A High Court Judge, Mr Justice Macdonald, gave an urgent ruling this summer to allow doctors to treat a 14 year old girl following an overdose, despite her refusal to consent.
The young girl, ‘YZ’, was rushed to Derriford Hospital in Plymouth after she had knocked on a stranger’s door stating that she had taken an overdose.
On the evening of 25 July 2017, it was reported that YZ had left the family home following an argument with her mother.
Once YZ arrived at Derriford Hospital, she claimed she had taken six migraine tablets and two or three paracetamol tablets. Following further examination, it became unclear how many paracetamol tablets YZ had taken as she claimed that she had taken “some”, but was not clear about the amount as she had thrown the packets away. YZ then told the medical staff that she had taken at least one “strip” which it was considered would probably amount to around ten to twelve tablets. The medical staff considered that a "toxic" dose for someone of YZ's size and weight would be over twenty tablets. Therefore, staff could not be sure that YZ had not taken a toxic dose and so considered that YZ needed blood tests to ascertain paracetamol levels and liver and kidney function, and an ECG to ascertain whether the migraine tablets were causing any issues.
Doctors were keen to begin treatment to avoid the risk of serious liver damage. If YZ had taken a toxic level of paracetamol and did not receive treatment within 24 hours, YZ was at risk of long term liver damage or death.
YZ was uncooperative; she would repeatedly agree to testing and treatment, only to refuse at the last minute. YZ’s mother, who was in favour of the treatment, advised the medical staff that this type of behaviour was normal for YZ and could potentially go on for a few days.
With the window of opportunity closing in, the medical staff sought legal permission to begin treatment, despite YZ’s refusal to consent. Dr A, who had spent a lot of time talking to YZ, considered YZ to be Gillick competent (a term used in medical law to decide whether a child under 16 years of age is able to consent to his or her own medical treatment without the need for parental permission or knowledge); however, there was some doubt regarding the question of Gillick competence given there was evidence that YZ had mental health difficulties, and was understood to be awaiting a mental health assessment, and other external pressures.
Urgent submissions were made by a barrister on behalf Plymouth Hospitals NHS Trust via telephone to Mr Justice Macdonald. The barrister was seeking an Order that:
1) YZ lacked capacity to consent to medical treatment;
2) It was YZ’s best interests to receive treatment as a matter of urgency in the form of blood tests to ascertain levels of paracetamol in the blood and, thereafter, an infusion of Parvolex (a solution used for the treatment of paracetamol overdoses) for up to 24 hours and blood tests as required to continually check the level of paracetamol in the body;
3) It was lawful and in YZ’s best interests for medical staff to provide this treatment and to use reasonable and proportionate measures, including physical or chemical restraint, to ensure that YZ received the treatment; and
4) Any deprivation of liberty as a result was lawful provided always that (i) any measures used to provide the treatment and/or any deprivation of liberty shall be the minimum necessary and (ii) all reasonable steps were taken to minimise distress to YZ and maintain her dignity.
Mr Justice Macdonald quickly concluded that there was “no time to waste” and ruled that it was in YZ’s best interests to be provided with medical treatment.
To read the full ruling by Mr Justice Macdonald, please click here.
Conroys Solicitors LLP are experienced in dealing with mental capacity issues including those relating to medical treatment. Please contact us on 01872 272 457 for advice, assistance or representation.