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Own practitioner, Ole Knudsen

Error upon error at own practitioner

In eight minutes you can boil an egg. Or run the subway from Nørreport to Flintholm. If you are a busy practitioner, you can also manage to diagnose a patient telephonically and prescribe a dangerous medicine in that time. It did not take longer for Danilo’s own general practitioner, Ole Knudsen to make the decision to prescribe antidepressants to Danilo. A medication that 11 days later would cost him his life. Eight minutes on the telephone was all Ole Knudsen needed to diagnose Danilo with depression and prescribe the antidepressant “Sertralin”. Usually, it is normal professional standards for doctors to see the patient for a personal consultation at least twice before a depression diagnosis is made and treatment begins. The fact that Ole Knudsen had only spoken on the phone with Danilo one single time, is very much against the proper treatment [1] when prescribing antidepressants.

Danilo’s parents never got the message
Despite Danilos young age and mental condition, Marianne and Denis were never informed about the medicine, their son was given. In the National Board of Healt´s guidance to General Practitioners on the treatment of depression, it is recommended that “the doctor makes an active effort to involve families in the treatment process [2], when assessed to be appropriate, and in accordance with the patient’s desire” . Yet Ole Knudsen chose not to inform Danilo’s parents – even though it is well known that “happy pills” increases the risk of suicidal behavior, particularly at the beginning of a treatment. It still frustrates Marianne and Denis today that they did not have the necessary knowledge to offer better help to their son in the middle of his crisis.

Danilo left to himself
After the eight-minutes long conversation practitioner Ole Knudsen noted in Danilo’s medical records that he was depressed and that he should consult a local practitioner. But Danilo’s parents can not understand why Ole Knudsen did not follow up on Danilo’s treatment [3] and made sure that the patient sought further medical care, which was so crucial because Ole Knudsen had drugged him with “happy pills”, which can increase the risk of suicide. If Danilo’s own doctor really believed that Danilo was depressed enough to receive “happy pills”, how could he put all the responsibility for the further treatment of Danilo on himself? This still amazes Marianne and Denis. Especially because research has shown how important it is to keep particularly close eye on children and young people in the first months after they are given antidepressants.

Never gave information about side effects
The day Danilo took his own life, he was in contact with one of his good friends. He told about the medication he had been taking, [4] and how the medication among other things gave him sleep problems and made him miserable. [5] Danilo was thinking about how the medicine affected him: he had not been told about the side effects when the doctor prescribed the pills. Danilo and his friend therefore agreed that Danilo should send the name of the happy pills to his friend, who would look further into the side effects

Text message to a friend 1 hour before

Text message to a friend 1 hour before

But his friend never got to check up on the medication because short time after, Danilo hanged himself. It is contrary to all principles that Danilo was never informed by his own practitioner, about the side effects, happy pills could have. As Danilo was never informed about the medicine’s side effects, he could not give his informed consent. Such a consent is the patient’s only chance to decide for himself whether he want to receive the treatment that the doctor wants to give, and it is thus a fundamental patient right, that he, on an informed basis, can say yes or no to a treatment.

Consent to treatment
No treatment may be initiated or continued without the patient’s informed consent, unless otherwise provided by law or regulations established pursuant to the Act. The Act § 6, paragraph. 1st

Danilo’s parents are angry that their son was never informed about the possible fatal consequences, “happy pills” could have. And because Danilo never got the knowledge, he could not pass it on to his parents, who followed him closely in his life, and who, like Danilo, thought that the medicine the doctor had prescribed was quite harmless.

Changed the Journal
The many errors that Marianne and Denis gradually found out that Danilo’s own practitioner had committed, got them to report him to the Agency for Patient Rights and Complaints. The Agency is part of the Health Authorities Disciplinary Board, which is the body that can give doctors criticism. When the Agency asked for Danilo’s medical record from the General Practitioner, Marianne and Denis, discovered that there was something wrong. One month after their son’s death, they had sought access [6] to Danilo’s records and had them delivered. However, the records, which were now submitted by Ole Knudsen to the Agency for Patient Rights and Complaints, was filled with changes and additions. In the original medical record, Danilo’s parents could read that Ole Knudsen’s colleague on September 30 had examined Danilo for problems with heel spur and prescribed medication for acne as well.

Original journal

Original journal

In the new journals, this was changed. Suddenly, it was now instead Ole Knudsen, who had treated Danilo September 30, and he had also spoken with Danilo about his state of mind and rated him as mildly depressed.

