Justice for Karina

Jakob Skjoldan, a lawyer who has taken up volunteer work with some of the patient organisations affected by the annexing to Functional Disorders, have written this letter to the §71-comitee who oversees forceful hospitalisations in Denmark, and the Parliamentary Health Board.

We were sent a translation of this letter, wich we are grateful for. However, the translation had some mistakes wich we had to weed out, and therefor we were not able to publish sooner. Please make no mistake about our gratitude for the help recieved, though.

This letter was originally published in danish here and here.

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The §71 Committee                                                                                                              xx.07.2014
Attn: Chairman Liselott Blixt and

The Parliamentary Health Board
Attn: Chairman Karen Klint

Regarding Karina Hansen’s incarceration at Hammel Neurocenter

I hereby address the §71 Committee on behalf of Karina's parents Ketty and Per Hansen, and on behalf of the ME Association Denmark, because we are aware that the §71 Committee recently visited Karina at Hammel Neurocenter.

I assume that the §71 Committee received a report on Karina's treatment from the Neurocenter, including the report from Chief of Psychiatry, Niels Balle Christensen (NBC) from the Research Clinic for Functional Disorders (RCFD/FFL), the physician who is responsible for the treatment of Karina.
(Translator note: In danish this is known as Forskningsklinikken for Funksjonelle Lidelser, shortened to FFL and I will use FFL from hereon, to be consistent).

I will hereby explain how specialists with expertise in post-viral fatigue syndrome (ME) estimate Karina's disease.

Initially, however, I provide the following general information about ME:

ME = Myalgic Encephalomyelitis; (myalgia = muscle pain; encephalomyelitis = spinal cord and brain inflammation/infection) is a serious somatic disease with profound effects on the nerve system, the endocrine system, the immune system, the energy metabolism at the cellular level and the body circuit.

For most patients, the disease starts with a simple infection, for example associated with mononucleosis or the flu, but the disease is also suspected to be caused by mold, blood transfusions, vaccinations, whiplash, heavy metal poisoning and borrelia infections.

The main symptom is a marked rapid fatigability during physical and mental activity, followed by flu-like and pain-related symptoms and a worsening of other symptoms mentioned below. Activity also leads to an abnormal exhaustion and a prolonged recovery period, wich is why the patient's previous level of activity is significantly reduced. A distinction is made between mild reduction (about 50%), moderate reduction (mostly housebound), severe reduction (mostly bedridden) and very severe reduction (bedridden and in need of assistance with basic functions).

The very severely ill patients may be bedridden in a darkened, soundproofed room and cannot tolerate the slightest physical or mental exertion. The Belgian professor DeMeirleir (who was one of the below mentioned 26 leading practitioners/researchers in the world, and who among other things treat Danish ME patients who aren't getting help in the Danish health system) have stated that very severely ill ME patients "must be chained to the bed." This Belgian professor has actually succeeded in significally improving the health of many severely ill ME patients.

Other serious symptoms are:

I Neurological Damage:

1. Cognitive Problems.

a, Hassled information management, including impaired thinking, poor concentration, confusion, disorientation, indecisiveness, slow speech.

b. Short-term memory loss.

2. Pain.

a. Headaches: chronic, generalized headaches often with pain in the eyes, behind the eyes or in the back of the head, which can be associated with neck pain; migraine; tension headaches.

b. Significant pain in the muscles, muscle attachments, limbs, abdomen and chest.

3. Sleep Disorders.

a. Disrupted sleep patterns, including insomnia, prolonged sleep, incl. naps, sleep during the day and awake at night, frequent awakening, awakening much earlier than before illness, vivid dreams/ nightmares.

b. "unrefreshed" sleep, including feelings of exhaustion regardless of duration of sleep, sleepiness at daytime.

4. Sensory and motoric disturbances.

a. Sensory disturbances, including inability to focus visually, sensitivity to light, noise, vibration, smell, taste and touch.

b. Motoric disturbances, including muscle weakness, involuntary muscle contractions, poor coordination, unsteadiness.

II. Problems with the immune system, digestive system and urination

1. Recurrent or chronic flu-like symptoms, which typically originates or is aggravated by activity, including sore throat, sinusitis, swollen or tender lymph nodes

2. Vulnerability to viral infections with prolonged recovery time.

3. Gastrointestinal problems, including nausea, stomach pain, swollen abdomen, irritable bowel syndrome.

4- Urinary problems, including sudden or frequent need to urinate; night urination.

