Vague critique from the Health Authorities Disciplinary board
When Danilo’s parents realized that there had been made a mistake in the doctors´treatment of their son, they went to the National Agency for Patient Rights and Complaints and the Health Authorities Disciplinary Board to report the mistakes, and prevent that other parents would have to end up in the same situation. The Agency for Patient Rights and Complaints is the public entity that handles complaints over concrete health persons treatment, and thereby ensures the rights of the patient in the healthcare system. The Disciplinary Board gives critique to healthcare personnel. In 2012, the family Terrida family filed a complaint over the mistakes, which, primarily Ole Knudsen, made in his treatment of Danilo. Around a year later, the ruling arrived.
While the complaint was treated, Denis called the Agency for Patient Rights and Complaints several times, to know what was going on, and he soon realized that the entity did not by themselves take initiative to gather the necessary documents in the case. This got the family and their lawyer to initiate an investigation by themselves, to find out what really happened when Danilo received the “happy pills”, and their discoveries were over several times sent to the Agency for Patient Rights and Complaints in September and December 2012 and January 2013.
A work of investigation that took both time and money for the family. When the family’s lawyer asked the Agency for Patient Rights and Complaints to gather important information about whether Danilo had consulted his doctor once or twice before the prescription of the pills, the Agency for Patient Rights and Complaints rejected that such information could be gathered. However, this showed not to be true, and when the family’s lawyer found documentation that this was the administrative obligation of the entity, the information was gathered. For Danilo’s family, the process has been extremely tough, and they are here today with a feeling that the Agency for Patient Rights and Complaints and the Health Authorities Disciplinary Board only was focused on getting the case out of the way as fast as possible, without going into depth with it.
The rulings form the Disciplinary Board came over several times. In Spring 2014, the board criticized the local practitioner, who had taken Danilo’s call in Frederikshavn. The criticism was that the doctor did not inform Danilo’s own practitioner about the call. This is very important, when a follow-up on the patient is required, or if the patient is taking contact in relation to a potentially serious condition, the Disciplinary Board says. The local doctor had thereby acted beneath the norm for recognized professional standard, when he treated Danilo in the phone.
Danilo’s parents had also complained about the doctor, Ole Knudsen’s, inadequate diagnose, lack of informed consent, wrong treatment of Danilo with antidepressants, as well as his creative medical record keeping. In the summer 2013, Denis and Marianne received the ruling from the Disciplinary Board. On one hand, the family could read that Ole Knudsen received criticism on several points: his medical record keeping, his lack of follow-up on the treatment of Danilo, and for not having received an informed consent for treatment from Danilo. Especially the fact that Danilo never got information about what medicine he received, still shocks Denis and Marianne. They feel that it is close to compulsory treatment, as Danilo did not have the required information to agree with the treatment. Further, it frustrates them that Danilo never received information about the dangerous side effects, because, if not even Danilo know about the side effects, how should Marianne and Denis know about them, and have any chance to prevent that their son was alone during the treatment, so far from the love and support of the family.
To the big surprise of the Terrida family, the doctor was never criticized for having prescribed the antidepressants to Danilo, without having a personal conversation with him. Strangely, further down in the ruling, the family could read the that the Disciplinary Board made the assessment that, “a General Practitioner should not prescribe medicine for depression based on a telephonic consultation, unless the General Practitioner recently has assessed the patient in his consultation”, and “it is not usually in compliance with the norm and usually recognized professional standard, that a General Practitioner prescribes antidepressant medicine telephonically”. But why was Danilo’s doctor not criticized for exactly the point that he had given him the “happy pills” after only one conversation on the phone which lasted 8 minutes. This, his parents could also read in the ruling.
