Finland sentenced in the European Court of Human Rights in 2012: pediatrist locked up in a mental hospital under suspicious circumstances
Tiistai 4.6.2019 klo 6:57 - Johannes Remy
In 2012, European Court of Human Rights sentenced Finland for forcing involuntary treatment on a patient on the basis of only one medical doctor’s assessment. This was how the case was broadcasted in short form in Finnish media which bypassed the case’s connection to suspected child sexual abuse. That connection is manifest in the ECHR’s sentence in Case of X v. Finland, 03/07/12 which can be read under this link:
In June 2000, a seven-year girl was taken into public care because of her mother’s mental health problems and was placed in a family support centre. From the ECHR’s sentence, it seems that the mother was found not in good mental health because she suspected that her daughter was being sexually abused. However, the mother still had access to her daughter who regularly visited her. The girl also visited her father. In December 2000 the mother brought the girl to a pediatrist’s practice, suspecting that the girl’s father was sexually abusing her during the visits. According to the mother, the girl had indicated to her mother that she was unwilling to go to her father’s home for the Christmas holidays. The pediatrist found that there were rational grounds for the mother’s suspicion.
After leaving the pediatrist’s practice, the mother neither took her daughter to the father nor returned her to the support centre which was closed for the holidays. She kept the girl with herself for four months until the authorities found them in April 2001. The mother was later sentenced for child abduction.
Shortly before the authorities caught the mother, also the pediatrist was arrested as a suspect in deprivation of the girl’s liberty, or of aiding and abetting such deprivation. The crime was suspected to have begun ten days before the mother brought the girl to her practice. The pediatrist’s home and practice were searched, and she remained in custody for one week at that time. The pediatrist denied that she had in any way had an impact on the mother’s actions: she had only provided medical treatment for the girl. She also stated that it had not been shown that the suspicions of sexual abuse were unfounded.
Even before her trial, the pediatrist unsuccessfully made an application to the Office of the Prosecutor General (valtakunnansyyttäjä, högsta åklagaren), requesting that the public prosecutor be replaced by an impartial one and alleging several irregularities in the performance of his duties. In August 2002 the District Court appointed a public defender to represent the pediatrist against her will. The pediatrist contested the appointment of Ms M.K. in a written representation which the Court of Appeal rejected.
The trial was held in October 2002. Against the expressed wish of the pediatrist, it was held in camera. The court rejected as irrelevant a request by the pediatrist that the girl, Mr J.R. [not me, I had nothing to do with this case], a police inspector and two lawyers be heard as witnesses regarding the alleged deprivation of liberty and, according to the pediatrist, misinterpretation of the facts by the public prosecutor, which she described as criminal. The pediatrist stated that the witnesses should testify about the background to the offence with which she was charged. The District Court also rejected that request, noting that she had not given any reasons which would have justified hearing the witnesses she proposed.
The court ordered the pediatrist and the girl’s mother to undergo a psychiatric assessment and adjourned the case. Niuvanniemi (mental) Hospital informed the pediatrist that it was ready to receive her in January 2003 for assessment, but she failed to appear there and went into hiding. However, she maintained contact with the court through her new lawyer, chosen by herself. She was finally caught in October 2004 and kept in custody. Because her lawyer wanted to withdraw from the case, the court again appointed for her a new public defender whom she herself did not want and she again unsuccessfully protested against the nomination.
In November 2004 the pediatrist was taken to Vanha Vaasa (mental) Hospital for psychiatric assessment. A doctor at the hospital found that the pediatrist was suffering from a delusional disorder and had not been criminally responsible at the time of the alleged offence. Dr A.K. also found that the criteria for involuntary confinement were met and that the pediatrist could not be heard at the trial. Her capacity to look after her own interests was diminished by her mental illness, and she was thus in need of a guardian for the criminal proceedings. According to the doctor, the pediatrist had observed indications of sexual abuse which other experts had not been able to detect. In conclusion, Dr A.K. considered that the applicant was paranoid and that she had made accusations against various authorities about continued abuse of office. Moreover, she was in denial of her illness.
The pediatrist questioned the psychiatric assessment’s impartiality and demanded an additional assessment. In this context, she presented a divergent opinion of another doctor. Her demand was not granted. In February 2005, the pediatrist was officially released. However, by the decision of National Forensic Medical Authority, she remained in the hospital undergoing involuntary treatment. She considered that she was not in need of mental health treatment, and wished to obtain a second opinion on her need for treatment. However, at the beginning of February 2005 the hospital refused to allow a Dr M-P.H. to visit her during the ongoing psychiatric assessment. The pediatrist remained in the mental hospital until late January 2006.
Forensic Psychiatry Board found that the applicant’s capacity to look after her own interests in the criminal proceedings was reduced by her mental illness and that she was therefore in need of a guardian. The pediatrist contested this, arguing that she was well, to no avail: the court appointed a guardian for her. In April 2005, the District Court found the girl’s mother guilty of serious deprivation of the girl’s liberty. The pediatrist was found guilty of aiding and abetting this crime. However, the court did not pass sentence on them as they were not deemed responsible for their actions, due to their mental illness. However, it ordered them to pay damages and legal costs. In the trial, the pediatrist's guardian did not support her demand for hearing eighteen witnesses. Unlike the pediatrist herself, the guardian did not find it necessary to question the psychiatric assessment's conclusions. The guardian announced that she was satisfied with the District Court's decision.
Because the pediatrist refused to take antipsychotic medicine during her involuntary treatment, it was forcibly administered to her as injections. She was released from the hospital only when two doctors who visited the hospital gave their statements regarding her treatment. One of them was a general practitioner who noted that the pediatrist was lucid and well-orientated. During their conversation he had not observed any signs of psychosis or delusion. This doctor considered that the conditions for involuntary treatment were not met. The other visiting doctor was a psychiatrist who found that
“…the choice of medication for the applicant (37.5 milligrams of Risperdal Consta injected into the muscle every two weeks) seemed excessive, given the patient’s age and state of health. Furthermore, he considered that the involuntary and forced medication fulfilled the constitutive elements of assault. In conclusion, he considered that open-care measures were possible and that the danger posed by the applicant to herself and others had been considerably exaggerated, and accordingly that the criteria for involuntary care were not met.”
European Court of Human Rights did not sentence Finland for forcing a guardian on the pediatrist or not hearing the eighteen witnesses. This was because the guardian was appointed according to a doctor’s assessment and because the guardian did not find it necessary to hear the witnesses. However, ECHR found that Finland had violated the pediatrist’s rights in that her involuntary treatment was continued for more than six months on the basis of only one doctor’s assessment, and in the forcible administration of medication by injections. The court ordered Finland to pay her a compensation of 18 000 euros.
The ECHR’s sentence did not create a scandal in Finland. It did not lead to any re-examination of the case, and the pediatrist was not granted a retrial. The girl’s father gained sole custody over her.
Of course, this is an old case. However, it is unlikely that this kind of problems disappear by being actively ignored.