Today’s question is about:

… the requirements for documentation prior to transportation under a Schedule 1 form from the Mental Health Act 2007 (NSW). Traditionally I have always required the hospital/doctor to provide a correctly completed original (top copy) of the Schedule 1 for a patient prior to loading. With the increasing occurrence of Telehealth and people being transferred under a Schedule 1 after a video assessment we are left wondering what paperwork we require and what happens if the receiving facility says that they have no record of this paperwork when we arrive?

The Mental Health Act 2007 (NSW) s 19(1) says:

A person may be taken to and detained in a declared mental health facility on the basis of a certificate about the person’s condition issued by a medical practitioner or accredited person. The certificate is to be in the form set out in Part 1 of Schedule 1.

Schedule 1 requires the examining medical practitioner to certify that:

I, [name in full—use block letters] (Medical Practitioner/accredited person) of       certify that on [date] immediately before or shortly before completing this certificate, at [state place where examination/observation took place] I personally/by audio visual link examined/personally/by audio visual link observed [name of person in full] for a period of [state length of examination/observation].

This anticipates that the doctor and the patient will not be in the same location so it will not always be possible for a transporting paramedic to get the original signed copy of the Schedule.

The Act says the person ‘may be taken to and detained’.  An ambulance officer may ‘may take to … a mental health facility … any person who is authorised by this Act to be taken … to … the facility’ (s 81).  The certificate provides that the person ‘may be taken to … a declared mental health facility’. The certificate is therefore sufficient authority to the ambulance officers to exercise their powers under s 81.

The Act itself says nothing about how the document is to be provided. Given the person may be taken to, and detained at, the mental health facility it seems reasonable that those that may be called to collect and transport the person plus the receiving facility would all want the document.  That would work if, for example, a doctor personally examined the patient, called an ambulance, handed the certificate to the paramedics who then transported the patient and handed the certificate to the receiving facility.

Where the examination has occurred by audio/visual link the doctor may want to email the certificate to the receiving facility and to the ambulance service.  Neither would have the ‘original’. 

The Evidence Act 1995 (NSW) provides that the content of documents can be proved by the production of a copy (s 48). The Evidence Act however applies in NSW courts (s 4).  That would be relevant if someone were complaining that they had been unlawfully obtained and the fact that the certificate was issued could be proved by tendering a photocopy or an emailed copy of the certificate.

The Electronic Transactions Act 2000 (NSW) s 10 provides:

If, under a law of this jurisdiction, a person is required [or permitted] to produce a document that is in the form of paper, an article or other material, that requirement is taken to have been met if the person produces, by means of an electronic communication, an electronic form of the document,

I think it is safe to accept that a faxed, photocopied, emailed or delivered via electronic messaging copy of the Schedule 1 certificate would be sufficient.

A paramedic can legally act if the certificate exists, so it also depends on the paramedic’s level of satisfaction. They may be satisfied if the doctor tells them that they have completed the certificate (it is not enough that the doctor tells them they will complete the certificate). You would not accept anyone, other than the doctor’s advice that the Schedule 1 certificate exists, and I would not think it wise to accept even that. 

If the certificate, or a copy, is not provided an ambulance officer should consider whether the criteria for action under s 20 have been met, that is do they believe ‘on reasonable grounds that the person appears to be mentally ill or mentally disturbed and that it would be beneficial to the person’s welfare to be dealt with in accordance with this Act.’  If they are personally satisfied of that then they could exercise their own judgment to take the patient to the prescribed facility and the facility could then detain the person based on the ambulance officers’ assessment without the need for the doctor’s certificate – that is the patient could be detained on the basis of s 20, rather than s 19.

Conclusion

I would want to see a copy but would not insist on ‘a correctly completed original (top copy) of the Schedule 1’. A photocopy, faxed, emailed or other electronic form of the schedule should be sufficient.

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.