I move that the Bill be read a Second Time.
The purpose of the Bill is to regularise the continued detention of a number of patients who were received into mental institutions as temporary patients.
Chapter III of Part XIV of the Mental Treatment Act, 1945, provides for the reception of temporary patients into mental institutions. The maximum period of detention of such patients is six months, in the first instance, but Section 189 of the Act provides that where the chief medical officer of the institution becomes of opinion that the patient will not have recovered on the expiration of that period, the person in charge may request the Minister to extend the period and where the Minister, by order, so extends the period the patient may be retained in detention in the institution. The Minister may not make an order extending the period of detention by more than six months but, on subsequent requests, he may make further orders, subject to the provision that the aggregate period of detention may not exceed two years. In recent years, requests for extensions of periods of detention number almost 3,000 per year.
As Deputies will appreciate, an application for an extension of the period of detention of a temporary patient cannot be made until it is clear that the patient will not have recovered within the then current authorised period of detention and consequently the application normally does not reach my Department until towards the end of that time. In fact, it was necessary some years ago to ask hospital authorities to make their applications a fortnight before the current expiry date; but, despite this, it frequently happens that applications are received only a few days before the then current period of detention is due to expire. There is thus a deadline to meet in regard to every one of the sixty or so applications, on average, received each week, but notwithstanding this no slip-up occurred until recently.
When an application for an extension is received in my Department, the previous papers in relation to the patient concerned are extracted and associated with the application. The file of documents is then passed to the Inspector, or Assistant Inspector, of Mental Hospitals. He examines the application and the previous papers and, if he is satisfied, recommends the grant of the extension. A draft of an order covering a number of extensions is then prepared. The draft is examined by a senior officer who certifies that he has personally seen the applications for extensions and the necessary certificates from an appropriate medical officer of each of the institutions in which the patients are detained. The draft order, accompanied by the certificate of the senior officer, then comes to me, as Minister, for signature. When the order has been signed the institutions concerned are notified as to the extensions granted, a separate notification being sent in respect of each patient. This procedure worked without hitch for many years.
On 13th December last a young and junior officer absented himself on sick leave. It had been part of his duties to deal with the initial part of the procedure which I have just described, —that is to say, the association of each application with the previous papers relating to the particular patient and their submission to the Inspector, or Assistant Inspector of Mental Hospitals. This is, of course, a simple routine task appropriate to junior staff. The officer to whom I have referred had been carefully trained in the work and the vital importance of dealing with applications immediately had been very strongly impressed on him. When he had been on sick leave for about a week it was found that he had suppressed a number of the applications received by him. In all, a total of 280 applications received in the period October to mid-December were suppressed. Further in an attempt to prevent discovery of his actions, he issued to the mental institutions concerned in all but 22 of these cases notifications that the Minister had approved the proposed extensions. As I have already indicated the number of applications received is high. The number arriving in a particular period, however, can vary considerably and, as the officer suppressed only some of the applications there were enough passing through to prevent the development of suspicion in the Department that anything was wrong. The issue of the irregular notifications to institutions that extensions had been granted also contributed to the delay in the discovery of the misconduct.
I should perhaps say at this stage that of the 280 patients in respect of whom the applications for extension were suppressed, the usual statutory notifications received in the Department indicate that 53 have since been discharged in the normal course. This figure of 53 includes seven of the twenty-two mentioned earlier whose period of extension had not been authorised and in which cases notifications have not been issued to the authorities concerned.
I should say also that the 22 cases in which notifications of the approval of the proposed extensions were not issued occurred in only eight of the mental hospitals. In all the other mental hospitals, the medical superintendents and other staff could have had no information that anything was amiss. In the case of the eight mental hospitals mentioned, inquiries were made by the staffs concerned in relation to the specific patients and they were told that the matter would be looked into but even up to now have not been told that the required orders have not been made.
The officer whose misconduct gave rise to the present difficulties has only recently returned from sick leave and consequently has only recently been in a position to furnish his explanation. This is at the moment being considered.
