remains great, and the area needs to continue to be developed and followed up.
Through a supplementary agreement between the state and Sveriges Kommuner och Regioner within the cancer area, Regionala cancercentrum were commissioned to carry out a number of interventions. From the reporting regarding the agreement, it appears that between the years 2020 and 2023, no overdiagnosis of the premalignant condition EIN has occurred in the country beyond Region Uppsala.
Through a workshop, a number of proposed measures within the following areas were also submitted: strengthened use of quality assurance programs, developed code systems within pathology, strengthened knowledge sharing and increased process thinking regarding premalignant conditions, developed registries, greater opportunities for competence development for pathologists and improved communication with the patient regarding premalignant conditions. During the development of the proposed measures, key actors for the implementation of the measures were also identified. From the final reporting of the agreement, which was shared with the Ministry of Health and Social Affairs in March 2025, it emerged that, among others, the care program group had taken measures based on the workshop's recommendations. Recommendations were also directed to the Swedish Society of Pathology, Equalis and the regions, as well as to hospitals and clinics.
A good, efficient, equitable and equal healthcare that is accessible and based on the principle of need is crucial for a well-functioning healthcare system where the patient's best interests are at the center. The responsibility to ensure that incorrect procedures are not carried out within healthcare lies primarily with the region and the healthcare provider. Furthermore, medical decisions are a matter for the profession with its experience and education, in dialogue with the patient. It is not the government that is best suited for such decisions.
With that, I would like to thank the interpellor for the question and look forward to the debate.
Carita Boulwén (SD)
Madam Speaker! I would like to begin by thanking the Minister for Health and Care for the answer and at the same time warmly welcome the Minister to the role. It is the first time that we meet here in the chamber.
Madam Speaker! In the autumn of 2024, one of the most serious healthcare scandals in modern times was revealed: At least 58 women had had their uteri removed unnecessarily following incorrect diagnoses. These are irreversible procedures with lifelong consequences. Women describe pain and a long recovery, a body that has become different, disrupted hormonal balance, changed sex lives, loss of fertility, and a tangible emptiness. One does not quite feel like a woman anymore. On top of all this, there is a gnawing doubt: Was the decision really correct?
I know how that feeling is. I have undergone this operation myself.
When healthcare faces irreversible interventions, the slightest doubt must lead to a pause and reassessment. The problem is that we lack general, nationally binding stop rules that automatically pause surgery when the diagnostics do not align. There is also a lack of a national requirement for double review of tissue samples before irreversible interventions. Today, this is decided by care programs and local routines. It creates inequality between regions and unnecessary risks for patients.
Within the Tidö agreement, we have agreed on a number of important initiatives, not least within health and medical care. As the Minister highlights, we continue to particularly strengthen women's health and the care for conditions that primarily affect girls and women. This is welcome and meets a clear need for knowledge. Therefore, we now need to move from initiatives to actual patient safety during irreversible procedures. Important steps have been taken. RCC is working according to the mandate, and the knowledge management is strong. That is good.
At the same time, the conclusion is based on the 2020–2023 coding. It is a periodized conclusion based on coded data. It says what was visible in the registers then, not what may have happened thereafter or outside the coding framework. And we have seen cases after this. This indicates a need for an extended analysis as well as for it to be supplemented with a national coding guidance and validation via journal samples in each region so that the code is reconciled against actual data.
Mr. Speaker! My question is this: Is the Minister prepared to let the audit cover the period after 2023 and validate the registers with record-based random samples in each region so that we get a current and complete national picture?
Binding rules are therefore lacking. Patient safety requires a national minimum level. The baseline should be the same everywhere; after that, the regions are welcome to do more.
In conclusion: Is the Minister prepared to further look into the possibility of a binding stop rule, mandatory double review, and a model for open follow-up per region?
Sjukvårdsministern Elisabet Lann (KD)
Mr. Speaker! Thank you, Carita, for a very pressing interpellation and for raising this question!
I share your despair that it can turn out this way. At the same time, the government's toolbox is somewhat limited when it is the regions that are responsible for healthcare. I know that our parties stand a bit closer to each other regarding what the solution is in the long term.
We must remember that Swedish cancer care is world-class. We are at the absolute top. Much of this is due to the fact that we have a great deal of national governance through the regional cancer centers, but also the routines surrounding cancer care.
The measures that have now been taken are within six development areas, where 17 concrete measures have been specified. This is happening in dialogue with the profession, where one learns from each other. The starting point is that it is within the medical profession that one improves the work in this way.
