DOLS - Should I have been informed?

[Suzanna1969]

My Mum is in hospital at the moment and yesterday afternoon she tried to break out! So the hospital have invoked DOLS. I do agree that she should NOT be released from hospital and is not safe to be out on her own, being in mid-stage Vascular Dementia, but what I object to is that, as her daughter and with LPA, I was NOT informed of this. I DID get a phone call from someone on her ward, missed it, heard the message and returned the call, the person was 'training', I left a message (this was at about 3pm) and heard nothing back. Only when I went in to visit today was I told of the DOLS.

Having read the government info on DOLS I am somewhat alarmed that I effectively have NO say now in her welfare and could even be prevented from seeing her (I see no reason why they would do this but.... it's the principle).

What are the rules about informing family when this happens? Should I kick up a fuss about it? I feel somewhat violated but am aware that I am probably much more brittle than usual because of events of the last 2 weeks (all very dramatic and too lengthy to go into here)

Any thoughts/suggestions from my learned forum friends?

 

[Kevinl]

No one can be "held" anywhere against their wishes without some legal mechanism being in place be that a DoLS, sectioned, arrested by the police or whatever.
If she tried to get out either they have to let her go or put in place one of the legal mechanisms to stop her and could face prosecution if they did.
They were probably not happy doing it without the next of kin/LPA holder being there but if you weren't available they had no other choice.
No one will stop you seeing her or anything but they need some legal authority to keep her there for treatment or they're breaking the law. Their choice was; DoLS, section her or let her go what else could they do?
K

 

[nitram]

Have a read through
https://www.scie.org.uk/publications/ataglance/ataglance43.asp
especially 'Urgent Authorisations'

The hospital should have a formal record of their attempt to contact you.

 

[Digilux108]

My Mum is in hospital at the moment and yesterday afternoon she tried to break out! So the hospital have invoked DOLS. I do agree that she should NOT be released from hospital and is not safe to be out on her own, being in mid-stage Vascular Dementia, but what I object to is that, as her daughter and with LPA, I was NOT informed of this. I DID get a phone call from someone on her ward, missed it, heard the message and returned the call, the person was 'training', I left a message (this was at about 3pm) and heard nothing back. Only when I went in to visit today was I told of the DOLS.

Having read the government info on DOLS I am somewhat alarmed that I effectively have NO say now in her welfare and could even be prevented from seeing her (I see no reason why they would do this but.... it's the principle).

What are the rules about informing family when this happens? Should I kick up a fuss about it? I feel somewhat violated but am aware that I am probably much more brittle than usual because of events of the last 2 weeks (all very dramatic and too lengthy to go into here)

Any thoughts/suggestions from my learned forum friends?

As your mother's LPA and representative, you have the right to appeal to the court of protection against the decision. Moreover, the supervisory body must review the DOLS authorisation if you so request it. Who gave the hospital authorisation to invoke it? Did they carry out the relevant assessments?

www.gov.uk/court-of-protection

 

[Kevinl]

As your mother's LPA and representative, you have the right to appeal to the court of protection against the decision. Moreover, the supervisory body must review the DOLS authorisation if you so request it.
www.gov.uk/court-of-protection

But why? Had the hospital contacted Suzanne she would have agreed to a DoLS given that the choice was letting her mum go as that's what she was wanted to do.
We don't live in North Korea or the former Soviet Union, the state has no powers other than those set out in law to detain anyone whether it's for the best or not.
You can appeal the DoLS but if you do then mum is free to go as she pleases so what would that achieve other than she would no longer have to "break free" the staff would have to let her go, open any coded or locked doors and let her go on her way.
The hospital did try to contact Suzanne, the missed call is a proof of that and when faced with no other choice they put a DoLS in place, what right minded person could disagree with that?
Putting an emergency DoLS in place is a nightmare of paperwork for the hospital as will be the on going implications of monitoring it which they could no doubt do without.
The hospital did what Susanne would want them to do "I do agree that she should NOT be released from hospital and is not safe to be out on her own" but as she was out they couldn't check with Susanne first as she was out, the hospital had no alternative.
K

 

[theunknown]

I can only speak from my own experience. My mum was sectioned and I needed to find a care home for her. Once my mum was in the care home I was asked if if I agreed to a DoL order. I was the point of contact and now have deputyship through the CoP. I took it that as my mum was sectioned and is in an EMI residence (she's now 83) it wouldn't be safe for her to have freedom of movement outside the home, thus the need for a DoL.

