Jail fear for contaminated patients

The new Health Bill could give magistrates draconian powers in infection cases, says Joe Lepper.

Tucked away in the draft Health and Social Care Bill is a clause relating to public health that gives magistrates sweeping powers over the care of patients and could leave GPs facing a crisis of conscience.

While much of the medical profession was focused on the Bill's proposals for professional regulation, its plans for public health have received relatively little attention.

The Bill updates existing legislation surrounding infection control in response to a raft of modern scenarios including avian flu, chemical and radiation poisoning.

The current legislation already places a requirement on GPs to notify authorities if a patient presents with a contagious infection or is contaminated, as well as giving magistrates the power to quarantine patients.

Under the new Bill, this duty for GPs remains but magistrates are set to be given far wider powers over patients, including ordering that they are regularly monitored, disinfected or decontaminated, forced to wear protective clothing, ordered to answer medical questions or attend training and advice sessions on contamination.

Concerns over new Bill
Among those to have raised concerns is patient organisation the Picker Institute.

Don Redding, the Institute's policy and communications director, said: 'Do GPs follow what may be the law and notify authorities, even if it leads to the incarceration of their patient and further restrictions on their movement?

'Patients may think twice about presenting themselves to a GP if they are ill as this may end up with them being detained.'

The DoH has assured the Picker Institute that powers are envisaged to be used as a last resort and in a small number of cases.

GPs such as Wessex LMCs chief executive Dr Nigel Watson, are concerned about magistrates having 'so much power in something that is beyond their competency'.

'They do not have that expert medical knowledge so I am very concerned that their powers here are being widened and I am not sure how they can come to a decision on this matter,' he said.

He added that he felt the new legislation was 'pointless' because GPs already notify authorities in such circumstances.

Lisa Power, head of policy at the Terrence Higgins Trust, said if the government is set on pursuing these powers for magistrates, the trust wants assurances that they will be given training by medical professionals and that their decisions will be monitored nationally so they can be regularly reviewed.

Another concern, raised by Ms Power, is the vagueness of the conditions and situations the Bill applies to. While her understanding is that it is mainly in response to new threats such as avian flu and radiation poisoning, there is no list.

'It could apply to almost any condition,' she said.

Forced treatment
There is also confusion about compulsory treatment. While the Bill spells out that there will be no forced treatment of a patient, it does say they can be disinfected or decontaminated.

Dr Watson said this aspect of the Bill certainly sounded like enforcement.

GPC chairman Dr Laurence Buckman added that he is supportive of the attempts to control the 'spread of serious diseases caused by infection and contamination' but only where the 'powers are proportionate and do not involve compulsory treatment'.

The DoH defended the Bill, saying they are vital to update existing legislation and to give magistrates greater flexibility to deal with certain situations.

A DoH spokesman added: 'This gives them a range of options to be proportionate to the situation. What we do not envisage is huge swathes of people being incarcerated. That is not what this is about.'

The Bill is currently at the committee stage.


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