Modified Journal – forwarded to Disciplinary Board

modified journal, forwarded to Patient Insurance

Modified Journal, forwarded to Patient Insurance

Marianne still remember that she drove Danilo to the doctor on September 30 so that he could get a prescription and a referral. It was a special weekend as Danilo was home to celebrate his 20th birthday. Marianne also remember that it was Friday, and that they had to rush so that Danilo could get to the specialist, who by coincidence was available the same day. Therefore, she waited outside in the car and know that the visit by the General Practitioner took less than 10 minutes, and it amazed her that the doctor – no matter who it was – with that amount of time could examine Danilo’s for his heel spur, write a prescription and a referral and examine his state of mind. But why did Ole Knudsen write all the additions to the record several months after Danilo’s death? And why had he changed the name of the doctor at the consultation on 30 September to his own? Denis and Marianne obviously cannot know, but to them, it looks like a deliberate attempt to hide his own mistakes and thus protect himself. Ole Knudsen could in fact avoid getting criticism for acting contrary to recommended instructions for treatment with antidepressant medication if it was he who had personally examined Danilo 14 days earlier, before the happy pills were prescribed, and if he on this occasion had made an assessment of Danilos state of mind. It is decisive whether the doctor has personally attended the patient immediately before prescribing the medicine and by the personal consultation examined the patient for depression. The guidance in this area from the Danish College of General Practitioner [7] (Dansk Selskab for Almen Medicin) describes how “diagnosis and treatment of depression requires a process of consultations” (plural), and only if there is signs of major depression conditions it may be necessary to initiate treatment with antidepressants and conversation therapy at the first consultation. But in Danilo’s case, there was not a severe depression – Ole Knudsen only initiated the treatment with happy pills. Conversation Treatment was not offered to Danilo.

More additions
In relation to the cases, which the Terrida Family have run against doctor Ole Knudsen in the public system, he sent in a statement of what had happened. In this one, Ole Knudsen had elaborated on his phone conversation with Danilo. Now the doctor said that Danilo had demanded help that day and therefore rejected Ole Knudsen’s offer to help him the next day and that they agreed that Danilo should seek a “local doctor immediately the day after” . However, these additions are still hard to believe for Marianne and Denis. They checked their calendars, and found that the “day after” was a Saturday [8]– where all General Practitioners are closed. Therefore, they feel confident that the additions was another lie from Ole Knudsen’s side.
In the report Marianne and Denis could also read that Danilo was previously known with sadness and depression. Actually, in Ole Knudsen’s opinion he was never happy [9] . However, the only time Danilo had been sad, was back in 2008 when he went to a psychologist a couple of times due to problems related to starting at a boarding school. The problem was solved when Danilo was allowed to change room and came away from four students, he just did not get along with. At that time, Danilo was diagnosed as mildly depressed by his own practitioner colleague [10]and in addition, Danilo quickly became happy again, as problems at the boarding was resolved. Therefore, Denis and Marianne do not recognize the image that Danilo’s own doctor is now trying to draw of their son in his statement.

No consequences of criticism
In the end of 2013, the Health Authorities Disciplinary Board criticized Ole Knudsen for several aspects of his treatment of Danilo (read more about the Disciplinary Board’s criticism in “Vague criticism from the Disciplinary Board” , including his record keeping, lack of informed consent from Danilo, and Ole Knudsen’s failure to follow up on Danilo after prescription of the potentially dangerous Sertralin. Additionally, the Patient Board of Appeals recognized Danilo’s suicide as an injury caused by the treatment of Ole Knudsen. The damage, or even murder, was very likely triggered by Ole Knudsen’s inadequate treatment, the Patient Board of Appeals chose to let the doubt go in Danilo’s favor and thus recognized the suicide as a patient injury. The probability was there because Ole Knudsen did not ensure that Danilo was monitored by a doctor, despite the fact that the patient information leaflet to “happy pills” – Sertraline [11], clearly states that the medicine has side effect which increases the risk of suicidal thoughts in young people under 25. Danilo’s own doctor has thus been criticized by several authorities for his role in the case, but despite this fact, he can now continue as a practitioner – without being subject to any legal or economic punishment. It is not possible for other present or future patients getting treated by Ole Knudsen to gain knowledge about the serious mistakes, the doctor has committed. The criticism of him exists only in the ruling which was sent to the Terrida Family. This amazes Marianne and Denis: Why is so important information not publicly available, for example on the National Board of Health Supervision List? Why is it required that restaurants, where we go to eat, have visible reports with their supervision results, while doctors, where we are going to be treated for serious illnesses are exempted from the same visibility? Where is the patient safety and rights?

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