Changes in the record were approved
The Disciplinary Board criticized the doctor for that he more than two months after Danilo’s consultations changed the journals. The changes meant that Ole Knudsen now, on two occasions – in September and telephonically in October – had spoken to Danilo about his psychological problems. According to the Disciplinary Board, it was “under the norm for usually recognized professional standards”, that Ole Knudsen neither wrote when he had changed the journals – and that he did it so long after the consultations. However, while the board criticized the record keeping, Marianne and Denis could read that the Board chose to use the exact same edition of the records, which had been changed by Ole Knudsen, in their assessment of the whole case. They did not use the original edition, which the Terrida family had accessed, and gotten delivered a month after Danilo’s suicide. Exactly because the Disciplinary Board accepted the new version with all the add-ons, Ole Knudsen had to be acquitted for acting directly against the rules. The important point here, was whether the doctor had assessed the patient at a personal consultation immediately prior to the telephonically prescribed medicine – and by accepting the changed records, Ole Knudsen could be acquitted from charges of severe negligence. Danilo’s parents still do not understand why the Disciplinary Board did not use the original records during the assessment of the case, and for the family this fact has left them with a clear sensation that the Board, who is there first and foremost to take care of the patient rights, rather sympathize with the healthcare personnel who have made the mistake.
Beside the additions to the record, Danilo’s own doctor could suddenly, in his statement to the authorities, report that Danilo previously was “known to be sad and depressive”. As though this was not enough, suddenly, Ole Knudsen had never seen Danilo happy. Additions and things which the Terrida family calls for undocumented lies, and a try to make Danilo even more sick than he really was. All of this was accepted in the assessment from the Disciplinary Board.
Degree of Depression after Danilo’s death
However, Ole Knudsen was not the only one who further analyzed Danilo after his death. In Danilo’s original record, Ole Knudsen wrote that Danilo was depressed, but in the ruling of the Disciplinary Board, Danilo’s condition was now described as a moderate depression – the condition in between mild depression and major depression. Marianne and Denis still do not understand how the Disciplinary Board arrived at that conclusion, as they cannot find anywhere in Danilo’s records that he was actually diagnosed. How could the Disciplinary Board assess Danilo’s depression after his death, and without the doctors, who were in contact with him, ever made a diagnosis of him suffering from a moderate depression? This is still a mystery to Danilo’s parents, but they do know that the degree of depression has an effect on whether it is legal to prescribe “happy pills”: in conditions with moderate depression, it is standard procedure to consider to medicate, while it is not allowed to medicate in cases of mild depression. In the ruling of the Disciplinary Board, this is used as an argument for acquitting the doctor, because if there is a suspicion about moderate depression, it is legal to prescribe antidepressant medicine before the patient is referred to a psychologist. Therefore, Marianne and Denis are left with the feeling that the degree of depression has been given with the exact purpose to rescue the doctor.
No diagnosis, and no information
The vague critique and lack of investigation are not the only experiences with the Agency for Patient Rights and Complaints that frustrates the Terrida Family today. After the suicide of their son, they have read a lot to understand the National Board of Health´s manual for the treatment with antidepressant medicine, and that manual, has not been a part of the assessment when the Disciplinary Board made their ruling on Danilo’s doctor. It is the clear belief of the family that Ole Knudsen could not diagnose Danilo solely based on eight minutes phone conversation. According to the manual from the National Board of Health, it is important that the doctor at the point of elucidation of the patient, goes through some fixed points, which Marianne and Denis do not understand how Ole Knudsen was able to go through on only one phone conversation. And exactly with the treatment of depressions, a correct diagnose is extremely important, as there is a big difference in how the different degrees of depression should be treated. Therefore, it is so important for the family to get the doctor’s elucidation of Danilo examined, and therefore, they are very disappointed and baffled by the fact that the Disciplinary Board did not consider the relevant manual from the Board of Health.
In the same manual, it is recommended that the “General Practitioner has an active role in involving the relatives in the treatment process, when it is estimated that this is relevant and according to the wishes of the patient.” Therefore, the Terrida Family complained that they were not informed about the treatment of their son. Among the reasons to inform the family, is the increased risk of suicidal behavior, especially in the beginning of the treatment with antidepressants. A side effect that Danilo was never informed about, and which his family therefore did not know about either. However, the Disciplinary Board did not agree with Danilo’s parents and acquitted the doctor on this point. They rather referred to the confidentiality of the doctor. Especially the fact that the family did not know about the risk from the pills Danilo received, hurts today. Had they known that Danilo was taking medicine that could increase the risk of suicide, they had not only encouraged him to come home, but brought him back to Zealand (Sjælland) to be able to keep an eye on him constantly.