I can't imagine any reason for you to be stopped from seeing your mum and, if you were, I'm sure you could legally challenge this with a positive result.

 

[Suzanna1969]

Kevinl but a full 24 hours passed and I STILL did not know about the DoLS until I turned up at the hospital and the ward sister told me what had happened.

I returned the call as soon as it was safe to do so. The answerphone message gave me no indication what had happened, it just said 'Don't worry it's nothing bad!'

I don't even know if the message was regarding that or something else actually.

Is THAT acceptable?

As I understand it, I, my brother and my father COULD in theory be prevented from seeing her because of the DoLS. I can't see why they would do that but....

 

[nmintueo]

What are the rules about informing family when this happens?

As usual, nitram nailed it:

Before granting an urgent authorisation, the managing authority should try to speak to the family, friends and carers of the person. ... The managing authority should make a record of their efforts to consult others.

So, yes, they should have informed you. They phoned and left a message that didn't inform you, so I think they could have done better.

(Incidentally, interesting that that guidance mentions family and friends but apparently doesn't mention attorneys.)

Should I kick up a fuss about it?

Well, maybe quite a mild fuss. Absent other evidence, it seems reasonable to suppose that if they had got you on the phone they would have told you. As it was, they left an uninformative message and didn't follow up over the next 24 hours. You could certainly take issue with that.

Later edit: nitram sensibly points out:

I suspect patient confidentially giving out information until they have verified who they are talking to.

 

[LynneMcV]

A DOLS was instigated for my husband back in March and I was fully involved in the process. Having said that I was there several hours every day for two months and very easy to locate. However, I suspect that had something kicked off and I had not been available for the process they would have used some kind of emergency power to put something in place.

Looking at the link supplied by nitram it sounds like an urgent DOLS can be put in place for up to 7 days - presumably to give time to set up a standard authorisation involving you in the process - but having something in place to protect your mother in the meantime.

I'm not an expert, I did not know that they could do this and I can understand how you feel. However, if they had to act fast to protect your mother in the first instance and could not reach you, I can understand them taking the initiative to ensure her safety until the necessary meetings could take place.

 

[Kevinl]

As I understand it, I, my brother and my father COULD in theory be prevented from seeing her because of the DoLS. I can't see why they would do that but....

In theory maybe, but that isn't going to happen so why even worry about it?
As I see it they had 4 choices:

1. Call the police and have her arrested, section 5 public order offence, cuff her and wait for you to answer the phone.
2. DoLS, the standard way of doing things, has to be approved by the medics, social services and monitoring has to be put in place.
3. Section her, either section 2 or 3 of the Mental Health Act which gives them powers that make a DoLS look like a picnic, they could medicate against her will, move her to a secure unit, take her out of the area for treatment...any number of things. Remember a DoLS ties her to one specific location/address it's not transfarable.
4. Let her go if that's what she wants.

My wife is Section 3 and I don't have a problem, I can see her, take her out for a while, visit when I like and I'm kept fully informed of everything that happens.
What would you want the hospital to do? As I said before we live in a free country and to take away someone's liberty requires a legal framework, which would you rather they did from the above 4 choices they have?
Schoolchildren are "deprived of their liberty" everyday parents and schools keep them in a place of safety for their own good but with an adult it's different there has to be due process of law.
K

 

[Beate]

Well, I know exactly where Suzanna is coming from. I'm his partner, carer, next of kin and attorney, and yet I learned my OH had been put under a DoLS in hospital through a letter sent AFTER his release. Not good enough. Of course I wouldn't have objected, but the protocols state I should have been consulted and informed every step of the way. I was too preoccupied at the time to make a fuss, but I really should have, thinking about it, because they'll just carry on like this with other people.