5. Sensitivity to food, medications, odors and chemicals

III. Damage to the energy system

1. Circulatory disorders, including intolerance to sit upright, palpitations with or without cardiac problems, dizziness

2. Respiratory problems, including breathlessness, labored breathing, fatigue of chest muscles.

3. Loss of temperature stability, including abnormally low body temperature, significant diurnal temperature change; sweating, recurrent feelings of fever with or without slight rise in temperature, cold hands and feet.

4. Intolerance to extreme temperatures.

The disease is internationally acknowledged and has the code G93.3 in the WHO disease registry (ICD-10).

By the definition of the disease, it explicitly states that there should be no mental reason for the fatigue condition or other symptoms of the disease. The disease is therefor, by definition, not a mental illness.

Source: Consensus document prepared in 2011 by a panel of the world's leading ME practitioners/ researchers (26 practitioners / researchers with total approx. 400 years of clinical and teaching experience).

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After this initial information about the disease ME, I enclose a copy of the journal from 18.02.2010 to May 2012 from a specialist in internal medicine and infectious medicine, dr. med. Henrik Isager (HI), DMSc, who was (he is now retired), one of the few Danish specialists with expertise in ME.

At the journals page 3, below, it is apparent that HI does not doubt that Karina is suffering from ME/CFS (WHO diagnostic code G93.3), that the disease was triggered by a mononucleosis infection in 2004 and that Karina is now (in 2010) is very severely sick from ME with a minimum of energy reserves.

In the journal's pages 4 and 5, it is further described what the physical causes of the disease is, like it is described how the very painful condition of the disease can be alleviated.

It is, however, acknowledged at the bottom of page 4 that the disease is permanent, ie. Incurable.

I attach further medical reports of 18.03.2011 and 01.09.2011 from the Norwegian physician and ME expert Mette Sophie Johnsgaard and a copy of a letter from 06.03.2013 from the same doctor. This Norwegian expert agrees that Karina is suffering from very severe ME and warns in her letter of 06.03.2013 (sent after the forced hospitalization) strongly against the stress, which a forced hospitalization causes.

The Neurocenter and NBC's view of Karina's disease is to the best of our knowledge in clear contradiction to HI's and Johnsgaard’s diagnoses. It appears that NBC perceives Karina's disease as a Functional Disorder, thus meaning that Karina’s serious condition really is mentally anchored (psychosomatic/somatoform). Thus, NBC have given Karina the diagnosis of "Other Somatoform Disorder" shortly after Karina's forced hospitalization at the Neurocenter in February 2013.

Subsequently (during Summer 2013) NBC shall have given Karina the very rare psychiatric diagnosis "Pervasive Arousal Withdrawal Syndrome" (PAWS). There are doubts about the extent to which this diagnosis is acknowledged, as it has no WHO code, and because it has only been used a few times, mostly on children in refugee camps. This mental disorder is characterised by the childs refusal to talk, walk, eat, care to its hygiene, etc. and angrily reject any contact with the outside world, including refusing any offer of help and treatment.
The diagnosis can not be applied to adults. Karina is now 25 years old! Karina has never before the forced hospitalization refused to talk, walk, eat or take care of her hygiene. On the contrary, she has cooperated to offers of help and treatment. (At one point, she could not walk or take care of her hygiene anymore, but she was still cooperative).

As seen above, there are basic medical disagreements about the cause of Karina's very bad health condition. The Karina Case is a glaring example of what happens when one in Denmark largely ignores a number of well-defined diseases with independent codes in the WHO register ICD-10, and instead call these diseases for Functional Disorders. Please refer to the many critical questions that members of the Parliamentary Health Committee asked during the recently held Consultation with the Minister of Health.

It seems, from a proper assessment, difficult to give credence to NBC's diagnoses since FFL never have presented medical evidence that ME (and the other 22 recognized illnesses that FFL has annexed under the research-diagnosis of Functional Disorders) are psychosomatic/somatoform disorders, whereas ME as mentioned, has been an internationally recognized, somatic illness for a long time (since 1969) and has been listed in the WHO disease registry.

Furthermore, I would like you to please note that psychiatrists have examined Karina several times in the past, without giving her a psychiatric diagnosis.

