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NFU protesterer mot etablering av isolater for utviklingshemmede

Smittevernloven gir en viss åpning for å godkjenne andre institusjoner enn sykehus for tvangsisolering. Helsedirektoratet har åpnet for å etablere slik tvangsisolater for utviklingshemmede.

Helsedirektoratet

 

                                                                                       Granneskrossen den 20.05.2020
                                       

Helsedirektoratet bes omgjøre sitt vedtak om godkjenning av andre institusjoner enn sykehus for tvangsisolering av mennesker med utviklingshemming

Vi er kjent med at Helsedirektoratet har godkjent Horten kommunes søknad om godkjenning av en kommunal hytte til bruk som isolat overfor innbyggere som ikke har «kognitive forutsetninger (psykisk utviklingshemming) til å verken forstå eller tilegne seg forståelse for karantene og/eller isolasjonsregler», som det heter i kommunens søknad.

Når Helsedirektoratet godkjenner kommunale institusjoner som tvangsisolat for utviklingshemmede, så innføres en ny og tvilsom rettslig standard langt fra de tilfellene som lovgiver har drøftet i forbindelse med smittevernloven. NFU oppfatter godkjennelsen som diskriminerende og i strid både med smittevernlovens formål og grunnleggende rettigheter. Det fremstår som ufattelig at en åpner for nye tvangshjemler i dagens situasjon hvor lovløsheten råder, kontrollorganene er fraværende og utviklingshemmede i stor grad ikke får sine rettmessige tjenester, men pålegges både besøksforbud og portforbud. Det naturlige ville vært å stramme inn på tvangsbruken, ikke ty til nye og kreative løsninger for å hjemle mer tvangsbruk.

Helsedirektoratet innfører i praksis planlagt tvangsisolering ved nødrett

I seg selv medfører godkjenning av tvangsisolat ingen myndighetsutøvelse overfor enkeltpersoner. Helsedirektoratet er utvilsomt gitt myndighet til å gi slik godkjenning gjennom smittevernlovens § 5-4. Men godkjenningen medfører at en ekstremt stor myndighet gis kommunelegen og vakthavende infeksjonsmedisinske overlege ved sykehus og en systematisk undergraving av rettsikkerheten. Smittevernloven er ikke skrevet med tanke på situasjoner som ved Covid-19, men for sykdommer med adskillig lengre varighet. Ved siste lovrevisjon i 2019, var det sterkt fokus på smittsom lungetuberkulose, multiresistent tuberkulose og HIV. En som blir smittet av Covid-19 skal umiddelbart i frivillig isolasjon, dette medfører at rettsikkerhetsordningene i smittevernloven med saksfremlegg i smittevernemnden, vedtak i smittevern nemnden og eventuell sak for tingretten ikke er relevant. Rettsikkerhetsordningene fungerer ikke raskt nok og når hovedregelen for slike tvangsvedtak er gjennomført, så vil isolasjonsperioden til den Covid-19 smittede stort sett være over. Isolasjon etter smittevernloven må derfor skje med hastevedtak som beskrevet i smittevernlovens § 5-8, hvor kommunelegen og vakthavende infeksjonsmedisinske overlege ved sykehus treffer vedtak som i ettertid behandles av smittevernnemnden. Hastevedtak er å forstå som en nødrettsløsning hvor rettsikkerheten er begrenset til en gjennomgang i ettertid. Det at mennesker med utviklingshemming kan bli smittet og at flere av dem ikke vil forstå og heller ikke forholde seg til smittevernreglene utøser ingen nødrett. Man planlegger ikke en ukelang nødrettssituasjon.

Helsedirektoratets godkjenning er ikke i samsvar med smittevernloven

Smittevernlovens § 5-4, 3. ledd sier at «Når særlige forhold krever det, kan smittede personer isoleres i andre institusjoner godkjent av Helsedirektoratet». I den forbindelse har Helsedirektoratet sagt at «den foreliggende situasjon med en pågående pandemi fyller kravet til «særlige forhold» i bestemmelsen». En pandemi vil isolert sett alltid utgjøre et «særlig forhold». Men ordlyden i bestemmelsen gjør at dette særlige forholdet må kreve at andre institusjoner godkjennes. Det kreves altså en mer konkret vurdering av den pågående situasjonen enn Helsedirektoratet har gjort her. Det er sitert fra forarbeidene, blant annet at «bestemmelsen tar først og frem sikte på å gjennomføre isoleringstiltak ved et alvorlig utbrudd». I Horten kommune er det siden utbruddet av Covid-19 bekreftet 26 smittede. Siste måned var det registrert en smittet person. Det må legges til grunn at de fleste av disse har kunnet og villet isolere seg i eget hjem. Selv om pandemien er alvorlig, er ikke dette et alvorlig utbrudd. Det har vist seg at sykehusene har god kapasitet til å ta imot de som må tvangsisoleres, og de som til enhver tid har behov for helsehjelp på sykehus.

