Danilo – complaint to the Danish Parliamentary Ombudsman:
In February 2015, the Terrida family finally received an answer from the National Board of Health – almost a year after they had filed the complaint to the Parliamentary Ombudsman. However, the answer did not ease Marianne and Denis, rather the opposite. They had hoped that the National Board of Health would recognize their responsibility in the death of Danilo, and admit their mistakes. If this had happened, Marianne and Denis could start believing that other parents would not end up in the same tragic situation as them. But as long as the National Board of Health did not want to – or could not – realize the fact that Danilo’s wrong treatment already started with their wrong manual, the Terrida family fear that more parent are at risk of losing their children. This fear, Marianne and Denis still have.
Knew about the risk, but did not change the manual
In the answer from the National Board of Health, Marianne and Denis could read that they did not think that ”it is possible to declare a clear point in time, for when there was enough knowledge pointing towards the fact that the general prescription in this connection could lead to a not insignificant risk in the security of the patient.” In other words, the National Board of Health denied that that they in any point in time had sufficient knowledge about the risk of increased suicidal behavior, to change the manual for the practitioners. But this answer, Marianne and Denis did not understand. Because, this did not make sense with the fact that the pills arrived to the Danish market already in 2003, where the risk of suicidal behavior with adolescents under 25 years was described. Further, it did not make sense as the European EMA in 2005 and the American FDA in 2007, published studies which exactly described this risk. In the end, it did not at all make sense for Marianne and Denis in relation to the answer they received from the National Board of Health, where they wrote that, since 2008, “it has been well-known that there is an increased risk of a patient committing suicide in case of depression, and that risk may increase in the first period after initiated treatment.” (kildehenvisning). In the same answer, the National Board of Health even described how they had made sure that the patient information leaflets in the box with antidepressants were provided with a warning about prescribing the pills to adolescents under 25. But why did the same Authority now claim that it did not have “sufficient knowledge” to change its manuals. And why did the Health Authorities not change its manuals even though they obviously knew about the risk? Could it in reality be, that the National Board of Health in 2008 simply forgot to change the manual, and were now seeking to cover their mistake? It was these questions, that drifted around in the heads of Marianne and Denis when they read the answer from the National Board of Health on the complaint from the Parliamentary Ombudsman.
Marianne and Denis tried to explain it with; maybe it was too comprehensive to change the manual. But this did not make sense to them either. Because the National Board of Health actually changed the manual in 2007 – but the increased risk of suicidal behavior was only mentioned in the age group of under 18 years. Not for the age group of 18-25 years, even though the National Board of Health already back then knew about the danger. A knowledge which the Authority denies.
Manual without significance
Marianne and Denis wondered about another phrasing of in the National Board of Healths’ answer. Here, they could read that the authorities’ manuals are an expression of how practitioners in their opinion should act when treating patients. The practitioners cannot be prosecuted only because they do not comply with the manuals from the National Board of Health, but the manuals are often used to assess whether the practitioners have shown care and consciousness in their work – and if they haven’t they can be prosecuted. Therefore, the manuals have to be important, according to Marianne and Denis. But a couple of lines further down in the answer it can be read that practitioners can deviate from the manuals without consequences. The manuals are therefore only indicative, which enables the practitioner to not comply with it, as long as he/she can argue for it. But what are the manuals there for then? This question is still unanswered for Danilo’s parents; because if the manual leaves so much room for interpretation that the practitioners do not have to follow it, what is then left when the Healthcare Authorities needs to assess a complaint about whether a practitioner, who is not working with the field of psychiatry at all, has shown care and consciousness?
New complaint to the Parliamentary Ombudsman
The letter from the National Board of Health has now given Marianne and Denis any answers for their questions. Instead, they are today left with even more questions and less faith in the Danish system. Therefore, they are in the process of formulating a new complaint to the Ombudsman, focusing on the fact that the National Board of Health should admit that they could and should have changed the manuals long before 2014, for adolescents between 18-25 and treatment with antidepressants. Further, also focusing on the fact that when the National Board of Health, still give the practitioners the option to prescribe the dangerous medicine, without any supervision of professional authorities, they should have made sure that they are at least equipped with the right tools to diagnose and distinguish between patients who are sad and real mentally ill patients. The Terrida Family is convinced that the largest part of the practitioners actually are not professionally competent to examine, and medicate potential mentally ill patients, as they are not educated to do this. Therefore, it is, according to Marianne and Denis, irresponsible of the National Board of Health to impose on practitioners to take care of these patients. In the experience of the family, the practitioners should, when they are contacted by potentially mentally ill patients, refer these directly to specialists, to prevent serious errors and ensuring the best possible treatment with respect for the patient security and the National Board of Health’s own vision to deliver the best possible treatment.