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Published 20 July 2016
A recent Court of Protection case (AG) provides guidance on the use of covert medication for people who lack capacity and are deprived of their liberty under a DoLS authorisation.
The case highlights the need for care providers to ensure that any decisions about administering covert medication are:
Care providers need to ensure that their processes around use of covert medication comply with the principles set out in this case.
The case is also important for best interests assessors and supervisory bodies in terms of the impact that use of covert medication may have on the length of DoLS authorisation granted and conditions which may need to be attached to it.
The case related to a 92 year old lady with dementia who had been moved to a care home in her best interests and was subject to a 12 month standard DoLS authorisation.
It was agreed that AG lacked capacity to make decisions about her care, accommodation and treatment and that she was deprived of her liberty in the care home because she was under continuous supervision and control and was not free to leave. She was at risk of self-harm due to risky behaviours (e.g. wandering at night and aggressive behaviour) and self-neglect.
The case came before the Court of Protection because the DoLS authorisation was challenged by way of a Section 21A application to consider whether AG could safely be managed in the community.
It emerged in the course of those proceedings that, at the time of the DoLS assessments, AG's treatment regime in the care home included the covert administration of medication. The medications being administered covertly at that stage were thyroxin (which was necessary to prevent AG becoming seriously unwell) and promethazine (which has a sedative effect). Although this use of covert medication was made known to the best interests assessor at the time, the DoLS authorisation was granted for the maximum period of 12 months with no conditions attached.
Subsequent to the DoLS authorisation being granted, AG was prescribed diazepam (a stronger type of sedative medication than previously) and this was again administered covertly by the care home. This change in medication was not however, notified to the supervisory body or to her RPR.
The Court decided that the use of covert medication in this case was not subject to proper reviews or safeguards.
The DoLS authorisation should have reflected a requirement to keep the use of covert medication regularly under review.
The care home was under a duty to inform the supervisory body of the change in circumstances relating to the use of covert medication. The care home should also have informed the RPR of this in order to give them an opportunity to request a review of the DoLS authorisation.
The Judge emphasised that use of covert medication must always call for close scrutiny, especially in cases where the medication impacts on the person's behaviour/mental health or has a sedative effect. Treatment without consent (covert medication in this case) is a serious interference with the right to respect for private life under human rights legislation and there must accordingly be proper safeguards against arbitrariness. The Judge also highlighted that use of covert medication is an aspect of continuous supervision and control and must be subject to the principle of least restrictive alternative.
The Judge outlined the following points by way of guidance for cases involving use of covert medication:
Our national team of mental capacity and deprivation of liberty specialists have extensive experience in advising health and social care providers and commissioners - both in the NHS and the independent sector - in relation to all aspects of the law in this area, including advising on:
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