A Queensland paramedic writes to ask ‘is there a way to transport a patient to hospital who is at risk to either themselves or their dependents, without putting them on an EEA?’ 

They provide a context of ‘the heavily intoxicated pt. Not necessarily requiring an EEA for mental health, but needing a safe place to be observed whilst they sober up. We were told that involuntary transport would suffice.’  In another context they discuss a patient who denies being drug affected, even though paramedics suspect otherwise. The patient is fully conscious and refuses treatment.

My correspondent says

Having reviewed the case and reflected, and having done some searching on the Qld Mental Health Act, I can’t seem to find anything relating to the involuntary transport of a pt from home to a healthcare facility other than an EEA under Public Health Act. Could it be possible that we essentially kidnapped the patient?

Kidnap is a strong word, suggesting keeping someone for advantage. It is not so much a kidnap but a false imprisonment.

In Queensland the power of paramedics to detain a person and impose treatment upon them is found in the Public Health Act 2005 (Qld) (see Involuntary detention by police or ambulance officers under the Public Health Act (Qld) (March 16, 2021); see also Paramedics and the mentally ill – Queensland – An update (October 14, 2019) and In Queensland, is threatening suicide evidence of ‘a major disturbance in [a] person’s mental capacity’? (August 6, 2020)).  It is assumed in today’s question that the criteria for an Emergency Examination Authority is not met. If that is the case is there any other power of ‘involuntary detention’? The answer must be ‘no’.

Where a patient cannot consent, or refuse consent, that is they are no longer competent, then treatment that is necessary and in their best interests, including transport to hospital can be given (see The doctrine of necessity – Explained (January 31, 2017) and Legal justification for treating the unconscious (April 11, 2021)). Where the patient is competent to make their own decisions, a decision to refuse treatment/transport must be honoured even if the paramedics and other health professionals think it is an unwise decision.  That is a fundamental legal and ethical principle and should not be at all controversial. You cannot impose treatment upon a person who is capable of giving consent and who does not consent no matter how beneficial it would be for them or for others.

Given that background I have no idea what a Queensland paramedic, or any other health professional, means by ‘involuntary transport’ if it is not an EEA.

With respect to a heavily intoxicated person who needs to be detained for their own protection, police have power to deliver them into protective custody – see Police Powers and Responsibilities Act 2000 (Qld) s 378 but that only applies where the person has been arrested for being intoxicated in a public place (an offence contrary to the Summary Offences Act 2005 (Qld) s 10). It does not apply to a person who is not in a public place, eg at their own home.

Conclusion

In Queensland the only power given to paramedics to impose treatment upon a patient is under the provisions of the Public Health Act 2005. If the patient is competent and refuses treatment, and the criteria for an Emergency Examination Authority does not exist, then an ‘involuntary transport’ is a false imprisonment, you have ‘essentially kidnapped the patient’.