The first time a psychiatrist examined Karina, was in early 2007 and was done by Ole Nielsen in Holstebro. The Psychiatrist writes in a journal dated 13.02.2007, wich includes the following:

"... I do not think there are any signs of depression or atypical depression, and there are no other symptoms, indicating that there should be a more virulent psychiatric disorder under construction. She keeps good contact, but is just extremely tired and has a headache .... "

The second time, Karina was examined by NBC himself, in the spring of 2008. NBC wrote a journal on 09.04.2008:

"Psychiatric evaluation:
19-year-old girl with age-appropriate looks. Awake, clear, comprehensive and relevant. She appears in no way as deeply depressed. She appears neither with anything productively psychotic. She is a bit quiet, but mostly relaxed in the evaluation-situation, and gives me good contact, both formal and emotionally. She is not affected by any severe disturbances in her character structure. She has subtle evasive moves as the only one. There is no anxiety problems and no depressive symptoms besides an understandable sadness about the situation. The symptoms seem ego dystonic and there is a clear distance from them.

Diagnosis:
/ F45.3 somatoform autonomic dysfunction obs pro. /

Conclusion:
19-year-old girl with vague predisposition to depression. Evaluated for chronic fatigue. So far there is no positive signs of a somatic disease. If all tests prove to be negative, there is a high probability that she is developing a somatoform condition, which she is informed about. In this case, I would suggest treatment with Cymbalta capsule starting with 30mg in the morning taken to the morning meal, increasing to 60mg in the morning after a week. In addition, cognitive symptom management by a cognitive informed and trained pain psychologist. Furthermore, currently recommended to continue the already agreed exercise program and exercises. She has been explained the link between bodily sensations and psyche. For further ambiguity, new supervisory can be obtained.

Yours sincerely
Niels Balle Christensen"

As this shows, psychiatrist Ole Nielsen and NBC agreed that there was no symptoms of depression or any severe psychiatric disorders (psychosis). NBC thought that Karina, if there were no signs of somatic disease, could be developing a somatoform condition and suggested in this case treatment with antidepressant Cymbalta. However, Karina was subsequently diagnosed by HI and Johnsgaard with the somatic disease ME (which NBC is fully aware of, see below), and it seems incomprehensible that NBC ignore these diagnoses, especially when NBC has publicly stated that he cooperates with HI on ME patients.

NBC's position seems even harder to understand in the light that he, on 27.9.2012 in a letter to the Rehabilitation Centre Holstebro, diagnosed her with G93.3 ME/CFS (which must have been a reference to HI's above journal). NBC gave admittedly at the same time also the diagnosis F48.0 Neurasthenia. This disease is a mental (functional) disorder, but it is surprising how NBC can make a mental diagnosis at a time when he has not examined or even talked to Karina (since spring 2008, see above).

NBC should otherwise not even have knowledge of PAWS, beyond what he read in the psychiatric literature, and therefore he has only made the diagnosis after consulting with British psychiatrists, including the controversial psychiatrist Peter White, who some years ago was the cause of an international conflict between the WHO and the United Kingdom, because he wanted to make ME into a psychiatric disorder. NBC is, nevertheless, very confident that he can cure Karina for the alleged mental disorders and therefore also for her serious physical problems/symptoms. These data was provided by NBC on a meeting with Karina's next-of-kin in August 2013.

Thus, there is considerable doubts about whether Karina is insane (PAWS).
If Karina should be insane at this point, it should be concluded that it happened after the forced hospitalization, since all medical examinations, including NBC ‘s own, shows that she was not insane before the forced hospitalization.

It may, in this context, be feared that the below-described isolation of Karina from her relatives has damaged her psychologically. It is generally known that a significant part of insulated imprisoned criminals develop mental disorders after only a few months of solitary confinement.

As far as we know, NBS treats Karina as every other patient with a functional disorders, that is to say like if she has depression. That means Graded Excersise Therapy (rehabilitation), Cognitive Behavioral Therapy and possibly antidepressants.

If NBC's diagnosis is wrong, this treatment can have fatal consequences for Karina;

Graded Excercise Therapy /rehabilitation for patients who suffer from severe ME, can worsen the condition and is at worst life threatening. Please refer to HI's journal, middle of page 4, where he explain this, and where references is made to the above-quoted Belgian professor.

Forced exercise and lack of medical knowledge about ME, must in general be regarded as the main reason that Karina’s condition has become so bad.