 

[Digilux108]

In theory maybe, but that isn't going to happen so why even worry about it?
As I see it they had 4 choices:

2. DoLS, the standard way of doing things, has to be approved by the medics, social services and monitoring has to be put in place.

K

My understanding is that before anyone can be legally deprived of their liberty, a hospital (or care home) must obtain permission from a supervisory body. However, prior to deprivation of liberty being authorised, six assessments must be carried out. Moreover, one of the conditions that the authorisation must contain is that it has to take steps to ensure contact with family members. Yes, urgent authorisations may be given, but these can only be granted for a maximum of 7 days, although they can be extended if necessary. That is the legal framework.

Of course we have the issue of safety to consider, I understand that, but I do hope that in suzzana1969's case, it wasn't just down to an overzealous member of hospital staff. I say this because when my mother was in hospital in June/July 2014 for a suspected mild heart attack, she tried to leave the day after she was admitted. This was because she was scared and didn't like being in hospital. I can assure you that if someone had tried to evoke DOLS I would have made my position abundantly clear.

The hospital apparently knew that my mother had dementia (it was even listed on her discharge summary). Nevertheless, neither the consultant, nor the ward staff bothered to tell me about it.

 

[Penmon79]

Can someone please tell me what a DOLS is please?

 

[Suzanna1969]

Can someone please tell me what a DOLS is please?

Deprivation of Liberty Safeguarding x

 

[Kevinl]

Can someone please tell me what a DOLS is please?

Depravation of Liberty Safeguarding order, it's one of a limited number of ways the state can detain someone against their wishes alone with the others I listed earlier.
A doctor or nurse has no more "power" to keep someone against their somewhere they don't want to be than I do with or without a diagnosis of AZ, dementia or anything else.
It's the "lightest touch" means used to "detain" someone legally. Without one the staff may be open to charges if I decide to rip all the tubes out and leave the hospital AZ or not, I'm free to do as I wish unless they have a legal right to stop me.
An LPA for health is fine but it doesn't restrict the freedom of the individual to remove themselves from the hospital, it only says they have to be involved in medical decisions and physically confining someone isn't a medical decision without a DoLS or a sectioning being in place.
K

 

[Chemmy]

I must admit, if you would have agreed to the DOLS anyway, I don't really see the problem. Save your energy by choosing your battles wisely. You need to work with the hospital team to secure the best outcome for your mother, so why risk antagonising them ?

 

[nitram]

"They phoned and left a message that didn't inform you, so I think they could have done better."

I suspect patient confidentially giving out information until they have verified who they are talking to.

 

[RedLou]

My question is simply this: if you would have agreed with the DOLS, do you have the energy to pursue this further? With dementia, you have to pick your battles, for your own sake. Will it make you feel better to pursue it? Will it rile your fragile emotions further? Do what's best for you; you need to think of yourself. *hug*

 

[Digilux108]

I am still concerned about the manner in which the DOLS was invoked. There is a fine and important line between restricting and depriving someone’s liberty, and I get the impression that the hospital has, in this example, acted rather impulsively and crossed it.

The crucial question here, as it appears to me, is not so much that the DOLS was used, but rather, that the hospital appears to have made very little effort to prevent it from becoming a necessity. The other thing to note is that DOL is not the same as being detained under the mental health act. Vascular dementia is not what I would classify as a mental disorder. Dementia as we all know, is due to neurological and not psychological impairments.

 

[Beate]

A DoLS will always be put in place in a hospital or care home if someone has lost capacity, so they have a right to hold them back if they try to leave. I don't think that's the issue here. The issue is that the guidelines clearly say that the family has to be involved in the decision, and it looks like this is often not done, at least in my case. Though in Suzanna's case at least they tried to get in touch, albeit not very convincingly.