‘Turning a blind eye’: denying people their right to treatment for acute alcohol, drug and mental health conditions – an act of discrimination

Abstract

Background: Australians seeking health care from any public hospital have the right to non-discriminatory safe medical assessment, treatment and nursing care. The literature clearly indicates that people presenting to public hospitals with acute alcohol- or drug-related conditions are at risk of dying by being denied medical and nursing treatment. This denial of treatment is on the basis that their presumed condition is solely drug- and alcohol-related. There is often even a greater risk for Aboriginal people who present for treatment. This literature comprises reports from coronial inquiries, police incidents, safety audits, and critical incidents in health services, and anecdotal information from specialist drug and alcohol nurses. Such violation of this vulnerable population's right to safe health care has often resulted in suicide and other preventable deaths, disability and exacerbation of physical and mental illness.

Method: A critique was conducted of recent available Australian ‘grey’ literature comprising coronial and police reports, local critical incident alert systems in hospital reports and anecdotal information from specialist drug and alcohol nurses associated with three case studies.

Findings: The reports revealed that some of the people seeking treatment for alcohol-, drug-and mental health-related crises, who were denied treatment, subsequently died in police custody, shelters, home, public places or elsewhere. The evidence showed that many who died did so because medical and nursing staff presumed they were just ‘alcoholic’ or ‘drunk’ and therefore were not seriously injured or ill. Commonly, stereotyping and racism were found to influence a health professional's decision to refuse treatment, and their unethical practice was directly linked to deaths because of missed or wrong diagnoses and poor standards of nursing assessment. Several cases, all occurring recently in South Australian country areas, were identified through a critical incident alert system and re-confirmed by local specialist drug and alcohol nurses who were aware of each case. One case was an Aboriginal man and two others were non-Aboriginal men. All were relatively young. Each man was denied proper medical assessment, treatment and safe nursing care by staff in the hospitals in which they sought help. As a consequence, the Aboriginal man developed delirium tremens requiring medical retrieval by air to a major teaching hospital for intensive care. The other two men required extensive support and intervention due to acute mental illnesses that co-existed with their drug use.

Discussion: This review offers important information from which to build strategies to remediate poor policies, practices, and attitudes. Hopefully, these strategies may assist to prevent similar situations occurring in the future.

Keywords:

• alcohol and drug
• discrimination
• health care
• human rights
• mental illness
• substance use