I Helsedirektoratets godkjenning av tvangsisolatet i Horten, siteres det fra forarbeidene at «i slike situasjoner vil det kunne oppstå behov for å ta i bruk alminnelige offentlige bygninger…». Det vil kunne oppstå et behov i disse alvorlige situasjonene. Men en alvorlig situasjon er ikke ensbetydende med at et slikt behov har oppstått. Som nevnt ovenfor er pandemien alvorlig. Men slik situasjonen er i Norge i dag, er det ingenting som skulle tilsi at man får en svært stor gruppe med smittede mennesker som motsetter seg isolasjon, og derfor må tvangsisoleres på sykehus uten at de har behov for behandling ved sykehus – heller ikke mennesker med utviklingshemming.

Helsedirektoratets godkjenning er diskriminerende

Etter Grunnloven § 98 er alle like for loven. Ingen skal utsettes for usaklig eller uforholdsmessig forskjellsbehandling. I følge søknaden fra Horten kommune fremgår det klart hvem tvangsisolatet hvem er beregnet på «I enhet for voksenhabilitering i Horten kommune er det flere tjenestemottakere som ved behov for kortvarig karantene og/eller isolasjon grunnet Covid-19 smitte, vil motsette seg dette. Noen av disse personene har ikke kognitive forutsetninger (psykisk utviklingshemming) til å verken forstå eller tilegne seg forståelse for karantene og/eller isolasjonsregler. Med bakgrunn i den kjennskap vi har til noen av disse tjenestemottakerne gjennom flere års tjenesteutøvelse – er det svært sannsynlig at enkelte av disse tjenestemottakerne vil yte motstand mot å bli satt i karantene og/eller bli holdt på isolat». Det gjelder mennesker med såpass stor kognitiv svikt at de ikke forstår karantene og/eller isolasjonsreglene og som mottar omsorgstjenester fra kommunen. I praksis er dette mennesker med utviklingshemming.

Helsedirektoratet konkluderer, «basert på disse forutsetningene», med å godkjenne de aktuelle lokalene for gjennomføring av tvungen isolasjon. Helsedirektoratet henviser altså til søknadsgrunnen til Horten kommune, og stiller seg bak disse. En egen måte å isolere en gruppe mennesker på basert på deres nedsatte funksjonsevne, er diskriminerende, jf. likestillings- og diskrimineringsloven § 6 og i strid med FNs konvensjon om rettighetene til mennesker med nedsatt funksjonsevne (CRPD) art. 5.

Helsedirektoratet som representant for staten, plikter å avstå fra alle handlinger og praksis som er uforenlig med forbudet mot diskriminering av mennesker med nedsatt funksjonsevne, jf. CRPD art. 4 nr. 1 bokstav d og e. Det understrekes i denne sammenheng at CRPD art. 14, kanskje særlig nr. 1 bokstav b, presiserer at mennesker med nedsatt funksjonsevne «ikke berøves friheten på ulovlig eller vilkårlig måte», og at en funksjonsnedsettelse «ikke i noe tilfelle skal rettferdiggjøre frihetsberøvelse».

Helsedirektoratets godkjennelse uthuler tvangsbestemmelsene

Helsedirektoratet skriver i sin vurdering at

«Det forutsettes at kommunen så langt det er mulig unngår å flytte personer som motsetter seg dette. Videre forutsettes at flytting og isolering av personer som motsetter seg dette ikke skjer før tillitsskapende tiltak er forsøk, og for øvrig gjennomføres på en så skånsom og hensynsfull måte som mulig. Nærmeste pårørende bør involveres i prosessen, etter samtykke fra personen hvis hun eller han er samtykkekompetent.»