We must be aware that if we introduce legislation that restricts the execution of healthcare very much, we often risk falling a step behind. It is clear that it is desirable that two people perform the review. That is the rule in most cases today. But we also see that very much is happening in the AI field. For example, when it comes to breast cancer screening, we see better accuracy when AI tools are included in the review of the screening. In that case, it is important that we do not have legislation that stands in the way of that type of development, without it being the profession itself that, in step with the development of the technology's possibilities, changes and develops the routines and develops the work in the best way for the patient.
That is why I think there is reason to be a bit restrained when it comes to legislation specifically. But the national governance in the area is strong, and we see that these measures are very important steps in the right direction.
Carita Boulwén (SD)
Mr. Speaker! Thank you, Minister for Health and Social Affairs, for the answer!
My thought, of course, is not that we should take over the role of the profession, but it is about clearer governance where we set the boundaries for what is the minimum level out in the regions. Naturally, it is the profession that then gets to determine how to work with these issues. What is very important for me, as we see that we have unequal care, is that we step in and set the boundary for what the minimum level shall be.
In my first speech, it was about causes and processes. Now I want to pause at those who have already been affected by incorrect, irreversible interventions. Behind the figures are women who live with a long recovery, as I said earlier, with hormonal imbalance, altered intimacy and loss of fertility and a doubt that does not quite let go.
On top of that comes the experience of a fragmented management with different messages between regions and an insurance process that many describe as heavy and difficult to oversee. The compensation levels have also sparked justified anger. Several affected individuals have been informed of a few thousand kronor – amounts from around 3,400 up to 18,000 kronor occur – despite having been operated on unnecessarily and in some cases lost both uterus, ovaries, and fallopian tubes with sudden menopause as a result. People who may have intended to start a family cannot do so because of this.
Those who live with such lifelong consequences naturally experience such levels of compensation as a mockery, not as a redress. The problem must therefore be clear. Those who have already been harmed face an order today where the responsibility is perceived as unclear. It is difficult to obtain a coherent path through care, certificates, and insurance. The compensation is often perceived as not being in reasonable proportion to the injury, especially when loss of fertility, lasting health impact, and psychological burden are factored in.
The review that the Minister refers to extends to 2023. After that, as I said earlier, more cases have been noticed. For these women, support and compensation is not a future issue but a question of here and now. Trust is determined by how they are received afterwards. It is determined by whether there is order, clarity, and respect, and whether the compensation is perceived as dignified.
Mr. Speaker! My question to the Minister in this part is: How does the Minister intend to ensure a coherent and dignified support for those already affected, and that the compensation is in reasonable proportion to the lifelong damage they have suffered? When can the Riksdag expect to receive the government's direction and timetable in just this part?
Sjukvårdsministern Elisabet Lann (KD)
Mr. Speaker! As I mentioned earlier, the care is the regions' responsibility. They also have an arrangement for compensation. It is the regions' own insurance company that handles these matters.
I completely agree that some of the compensation levels are extremely low, and I understand that people are upset and disappointed about it. I have also understood that Region Uppsala, in the case at hand, has offered to pursue the compensation issue on behalf of the affected women, which I think is good.
I do not see that the government can step in and take over the insurance company and the arrangement that the regions have for insuring patients against the inevitable damages resulting from mistakes that the healthcare system has made. It is reasonable that it is the regions that take responsibility for this, because it is they who are responsible for the healthcare. Accountability is a very important part of the issue of principal-agent relationship. As long as the regions are responsible for the healthcare, they need to take responsibility also when things fail, and they have an arrangement for this.
Carita Boulwén (SD)
Mr. Speaker! I thank the Minister for Health and Care again for the answers.
I believe it is important to highlight this. Many women have been affected, and in some places, trust in healthcare is lacking after such incidents.
I think it is important that we turn over every stone to see what we can do here in the Riksdag and what legislative changes can be decided upon from the government's side so that this does not happen again, and so that those who have been affected receive a dignified compensation for what they have suffered.
I look forward to continued close and good cooperation with the Minister for Health and Social Affairs. I will return with other relevant questions on this subject.
Sjukvårdsministern Elisabet Lann (KD)
Mr. Speaker! I shall be brief.
A lot is happening in this area. We are waiting for a new cancer strategy that is to be presented before the turn of the year. We are getting increasingly clear state direction in these matters. I share Carita Boulwén's view that this is important. It is also important that the guidelines that are developed are followed, so that knowledge is shared between regions and so that this type of incident is not repeated.
I thank you for a good interpellation.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.