Commissioner's directive 800-3: Consent to health service assessment, treatment and release of information

Guidelines

1. Regional Directors, Health Services, Executive Directors of the five Correctional Service of Canada (CSC) Regional Treatment Centres and health care professionals must be aware of federal and provincial/territorial legislation and other information pertinent to the issue of consent to health services.
2. Apart from exceptions described in these Guidelines and in relevant legislation, the consent of the offender must be obtained for:
   1. all health assessment and treatment
   2. involvement or participation in any form of research
   3. the sharing of health care information.
3. If an offender refuses to consent to a psychological risk assessment, this assessment will be completed using available information in the interest of public safety, as per CD 705-5 – Supplementary Intake Assessments.

4. Subsection 88(2) of the CCRA sets out criteria for informed consent of inmates. Where CSC provides health services in the community, the same criteria will apply.
5. In accordance with professionally accepted standards, consent may be express or implied. It may be provided by the offender verbally or in writing. If consent is provided verbally, it should be documented and signed by the health care professional.
6. If the offender does not have the capacity to give informed consent, consent will then be governed by the relevant federal and provincial/territorial legislation.
7. Where the offender meets the criteria for involuntary treatment (as described in the section on Involuntary Admission and Treatment), treatment will be administered in accordance with relevant federal and provincial/territorial legislation.

8. Subsections 88(1) and (2) of the CCRA set out the rights of the inmate to refuse treatment.
9. If the offender refuses to consent, the health care professional will document information regarding the refusal. The offender will be asked to sign a statement outlining the recommended health service and his/her refusal to consent. If the offender refuses to sign the statement, the health care professional will document the information given to the offender and his/her refusal. Whenever a witness is available, he/she will also be required to sign the statement.
10. When an offender refuses to consent to a specific treatment, an alternative treatment, if possible and appropriate, will be made available.
11. When an offender refuses health services, the health care professional will advise the offender of the potential health consequences of such a refusal.
12. Where the refusal to consent poses a risk to the health or safety of other persons (i.e. communicable diseases such as active tuberculosis or acute mental health problems), staff will abide by applicable federal and provincial/territorial legislation when determining a course of action.

13. An offender’s informed consent to treatment is not required in medical emergency situation, where there is an immediate threat to the offender’s health or life and the offender is not able to provide consent to treatment.

14. Where the refusal to consent to treatment poses a known immediate risk for serious bodily injury or death to the offender or other persons, CSC will determine where the offender will be housed until such time as the need for observation has passed as determined by a health care professional.

Some examples are:

1. suspected or confirmed communicable diseases such as active tuberculosis
2. acute mental health problems
3. post overdose interrupted (including known or suspected methadone overdose).

15. When involuntary admission to a CSC Regional Treatment Centre for mental health issues is required, the admission will be done in accordance with relevant federal and provincial/territorial legislation.
16. In all situations where involuntary treatment is necessary, including in a CSC mainstream institution, the attending Physician or Psychiatrist must:
1. assess the offender in person to determine if he/she has a condition that meets the criteria for involuntary admission and/or treatment in accordance with relevant federal and provincial/territorial legislation
2. document the assessment, diagnosis and findings in accordance with the provisions of the legislation that satisfy the criteria
3. in consultation with relevant health care professionals, determine where (i.e. CSC Regional Treatment Centre or Regional Hospital) the offender will be further assessed and/or monitored.
17. The Physician or Psychiatrist must make all orders for involuntary health interventions, such as medication, in writing. Verbal orders for involuntary health interventions are not permitted, except in a Regional Treatment Centre if there is an existing treatment plan on file by the Physician or Psychiatrist making the order and the order is in accordance with provincial/territorial legislation. If an order is provided verbally, it will be documented in the inmate’s health care record by the health care professional who took the verbal order. The Physician or Psychiatrist who provided the verbal order will sign it when he/she is next at the institution.
18. In provinces where provincial legislation requires a board or a court authorization for involuntary treatment, CSC will administer such involuntary treatment as directed by the said authorization.

19. The confidentiality of the offender’s health information will be maintained except in circumstances for which there is a need to know related to risk or case management. The level of detail shared, and the parties with whom the information is shared, must be decided on a case-by-case basis. (Refer to Guidelines for Sharing Personal Health Information).
20. Disclosure will be documented on the offender’s file and the offender notified of the disclosure unless doing so could jeopardize the safety of any person.

21. Strategic Policy Division
    National Headquarters
    Email: Gen-NHQPolicy-Politi@csc-scc.gc.ca

Assistant Commissioner,
Health Services

Original Signed by:
Michele Brenning

CD 701 – Information Sharing
CD 705-5 – Supplementary Intake Assessments
CD 800 – Health Services
GL 800-1 – Hunger Strike: Managing an Inmate's Health
GL 800-5 – Gender Dysphoria
Guidelines for Sharing Personal Health Information

Provincial/territorial mental health legislation and regulations
Provincial/territorial standards of practice for health care professionals

Health Services: physical and mental health services which include health promotion, disease prevention, health maintenance, patient education, diagnosis and treatment of illness.

Implied consent: a form of consent which is not expressly granted by a person, but rather inferred from a person’s conduct, including inaction or silence, and/or from the circumstances or facts of a particular situation.

Involuntary health intervention: health intervention provided without a person’s consent.

Medical emergency: an injury or condition that poses an immediate threat to a person’s health or life and which requires medical intervention.

Need to know: information that is pertinent and necessary to an individual performing his/her duties.