EMS1.com is reporting a Florida man who was transported after a loss of consciousness may sue the agency that transported him.
According to the report, the patient suffered a loss of consciousness and was assisted by neighbors to his home and someone other than the patient dialed 911.
After an assessment, according to the patient, the paramedics determined he was "at risk for a stroke" and needed transport.
Kenneth Rothwell, the patient, states he was told, "It was either go, or you're going to be handcuffed and we're going to take you."
Hang on here a minute folks.
The story does not elaborate WHO said anything about the handcuffs, but a deputy and EMT were at the scene. Now we have reports of 3 rescuers ("Paramedic" "deputy" and "EMT"). I wonder which one brought up the idea of handcuffs?
We have safeguards in place for this kind of situation by way of direct Medical Control. Whenever I have a high index of suspicion of illness or injury and a patient refuses, I do my best to convince them of what I think is in their best interests. If that fails I fall back on direct Medical Control to talk to the patient. If that fails, most times, the MD will instruct me to explain the dangers of staying home to the patient and...wait for it...leave them there.
There is never a threat of "being handcuffed and we're going to take you." That should NEVER be an option. The urban myth that is patient kidnapping is being supported by poor decision making based on false presumptions. I can only imagine that the deputy who made the hand cuff comments (unconfirmed) had no intention of placing Mr Rothwell under arrest for passing out. I'll have to confirm with Motorcop that is not an arrestable offense.
Point is that Mr Rothwell has a very good argument against whoever told him he "had" to go, either willingly or in cuffs. THAT is the part that bothers me about all this. That and the fact Mr Rothwell is required to make health care decisions based on out of pocket expenses, but that's another issue entirely.
Comments will surface soon about foolish EMTs or that this is a good reason EMTs and Paramedics should not be making refusal referrals pre-hospital, but this is EXACTLY what Mr Rothwell needed. BLS before ALS failed Mr Rothwell. A well trained Paramedic could have offered Mr Rothwell a calm comfortable ride in his first response vehicle, or even to follow him to the local ER if he likes. Maybe even make an appointment to call or drop by later in the day to check in on him, but we are locked into a 40 year old model that scares our people into transporting every scratch and scrape, tummy and head ache so we don't get sued.
And this is where it gets us.
At the very least, the agency who mislead Mr Rothwell using intimidation in order to remove him from his home against his will is at risk for setting an industry wide precedent and prove the urban myth a reality.
Your training exercise for the day:
Was Mr Rothwell, based on the EMS1.com story facts as reported, kidnapped?
According to the report, the patient suffered a loss of consciousness and was assisted by neighbors to his home and someone other than the patient dialed 911.
After an assessment, according to the patient, the paramedics determined he was "at risk for a stroke" and needed transport.
Kenneth Rothwell, the patient, states he was told, "It was either go, or you're going to be handcuffed and we're going to take you."
Hang on here a minute folks.
The story does not elaborate WHO said anything about the handcuffs, but a deputy and EMT were at the scene. Now we have reports of 3 rescuers ("Paramedic" "deputy" and "EMT"). I wonder which one brought up the idea of handcuffs?
We have safeguards in place for this kind of situation by way of direct Medical Control. Whenever I have a high index of suspicion of illness or injury and a patient refuses, I do my best to convince them of what I think is in their best interests. If that fails I fall back on direct Medical Control to talk to the patient. If that fails, most times, the MD will instruct me to explain the dangers of staying home to the patient and...wait for it...leave them there.
There is never a threat of "being handcuffed and we're going to take you." That should NEVER be an option. The urban myth that is patient kidnapping is being supported by poor decision making based on false presumptions. I can only imagine that the deputy who made the hand cuff comments (unconfirmed) had no intention of placing Mr Rothwell under arrest for passing out. I'll have to confirm with Motorcop that is not an arrestable offense.
Point is that Mr Rothwell has a very good argument against whoever told him he "had" to go, either willingly or in cuffs. THAT is the part that bothers me about all this. That and the fact Mr Rothwell is required to make health care decisions based on out of pocket expenses, but that's another issue entirely.
Comments will surface soon about foolish EMTs or that this is a good reason EMTs and Paramedics should not be making refusal referrals pre-hospital, but this is EXACTLY what Mr Rothwell needed. BLS before ALS failed Mr Rothwell. A well trained Paramedic could have offered Mr Rothwell a calm comfortable ride in his first response vehicle, or even to follow him to the local ER if he likes. Maybe even make an appointment to call or drop by later in the day to check in on him, but we are locked into a 40 year old model that scares our people into transporting every scratch and scrape, tummy and head ache so we don't get sued.
And this is where it gets us.
At the very least, the agency who mislead Mr Rothwell using intimidation in order to remove him from his home against his will is at risk for setting an industry wide precedent and prove the urban myth a reality.
Your training exercise for the day:
Was Mr Rothwell, based on the EMS1.com story facts as reported, kidnapped?
Comments
Regardless of who said what, this was just bad judgement and unprofessional. We, the medical professionals, are to advocate for our patients and give them the knowledge to make an informed decision and then follow through with wishes.
Somebody crossed the line....waaaaaaaay over the line!
