A Queensland based paramedic has a question regarding Emergency Examination Authorities (EEAs). They say:
…when completing an EEA we must provide the time of which we hand the patient over to the care facility. I was wondering what power we have during transport of the patient as we are not under the time of the EEA during transport?
EEAs are provided for in the Public Health Act 2005 (Qld). An emergency examination authority is issued by an ambulance officer (s 157D). The issue of the authority authorises others to detain the person the subject of the authority (s 157E). It follows, as my correspondent says, that a person detained by an ambulance officer is not subject to an EEA; the powers of an ambulance officer are found in s 157B which says:
(1) This section applies if an ambulance officer or police officer believes—
(a) a person’s behaviour, including, for example, the way in which the person is communicating, indicates the person is at immediate risk of serious harm; and
a person is threatening to commit suicide
(b) the risk appears to be the result of a major disturbance in the person’s mental capacity, whether caused by illness, disability, injury, intoxication or another reason; and
© the person appears to require urgent examination, or treatment and care, for the disturbance.
(3) The ambulance officer or police officer may detain the person and transport the person to a treatment or care place…
The ambulance officer must (s 157C) tell the patient that they are ‘detaining the person and transporting the person to a treatment or care place’ and must tell them:
(a) in an appropriate way having regard to the person’s age, culture, mental impairment or illness, communication ability and any disability; and
(b) in a way, including, for example, in a language, the person is most likely to understand.
The ambulance officer may use ‘the force, that is necessary and reasonable in the circumstances’ (s 157L).
The Act does not specifically say what if any treatment may be given but the use of necessary and reasonable force would imply the use of both chemical and physical restraints where they are provided for in the ambulance service clinical practice guidelines and are based on appropriate health science.
Ambulance officers may detain and transport, using reasonable force, a patient who meets the criteria set out in s 157B. The authority of an ambulance officer is not found in the EEA as ambulance officers issue an EEA to authorise future detention by others.
For related posts see
- Paramedics and the mentally ill – Queensland – An update (October 14, 2019);
- In Queensland, is threatening suicide evidence of ‘a major disturbance in [a] person’s mental capacity’? (August 6, 2020);
- Involuntary detention by police or ambulance officers under the Public Health Act (Qld) (March 16, 2021);
- No power of generic ‘involuntary transport’ in Queensland (May 15, 2021); and
- Completing a Queensland EEA with the paramedic’s name (May 20, 2021).
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.
A person’s state of mental health is NOT a criminal offence, requiring use of force … whether deemed ‘reasonable’ or not.
The State is supposed to provide health care, not custodial imprisonment for those who are ‘having a bad day’ …
When will the State cease FORCING so-called ‘treatment’ upon those who don’t want to be forced to take medication, be locked up, and worse still, be tied down and undergo ECT against their will.
Mental HEALTH ?
It’s not a crime …
They are indeed good questions. It is part of my argument why I don’t think s 20 of the NSW Act should be read as authorising ambulance officer to detain a person. Section 22 allows police to do that in limited circumstances and we should leave it to police to detain people of their liberty. See also Bradley, E., Townsend, R. and Eburn, M. ‘Paramedics and ACT Mental Health Legislation’ (2015) 12(4) Australasian Journal of Paramedicine, Article 1, 1-6.
So to confirm, the moment the paramedic decides/determines that the patient is required to be transported to hospital or other place on an EEA is when they are detained under the relevant legislation? Therefore, the time recorded is at this point, not when handing over to hospital or other staff? Because as you have alluded to, if the time is recorded as when the paramedic hands over, the patient has technically been kidnapped.
I’ve been having this exact discussion a lot recently and would love to have a clear answer.
Craig, I’m afraid your comment/questions do not reflect what I said (which I note reflects more on me than you). A paramedic does not detain and transport a person under an EEA. The paramedic’s (or more accurately the QAS officer’s) authority to detain and transport the patient is found in s 157B. Having determined that the person is ‘at immediate risk of serious harm’ due to ‘a major disturbance in the person’s mental capacity’ then they can detain the person. At that point there is no EEA, but this is not ‘kidnapping’ as there is statutory authority.
