A SAD assessment of capacity!

Author: Frank Sutherland / Editor: John P Sloan / Reviewer: Rebecca Ford / Codes: A5, CC5, CC6 / Published: 28/05/2021

You are an Emergency Department Consultant and you are checking your email inbox on a Monday morning 09.00hrs. You have received the following email from the StR who has just finished weekend nights:

‘Last night was very busy and I spent most of the night in resus. I thought you should know about a patient who attended the department.

Her name is Miss X (Age 44). She has attended multiple times with DSH and alcohol abuse. She was brought in by the police at 23.36hrs yesterday evening. According to the triage nurse she was not drunk but had consumed alcohol and had apparently been threatening to kill herself. The police left her with us, and the nurse in charge asked the crisis team to see her as she is well known to them and they have a management plan. The crisis team would not see her unless she was “medically fit”.

Miss X was seen by Dr Y, FY2 at 00.46 who thought she was medically fit (no history of overdose) but needed mental health assessment. She also felt that she may harm herself if discharged. On my advice Dr Y referred Miss X to the crisis team who said they would see her, but it could be several hours before they attended the department.

According to the nurse in charge, Miss X was verbally abusive, kept wandering around the department and wanted to take her own discharge. As the crisis team still had not arrived, Dr Y, was asked to review the patient. According to the nurse in charge Dr Y said she was not sure if Miss X had capacity to self-discharge. However, since Miss X was adamant she wanted to leave Dr Y discharged her without talking to me as I was busy in resus. Miss X left at 03.31hrs.

Dr Y went home at 04.00hrs and the notes she wrote were minimal with just a brief history and stating Miss X was, in her view, medically fit for discharge. At 06.30 Miss X was brought back to us by ambulance and accompanied by the police. She had apparently tried to jump in front of a train. Fortunately she landed just off the track, but she did sustain a tri-malleolar ankle fracture which needs ORIF and she also sustained an extensive laceration to the scalp. She was very tearful and said she wanted to die. She was cooperative and was admitted under the care of the orthopaedic surgeons. I think this was a near miss.

Yours truly,

Dr Z’

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