The disease’s triggering factor, as previously mentioned, is presumed to have been a mononucleosis infection in 2004. This infection was first recognized in 2005 and therefore it was not treated effectively. The symptoms of ME (including additional infections, stomach problems, and above all an overwhelming fatigue), which appeared in the years after mononucleosis infection, was not diagnosed properly by any doctor, but they all encouraged Karina to excersise and otherwise stay active, and this advice has very likely have continuously deteriorated Karina's health.

First in early 2008, doctors tenttatively diagnosed Karina (at an arthritis hospital in Gråsten) with ME and diagnostic code G93.3. Karina's parents were however not made aware of wich disease they suspected. Furthermore, both the arthritis hospital and Karina's doctor at the time, stated that it was important that she was more physically active and possibly even be pressured to be so!

First in 2009 were Karina's parents informed that Karina could suffer from ME, suggested by a family member, and then confirmed by Chief Physician Valerius from Hvidovre Hospital, and later followed up with HI's thorough examination and diagnosis in early 2010, see above.

Please also refer to HI's journal, middle of page 13, where Karina's condition was estimated to be life threatening, after she had gotten significantly worse in connection with the New Year Fireworks at the turn of 2011/2012.
However you should be made aware that Karina got better from the summer of 2012, and that she in February 2013, when she was involuntarily committed, still felt better than the year before!

It is not known, if NBC has given Karina antidepressants, but if this were the case, it would be very dangerous as ME patients usually do not tolerate that kind of medicine, see above. In Karina’s case there has previously been three significant deteriorations of her condition, respectively, after the application of anesthesia in connection with a gallstone operation, by an influenza vaccination and at a (tentatively) previous treatment with antidepressants (by above-mentioned psychiatrist Ole Nielsen).

Karina has also, according to information from the Neurocenter, clearly resisted the treatment with antidepressants, and the parents has warned the Neurocenter against antidepressants and similar drugs.

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Since there is considerable doubt whether NBC's diagnosis and treatments are correct, the §71 Commitee are encouraged to recommend The Neurocenter to let Karina be examined by an independent, foreign expert in ME, as well as making an analysis of blood samples, etc. from Karina, so it once and for all can be determined whether Karina suffers from a serious physical illness or if her troubles s are psychosomatic.

The §71 Committee is further encouraged to recommend the Neurocenter to get a second opinion from an independent specialist in psychiatry (not affiliated with FFL) , who are familiar with the symptoms of ME, especially the cognitive problems as described above, so it can be assessed if Karina now suffers from a rare (questionable?) psychiatric disorder, like NBC claims.

It is also reported that the Neurocenter, ever since the forced hospitalization of Karina in February 2013, has consistently denied Karina's parents access to visit Karina. The refusal is formally justified by the fact Karina has not authorized it, but the cause may indeed be found in the fact that the parents are highly critical of NBC's psychiatric diagnosis.

Karina is therefore de facto treated as a solitary confinement criminal, although her only "crime" is that she has sustained a very serious disease. It should be pointed out that Karina several times before the forced hospitalization expressly objected to be removed from her home, and that she, according to the Neurocenter's own data after the forced hospitalization, have both verbally and physically attempted to resist treatment.

The §71 Committee are therefore encouraged to further recommend to The Neurocenter, that Karina's parents and siblings are allowed to visit her.

I enclose a copy of Karina's parents comment on the matter dated 20.05.2014.

I am aware that The §71 Committee can not rule on the question of the legality of Karina's forced hospitalization, which is why I below outline the issue for the Parliamentary Health Committee as given this aspect of the case, it can hardly be ignored when considering the purely medical questions in the case

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The legality of the forced hospitalization

In May 2010, Karina's former doctor forced Karina to be hopsitalized on a neuroligcal ward. At the hospital Karina's condition worsened because the staff did not know how a severely ill ME patient should be treated. Nevertheless, the doctors examined whether there was an opportunity to compulsory detain Karina according to the Mental Health Act (Act on the Use of Force in Psychiatry). However, this was abandoned when Karina (according to the Medical Officer, Børge Sommer) was "not considered depressive or psychotic."

Karina was therefore, at her own request, sent home again after 3 days of hospitalization. After this experience, Karina was determined to never be treated in a hospital again.

In mid-May 2011, the special consultant Jytte Dahler-Larsen, staff physician Lars Kabel Kristensen and both the public health officers of Mid Jutland paid a forewarned supervisory visit to Karina, at the request of Holstebro Municipality. Prior to the visit, the two officers examined Karina's extensive medical records, including the above records (the first) from HI and Johnsgaard.