When these irregularities came to light, the time in which extensions could be granted had expired in respect of most of the applications. This Bill seeks to rectify the position by providing, broadly, that where an application for an extension was duly made, the patient may be continued in detention as if an order had been made extending the period, notwithstanding the fact that no order was actually made. Provision is also made that no damages shall be recoverable by or on behalf of a person in respect of his detention during the period in question.
In asking the House to agree to this measure it is well that I should ask it to view in proper perspective what has happened in relation to the patients involved. As I explained on the Second Reading of the Mental Treatment Bill, 1960, which is now before the House in Committee, in deciding whether or not to grant an extension of the period of detention of a temporary patient, the person who happens, for the time being, to be Minister for Health has to rely on his professional advisers. In view of the number of extensions involved, now running, as I have mentioned, at close to 3,000 a year, they, in turn, have to rely to a very large extent on the recommendation of the senior medical officers of the institutions concerned; for it will be fortuitous that they will know the patient qua patient. Even in the exceptional case where they may remember having seen the patient it will usually have been only once or twice and then for short periods. Very, very rarely can they be in a position from their own knowledge of him to decide whether he should, or should not be detained.
While in practice all applications are carefully considered, invariably the word of the chief medical officer of the institution has to be accepted and the extension granted. So automatic is the procedure that in September last, three months before the events which led up to this Bill first came to light, I had decided that it served no useful purpose and that I should ask the Oireachtas to amend it. I recommended accordingly to the Government in a general memorandum dealing with the amendment of the Mental Treatment Acts and the Government approved the proposal on 18th October and the necessary provision was included, as Section 18, in the Mental Treatment Bill, 1960, which was circulated as the House may remember, to Deputies on 29th November, 1960, while I and my Department were still unaware of the irregularities which, in fact, were occurring at this time. The Section mentioned provides for the transfer from the Minister to the chief medical officer of the institution concerned of the power to extend the period of detention of a temporary patient.
All the suppressed applications have been examined with special care by the Inspector of Mental Hospitals and he is fully satisfied that if the applications had come to him at the proper time he would have recommended the grant of the extensions sought. There is no shadow of doubt, therefore, that the extensions would have been granted if the applications had been dealt with in the normal way.
Notwithstanding the fact that the grant of the extensions sought would have been virtually automatic if they had been dealt with in accordance with the usual procedure, I do not wish to minimise, in any way, the seriousness of the fact that the necessary Ministerial orders were not made. I regard what has happened as most regrettable and most deplorable.
After the initial discovery on 19th December it was necessary to make the fullest enquiry and search of records to ascertain which patients were, in fact, detained in accordance with law and which were being detained irregularly. When that had been done and the facts established, the measures which might be taken to deal with the situation were considered.
I may say that I first considered notifying all the institutions concerned that, through no fault of theirs, particular patients were being irregularly detained and that these should be released immediately without waiting to determine the form of any legislation which might be required. I decided against that course. The patients concerned had been certified by the competent medical authority a short time previously to need further detention for their recovery. In the interim, any who had recovered sufficiently to justify their discharge had, in fact, been discharged. Of the remainder, some would have progressed to the stage where their discharge was imminent and the majority were in need of longer-term detention and treatment. I submit that to have discharged those still undergoing treatment so that they could be readmitted and detained in accordance with law would have had a most disturbing effect on the patients and would have caused unnecessary worry and anxiety to the relatives. I think it was the least humane course that I could have adopted. I therefore rejected it.
The provisions in the present Bill are, in my opinion, the most appropriate to meet the position as it exists.
In asking the House to give the Bill a Second Reading and to allow it to pass through all its Stages today, I should like again to stress four points:—
1. The arrangements which were in force for dealing with applications for extensions were regarded for many years as reasonable by me, by my predecessors and by the senior officers of the Department. They are still regarded as reasonable, subject only to a minor modification, which has since been made.
2. No blame attaches to any medical superintendent or other officer of a mental institution in relation to this matter.
3. No patient was detained whose detention was not justified.
4. No patient has been detained for a day longer than was justified by his condition, or will be so detained.
In these circumstances, I ask the House to give me the Second Reading of the Bill and also the remaining Stages to-day.