Auckland District Health Board Taikura Trust Aranui Home and ...

Health and Disability Commissioner
operation between staff and with other providers, particularly Taikura Trust and Oak
Park (discussed later).
147. Accordingly, I find that ADHB breached Rights 4(1) and 4(5) of the Code. 29
Informed consent
Inpatient care and treatment prior to 31 May 2007
148. Ms A was admitted to ACH on 11 May 2007. She was diagnosed within a week with
cryptococcal meningitis and communicating hydrocephalus, and commenced
treatment. The extent to which these conditions were causing or contributing to her
impaired mental functioning was not known. At times she was confused and
disoriented, while at other times she was lucid, knew that she was in Auckland
Hospital, and knew the reason for her admission. She was sometimes resistant to, or
declined treatment, but for the most part she appeared to accept the need for
admission and medical care.
149. Under Right 7(2) of the Code the presumption is that consumers are competent to
make an informed choice and give informed consent, unless there are reasonable
grounds to think otherwise. 30 The possibility that Ms A was not competent to make an
informed choice and give informed consent was flagged early in her admission, when
the question of welfare guardianship was raised on 15 May. A formal assessment of
her competence was requested a fortnight later. It would appear that, initially, Ms A
was presumed competent and able to give consent on her own behalf. There were no
documented attempts to contact her family at this time, and Ms A’s refusal of
permission to contact her friends was respected.
Inpatient care and treatment after 31 May 2007
150. Dr C assessed Ms A on 31 May. He recorded that she lacked the capacity to make
informed decisions, and suggested an application for welfare guardianship under the
PPPR Act would be needed.
151. This indicates that Dr C considered Ms A lacked capacity in accordance with the
definition set out in the PPPR Act, which states that the person ―lacks, wholly or
partly, the capacity to understand the nature, and to foresee the consequences, of
decisions in respect of his or her personal care and welfare‖. 31
152. Having assessed Ms A as lacking capacity to make informed decisions, the basis for
continuing to provide her with services becomes more complex, and ADHB needed to
pay attention to who could make decisions about Ms A’s care and welfare.
29 See footnotes 2 and 3.
30 Right 7(2) — Every consumer must be presumed competent to make an informed choice and give
informed consent, unless there are reasonable grounds for believing that the consumer is not competent.
31 Protection of Personal and Property Rights Act 1994 Part 1, 6(1)(a).
26 3 November 2010
Names have been removed (except Auckland DHB, Taikura Trust, Aranui Home and Hospital/Oak
Park Dementia Unit and the expert who advised on this case) to protect privacy. Identifying letters are
assigned in alphabetical order and bear no relationship to the person’s actual name.