Psychiatric Law and Preventive Confinement

Law 2 - Confinement, Privacy & Confidentiality, and Resources

• Course: NUR1 424 – Fall 2024
• Lecturer: Daria Kapnik

Plan

• Authorization for Treatment:
  • Recap of Court Orders under CCQ
  • Treatment order
• Confinement Law:
  • General Principles
  • Parameters
  • Types of Confinement (Preventive, Provisional, Authorized)
  • Rights of the person under confinement
  • Potential issues in confinement
• Privacy, Confidentiality and Resources:
  • Patient access and medical records (General, Deceased patients, Privacy, confidentiality and care issues regarding minors)
  • Management of Limited Resources and Patient Rights (Key Provisions, Caselaw)

Outline

• Authorization for Treatment:
  • Recap of Court Orders under CCQ (situations for obtaining court orders)
  • Art. 16 CCQ: person of full age incapable of giving consent refuses care
  • Art. 16 CCQ: no delegate for consent or refuses without justification
  • Art. 16 CCQ: Minor over 14 refuses care
  • Arts. 17/18 CCQ: Care entails serious risk for minor's health
• Confinement in an Institution:
  • General Principles (Confinement is exceptional; person is a serious and imminent danger to themselves or others)
  • Types of Confinement (Voluntary, Forced - Preventive, Provisional, Authorized)
  • Locations for confinement (local community service centre, hospital)
  • Preventive Confinement (no court order, ordered by physician, dangerous to oneself or others; immediate and grave danger)
  • Prevenitive Confinement - further process (72-hour period, physicians conclusion of danger, court order for extension, provisional confinement, psychiatric examination, ideally within 24 hours)
  • Section 8 Act P-38 (peace officer action)
  • Section 23 Act P-38 and more pressing medical emergencies, hospital responsibilities
• Confinement in an Institution - Types of Confinement (cont'd):
  • No one may be confined without consent or authorization by law (CCQ 26 par 1) or by a court
  • Specifics for 'Grave or important danger' to ensure it's detailed, specific and precise
• Confinement in an Institution - Types of Confinement (cont'd):
  • (Preventive Confinement cont'd)
  • Assessment and authorization within 72 hours
• Confinement in an Institution - Provisional Confinement:
  • Person must present a danger (grave or serious potential danger) to themselves or others
  • Court order required
  • Obtained for evaluation if patient refuses evaluation
• Confinement in an Institution - Provisional Confinement (cont'd):
  • For situations outside of a hospital
  • Court action to force psychiatric examination - required (Art. 28 CCQ)
  • Court Order if immediate danger
• Confinement in an Institution - Provisional Confinement (cont'd):
  • Procedures for the initial process
  • Timing for completion of 1st/2nd examination/
• Confinement in an Institution- types of confinement (cont'd) :
  • Initial 48-hour limits (review and renewal)
  • 96-hour review after initial confinement
• Confinement in an Institution - Motion for Authorized Confinement - Process: -Physician's conclusion about the need for confinement -Court presentation within 48 hours
• Confinement in an Institution - Motion for Authorized Confinement - Process (cont'd):
  • Court procedures (2 days for service of the motion)
  • Patient’s family, close friend, or Public Curator if needed
• Confinement in an Institution - Motion for Authorized Confinement - Duration:
  • Maximum 30 days
  • Other time frames if necessary -Release as soon as not dangerous to self or others
• Confinement in an Institution - Motion for Authorized Confinement - PSY content:
  • Psychiatric examination report specifics
  • Necessity for confinement, ability to care for themselves/administer property, need for protective supervision
• Confinement in an Institution - Motion for Authorized Confinement - Court order criteria: -Confinement only if both reports conclude it's necessary -Court needs serious reason to believe in danger
• Confinement in an Institution - Motion for Authorized Confinement - Court order criteria (cont'd): -Judge’s discretion in these matters -Detailed reports needed
• Confinement in an Institution - Motion for Authorized Confinement - Renewal:
  • Extension possible, up to 90 days more -New psychiatric examination required
• Confinement in an Institution - Motion for Confinement - End of Confinement: -Confinement ends without formality -Conditions for ending confinement: physician's certificate, time expiration, court decision on confinement (order)
• Confinement in an Institution - Motion for Confinement - Longer Confinement (Section 10 of Act P-38): -Examination required every 21 days if longer than 21 days, every 3 months.
• Confinement in an Institution - Rights of the person under confinement: -Review of rights (Schedule of P-38) , need for service of application ,exception for clinical
  • Testimony needed unless otherwise not possible
  • Right to communication with outside, counsel (at all stages)
• Confinement in an Institution - Rights of the person under confinement (cont'd):
  • Information about the program of care
  • Right to appeal (Tribunal Administratif, Court of Appeal)
• Confinement in an Institution - Potential issues in confinement:
  • Consent to care during confinement still needed (through the Superior Court)
  • Restraints (only if ordered or emergency)
  • AWOL (lack of communication with DPS office which could result in forced return to hospital)
• Caselaw:
  • Charles Le Moyne v. E(F) (CQ)
  • CSSS Côte-de-Gaspé, P(C) (CQ)
  • Hôpital Maisonneuve-Rosemont c. H(M) (CQ)
  • J.M. c. Hôpital Jean-Talon du (CIUSSS) du Nord-de-l'Île-de-Montréal (2018 QCCA 378)
• Privacy - Patient Access and Medical Records:
  • Patient's right to access health information. -limitations
  • Rights for Deceased Patients. – legal representatives of a deceased person may access the record.
• Privacy, Confidentiality and Care Issues Regarding Minors:
  • Parental Access
  • Access by other bodies, Statutory duties of disclosure
• Management of Limited Resources and Patient Rights:
  • Rights and obligations (LSSSS)
  • Conflicts and Caselaw (Jasmin v Cité de la santé de Laval (AZ-90021046), Noël-Voizard, JO v. Hôpital Royal Victoria) (related to access or denial of certain services, and possible discriminatory practices)