If a medical recommendation A8, has failed medical scrutiny for not satisfying the criteria, can it firstly be amended? Secondly, can it be sent to a second scrutineer to see if they will pass it?
No it cannot be amended as it isn’t a slip of the pen but an inadequate or incomplete recommendation. What happens next depends if it is still within the 14 day scrutiny period. If it is then a fresh medical recommendation (potentially by the same medic once they address the deficiencies in their original recommendation) can be arranged for and considered by the AMHP. But don’t be surprised if they no longer consider admission required as the AMHP must reconsider whether an application remains appropriate in light of the failed scrutiny.
I’m afraid your suggestion re a second opinion shouldn’t be acceptable to the hospital managers as it would create a risk that the detention lacked legal authority from the outset and amount to an unlawful deprivation of liberty.
If not within the period then its likely there’s no lawful authority to detain the patient.
A fresh assessment may be applied for but the hospital should follow its own procedures in terms of considering whether to potentially unlawfully detain a patient considering the risk to self and others or release them and request a fresh community assessment. The patient never agreed to informal admission so it would be questionable how s5 could be said to apply so local policy followed or legal advice may be taken before considering this step if over 14 days.
Hi Alasdair,
Most of my team were of the same view after reading Jones, so thank you for confirming our views.
As I used to domedical secrurtenizing, you can amend, amissing, part such as capacity, the fact no mention of possible community
Option, but if there’s no enough clinical justification, it will be unvalid
Best regards
Abdul
Hi Amy, if you are referring to a real example, it would be interesting to know how the reasons set out on the medical recommendation did not satisfy the criteria and what criteria those reasons were being measured against?
Re your specific questions; I agree with Alasdair that if the reasoning in the med rec is insufficient, the only remedy is to obtain a fresh medical recommendation within 14 days of the detention taking effect. If a fresh application is required, section 5(2) can be used, because the patient is an inpatient, despite how that came to be. To release the patient when the opinion is that they should be detained, would be absurd.
More generally, the (in)sufficiency of the narrative on a medical recommendation is usually going to be a subjective view and so the managers (i.e. the MHA admin on their behalf) may want to seek a view from someone more senior, before deciding on a course of action. In my experience, one person’s opinion about the insufficiency of reasoning on a med rec, has rarely been deemed to be the right opinion.
I’m not a fan of the term ‘medical scrutiny’. The term does not feature in the Act or the Code and it implies that only doctors can carry it out, which is not the case. When the Code is revised, paragraph 35.12 should be rewritten to state “Medical recommendations should also be scrutinised by someone with appropriate clinical expertise…” Properly trained MHA staff are more than capable of carrying out this administrative task.