Vancouver IM LMR

Many thanks to Dr. JJ Sidhu (VA Department Head & Medical Director, Psychiatry), Aaron Leung RN (VCH/ PHC Project Manager), and Julia Lauwers (VCH Senior Legal Counsel) for presenting on the very important topic of consent in health care, specifically the Mental Health Act (MHA) and the Health Care Consent Act (HCCA).

See the slide deck here.

Key Takeaway points:

• Mental Health Act: allows involuntary admission for PSYCHIATRIC (not medical) treatment in a designated facility (this does not include many of the smaller rural/ community hospitals!)
  • Form 4.1: First Medical Certificate (needs to be signed by a fully licensed physician/ NP AND director/ delegate, ideally within 4 hours of the physician/ NP signature) certifies the patient for 48h.
  • Form 4.2: Second Medical Certificate (needs to be signed by a fully licensed physician/ NP, different from the one who signed Form 4.1, AND director/ delegate, ideally within 4 hours of the physician/ NP signature)
    • For Forms 4.1 and 4.2, the physician does not need to be a psychiatrist. The director/ delegate is usually a head nurse/ charge nurse/ PCC.
  • Form 5: Consent for Treatment (needs to be signed by a fully licensed physician/ NP AND director/ delegate)
    • Specifically this is for psychiatric treatment, including any medications, restraints or seclusion, or detention.
  • The other forms 13, 15, and 16 should be signed by the director/ delegate. There is a Cerner Powerplan that initiates completion of these forms.
• Health Care Consent Act (i.e. Section 12) authorizes emergency health care to be provided without consent (including medical treatment)
  • A healthcare provider (HCP) can provide health care to an adult (+19) without the adult’s consent if:
    • It is necessary to provide care in order to preserve the adult’s life, to prevent serious physical or mental harm, or to alleviate severe pain
    • The adult is incapable of giving or refusing consent
    • The adult does not have a personal guardian or representative who is authorized to consent/ capable and available to do so, and
    • A second HCP confirms the first HCP’s opinion
  • Incapability is based on whether or not the adult understands:
    • The information given by the HCP on the condition for which the health care is proposed, the nature of the proposed health care, the risks and benefits, and alternative courses of health care.
    • That the information above applies to the adult and their situation
  • Caveats:
    • You cannot continue to provide treatment without consent once the person becomes capable
    • You cannot use the HCCA to provide treatment without consent if delays in that treatment would not cause patient harm