I’ve been asked to rescind medical recommendations. I refused point blank.
The scenario:
Patient in S136 suite brought in on a S135.
The 24 hour limit was breached days ago.
Two med recs say P should be admitted to a hospital under S2 with clear reasons recorded in the EPR. To be clear the med recs had not expired.
AMHP has seen patient and agrees with med recs.
Application not completed by AMHP because ‘no beds’ - the usual where tails wag the Parliamentary head.
P held under common law thereafter, waiting for a bed. [Don’t ask - accept it as fact].
A supervised facility that is not a hospital in the community was found (not another 136 suite)
The arrangements required that for the patient to be transfer to that facility that I "rescind the medical recommendations". I’m told the latter word of mouth by three staff FTF - and same is written in the records.
I said that I have no such powers to ‘rescind’ two medical recommendations.
An authoritative noctor insists that I have such powers but is unable to inform me where those powers might come from.
Same above from another non-CCT consultant psychiatrist.
Six hours study of the law followed. I am unable to find anything giving me powers to rescind medical recommendations.
In case anyone reading this is in disbelief, thinking there ‘must have been a misunderstanding.’ - there was none! I know that “rescind the medical recommendations” was said and written. There was very clear documentation of four individuals who ‘agreed’ that resciding of the med recs was necessary to enable the transfer to a non-hospital location in the community.
I am not in a position to ask the four individuals for their souces of knowledge, because such actions will be taken as ‘challenging and confrontational’ even if the most dispassionate language is used. Those who know NHS cultures in the last 5 years will know what I mean.
Exhausted I am - and now I seek sound references in law, from knowledgeable folk on one point: “Where in law are my powers to rescind existing valid medical recommendations coming from?”
For the avoidance of doubt, I am not interested in any ‘logic’ that may apply to transfering a patient held under common law to another supervised non-hospital facility, even if the patient was of capacity and consented to the transfer. The one question above is what occupies my mind.
It is my understanding, from nearly 32 years experience of being an ASW/AMHP, that once the medical recommendations are written and signed it is up to the AMHP to decide whether they will make an application for detention or not. The AMHP can wait up to 14 days before making the application. In the circumstances you have described I fail to understand why you were requested to rescind your med rec. Until an AMHP has completed their section 2 application the patient is NOT liable to be detained and the med recs remain only there to be acted on when a bed becomes available. Indeed, the patient may improve in their condition, as I have experienced personally within the last five years, and the application is no longer needed. The AMHP is the professional who destroys the med recs.
So I don’t understand why the managers seeking to transfer this patient needed you to rescind the med rec. But, answering your specific question, I don’t think anywhere in the MHA itself, the Code of Practice, Reference Guide or Memorandum, does it say that a s.12 doctor can rescind their med rec once signed and completed. The main reason for that is that it is now in the hands of the AMHP awaiting their decision, as stated earlier. I hope that makes sense.
Hi Russell, I am so sorry you had to undergo this experience. My take on this as an AMHP is that nobody may direct you to withdraw your medical recommendation. You have deemed it appropriate to make a medical recommendation based upon evidence following your clinical assessment. If I were the AMHP in this situation I would retain the medical recommendations irrespective of whether or not an application was being made. I think the key point here would be if the AMHP was minded to make an application. If they were then there is no debate, the med recs remain alongside the intention of the AMHP to make an application. Without knowing the specifics Russell, if this is a case of the service rethinking the care plan for the patient which is accompanied by alternative arrangements without the agreement of the assessment team, then they can do this. You don’t have to withdraw the medical recommendation if you do not assess the situation as changed other than the place of care intended which I suspect is unable to take patients detained under the act. Hope this helps and feel free to email me Russell and I am happy to walk through the case with you as I might not have fully understood the intricacies of the case.
I think what Jacob says in passing is really the key here - you made that recommendation at a specific time with specific information. If things change, then it’s the AMHP that should discontinue the search for a bed (or if the patient has already been admitted, the doctor to assess whether they still meet the statutory criteria for detention).
But also very curious about the circumstances where the s2 process would have to be voided rather than discontinued. Is it perhaps a commissioning issue? Does the placement need to know that the s2 won’t be applied for? Surely any issues that arise in respect of this can be resolved by the AMHP refusing to act on the recommendations.