Today’s correspondent

…recently resigned from a state ambulance service to work with a private ambulance company [in South Australia] …

I have received informal advice that private ambulance companies can’t transport patients under an Inpatient Treatment Order unless they are considered an authorised individual / ambulance officer under the Mental Health Act.

I would be extremely interested in your opinion on this given:

• we are a licensed, non-emergency ambulance service
• we have AHPRA registered nurses and Paramedics working for us
• most, if not all ‘ITO work’ would be facility to facility i.e., not from the community to ED

I guess I’m interested in whether a private ambulance services staff are considered authorised officers and ambulance officers with relevance to the Mental Health Act, and therefore allowed to convey mental health patients?

The Mental Health Act 2009 (SA) provides for ‘Level 1’, ‘Level 2’ and ‘Level 3’ inpatient treatment orders (ss 20-38).  

A level 1 order may be made by a medical practitioner or authorised mental health professional (s 21(1)).  It is valid for not more than seven days (s 21(4)). The patient must be examined by a psychiatrist or authorised mental health professional within 24 hours and that professional must either confirm, or revoke the order (ss 21(5)). 

A level 2 order may be made by a a psychiatrist or authorised mental health professional who examines a patient subject to a level 1 order (s 25(1)). It is valid for not more than 42 days (s 21(6)).  A level 3 order may be made by the South Australian Civil and Administrative Tribunal (s 29(1)).  A level 3 order is not valid for more than 6 months in the case of a child or 12 months in the case of an adult (s 29(5)).

A person who is subject to an inpatient treatment order is an ‘involuntary patient’ (s 3).

Section 35 provides that ‘the director of a treatment centre’ may ‘may give a direction for the patient to be transferred to [another]… treatment centre’ if that is necessary or appropriate.  A direction may also be given to transfer a patient to or from a hospital if they require hospital treatment for an illness other than a mental illness’ (and also presumably if they require treatment for an injury).

Where the director authorises the transfer of a patient, he or she may issue a ‘patient transport request’ (s 55(1)(d)).  The request (s 35(2)) must be:

(a) directed to authorised officers and police officers generally; and

(b) in writing in the form approved by the Chief Psychiatrist.

Authorised officers are (s 3):

(a) a mental health clinician; or

(b) an ambulance officer; or

(c) a person employed as a medical officer or flight nurse by the Royal Flying Doctor Service of Australia (Central Operations) Incorporated or the Royal Flying Doctor Service of Australia (South Eastern Section); or

(d) a person, or a person of a class, approved by the Chief Psychiatrist, by notice in the Gazette, for the purposes of this definition; or

(e) any other person, or person of a class, prescribed by the regulations for the purposes of this definition;

The term ‘ambulance officer’ means (s 3):

… a person who is—

(a) employed as an ambulance officer, or engaged as a volunteer ambulance officer, with an organisation that provides ambulance services; and

(b) authorised by the chief executive officer of SA Ambulance Service Inc to exercise the powers conferred by this Act on authorised officers;

By notice in the government gazette dated 30 May 2017 a number of people were appointed authorised officers for the purposes of paragraph (d) of the definition of authorised officers – see Mental Health Act 2009: Authorised Officers published by the Office of the Chief Psychiatrist or refer to Government Gazette No. 35 (30 May 2017) p. 1966. There is no person nor class of persons prescribed by the Mental Health Regulations 2010 (SA) for the purpose of paragraph (e) of the definition of authorised officers.

Section 56(3) provides that an ‘authorised officer may … exercise the following powers in relation to a person to whom this section applies’ (which includes a person subject to a patient transport request (s 56(1))):

(a) the authorised officer may take the person into his or her care and control;

(b) the authorised officer may transport the person from place to place;

(c) the authorised officer may restrain the person and otherwise use force in relation to the person as reasonably required in the circumstances;

(d) the authorised officer may restrain the person by means of the administration of a drug when that is reasonably required in the circumstances;

(e) the authorised officer may enter and remain in a place where the authorised officer reasonably suspects the person may be found;

(f) the authorised officer may search the person’s clothing or possessions and take possession of anything in the person’s possession that the person may use to cause harm to himself or herself or others or property.

Conclusion

The term ‘authorised officer’ refers to ambulance officers, not paramedics.  Paramedics are not approved under either paragraph (d) or (e) of the definition of ‘authorised officers’. My correspondent may be ‘employed as an ambulance officer … with an organisation that provides ambulance services’ (see Health Care Act 2008 (SA) s 57 ‘Emergency ambulance services’ and s 58 ‘Licence to provide non-emergency ambulance services’) but that does not make them an ‘authorised officer’. Equally a paramedic employed by the South Australian Ambulance Service (SAAS) is not, by virtue of their employment, an authorised officer. In either case they must also be ‘authorised by the chief executive officer of SA Ambulance Service Inc’ for that purpose.

It follows that a paramedic who is employed by a private ambulance provider, but who is not authorised by either the Chief Psychiatrist or ‘the chief executive officer of SA Ambulance Service Inc’ is not an ‘authorised officer’ for the purposes of the Mental Health Act 2009 (SA) and cannot ‘transport patients under an Inpatient Treatment Order’.

This blog is made possible with generous financial support from the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), Natural Hazards Research Australia, NSW Rural Fire Service Association and the NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.