Prime Minister, Viorica Dăncilă,
Minister of Health, Sorina Pintea,
Deputy President of the National Authority for the Protection of Children’s Rights and Adoption, Gabriela Coman,
Mr. President of the Romanian College of Physicians, Dr. Gheorghe Borcean,
Mr. President of the College of Psychologists from Romania, Prof. Univ. Dr. Ion Dafinoiu,
Mr. President of the College of Social Workers in Romania, Prof. Univ. Dr. Doru Buzducea,
Bucharest, March 20, 2019
Since we have been waiting for a few days for a response from your part concerning the information that has appeared in the media concerning pornographic video materials produced in psychiatric hospitals and the abusive sedation of children in the child protection system, we are asking the following questions:
1. The Ministry of Health is the competent authority for organizing and controlling the activity concerning public mental health protection, in particular with regard to the abuse of psychoactive substances, violence and pornography and selective prevention through the implementation of programs aimed at groups which face a significantly higher risk for developing mental health problems (i).
2. Any natural or legal person, as well as a child, may notify the General Directorate of Social Assistance and Child Protection (DGASPC) to take the necessary measures to protect a child against any form of violence, physical or mental abuse, ill-treatment or negligence. Employees of social or medical care institutions, both public and private, who, due to the nature of their profession come into contact with the child and have suspicions about possible abuse or ill-treatment are under the obligation to immediately notify the DGASPC. The problem is that the DGASPC Director is also the legal representative of the child during the placement in residential services (ii).
Ms. Prime Minister, Ladies and Gentlemen Presidents of the Professional Colleges, we hereby ask: Who has notified cases of arbitrary deprivation of liberty of children in psychiatric hospitals, the sedation of children with disabilities, with depressive episodes, autism, ADHD or with conduct disorders? How many cases of abuse or ill-treatment have been reported by social workers, doctors and psychologists employed by these institutions? How many times have employees of these institutions or professional foster caregivers complained about the lack of knowledge or specialized services in managing difficult behaviors or depressive episodes encountered in institutionalized children?
Children who are placed in foster care by the DGAPSC – and are then transferred from placement center to foster care and then back home again (sometimes in families without financial resources or with a history of physical and sexual abuse), and again to the placement center or family-type home (which is also an institution) – are at increased risk of developing emotional disorders and are at risk of receiving one or more types of psychotropic drugs (another high risk that will lead to the development of cardiovascular health problems and delays in the educational process). Therefore, in how many cases did the DGASPC directors, as legal representatives of the children, supervise the measures ordered and asked for specialized help from the National Authority for the Protection of Children’s Rights and Adoption (ANPDCA) and the Ministry of Health?
3. Pediatric psychiatrists have prescribed psychotropic medication in alarming proportions to children in the special protection system and, most often, at the request of their carers and not at the request of their legal representative. Thus, the data provided by ANPDCA at the request of the Center for Legal Resources (CLR) indicate that psychotropic drugs haven been administered to approx. 6000 children, beneficiaries of the special care system, out of a total of 9,000 children diagnosed in 2018. Also, approx. a quarter of them were hospitalized in a psychiatric hospital in Romania during the same year.
Nearly 400 were hospitalized more than 3 times in psychiatric hospital units in the same year, and 150 of them were hospitalized for more than a month (iii). These figures, as well as reports published by the CLR over the past 16 years, indicate that medication is used to control children’s moods and behaviors rather than to treat their mental health. In other words, psychiatric medication is used as a substitute for the children’s need for affection, but also as a punitive method.
4. It is unlikely that you are in possession of such data, and even less likely that you requested and analyzed them with the responsibility incumbent on the authority in charge of these children, since we found out from TV that you haven’t been notified and, consequently, you did not take any steps in this respect either. Thus, out of the few and incomplete data that were collected by the CLR, following requests (iv) transmitted to psychiatric hospitals – because, once again, Ms. Minister of Health, the Ministry does not have such data – the CLR has noticed that there are big discrepancies between the number of children as reported by the DGASPC and the number reported by psychiatric hospitals or psychiatric units. For instance, DGASPC Botoșani indicated a number of 159 hospitalized child beneficiaries in psychiatry units, while the psychiatric hospital indicated that there had only been 77 hospitalized patients from the child protection system in Botoșani County. At the opposite pole, the psychiatric hospital in Galați informed us that it had admitted 165 minor beneficiaries of the DGASPC Galați, while the DGASPC Galați have only reported 55 children from the special protection system (v). What is the cause of these discrepancies? What prevents pediatric psychiatrists to report the correct figures? In the TV news report broadcasted by ProTV during the show “România, Te Iubesc“, a pediatric psychiatrist from the Târgoviște hospital stated that all the admitted child patients came from placement centers in Târgoviște. The same hospital replied to the CLR that they did not have any patients from placement centers.
