Commissioner's Directive

Policy Objectives

1. To balance the safety of the public, staff, and other offenders with the need to safeguard an offender’s right to confidentiality and right to accept or refuse health services.

2. To ensure relevant information is shared in accordance with professional standards and legal requirements.

Authorities

• 3. Corrections and Conditional Release Act (CCRA), sections 85 to 89
• Access to Information Act
• Privacy Act, section 3, subsections 6(2) and 8(2)
• Provincial/Territorial mental health legislation and regulations
• Provincial /Territorial standards of practice for health professionals

Application

4. This Directive applies to all health services delivered by the Correctional Service of Canada (CSC).

Responsibilities

5. Regional Directors of Health Services, Executive Directors of the five 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.

6. All health care professionals will provide health services in accordance with this policy and federal and provincial/territorial legislation.

PROCEDURES

7. Apart from exceptions described in this CD, the consent of the offender must be obtained for:

1. all health assessment and treatment;
2. involvement or participation in any form of research; or
3. the sharing of health care information, except as provided for in this directive and in relevant legislation.

8. 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.

Criteria For Valid Consent

9. 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.

10. 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.

11. 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.

12. Where the offender meets the criteria for involuntary treatment (as described in the Involuntary Admission and Treatment section), treatment will be administered in accordance with relevant federal and provincial/territorial legislation.

Refusal to Consent

13. Subsections 88(1) and (2) of the CCRA set out the rights of the inmate to refuse treatment.

14. 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.

15. When an offender refuses to consent to a specific treatment, an alternative treatment, if possible and appropriate, will be made available.

16. When an offender refuses health services, the health care professional will advise the offender of the potential health consequences of such a refusal.

17. 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 refer to applicable federal and provincial/territorial legislation when determining a course of action.

Medical Emergency Situations

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

Involuntary Placement for Medical Observation

19. 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:

• suspected or confirmed communicable diseases such as active tuberculosis;
• acute mental health problems;
• post overdose interrupted (including known or suspected Methadone overdose).

Involuntary Admission and Treatment

20. 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.

21. In all situations where involuntary treatment is necessary, the attending Physician or Psychiatrist must:

• 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 the relevant federal and provincial/territorial legislation;
• document the assessment, diagnosis and findings in accordance with the provisions of the legislation that satisfy the criteria; and
• 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.

22. 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.

23. In provinces where provincial legislation requires a board or a court authorization for involuntary treatment, CSC will execute such involuntary treatment as directed by the said authorization.

Sharing of Information and Need to Know

24. 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 must be decided on a case-by-case basis.

25. More detailed information is contained in the Guidelines for Sharing Personal Health Information.

26. Disclosures will be documented on the offender’s file and the offender notified of the disclosure unless to do so could jeopardize the safety of any person.

ENQUIRIES

26. Strategic Policy Division
National Headquarters
Email: Gen-NHQPolicy-Politi@CSC-SCC.GC.CA

Commissioner,

Original Signed by

Don Head

ANNEX A
CROSS-REFERENCES AND DEFINITIONS

CROSS-REFERENCES

• CD 701 – Information Sharing
• CD 705-5 – Supplementary Intake Assessments
• CD 800 – Health Services
• CD 805 – Administration of Medication
• CD 821 – Management of Infectious Diseases
• CD 835 – Health Care Records
• CD 840 – Psychological Services
• CD 843 – Management of Inmate Self-Injurious and Suicidal Behaviour
• CD 850 – Mental Health Services
• Guidelines for Sharing Personal Health Information
• GL 800-1 – Hunger Strike: Managing an Inmate’s Health
• Provincial/territorial legislation (Canadian Legal Information Institute)

DEFINITIONS

Health care professional:

an individual registered or licensed for autonomous practice in the province of practice. Individuals must operate within their scope of practice and competence. Examples include Psychologists, Psychiatrists, Physicians, Nurses, Mental Health Nurses, and Clinical Social Workers.

Health services:

physical and mental health services which include health promotion, disease prevention, health maintenance, patient education, diagnosis and treatment of illnesses.

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 which requires medical intervention.

Need to know:

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