CL Case Conference: Treatment Over Objection in the General Hospital.

Abstract

We present the case of a 65-year-old female with schizophrenia admitted to the general hospital for a urinary tract infection complicated by psychotropic non-adherence and severe agitation. Treatment over objection (TOO) for UTI and underlying severe mental illness was granted by the court. However, treatment was delayed by staff discomfort and unfamiliarity with TOO and further complicated by the patient's ongoing psychosis and agitation. The multidisciplinary team provides commentary and guidance on the management of this commonly encountered scenario. Key teaching points include the ethical dilemmas of TOO, goals of TOO and difficulties implementing TOO in the general hospital from both physician and nursing perspectives. We discuss the logistical barriers hindering implementation of TOO in the general hospital setting, the pivotal role of the consultation-liaison psychiatrist and provide a general guide for implementing TOO in the general hospital.