What is our responsibilities once a patient has been arrested under the mental health act? Is it considered implied consent? Are we responsible for vital taking, blood sugar and treatment if the BG is below four? Can the patient refused treatment with a decreased BG and a GCS of 14(confusion)?
Answer: If called to attend to a patient due to medical reasons that has been apprehended under the Mental Health Act, you are still required to attend to the patient from a medical perspective. Per the Health Care Consent Act, 1996, S.O. 1996, under Section 25, Emergency Treatment, subsection (2) Emergency treatment without consent: incapable person, “A treatment may be administered without consent to a person who is incapable with respect to the treatment, if, in the opinion of the health practitioner proposing the treatment: (a) there is an emergency; and (b) the delay required to obtain a consent or refusal on the person’s behalf will prolong the suffering that the person is apparently experiencing or will put the person at risk of sustaining bodily harm.” In this situation judgment needs to be utilized for the balance of patient consent and autonomy and patient safety. It is important to stay with the patient through the process to the hospital in case the situation changes and the patient becomes further incapacitated and confused necessitating intervention for patient safety. These situations can be dynamic; perhaps there has been a struggle, and trauma, or intoxicating substances clouding the picture. Always avoid clearing the patient medically and signing off, and make it known to the supervising officers that you strongly suggest and insist hospital attendance and assessment if there is an altered GCS. This should be documented. Once paramedics have been activated for a case, then you are responsible for patient safety and medical care. Police having patients in custody are responsible for facilitating their medical care. This is not a situation for diversion but rather important they attend the ER. It is important to note all care offered and refused, and the reason it was not completed, as the situation changes then it’s important to reassess and either facilitate consent or move into treating without consent if you feel there could be a risk to the patient and bodily harm. Again this reasoning should be later documented. Examples might be worsening head injury, delirium, intoxication, or other medical instability, always proceed on the side of patient safety. If it becomes apparent that patient is more alert then again reassess consent and back away if it is not approved, and again document. Team safety is also important and that needs to be strongly considered in more violent situations like excited delirium where interagency communication is key for safe patient and team outcomes. Documentation is extremely important, as these can often become medical legal cases. Ensure to properly document the call details in the ACR. This is specified under the Health Care Consent Act in subsection (5), “After administering treatment under subsection (2) the healthcare practitioner shall promptly note in the person’s record the opinions held by the healthcare practitioner that are required by the subsection on which he or she has relied.” Health Care Consent Act, SO 1996 Health Care Consent Act, SO 1996