Case study
Ambulance team was dispatched to an Elderly gentleman unwell.
3rd party caller. Pt was visiting from out of the area and felt unwell. This 3rd party caller had arranged for the PT to stay with another elderly gentlemen (different race/religion).
O/a crew was greeted on the street and led into an apartment which was over loaded with boxes and in a neglect state (safeguarding x 2).
Pt siting in armchair Alert, talking. Pt had been sitting in the same chair for 4 days without leaving. Not eating just drinking fruit juice. Strong smell of urine (amongst others). Obs: Tachy, hypotensive, slightly hypothermic – no consent for BM. ?? Dehydration. No pain. No pmhx no reg meds. Pt lives alone (not wiling to share details). Chief complaint – dizziness and weakness.
PT appeared to have capacity and refused treatment /transport.
Crew called CSD for (practitioner) support. 2 paramedics arrived and called police as well as on duty Dr.
Eventually initial crew convinced to get patient transported just so that they would wash him and he would get a warm bed to sleep in.
Concerns:
Safeguarding – pt didn’t really know the caller (who identified himself as a friend).
Hoarding in the apartment (safeguarding for other elderly person (the permanent resident) – fire risk
Mental Capacity Act: with dehydration one would expect altered mental status – this pt retained, evaluated and repeated info.
Can a DR override and declare lack of capacity (even though according to assessment tool pt had capacity).
Discuss how you would apply the relevant mental health legislation, professional standards and public health practices in order to deliver high quality and dignified patient care.
