Today’s correspondent asks

Is there a law where health professionals (paramedics) cannot schedule or diagnose other family members?

The simple answer is that there cannot be a law that people cannot treat or diagnose their family members; people do it all the time and in many cases must do so. The Paramedic Board’s Code of Conduct (Interim)  (June 2018) does not prohibit treating family members but it does caution against it.  The Code of Conduct says (at [3.14]):

3.14 Understanding boundaries

Good practice includes recognising the potential conflicts, risks and complexities of providing care to those in a close relationship, for example close friends, work colleagues and family members and that this can be inappropriate because of the lack of objectivity, possible discontinuity of care and risks to the practitioner or patient. When a practitioner chooses to provide care to those in a close relationship, good practice requires that:

  • adequate records are kept
  • confidentiality is maintained
  • adequate assessment occurs
  • appropriate consent is obtained to the circumstances which is acknowledged by both the practitioner and patient or client
  • the personal relationship does not in any way impair clinical judgement, and
  • at all times an option to discontinue care is maintained.

And at [8.11] Conflicts of interest:

Patients or clients rely on the independence and trustworthiness of practitioners for any advice or treatment offered. A conflict of interest in practice arises when a practitioner, entrusted with acting in the interests of a patient or client, also has financial, professional or personal interests or relationships with third parties which may affect their care of the patient or client…

When these interests compromise, or might reasonably be perceived by an independent observer to compromise the practitioner’s primary duty to the patient or client, practitioners must recognise and resolve this conflict in the best interests of the patient or client, practitioners must recognise and resolve this conflict in the best interests of the patient or client.

Where a practitioner is genuinely treating a family member, he or she has to bear in mind those provisions and act in the best interests of the patient.

But the focus in this question is on mental health law and, to put it into context, I’m told this arises in court proceedings where one party has claimed in evidence that the other party is suffering a mental illness and this diagnosis is based on that party’s experience as a paramedic.

If there really is, or has been, a therapeutic relationship between the parties, putting details of the patient’s diagnosis in an affidavit that is being used to advance the practitioners, and not the patient’s best interests is failing in all respects to act as an appropriate professional and is in breach of so much of the code of conduct as to be indefensible.

If, on the other hand, the paramedic does not have a therapeutic relationship with the person then I would expect that any judge would think the opinion in any affidavit would be irrelevant.  The conflict of interest is obvious and the person has not undertaken a proper or professional assessment of the other party – the alleged patient. That is not a diagnosis it is an abuse of power and, I would suggest, a breach of the obligation to maintain professional boundaries.

It’s not for me to give legal advice in particular cases but if I was a lawyer acting for a party in proceedings, I would consider seeking orders to have that material struck out of the other party’s affidavit on the basis that it is inadmissible.  It does however all depend on the jurisdiction and whether the rules of evidence apply.  Many judges may ‘allow it in’ but say that the obvious conflict is something they’ll consider when assessing the value of that evidence.  How to proceed requires legal advice from those involved in the matter not from the author of a blog.