Can one covering RC assess for revocation on one day but the next day when the AMHP has agreed a different covering RC sign off the revocation?
My thoughts are that an RC cannot sign to revoke if they have not assessed the patient?
Yes. Following Devon judgement the patient needs to be examined in person by the doctor before making an application to detain
Hya Amy
I think you are correct
Steve
I think it’s slightly more of a grey area.
The RC’s power of recall in Section 17F(4) is parasitic on the personal opinion of that same RC (s.17F(4)(a)). However, it conspicuously does not use any of the phrases “seen”, “personally examine” or “examine” which are found in Sections 6, 11 and 20/20A (detaining and renewal sections).
The RC exercising the power of revocation must hold the “opinion” that the Section 3(2) criteria are met, and there might be a strong argument this should be by way of examination, but it’s not something statute specifically requires and Parliament’s decision not to use that specific wording is notable given the comparable sections above.
I think therefore this can be distinguished from the Devon/Derbyshire cases.
I don’t need to get into specifics of the legal transactions between the AMHP and the assessing RC. Why - because what I think next is primary:
- It is grossly improper for any doctor to sign such a form for a patient they have not assessed. Would they sign a S2 or S3 form for a patient they have not assessed? They can, but they would be paddling close to the General Medical Council’s jaws.
- Anyone can sign anything but the issue is about legality, legal accountability, status and authority, and appropriateness.
There is a long standing myth in health services across this land that a signature on a form is ‘everything’. Look, I’m not debating what I’ve seen with my own eyes over the last 30-odd years of practising psychiatry. Once a signature is there, ‘everybody’ is happy and potentially wrong.
Indeed grey area as not specifically mentioned. But it would seem odd a patient can be detained for up to 6 months without an in person examination. Would also raise questions as to how one would complete the CTO5 form without seeing the patient? Recall can happen without seeing the patient but revocation not so sure. Interesting discussion
With the additional ruling that renewal assessments must be carried out in person, I would always air on the side of caution in terms of anything requiring an assessment to take away someone’s liberty.
I also agree with you Russell as to why anyone would want to sign a form to do this when they have not actually assessed the person themselves. My point when asked was that a medical examination for the initial detention requires the same person to sign the form as who examined so I don’t think this should be any different. Even though the Act does not specify in words that the same person should sign an initial medical recommendation, it should be inferred and I believe would be subject to challenge?
Doesn’t cover the actual scenario in the OP, but the Act is generally drafted in a very specific way to take account of the myriad sorts of scenarios that can arise.
My guess is that s.17F is worded in such a way that it covers situations such as when the patient finds themselves recalled to hospital in a part of the country, far away from the Responsible Hospital where the RC is based, such that it may not be practicable for the RC to see the patient to potentially exercise the power of revocation in good time within the 72 hours, because conveyance back to the Responsible Hospital may not be practicable i.e. the patient is too unwell to travel.
The patient is already known, if not very well known to the RC, who can rely on examinations by colleagues in the other hospital. Not saying it’s ideal and there is the power to reassign responsibility for a recalled patient, but it might be the best option in the circumstances.
One safeguard is the requirement to refer to the Tribunal subsequent to the revocation.
Must examine the patient in person, must consult and agree with the AMHP. If both criteria are not met or in doubt then I would reject the paperwork.
‘Revocation’ via S17F(4). Here it is:
(4) The responsible clinician may by order in writing revoke the community treatment order if—
(a) in his opinion, the conditions mentioned in section 3(2) above are satisfied in respect of the patient; and
(b) an approved mental health professional states in writing—
(i) that he agrees with that opinion; and
(ii) that it is appropriate to revoke the order.
The word ‘assessed’ is not in that part of the law.
So the OP could look something like this:
Day 1: RC A sees/reassesses the recalled patient and concludes that detention criteria are met.
Day 2: RC A is on leave. The AMHP agrees that revocation is appropriate. RC B is providing RC cover. Can RC B complete the revocation?
The MHACOP at 29.63 states:
The responsible clinician and an AMHP should reassess the patient before revoking their CTO. They must do so if necessary to satisfy themselves that the patient again needs to be admitted to hospital for medical treatment under the Act.
RC A’s clinical examination can be evidence available to RC B. It cannot substitute for RC B’s statutory decision.
Paragraph 29.70 says hospital managers should have arrangements for “any necessary transfers of responsibility between responsible clinicians in the community and in hospital” during the recall/revocation process
29.61 refers to assessment on recall. So 29.70 points to that assessment, hence ‘reassess.’
There is no statutory prescribed examination or assessment procedure in S17F, but the Code plainly envisages an initial post-recall assessment followed, where revocation is contemplated, by reassessment directed specifically at whether continued detention is now required.
RC B would need to satisfy themselves afresh that the revocation criteria are met and, under the Code, ordinarily reassess the patient. The AMHP agreement must then be agreement with RC B’s assessment, not merely an agreement previously given to RC A’s assessment.
So my original opinion that “It is grossly improper for any doctor to sign such a form for a patient they have not assessed.” - remains correct.
What do you mean by ‘reject the paperwork’ Roberta?
I agree. So it seems that we now have a situation. For a substantial impact on liberties on ‘the individual’ where - “Personally seen” and “personally examined” requiring the physical presence a medical practitioner for ‘assessment’ (in the captioned circumstances of the OP) - are not required.
If my understanding is correct, it confirms that Parliament can do what it likes. And as a matter of fact for everybody, Parliamentary sovereignty prevails.