Og videre understrekes det «at det må fattes vedtak av kommunelege og smittevernnemnd etter reglene i smittevernloven kapittel 5 i hvert enkelt tilfelle ved behov for isolering med tvang». Dette er NFU svært glade for, og det følger også direkte av loven. Like fullt mottar NFU henvendelser daglig, hvor det fremgår at det utføres tvang uten hjemmel. Mange av henvendelsene til NFU er videresendt til Helsedirektoratet. Det er tydelig at kriteriet om nødvendighet blir vurdert svært forskjellig, og ikke minst blir det utøvet mye tvang som tjenesteyterne ikke vet er tvang. NFU er redd for at muligheten for tvangsisolasjon på en «bedre egnet lokasjon», vil føre til at kravene om vurdering av frivillighet eller andre egnede tiltak i realiteten ikke blir fulgt. Da har jo kommunen et tilbud de anser som det beste, så hvorfor skal det da forsøkes med isolasjon av noen i egen leilighet og risikere at de utagerer og yter motstand. Selv om dette helt klart strider mot loven, er det ikke sjeldent i praksis.

Denne engstelsen underbygges av at Horten kommune skriver: «for å forebygge og forhindre unødig bruk av tvang og makt som eksempelvis fastholdelse og nedleggelser i akutte nødsituasjoner (jfr. HOL Kapittel 9; § 9-5 tredje ledd bokstav a) vurderer kommunen at det vil være hensiktsmessig å gjennomføre isolasjon av tjenestemottakere som yter stor grad av fysisk motstand».

Tanken om forebygging er det urovekkende. Det er ikke utfordringen med å isolere enkelte tjenestemottakere som skal gjøre det lovlig og greit å flytte mennesker med utviklingshemming til denne hytten, slik det antydes i det siterte fra søknaden til Horten, i nederste avsnittet på første side i vedtaket til Helsedirektoratet. Det er det faktum at de har blitt bekreftet smittet med Covid-19, og frivillighet og alle andre tiltak har blitt forsøkt først.

Flere av personene som Horten kommune vil isolere på denne hytta, er gjerne mennesker som har svært begrenset bevegelsesmønster, og svært få mennesker de omgås. Dersom kommunen hadde innvilget nok tid og ressurser til tilrettelegging for at isolasjon kan gjennomføres uten vansker, hadde nok dette i stor grad latt seg gjøre.

Når kommunen påpeker bosituasjonen og faren for å smitte andre beboere, så vil vi påpeke at det i praksis er kommunen som stort sett bestemmer hvor, hvordan og med hvem mennesker med utviklingshemming skal bo.

Nødvendighet og forholdsmessighet

Tvangstiltak overfor utviklingshemmede innføres alltid for å hjelpe og som siste utvei, ut i fra tvangsutøvende myndighets argumentasjon. Opp gjennom historien, har det vist seg at de fleste slike nødvendig tiltak slett ikke var nødvendige. Ser en på variasjonen i tvangsbruk etter helse- og omsorgstjenestelovens kapittel 9 mellom fylkesmannsembetene, så vil den variere med fagmiljøenes forståelse av nødvendig tvangsbruk og alternativene til tvangsbruk. Det er vanlig at overprøvingsorganet og sentrale myndigheter legger tvangsutøvende myndighets vurdering til grunn for sine beslutninger. Det er ytterst uvanlig at den som underlegges tvangstiltakene overhode høres, og langt mindre vektlegges. Helsdirektoratet bør ikke bidra opprettholde denne ensidige posisjonen.

For folk flest er isolasjon basert på frivillighet og i liten grad under offentlig kontroll. Det er forståelig og aktverdig når myndighetene har et sterkt fokus på skjerming av sykehjemspasienter med stor risiko for komplikasjoner med smitte. Men myndighetene bør være svært varsomme med å forsterke stigmatiseringen av allerede stigmatiserte grupper som i liten grad er inkludert i samfunnet og som i mindre grad får fremmet sitt syn.

«Ingen særlige omstendigheter av noen art, f.eks. en offentlig krisesituasjon kan påberopes for å rettferdiggjøre nedverdigende behandling», sier torturkonvensjonen. I Helsedirektoratets godkjennelse, er slike forhold ikke berørt. Langt flere konvensjonsforpliktelser kan nevnes, men det viktigste er kanskje ikke paragrafer og artikler, men opphavet til paragrafene og artiklene: Det er et ønske om å skape et godt samfunn for alle og å begrense myndighetsmisbruk, spesielt overfor utsatte grupper. Den rollen har også Helsedirektoratet. Helsedirektoratet bør ta sin oppgave alvorlig og trekke tilbake godkjenningen av hytta for bruk ved tvangsisolasjon.

                      Med hilsen                                    
                                                           
Jens Petter Gitlesen                                                         Monica S Tøllefsen  
Forbundsleder                                                          Juridisk rådgiver
20 mai 2020

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