During the visit, the public health officers spoke with Karina in private and then with the relatives, after which they concluded that there was found no discrepancy between the written material (Karina's records) and what was communicated during the visit.

About the conversation with Karina the following is reported:

"Karina appears clear, alert and oriented. She seems immediately mentally inconspicuous. She is considered to be well informed about her situation and she agrees with the "alternative" or "complementary" way to cope with the illness. She's crying when she informs us that she would very much like to participate in rehabilitation, but that she cannot manage anything because of extreme fatigue, extreme fatigability and activity-induced pain. She hopes that maximum relief in the long term will allow for spontaneous improvement of the disease.

She has thus given informed consent to the omission of conventional medical treatment in, favor of an "alternative" or "complementary" medical treatment."

Late in March 2012 the staff physician Lars Kabel Kristensen asked the family for permission to carry out a control visit to Karina, preferably together with her own physician and HI.

The visit was scheduled for 11.04.2012, but a few days earlier the meeting was canceled by Lars Kabel Kristensen, apparently under orders from "a higher place" (probably from the The Health Board). Please refer to HI's aforementioned journal, page 14 above.

In the spring of 2012, The Health Board intervened in this case because the public health officer Lars Kabel Kristensen urged Karina's doctor at the time, Lotte Jacobsen, to contact lawyer H. Christensen at the Health Board. The lawyer instructed Lotte Jacobsen to inspect Karina together with a psychiatrist. in order to decide whether Karina could be compulsory treated. Lotte Jacobsen was in this context also asked to speak to psychiatrist Jens Nørbak from the Liaison clinic at Bispebjerg Hospital (FFLs office in Copenhagen), whos psychiatrist apparently advised the Board of Health. Psychiatrist Jens Nørbak thought (without having examined or even seen Karina) that she could be (forcibly) hospitalized in "red papers" (ie, she should be insane or in a very similar condition and either a danger to herself (suicidal) or to others!?, in accordance with the Psychiatry Law § 5).

Lotte Jacobsen however, presented this evaluation for a local psychiatrist who believed that a maximum of "yellow compulsion" could be made, ie. if Karina was insane, and it was considered essential to her health.

Then Lotte Jacobsen contacted chief physician Lena Graversen at the Health Board and announced that she would not participate anymore.

The Health Board did apparently not accept this, as the lawyer H. Christensen contacted Lotte Jacobsen and informed her that she was legally obliged to promptly examine Karina together with a psychiatrist (professor and specialist in psychiatry, Per Fink, who is head of the FFL clinic in Aarhus, shall have been sugeested).

Lotte Jacobsen however,argued that it is hardly possible to get hold of a psychiatrist at such short notice, so it is agreed that she should get hold of a prehospital doctor, after which they had to pay an unannounced visit to Karina.

This happened on 03.05.2012, where the two doctors - after having studied and spoken with Karina, who unequivocally opposed the hospitalization - agreed that the terms of forced hospitalization was not present. Karina was in this event described as "awake, alert, without symptoms of hallucinations."

This course of events arose from physician Lotte Jacobsen's records, as summarized by HI in his above journal, page middle of page 15 to middle of page 16.

After the failed attempt to get Karina coersively committed in May 2012, Karina's parents were contacted during the summer of 2012 by NBC from the FFL. NBC informed the parents that he came as a physician and not as a psychiatrist, that he was the leader of the FFL-established Research Centre for ME/CFS and that he was very interested in treating Karina. NBC pointed out that Karina of course were free to decide whether she would submit to his treatment.

At the first meeting with the parents NBC came together with HI, and expressed that he would cooperate with HI about the treatment of Karina and other ME sufferers.

Neither Karina nor the parents however, had an interest in Karina being hospitalized again , and they were also uneased about the fact that NBC was not very eager to tell what the treatment plan was.

NBC tried several times at meetings with Karina's parents and by telephone conversations with respectively Karina's mother and Karina's sister (who is a nurse) to persuade the family (the parents had general power of attorney from Karina, to care for her interests during the disease) to let Karina be hospitalized, but without any luck.

In this process, NBC neither examined nor spoke to Karina. The closest he came to her, was when he during one of the meetings with the parents stood just inside the door in her bedroom and overheard that she, with a weak voice, said she was too tired to talk to him.

