Case Studies / IMCA Client D

IMCA Client D

Client D was a gentleman who lived in care home. He had a learning disability and an undiagnosed stomach issue. IMCA was instructed to act in relation to a Serious Medical Treatment proposal to sedate D and to carry out investigations to determine what the stomach issue was.

Barriers faced in being heard:

It was evident to the IMCA from gathering information and meeting D and speaking to staff that supported him that D would be very reluctant to engage in any medical treatments. Careful planning before, during and after the procedure would be required, to ensure the least restrictive and least distressing options were being utilised.

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Advocacy undertaken:

  • IMCA attended an initial best interest meeting. It was explained by the GP that she would like D to be sedated and conveyed to A&E to undergo a colonoscopy. IMCA explained that if D was going to be in hospital then the decision maker for a colonoscopy would be a hospital consultant. IMCA asked if one could be appointed so that questions could be raised with them about this proposed decision.
  • Whilst waiting for a hospital consultant (decision maker) to be appointed, the GP made the decision that D should be sedated and sent into hospital as an emergency decision. D was prescribed Lorazepam and his care home staff attempted to take him to hospital. On arrival to the hospital D refused to leave the car and the hospital staff at A&E explained that they were not able to sedate D further, nor were they able to support D’s complex needs. D was subsequently returned home. A second unsuccessful attempt to sedate D and take him to hospital as an emergency was carried out. No prior best interest decision had been made in either case.
  • A hospital consultant involved in this case had requested blood tests. Again without any best interest process, IMCA was informed that there had been two occasions when a blood test was carried out on D, one time involved safe holding to which it had been previously agreed by his MDT was overly distressing and should not be used.
  • As a result, IMCA raised a safeguarding referral and an ongoing investigation is currently being carried out. D’s health concerns have now resolved on their own, however there is now a formal best interest process in place regarding taking a further blood test, to which the IMCA is involved.

Outcomes:

As a result of IMCA involvement, the IMCA ensured that the correct best interest process was being followed, and raised a safeguarding referral when D was at risk of emotional, psychological and physical abuse due to sedation and being conveyed to hospital against his will without proper planning.

As a result of IMCA involvement the safeguarding team worked closely with the MDT to ensure that the least restrictive options were sought and correct care planning was in place. IMCA continues to represent D in relation to the decision regarding a blood test and will continue to act as a safeguard for him.