On 24 August, a municipal superintendent in Trøndelag was charged by the police with abusing his position to obtain sexual intercourse. The Norwegian Health Authority has temporarily revoked the doctor’s authorization. The background is several reports of offensive and unpleasant behavior towards female patients: Stories of unnecessary nudity, inappropriate touching, violent treatment and consultations after closing time – alone with the doctor without other staff present. The doctor has appealed against the suspension and denies criminal liability. Promised to change the routines When the municipality first became aware of the case this summer, they promised to change the routines for gynecological examinations (GU) at the doctor’s office where the doctor worked. In a letter to the Norwegian Health Authority, the municipal director wrote that “measures have been taken to prevent recurrences through implemented and changed routines for GU” at the doctor’s office. A similar promise must have been made fifteen years ago – by the doctor himself. It was the director of the municipality who wrote the letter to the Norwegian Health Authority on 4 July 2022. There he pointed out that the municipality will “follow up with interviews for all GPs in the municipality, to ensure proper practice related to internal routines.” Photo: Nareas Sae-Khow / news The warning in 2007 In 2007, the now suspended and accused of assault municipal superintendent received a warning from the Norwegian Health Authority, following a breach of Section 4 of the Health Personnel Act on irresponsible activities. It happened after three female patients a year earlier had told about experiences they had had during gynecological examinations at the doctor. Among other things, the doctor should have offered clitoral massage. Something that the Norwegian Health Authority referred to as an “untraditional” treatment method. On 5 March 2007, the Norwegian Health Authority sent this letter to the municipality. There it was informed that the doctor had received a formal warning. Thought new practice would prevent “misunderstandings”. Several people in the municipality’s administrative management at the time were involved and informed about the accusations against the municipal doctor in 2006-2007. This is shown in documents that news has been given access to. There it emerges that the doctor himself must have informed and assured the municipal management that he had changed the practice of gynecological examinations: “… so that such misunderstandings as those women had raised, would not should arise afterwards.” news has asked the doctor’s defender, Erlend Hjulstad Nilen, to tell more about this change of practice back in 2007 – and how it was followed up. – According to what my client states, the change in practice consisted in patients being clearly asked if the patient wanted a companion at GU. Whether this was actually done by the doctor going forward, news does not get an answer. The now-suspended and assault-accused doctor worked 60 percent as a GP at the municipality’s doctor’s office, alongside his position as municipal chief medical officer. Photo: Nareas Sae-Khow / news New routines: Must be accompanied According to the new routines decided by the municipality this summer, it is stated that “there must be a companion at GU consultation” and that the new routines “apply with immediate effect”. It appears in a document to which the municipal director refers: news has been in contact with the other GPs at the doctor’s office where the doctor worked until he was suspended this summer. The two GPs, a woman and a man, say that they have always followed the national guidelines. Among other things, it is recommended that patients be offered a third person present. – My colleague and I have dealt with this. For me as a female doctor, it has rarely been desirable. My male colleague carries out GU with a nurse present. That’s what one GP writes in an SMS. She speaks on behalf of both. – Was any form of new practice introduced at the doctor’s office this summer? – Not known to us. Complete confusion The GPs deny that any new routines have been introduced, as the municipal director claimed in his letter to the Norwegian Health Authority on 4 July. – We have not been informed about new practice around gynecological examinations this summer. The first time we heard about it was through the media, writes the GP to news. The municipal director has been presented with the answers from the GPs. He thought these routines were already in place. – The routine was adopted on 4 July, applicable to all doctors at the doctor’s office. At this point, we had confidence in our municipal superintendent. Implementation of such a routine is the responsibility of the municipal superintendent, the municipal director explains in an e-mail and elaborates: – We assumed that the municipal superintendent briefed the GPs about the routine, in writing and orally. Throughout the month of July, there are many conversations between the GPs and my managers, and I understood that the new routine was mentioned in these conversations. Admits failure When it comes to the now-suspended and assault-accused doctor’s restructuring of practice back in 2007, the municipal director is tight-lipped. – Did any of you in the municipality check that the doctor actually followed up? – It may look like this has not been followed up afterwards, replies the municipal director. At the same time, he points out that the Norwegian Health Authority is the supervisory authority for GPs. The municipal director has previously stated that he believes both the municipality, the State Administrator and the Norwegian Health Authority have failed in this matter. Ragnar Kvie Sande is section chief at the Women’s Clinic at Stavanger University Hospital (SUS) and head of the Norwegian Gynecological Association (NGF). Photo: Hanne Høyland / news No regulations exist – Gynecological examinations, like all other medical procedures, must be carried out in the most gentle and respectful way possible. This is explained by Ragnar Kvie Sande, head of the Norwegian Gynecological Association (NGF) to news. It is therefore not the case that patients can formally demand that a third person be brought in during gynecological examinations. – But if a woman asks for it, the doctor will of course meet her on this. – What do the regulations say? – There are no regulations on this. – Is it just a slightly different practice all around? – There are probably different practices on this. In hospitals, it is customary for a male doctor to have a third person with him during GU. With general practitioners, this varies. GPs often have a doctor-patient relationship that goes on for a long time, where mutual trust has been built up.
ttn-69
Should change the practice of gynecological examination in 2007 – news Trøndelag