In the late summer of 2012, NBC apparently abandoned getting Karina under his treatment.

Hereafter Karina was cared for by her parents, in collaboration with a physician from Copenhagen, which they themselves had to pay for (after Lotte Jacobsen's resignation as a physician, as mentioned above, there were no local doctors who would take on the task!?).

Until 12.02.2013 Karina was only seen by the Copenhagen doctor. On 12.02.2013, 5 police officers, 2 doctors and 2 employees from the Holstebro Municipality,, arrived unannounced on the parents address (and hidden around the corner, a locksmith was waiting, as well as a manned ambulance).

The doctors went to Karina's bedroom while the police officers prevented the mother and father, who arrived later, to see what was going on.

This resulted in Karina being removed from her bed, and commited at Hammel Neurocenter, which happened against Karina's (and the parents) will. Karina, who had long been too weak to use her mobile phone, called during the process to her father (who was at work when the authority officials came), to her mother, to her sister and to her cousin. And the day after, from the Neurocenter, again to her mother and eventually the police! All in a desperate attempt to resist forced hospitalization. She said to her mother; "Mom, how do I get out of here? I can't take this."

Subsequently, it has been very difficult to get an official explanation of the foundation of the forced hospitalization. The authorities refused to recognize the parents’ general power of attorney, and thus avoided giving details of the case on grounds of professional secrecy. This was also the case in regards to the lawyer, who Karina had hired as early as 2012 when forced hospitalization first came up, see above.

The situation was further locked from the end of May 2013, when the State Administration appointed a guardian for Karina. Now the authorities can refuse all requests for access, citing the confidentiality, which is administered by the guardian. The guardian apparently has the view that the he cannot question the information he gets from the Neurocenter and NBC, so there is no help from him.

However, it has come to light that the forced hospitalization should have been based on the Law Of Nescessity rule in the Penal Code §14. This is stated by Chief Physician at Hammel, Merete Stubkjær, on a meeting with the family in august 2013, and have anonymously been confirmed by healthboard officals to the newspaper BT.

The Penal Code §14 says that
an act that would normally constitute a criminal offense, is not punishable if the act was necessary to help prevent imminent harm to persons or goods, and the offense is deemed to be of relatively minor importance.

The authorities' view, may have therefore been that forced hospitalization of Karina was not punishable at the time it happened, to avert threatening injuries (on Karina herself). The authorities must further have considered that the offense (forced hospitalization) was of relatively minor importance!?

The authorities useage of Penal Code §14 as a foundation for the forced hopsitalisation may be considered to be due to a severe misunderstanding of the law:

The question of when forced hospitalization of sick people can legally happen is exhaustively regulated by the Mental Health Act, where Act §5 can be described as a special emergency rule related to mentally ill people. These can only be committed if they are insane or in a very similar condition, and if it further is essential for their health (on yellow paper, see above), or if the person is a danger to themselves or others (red papers, see above). These conditions apply, according to the Mental Health Act §13, also to the people who are prefered to be involuntarily committed for treatment of physical illness.

Sick people can therefore only be legally committed to the hospital, if the provisions of the Mental Health Act, especially when emergency legal provision §5 are met. There is no place for the general emergency rule in the Penal Code §14, in the case of coercion against sick people.

As mentioned above, it is twice previously found that the Mental Health Act rules for forced hospitalization could not be applied to Karina's case, simply because she was not insane nor in a very similar condition.

This seems to be further supported by the above-cited records from Psychiatrist Ole Nielsen and NBC.

This is also supported by the fact that NBC, shortly after the forced hospitalization, shall explicitly have stated that Karina was not psychotic (insane).

During the forced commitment on 12.02.2013, it also does not appear to have been any attempts to use the Mental Health Act rules, as, among other things, it was not attempted to get Karina’s prior consent to being admitted to a hospital, or to agree to treatment, as is recommended under these rules. Nor does it seem that there were prospects of an improvement of her health status, as defined under paragraph 3. There also should have been a medical examination of Karina as a preparation for the forced commitment within 7 days prior to the decision to commit her and this was not done. Also the police made a decision about implementing the forced hospitalization under paragraph §7, but she was not hospitalized at a psychiatric hospital or unit, as is defined under §7, and therefore a "second opinion" could not have been made by the psychiatric chief physician at the admission location, as stated by §9 part 2, since such a chief physician was not available at the Neurocenter.

