CTO1 failed medical scrutiny

Hi all

So a CTO1 application completed by the RC/agreed by the AMHP which has come into legal effect has failed medical scrutiny on the grounds that the RC has failed to justify the need for a CTO because there just isn’t information regarding nature or degree which makes it appropriate for the patient to receive medical treatment for their own health or safety or for the protection of others or evidenced their opinion of why it is appropriate for the person to be made subject to the CTO and has not described the patient’s symptoms/behaviour or explained how those symptoms/behaviour led them to their opinion.

The reasons given by the RC that failed medical scrutiny are as follows:
Patient has diagnosis of Paranoid Schizophrenia.
He had been on CTO before which has helped him stay well in community
In order to ensure concordance, he needs to be monitored for progress and requires legal framework of CTO.
He agrees to CTO Conditions

As there is no provision in the MHA for CTOs to be rectified would the above inadequacy render the patients’ CTO as invalid?

The underlying s3 is still valid and was not due to expire until Sept 2024.

Thoughts please.

Thanking you in advance.

I would suggest that there is no such thing as, or need for, ‘medical scrutiny’ in relation to the ‘opinion’ for a CTO1 (the form does not use the term ‘reasons’); especially when you consider that the RC might be a non-medic and that it is an order rather than an application, which is why section 15 does not apply.

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So this is what Jones/Code says

Although there is no provision in the Act for the documents relating to CTOs to be rectified, appropriate arrangements should be put in place to check that such documents have been properly completed: see the following paragraphs of the Code of Practice:

“35.16 There are no provisions in the Act for community treatment orders (CTOs) and related documents to be rectified once made. Hospital managers should nonetheless ensure that arrangements are in place to check that documents have been properly -completed.

Significant errors or inadequacies may render patients’CTOs invalid, and errors in recall notices or revocations may invalidate hospital managers’ authority to detain.

35.17 To avoid errors being made, hospital managers should ensure that responsible clinicians have access to advice about how the relevant forms should be completed and the opportunity (where practicable) to have them checked in advance by someone else familiar with what the Act requires.”

Minor errors and or slips of the pen may be corrected and initialled without affecting the validity of the CTO.

My reading of all that (I should declare that I led on the review of that chapter of the Code as part of the DH’s working group in 2014/15), is it relates to making sure concrete things like signatures and dates are completed, and in the right order. I can’t see that the example you give amounts to serious error or inadequacy, but then a court might say otherwise.

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Hi - if a CTO1 application that had come into legal effect and was declared as defective/invalid for whatever reason (just say the CTO1 was not made in the right order because the RC had signed part 1 and 3 at the same time but before the AMHP had signed Part 2) and the underlying s3 would have still been running if the CTO1 hadn’t been put in place could the RC issue an urgent S17 leave then recommence the CTO1 process again (after liaising with the patient of course)?

Bringing the CTO to an end under s23 would also bring the underlying s3 to an end even if the s3 hadn’t expired so how would one deal with the defective CTO in a way that does not end the s3 so that the CTO1 could be recommenced - is it even possible?