Today’s question came as a comment on an earlier post – NT Paramedics and the mentally ill (February 2, 2017).  The comment/question is:

It has been explained to me (as a NT Practitioner) that a Paramedic working in the NT legally has the ability to detain and section a patient. However [St John Ambulance Australia (NT)] SJANT policy for detaining does not exist nor does any formal section documentation and as such this requires [Northern Territory] police [NTPOL] attendance to detain the patient for transport to hospital as an involuntary patient. Hearsay being that SJANT does not wish to be involved in the sectioning of patients despite having policies for the restraint and sedation of involuntary patients.

In the unlikely event that NTPOL is unavailable and an involuntary patient was transported in accordance with sedation and restrain policies without formal documentation of the section order, how would this fall?

As a policy does not exist to say not to section a patient would the paramedics involved still be liable for violating company policy and such be up for dismissal? Would they still be protected under the legislation if the patient were to lodge a case in court or the patient deteriorated, and the event became a coronial matter?

Let me first put aside one issue.  One doesn’t get ‘protected’ if an event becomes a coronial matter. Coroners investigate deaths where the identity of the deceased or cause of death is uncertain or where there are matters that warrant investigation to allow the Coroner to make recommendations to avoid future deaths. Coroners do not determine liability for either crime or compensation.

Putting those issues aside we can turn to the question. It is correct that the originally post is old (2017) so we’ll revisit the Mental Health and Related Services Act 1998 (NT).  Section 31 has been amended from the time of that first post and now refers to paramedics rather than ‘ambulance officers’. The current version of the section says:

(1) A paramedic may detain a person being conveyed in an ambulance for up to 6 hours where the paramedic believes, on reasonable grounds, that the person may fulfil the criteria for involuntary admission on the grounds of mental illness or mental disturbance.

(2) When detaining a person under subsection (1), a paramedic may use reasonable measures, including the use of restraints, on the person:

(a) to prevent the person causing serious harm to the person or to someone else; or

(b) to prevent behaviour of the person likely to cause serious harm to the person or to someone else; or

(c) to prevent further physical or mental deterioration of the person; or

(d) to relieve acute symptomatology.

(3) A paramedic who detains a person under subsection (1):

(a) must convey the person to the nearest approved treatment facility or, if that is not practicable, to the nearest hospital, as soon as practicable after the person is detained; and

(b) on arriving at the approved treatment facility or hospital, must complete the approved form and send it to an authorised psychiatric practitioner.

(4) For subsection (3)(b), the form may be sent by fax or email.

The prescribed form is the Form 6 – Ambulance Officer Detention Notification but I am unable to locate that form online (see however, Northern Territory Department of Health Mental Health and Related Services Act 1998, Approved procedure number 28: Transport of Patients (9/03/2020, Version: 7.0)).

In my original post, when the Act referred to an ‘ambulance officer’, I said:

In the absence of any ambulance service legislation, the term ‘ambulance officer’ must be defined. For the purposes of the Mental Health and Related Services Act, ‘ambulance officer’ means any person ‘employed as an ambulance officer, or engaged as a volunteer ambulance officer, by an approved ambulance service at the level of qualified ambulance officer or above’ or a person appointed as an ambulance officer by the Chief Health Officer (ss 4 and 24).

That meant a person’s authority to act under s 31 came with his or her employment or appointment.  Now that the Act refers to a paramedic, it comes with his or her registration as a paramedic (see also s 4, definition of ‘paramedic’).  The power is not now a power vested in St John Ambulance (NT) but a power vested in any and every registered paramedic.

Let me then break down my correspondent’s question. They said:

It has been explained to me (as a NT Practitioner) that a Paramedic working in the NT legally has the ability to detain and section a patient.

We can see that by virtue of s 31 that is correct.

However [St John Ambulance Australia (NT)] SJANT policy for detaining does not exist nor does any formal section documentation

There is ‘formal section documentation’ it is just not a St John document.  It is the Form 6 – Ambulance Officer Detention Notification.

and as such this requires [Northern Territory] police [NTPOL] attendance to detain the patient for transport to hospital as an involuntary patient.

No, it doesn’t and neither did the earlier version of the Act. The power of paramedics to treat their patient is found, relevantly in s 31.  That in no way requires police attendance regardless of whether there is or is not formal documentation.

In the unlikely event that NTPOL is unavailable and an involuntary patient was transported in accordance with sedation and restrain policies without formal documentation of the section order, how would this fall?

Provided the paramedic complies with s 31 then he or she is acting according to law.  Section 31(1) gives the paramedic the power to detain and s 31(2) gives him or her the power to restrain the patient. Section 61 talks of ‘mechanical restraints’ whereas s 31 refers to ‘restraints’.  If it was intended to limit s 31 to ‘mechanical restraints’ the words would have been used so s 31 must have a wider application and would appear to include chemical or pharmaceutical restraints.

There is nothing in s 31 that says NTPOL need to be involved in the decision making, detention or transport of the patient.

As a policy does not exist to say not to section a patient would the paramedics involved still be liable for violating company policy and such be up for dismissal?

It is outside the scope of this blog to go into details of an employment contract with St John (NT) but the obvious answer is that if there is no policy to say ‘don’t act under s 31’ you are not in breach of any policy if you do.

Further an advantage of paramedic registration is that paramedics now have independent duties and authorities.  If a paramedic believed ‘on reasonable grounds, that the person may fulfil the criteria for involuntary admission on the grounds of mental illness or mental disturbance’ and that they needed care, and they complied with the Act and the Mental Health and Related Services Act 1998, Approved procedure number 28: Transport of Patients I cannot see how any employer could take action against them. As a paramedic they have a professional duty to act in their patient’s best interests and provide treatment and care that is available. It is the Northern Territory Parliament that has determined that paramedics can detain and transport a patient. They can do that whether they have their employer’s permission or not. With that authority a paramedic could be negligent or guilty of professional misconduct if he or she refused to treat and transport a patient because their employer had not said they can.

Would they still be protected under the legislation if the patient were to lodge a case in court or the patient deteriorated, and the event became a coronial matter?

Absolutely. The authority under s 31 is given to a paramedic. Provided he or she had the necessary belief and acted reasonably (evidence of which would be compliance with the Mental Health and Related Services Act 1998, Approved procedure number 28: Transport of Patients) then they have complied with the law. The attitude of St John (NT) or NTPOL would be irrelevant.