Case Studies / IMCA Client B

IMCA Client B

B was a patient in hospital and had been admitted to the ward after collapsing whilst out in the community. B was diagnosed with a brain injury and was deemed to meet the ‘acid test’ for a DoLS authorisation whilst in hospital. An IMCA was instructed to act as B’s Relevant Persons Representative (RPR). It became apparent that medical professionals felt that B would benefit from a period of rehabilitation at another hospital. B became very distressed and did not want this transfer to happen and instead expressed a wish to return home.

Barriers faced in being heard:

B acknowledged that he had initially needed to be in hospital but felt that he had recovered and did not need to be in hospital anymore.

The IMCA RPR requested a Part 8 review (MCA 2005) of the DoLS authorisation which was completed. It was acknowledged by the DoLS team that B was orientated to time, place and person, but the best interest assessor felt that due to B’s ‘delusional behaviour’, he lacked capacity around being in hospital and therefore required a further DoLS authorisation.

The IMCA attended a best interest meeting for B where B’s wishes and views were represented. The MDT felt that it was in B’s best interest to transfer to Rookwood Hospital for rehabilitation. The IMCA highlighted the condition placed on the DoLS authorisation which stated a neuropsychiatry assessment should be completed. The assessment had been carried out and had found that rehabilitation would have “little benefit”. Despite this, the consultant and MDT felt that this assessment was “untested” and therefore B should be transferred to Rookwood Hospital.

During the best interest meeting, the IMCA RPR requested legal advice be sought by the hospital around the legal framework of moving B against his wishes to another hospital. This was completed by the consultant, and a response was provided by the legal team that B could be moved without his consent for medical treatment if it was deemed to be in his best interest.

Subsequently, B was moved from the first to the second hospital. This had been completed with the involvement from the initial hospital’s staff and a security team. The IMCA RPR requested that a DoLS application was made as a matter of urgency.

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Advocacy undertaken:

  • A DoLS authorisation was put in place the following week and the IMCA RPR received a new mandate to represent B. The IMCA RPR visited at the second hospital where B informed the IMCA RPR that he had been “tricked” into moving there.
  • B objected to being a patient in and stated a wish to return home immediately. B refused to engage with professionals as a protest to being on the ward.
  • The IMCA RPR raised B’s views to the responsible hospital team and another best interest meeting was arranged. During the best interest meeting, the OT and physiotherapy team explained that B had little needs in regard to activities of daily living and was managing his own medication on the ward. The Ward Psychologist had a different experience where B did not wish to engage with her. Despite this, it was felt by the consultant that rehabilitation was of no benefit to B and he should be discharged home.
  • The OT raised a concern that B refused to allow anyone into his home without him being there. Furthermore, B had grown a deep distrust for the hospital professionals and did not want to go to his home with just hospital staff.
  • The IMCA RPR met with B and explained that the hospital wanted to discharge him home but that a home assessment was required. B agreed to the assessment taking place, on the condition that the IMCA RPR accompanied him and the OT to ensure he wasn’t “tricked” again.

Outcomes:

Following the home assessment, it was decided that there were no issues and B was discharged home.

Through the IMCA RPR, B was able to access his legal rights within the DoLS. The IMCA RPR ensured that B had his authorisation reviewed when necessary, and also ensured that conditions within the DoLS were adhered to.

The IMCA RPR represented B’s wishes and views in best interest meetings, and ensured that legal advice was sought when appropriate.