1. Summary in English

This report is part of our ongoing effort to improve how county governors handle cases involving the use of force under Chapter 4 A of the Norwegian Patient and User Rights Act. The project, called ‘Coercion and Force’, was started by the Norwegian Board of Health Supervision in 2023. Its goal is to enhance the quality of supervision and case handling related to the use of force.

The report examines the county governors' role as supervisors and appeal boards for individuals who cannot consent and refuse healthcare. We looked at how decisions about using force are received and processed by the county governors and suggested ways to improve these processes to better protect patients' legal rights.

We compared current practices with the “Guidelines for County Governors’ consideration of decisions and appeals pursuant to Chapter 4 A of the Norwegian Patient and User Rights Act. Internal series 9/2019.” When we found that practices did not follow these guidelines, we checked if these were significant issues. We also considered if the guidelines need updates.

The report suggests several improvements, such as updating the guidelines, enhancing digital coordination, and organizing regular meetings and training for case officers. We found significant differences in how county governors handle cases, and it is crucial to address these issues.

Key recommendations include:

• Updating and clarifying the guidelines for decision-making and appeals.
• Continuing specialist forums on coercion and force.
• Holding annual courses on relevant topics.
• Providing useful resources and tools on the Losen intranet.
• Creating more standardized decision templates.
• Further developing digital templates for decisions.

Finally, the report stresses the need for adequate resources to support the county governors in reviewing decisions effectively.