Ms. Minister of Health, what conclusions you have reached concerning these discrepancies? After 16 years of unannounced monitoring visits in psychiatric hospitals and residential centers, after reports and recommendations in this area of expertise, the Ministry of Health has revoked the access authorization for the CLR in these institutions: why is the access for NGOs no longer permitted, what exactly is there to hide?
5. Is the lack of complete and adequate information concerning the hospitalization and treatment of children in the special protection system caused by the manner in which informed consent is obtained from the legal representative of the child? (vi) In particular, how many medical files of minor patients from the special protection system record the informed consent of DGASPC directors, who are often their legal representatives? By informed consent, we also implicitly refer to the signature confirmation that the physician has provided the legal representative with information about diagnosis, treatment, doses, side effects and has reported the side effects, that he has taken into account the child’s and the legal representative’s opinion, and that he or she has provided information on the complementary services available.
The European Court of Human Rights itself has held in its case-law that the administration of psychiatric treatment without the patient’s legal consent constitutes an interference with the right to respect for private life when a “psychiatric hospital exercises […] complete and effective control” over the patient. For minor patients, in the absence of an emergency, medical treatment in the absence of the legal representative’s consent violates the child’s right to physical integrity. (viii)
6. Complementary services (ix): how are they reimbursed? From the responses received by CLR, it appears that only approx. 2.4% of child beneficiaries of the special protection system benefited from psychotherapy services. However, it does not appear that these services have been prescribed or provided in psychiatric hospitals or mental health community centers.
Minister Pintea, what data do you have about the functioning of these services? Where do they operate, with what staff, and how many minor patients from within the special protection system or from outside of the system have been treated there? How many clinical psychologists are employed in the mental health network? In how many psychiatric hospitals have doctors recommended and prescribed psychotherapy to children in the special protection system?
In conclusion, when psychotropic drugs have been administered to 30% of all children beneficiaries of the special protection system in 2018, we are witnessing a chemical extermination of these children. (x)
Prime Minister, Ladies and Gentlemen, we call upon you to verify how was the consent of the children’s legal representative obtained, in this case the DGASPC directors, how was the treatment supervised, especially for those children with intellectual disabilities who are unable to complain or to notify abuses (monitoring the rates and prescription doses; for example in Gorj County, the Directorate for Investigating Organized Crime and Terrorism investigates over-prescription of these doses for several years), how are second opinions obtained, how are independent evaluations carried out, how are independent assessments made, how are the children’s families consulted and how are all those who interact with the beneficiaries of the special child protection system adequately informed (the role and use of psychotropic drugs for clinicians, carers and foster families or professional foster carers).
We are at your disposal for any help you will consider necessary.
Center for Legal Resources
For further information: Georgiana Pascu, Program Manager, Center for Legal Resources, email: email@example.com, tel. no.: 0729 881 159, 021.212 0690, www.crj.ro/en
Note: The data was made available to the Center for Legal Resources (CLR) on 18.02.2019 and was collected from the County Directorates for Social Assistance and Child Protection by the National Authority for Child Protection and Adoption (ANPDCA), following the request of CLR no. 11/29.1.2019. Information regarding the beneficiaries of the special child protection system (residential services for those with or without disabilities or placed in a professional maternity ward) on 31.12.2018 does not include beneficiaries of family placement services. Data from the mental health system is based on complete responses provided by 10 hospitals and partial responses from other 5 hospitals. The Ministry of Health has not yet responded to CLR’s request no. 14 / 30.1.2019.
Infographic material (also available as pdf):
Concerning the Center for Legal Resources Reports: www.crj.ro/pledoarie-pentru-demnitate/rapoarte-de-monitorizare/, https://www.crj.ro/pledoarie-pentru-demnitate/clinica-juridica-mobila/rapoarte-si-raspunsuri/ ;
EctHR judgement „Centre for Legal Resources on behalf of Valentin Câmpeanu v. Romania”: www.crj.ro/curtea-europeana-pentru-drepturile-omului-a-condamnat-romania-in-dosarul-crj-in-numele-lui-valentin-campeanu-vs-romania/
i Art.3 and art.7 of Law no. 487/2002 regarding mental health and the protection of persons with psycho-social disabilities
ii Law no. 272/2004 regarding the protection and promotion of children’s rights
Art. 89, para. 2 and 3
Art. 66 para. (3) Parental rights and obligations towards the child, during the entirety of the court-ordered placement measure for the situation of the child foreseen under art. 60 para. c) and d) are carried out by the director of the General Directorate for Social Assistance and Child Protection.