The ambulance officer can then transport the person to a ‘treatment or care place’ (s 157B(3)).
Section 157D(1) says “If the ambulance officer or police officer takes the person to a treatment or care place that is a public sector health service facility, the officer must immediately make an authority (an “emergency examination authority” ) for the person.” Does that mean ‘immediately’ upon detention or immediately upon arrival at the treatment place? I would infer it means the later. Section 157D(3) says ‘The person may be detained in the treatment or care place while the authority is being made’. If it had to be made at the scene there would be no need for subsection (3). Section 157D(4) ‘Immediately after making the authority, the ambulance officer or police officer must give the authority to a health service employee at the treatment or care place.’ They could not do that if they had filled the EEA out at the scene. Next s 157E says “(1) A person subject to an emergency examination authority may be detained in a treatment or care place that is a public sector health service facility for a period (the”examination period” ) of not more than 6 hours starting when the authority is given to the health service employee under section 157D (4)“. It is critical that the QAS officer records the time of the EEA as that is when the 6 hour examination period begins. If the time is the time of initial detention that may take significant time off the examination period (eg if there was a long transfer to the facility). Finally s 157D(b)(2) says that the EEA is to record ‘the time when it is given’ that is the time the EEA is given to the staff (s 157D(4)) not the time the patient was first detained.
So, the QAS officer finds a patient who meets the criteria in s 157B. They can detain them and take them to a ‘treatment or care place’. At that place they complete an EEA and hand that to the staff. The EEA then authorises to the staff at the facility to continue the patient’s detention (s 157E) and authorises a doctor to examine the patient (s 157F).
To return to the comment:
“So to confirm, the moment the paramedic decides/determines that the patient is required to be transported to hospital or other place on an EEA is when they are detained under the relevant legislation?” No; the moment the paramedic decides the patient meets the conditions set out in s 157B, advises the patient as required by s 157C and then detains the patient is when the patient is detained under the legislation but they are not, at that time, detained pursuant to an EEA.
“Therefore, the time recorded is at this point, not when handing over to hospital or other staff?” No; the time recorded should be when the EEA is handed to ‘a health service employee at the treatment or care place’. That represents the start of the 6 hour examination period provided for in s 157E.
“Because as you have alluded to, if the time is recorded as when the paramedic hands over, the patient has technically been kidnapped.” At no point have I alluded to or made a claim that ‘if the time is recorded as when the paramedic hands over, the patient has technically been kidnapped’. I never used those words and that conclusion is absolutely contrary to the conclusion I was trying to draw. Between the decision of the ambulance officer to detain the patient, and the time they are delivered to the ‘treatment or care’ place, the patient is detained by the ambulance officer by virtue of s 157B, not an EEA. The ambulance officer completes the EEA, and hands it to the facility staff, in order to provide the authority for the patient’s continued detention by the facility and to record the start of the examination period.
The time recorded on the EEA should be the time the ambulance officer gives ‘the authority to a health service employee at the treatment or care place.’
I hope that is a clear answer but if it is not, and for a more detailed discussion see https://australianemergencylaw.com/2021/03/16/involuntary-detention-by-police-or-ambulance-officers-under-the-public-health-act-qld/
And for a discussion about what may constitute a ‘kidnap’ by a QAS officer see https://australianemergencylaw.com/2021/05/15/no-power-of-generic-involuntary-transport-in-queensland/
Thanks for the follow up Michael. Firstly, apologies with the kidnapping reference, I think that might have been my inference from previous discussions.
I guess the specifics in the timing comes down to the actual EEA document itself, where a time must be recorded. As you stated, long transfer times and as you’re aware, even longer ramping times, sometimes means that the patient remains in the care of the paramedic for a number of hours. The patient is generally not that happy to be there in the first place,
But if there is allowance in legislation where detaining the patient for the purpose of an EEA and actually handing over the patient to the appropriate facility on the actual EEA (and hence commencing the 6 hour with possibility of extension) are two distinct and separate components, then all good.