Furthermore, there is no evidence to suggest that the Mental Health Act provisions on the appointment of a patient advisor has been respected. The Patient adviisor shouldm as soon as possible, be appointed by the head nurse, and the adviser must then, within 24 hours from the appointment, visit the involuntarily hospitalized patient and among other things assist them with iinitiating and mplementing complaints about the forced hospitalization, as defined under § § 24-26.

It does not, however, appear that a patient adviser has been appointed and visited Karina shortly after the forced hospitalization, as we could assume that Karina would have complained about the hospitalisation in accordance with Karina's above-mentioned call to her mother the day after hospitalisation, where she explicitly asks how she can get away from the Neurocenter.

It can therefor be concluded that the forced hospitalization on 12.02.2013 was clearly illegal.
Besides the fact that Karina thus is illegally incarcerated under prison-like solitary confinement, she is also continually exposed to unlawful coercion and experimental treatment.

The Neurocenter has, as mentioned earlier, stated that Karina both verbally and physically have resisted treatment. Verbally, she has clearly, on several occasions, said "You are killing me." This was told by Chief Physician Jens Gyring at the Neurocenter on a meeting with the parents in May 2013. The Chief Physician supposedly said this because he wanted to convince the parents that Karina still could speak! (Which she was not able to, when her sister briefly saw her some months after the forced hospitalization).

It is also stated by the Neurocenter that Karina has resisted treatment by crying, scratching and turning her back to the staff. Karina has also, according to the information, cried so much that the Neurocenter kept her under video surveillance for a while (presumably because she was considered suicidal).

Thus there is no doubt that Karina has been forcefully treatedt, which is illegal according to the Mental Health Act §12, when the terms of the Act, §5 are not met.

Furthermore, Karina have been experimentally treated, as there is no medical evidence that severely ill ME patients can be treated as if they have a depression, with graded exercise, cognitive therapy and antidepressants. On the contrary, doctors specializing in ME thinks that this treatment can be very harmful to these ME patients, see above.

Experimental treatment on the involuteerly committed are banned under the Mental Health Act §23

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As mentioned, it has been very difficult for Karina's parents and lawyers to get information on the reasons for the involuntary commitment.

But it appears that the incarceration is done in collaboration between Holstebro Municipality, Region Mid Jutland, FFL with professor and specialist Per Fink in charge, The National Board Of Health, The Police and The Health Minister.

Executive of Region Mid Jutland, Ole Thomsen, gave a speech at a Symposium on Functional Disorders, on the occasion of Professor Per Fink's 60th birthday recently, where the following information about Karinas case was stated:
".... I have also seen you take chances. A year ago, you took a chance with Hammel Neurocenter whom is also present here today. Should you take a very private matter in the western part of the country, should you save a young woman's life .. Dare we do that? With the help of the police and the Health Minister, you dared to do it. Maybe that is why there are protesters outside the auditorium today. It is perhaps for that reason alone, the case which annoyed a very small part of the population; you took this step to save this young woman's life ... "

It thus appears that Professor Per Fink is one of the main perpetrators of the forced hospitalization, and that he has received help from the Minister of Health (Astrid Kragh). In this connection, it should be noted that the Neurocenter also reported that the Health Minister approved the forced hospitalization.

It is very puzzling that the former Minister of Health, the National Board Of Health, Region Mid Jutland and FFL with Professor Per Fink in charge, have engaged so strongly in this case.

The normal procedure would be that it was the local authorities and doctors who took decisions about a forced hospitalization, after carefully having followed the procedures prescribed in the Mental Health Act.

Then, one would expect that The Health Board and/or the Ministry of Health intervened if some irregularities in the procedure were found. In this case, it has been just the opposite:

The local doctors have repeatedly held that the conditions for compulsory admission was not present, and then the overall health authorities along with the FFL and the police carry out a clearly illegal forced hospitalization.

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The case raises the following questions to the Minister of Health:

1. Can you confirm that the former health minister, Astrid Kragh, approved the forced hospitalization of Karina?

2. Can you confirm that Karina is involuntarily committed according to the emergency legal rule in the Penal Code §14?

3. If so, does the Health Minister agree that the forced hospitalization is clearly illegal?

4. If so, will the Health Minister make sure that Karina is immediately released from the Hammel Neurocenter?

I would like to hear more at your earliest convenience.

Sincerely,
Jacob Skjoldan
Lawyer (SC)