DZ (Medical Consent)

[2008] TASGAB 9

GUARDIANSHIP AND ADMINISTRATION BOARD
HOBART

Mr DZ application for consent to medical treatment Dr M Evenhuis

Neutral Citation:  DZ (Medical Consent) [2008] TASGAB 9

REASONS FOR DECISION

Kereth West (Chair)
Date of Hearing: 23^rd June 2008

Application for consent to medical treatment – treatment of person with psychiatric illness with antipsychotic drugs
Guardianship and Administration Act 1995 ss 45

Disability

Mr DZ was identified by the treating doctor, Dr M Evenhuis as suffering from delusions that he believed were being driven by auditory hallucinations.  Mr DZ was considered to have a delusional belief that people believed he was a paedophile and were talking about him.  Dr Evenhuis stated the onset was whilst Mr DZ was in Risdon Prison where several incidents of his being distressed by the belief were reported.  Since being admitted to WLC there have been at least two incidents where Mr DZ was felt to have been hallucinating and had reported staff and patients referring to his paedophilia.  There was no evidence to suggest that the conversations had taken place and the suggestions given by Mr DZ’s lawyer to explain his experiences were considered possible but not plausible.

According to Dr Evenhuis, Mr DZ’s symptoms were insufficient to meet the criteria for a diagnosis of schizophrenia but that the presence of hallucinations ruled out a formal diagnosis of delusional disorder.  However, Mr DZ’s total belief in his delusion and reported level of distress  associated with the symptom, was sufficient to convince the Board that Mr DZ is currently experiencing a mental illness and, as such, meets the criteria for having a disability under the Act.  

Proposed Medical Treatment

Prescription and administration of either Risperidone Quicklets to a maximum of 8 mg daily or Risperdal Consta, IMI, to a maximum of 75 mg fortnightly.  

Capacity

The issue of capacity of consenting to proposed treatment was a difficult one.  Mr DZ presented as capable of making reasoned decisions in most areas of his life.  However, as his delusional belief was unshakeable and he was unable to rationalise his situation, he was considered to be unable to consider the need for treatment reasonably.  For Mr DZ, his belief that other people were talking about him and considered him to be a paedophile was his truth and he was unable to contemplate that the belief was in fact part of an illness.  In being unable to recognise that he was ill, he was unable to weigh up the need and possible effects of accepting or refusing treatment and was considered by the Board to lack the capacity to consent or otherwise to the proposed treatment.   

Best Interests - Relevant Matters
What are the person’s wishes?

Mr DZ did not feel that he had an illness that required treatment and as such did not want any medication.  He felt that he would be okay if he was moved to the Prison farm as he believed that the prisoners at the Farm were unlikely to believe that he was a paedophile.

What are the consequences of not carrying out the treatment?

Continuation of symptomatology causing Mr DZ intermittent distress and increased probability of him seeking to clarify his situation with other prisoners and thus place himself at increased risk of physical or social harm.

Is there a viable or alternative treatment?

Dr Evenhuis stated that there were alternative medications to Risperdal but the inability to ensure compliance through depot administration did not make them an option.

Mr DZ and his advocates felt that he would not require medication if he were housed at Hayes Prison farm where it was less stressful.  Whiles there is no doubt that stress has contributed to the development of Mr DZ’s symptoms, there is no evidence that they would disappear in a less restrictive albeit correctional facility.  Certainly, the treating team suggested that WLC is probably less stressful than the farm and that the symptoms had not abated since his admission.

Can the treatment be postponed or deferred?

Potentially could be postponed but the longer delusional beliefs are held the harder they are to shift or treat.

What is the nature or degree of any significant risks?

Potential extrapyramidal side-effects, sedation.  Most side-effects are managed by modifying dose or, in extreme situations prescription of another medication.

Describe why the proposed treatment was approved/not approved

The Board was satisfied that Mr DZ was suffering from a mental illness that was impairing his judgement, causing him distress and potentially exposing him to unnecessary risk.  The Board was of the opinion that the delusional beliefs may well have had their origins in fact but Mr DZ appeared to have crossed the threshold into a psychotic delusional state.    Because Mr DZ was unable to accept the possibility that the beliefs were in fact delusional he was unable to reasonably assess the benefits of medication in assisting him.  The Board took into account the statement by Mr DZ’s lawyer that delusional beliefs are often resistant to treatment and considered the treating team’s belief that benefits or otherwise would be apparent within 3 months in determining the length of the order.  The expiration of this order would allow a full review by the treating team, and if necessary the Board closer to Mr DZ’s release from prison.

Commencement and duration of treatment

Treatment should commence immediately and is approved for a period of 3 months

Kereth West
CHAIR

23rd June 2008