Inadequate health care

In connection with the case involving ambulance personnel in Sofienberg Park on 6 August last year, the Norwegian Board of Health Supervision has concluded that the behaviour of the two ambulance personnel (emergency medical technicians) was not in accordance with sound professional practice, and not in accordance with the requirement to provide diligent care. However, we do not find that the failure to meet these requirements represents a breach of the Health Personnel Act that is of a sufficiently serious nature that there are grounds to apply for prosecution. The Norwegian Board of Health Supervision does not find adequate grounds to conclude that the way in which the emergency medical technicians behaved was a consequence of racism.

The way in which the emergency medical technicians behaved was not in accordance with sound professional practice: they did not transport the patient to a hospital or emergency unit, or in any other way ensure that the patient was transported to a doctor within reasonable time. This failure to provide care was also in breach of the requirement to provide emergency care. Several of the comments that the emergency medical technicians made about the patient and to the patient are also unacceptable, and in breach of the requirement to provide diligent health care.

That the emergency medical technicians did not transport the patient to a hospital or emergency unit, or in any other way ensure that the patient was transported to a doctor within reasonable time, gives grounds to notify them that they will be issued with a warning. The same applies to their comments about the patient, and their comments to the patient.

The Norwegian Board of Health Supervision has therefore notified the emergency medical technicians today that they will be issued with warning for breach of the Health Personnel Act. A warning is a serious administrative reaction, and health care personnel who do not take heed of a warning may loose their authorization.

A letter has also been sent to Ullevål University Hospital Health Trust, notifying the Trust that the Norwegian Board of Health Supervision is assessing whether the Trust has organized its ambulance service and accident and emergency unit in such a way as to provide health care that is in accordance with statutory requirements.

However, we do not conclude that the breaches of the legislation represent nonconformities of the Health Personnel Act that are so serious that they provide sufficient grounds for applying for prosecution, according to case law in this area. Neither will we apply for prosecution against Oslo Accident and Emergency Unit nor Ullevål University Hospital Health Trust.

Examples of conduct that could provide sufficient grounds for applying for prosecution, are if the emergency medical technicians had not examined the patient and if they had made racist comments. The Norwegian Board of Health Supervision has taken into account the fact that the patient was examined and that the comments the emergency medical technicians made were unacceptable, but not racist.

Today, we have sent a letter with our assessment of the issue of applying for prosecution to the Special Unit for Police Cases (Spesialenheten for politisaker).

Alleged racism
Allegations have been made that the emergency medical technicians behaved in a way that was racist. The Norwegian Board of Health Supervision has assessed whether the breaches of the requirements to provide adequate and diligent health care can be attributed to racism. There must be concrete grounds in order to conclude that breaches of the Health Personnel Act were motivated by racism, or that the health care personnel behaved in a way that was racist. In cases that involve punishment and reactions pursuant to the Health Personnel Act, allegations are not sufficient.

After studying the documents in the case, and particularly the interviews carried out by the Special Unit for Police Cases of the witnesses who were present at the scene, the Norwegian Board of Health Supervision has not identified any comments made by the emergency medical technicians that are racist. Neither have we found sufficient grounds to conclude that the way in which the emergency medical technicians dealt with the incident was the result of racism.

There is evidence that the emergency medical technicians used words of abuse. As mentioned previously, this is not acceptable, and in breach of the Health Personnel Act.

Several of the witness at the scene described the emergency medical technicians as racist. We regard it as serious that several witnesses experienced what happened as an expression of racism. Some of the witnesses believe that a white person would have been treated differently. The patient received inadequate treatment. But there is no evidence that he received inadequate treatment because he was not white. The emergency medical technicians did not use racist words or expressions.

Documentation of the caseWith regard to some important points, the documentation used by the Norwegian Board of Health Supervision (the central office) to assess the case was different from the documentation used by the Norwegian Board of Health Supervision in Oslo and Akershus (the County Office) when they assessed the case in August 2007. At the press conference held in August by the County Office, it was pointed out that documentation of the case at that time was incomplete.

More information about the case is now available, since the County Office assessed the case. The documents now include the statements and interviews carried out by the Special Unit for Police Cases of the emergency medical technicians, two policemen and fifteen witnesses who were present in the park. Other documents from the County Office are now available, including the audio tape from the emergency service headquarters (Akuttmedisinsk kommunikasjonssentral) and the ambulance records.

In contrast to the County Office, we have taken into account the fact that the emergency medical technicians had close contact with the patient. We do not think that it is likely that the patient had urinated without control before the emergency medical technicians came to the scene. We base our assessment on the assumption that he urinated after he had stood up.

Also, in contrast to the County Office, according to our assessment, it was not necessary for the patient’s neck and back to be immobilized.

The examination of the patient was in accordance with sound professional practice as the basis for immediate transportation, but was not in accordance with sound professional practice when the emergency medical technicians did not take him with them or ensure that he was transported by other means.