Art. 60 The following persons benefit from special protection measures established by the present law:
a) the child whose parents are deceased, unknown, parents who have lost the rights to exercise parental rights, or who are under a parental rights ban penalty, are under guardianship or have been declared dead or missing by a court, when guardianship could not be instituted; (b) a child who, in order to protect his or her interests, can not be left in the care of his parents for reasons that are not imputable to them; c) the abused or neglected child; d) the child found or left in sanitary units; e) a child who has committed an act foreseen by criminal law and is not criminally liable.
Art. 99 In order to investigate cases of child abuse and neglect, the General Directorate for Social Assistance and Child Protection representatives have, under the law, the right of access to the premises of legal persons and to the residence of natural persons who care for or provide child protection.
(1) The representatives of the legal persons, as well as the natural persons who care for or protect a child, are obliged to cooperate with the representatives of the General Directorate for Social Assistance and Child Protection and to provide all necessary information for the resolution of complaints.
(2) If, following verifications, the representatives of the General Directorate for Social Assistance and Child Protection state that there are good reasons to believe the existence of an imminent danger to the child due to abuse and neglect, and there is no opposition from the persons referred to in paragraph (1), the Director of the General Directorate for Social Assistance and Child Protection shall establish the emergency placement measure.
Where abuse, neglect, exploitation and any form of violence against the child has been committed by persons who, on the basis of a labor law relationship or another kind of legal relationship, were ensuring the child’s protection, growth, care or education, employers have an obligation to immediately notify the authorities responsible for criminal investigation and order the person to be removed from caring for the children under his care.
iii Response from the National Authority for the Protection of Children’s Rights and Adoption no.127/DGPDC/SM/so/28.02.2019 to the Center for Legal Resources request no. 11/29.01.2019.
iv Data on the administration of psychotropic drugs to minors (including those from the special protection system, according to articles 120-123 of Law 272/2004 on protection and promotion of children’s rights) were collected through requests for public information formulated on the basis of Law no. 544/2001 regarding the free access to information of public interest. The requests were addressed to psychiatric hospitals and psychiatric wards that hospitalise minor patients or treat them on an outpatient basis. Thus, out of a total of 24 psychiatric hospitals that hospitalize and/or treat minor patients, 10 hospitals have provided complete information; 5 hospitals provided only partial information, lacking data on the diagnoses of minor patients or the number of patients coming from the social protection system. Two hospitals have explicitly refused to provide the required data, and seven hospitals have not responded to the request at all.
v Response no. 159/28.02.2019 of the Botosani Mavromati County Hospital and the Galati „Elisabeta Doamna” Hospital of 01.03.2019 to CLR’s request no. 29/11.02.2019.
vi Art. 29 of Law no. 487/2002 concerning mental health
(2) The psychiatrist may institute treatment without the patient’s consent in the following situations:
c) the patient is a minor or a person placed under guardianship, case in which the pshychiatrist must obtain the consent of the legal representative.
Art. 32 All therapeutic decisions are immediately communicated to the patient and, the the shortest time, to his or her legal or conventional representative, recording this in the medical file.
vii Atudorei v. Romania, application no. 50131/08, judgement of 16.12.2014, para. 160-166
viii M.A.K. and R.K. v. Marea Britanie, applications no. 45901/05 and 40146/06, judgement of 23.06.2010, para. 75-80 and Glass v. Marea Britanie, application no. 61827/00, judgement of 09.03.2004, para. 70-83;
ix Art. 5. f) and g) of Law no.487 / 2002 regarding mental health
f) “complementary services” represent services that provide mental health and psychiatric care, such as: psychological counseling, professional guidance, psychotherapy and other medical-psychosocial procedures;
(g) “community services” are services which enable the patient to be cared for in his/her natural environment;
x On 31 December 2018, according to the response of ANDPCA, in the special protection system there were 30,855 beneficiaries of residential services for children with disabilities, residential services for children without disabilities or placed in a the care of a foster parent, out of which 9,197 were diagnosed with a disorder or an intellectual disability.