Hospital centre - Rights of people placed in preventive confinement in a hospital: Violations

A citizen who had been placed in preventive confinement said the hospital had not adequately informed him of the situation, or of his rights.

The citizen’s complaint concerned the fact that:

• when he was in preventive confinement in a hospital’s psychiatric emergency room, he was not informed of the specific nature of the confinement until two days after his admission. He said he was not given the leaflet describing the rights and recourses of people in confinement, and had received very little information on the situation, which he felt to be abusive.

The Québec Ombudsman’s investigation revealed that:

• preventive confinement may be ordered without the user’s consent or the court’s permission for a period not exceeding 72 hours, when a physician believes the patient’s mental state presents a grave and immediate danger to himself or herself or to others;
• the 72-hour period begins with the physician’s opinion. However, if it ends on a non-juridical day (i.e. a day on which the court is not available), it may be extended to the next juridical day;
• the duration of the citizen’s preventive confinement was consistent with the provisions of the Act respecting the protection of persons whose mental state presents a danger to themselves or to others (R.S.Q., c.P-38.001);
• the notes in the user’s record must indicate that the confinement is preventive in nature, document the level of danger, and state when the user was taken in charge in order to establish the duration of the confinement. The notes must also show that the user was informed of his or her rights, and that the director of professional services was informed of the confinement;
• the notes in the citizen’s record did not show whether or not he had been informed of the fact that he was in preventive confinement, the grounds for the confinement or his right to contact his relatives and a lawyer.

The Québec Ombudsman recommended that the hospital should:

• standardize the notes to be placed in the record of a user in confinement, so that it is possible to ensure that the legal requirements have been met, including the right to information and the right to contact relatives or a lawyer, and to ensure that the time at which the confinement begins is clearly shown;
• ensure that its personnel are aware of the importance of answering users’ questions concerning the length of preventive confinement and the consequences of non-working days and physicians’ vacation days.

The hospital accepted and applied the Québec Ombudsman’s recommendations.