Furthermore, when negotiating with altered patients that possibly pose a danger to themselves, the use of scare tactics such as the empty threat of incarceration are not only effective, they are preferred to the use of force.
I've decided to give the medic the benefit of doubt. Let's not jump to conclusions without all the information.
"5150. When any person, as a result of mental disorder, is a danger
to others, or to himself or herself, or gravely disabled..."
http://www.leginfo.ca.gov/cgi-bin/displaycode?section=wic&group=05001-06000&file=5150-5157
What mental disorder is he suffering from? What's next, threatening hospice patients to renounce their DNR order?
I'm not assigning blame, just looking for opinions as to the initial facts.
Please read section 5150 and respond with a quote where a 5150 hold can be issued for non-mental health related issues. This patient needs a neurologist, not a psychiatrist, and that alone disqualifies him for a 5150 hold.
I should also note that a 5150 hold comes with some very specific restrictions on one's rights, such as the right to bear fire arms. Should a person who was placed under a 5150 for proper reasons be restricted? Sure. Someone placed under it because they might be having a stroke and wants to exercise their right as an individual to direct their own medical care? Absolutely not.
We are assuming too much here, I'm just asking if, on the basis of what we know now from the article, if there was a basis for the urban myth (in my opinion) of patient kidnapping and, if so, who was the initiating agency.
I'm fairly certain the threats of incarceration were not made by EMS, but again, as has been as stated by many, we do not have the facts.
But we never will have the facts, so let's keep the lines of communication open before this kind of thing happens again.
Thanks for reading.
Do you want to be the medic justifying your actions in this case? He may show up in court in a suit and sober, claiming you kidnapped him and cost him thousands of dollars in an effort to justify your salary amid budget cuts. Or will he be in a wheelchair with his sympathetic wife who will cry and say that she told you he was sick and you were too lazy to do your job?
Personally, I would rather be sued for kidnapping in this case than abandonment.
According to your abbreviated description he is fit to sign a refusal in my system, or I will quote him clearly in my report, which I'll write in the parking lot, and if he heads for his car I'm calling MC and his buddies.
We can only do as much as our patients will let us. And since this man did not call and was physically able to remove himself from our presence, he isn't even a patient.
On the same note. You and I are playing cards in the garage, garage door open, in your home, when you tip back too far and fall and hit your head. You're bleeding and we've had a few drinks, but you say you're fine. The neighbor across the street calls 911 and an ambulance has arrived and is trying to assess you. Do you allow them? If you were the responding crew, is this even a patient contact?
Only recently did my service even file a definition of the word patient.
Thanks for reading.
Patients have the right to refuse, even if we think it's the wrong decision. The key is the mental capability of the patient, the detail of explanation given, and documentation.
Your post is directly on point. Or points actually. From the article, we don't know what the patient's condition was, what his competence level was, what the medic may or may not have told him, or what is in the PCR. Is the fire commission backing the fire department because they read the reports and have a good understanding of the legal issues involved? Or are they just circling the wagons? Time will tell.
It depends on the patient's capacity to consent.
401.445 Emergency examination and treatment of incapacitated persons.-- (1) No recovery shall be allowed in any court in this state against any emergency medical technician, paramedic, or physician as defined in this chapter, any advanced registered nurse practitioner certified under s. 464.012, or any physician assistant licensed under s. 458.347 or s. 459.022, or any person acting under the direct medical supervision of a physician, in an action brought for examining or treating a patient without his or her informed consent if: (a) The patient at the time of examination or treatment is intoxicated, under the influence of drugs, or otherwise incapable of providing informed consent as provided in s. 766.103; (b) The patient at the time of examination or treatment is experiencing an emergency medical condition; and (c) The patient would reasonably, under all the surrounding circumstances, undergo such examination, treatment, or procedure if he or she were advised by the emergency medical technician, paramedic, physician, advanced registered nurse practitioner, or physician assistant in accordance with s. 766.103(3). Examination and treatment provided under this subsection shall be limited to reasonable examination of the patient to determine the medical condition of the patient and treatment reasonably necessary to alleviate the emergency medical condition or to stabilize the patient. (2) In examining and treating a person who is apparently intoxicated, under the influence of drugs, or otherwise incapable of providing informed consent, the emergency medical technician, paramedic, physician, advanced registered nurse practitioner, or physician assistant, or any person acting under the direct medical supervision of a physician, shall proceed wherever possible with the consent of the person. If the person reasonably appears to be incapacitated and refuses his or her consent, the person may be examined, treated, or taken to a hospital or other appropriate treatment resource if he or she is in need of emergency attention, without his or her consent, but unreasonable force shall not be used. (3) This section does not limit medical treatment provided pursuant to court order or treatment provided in accordance with chapter 394 or chapter 397. History.--s. 17, ch. 89-275; s. 15, ch. 89-283; s. 3, ch. 89-336; s. 1, ch. 90-192; s. 25, ch. 92-78; s. 3, ch. 93-12; s. 25, ch. 93-39; s. 802, ch. 95-148; s. 1, ch. 2007-176.
Not just the examples you list, but cough medicine often contains alcohol.
Many medications may contain alcohol in quantities that may not even show up on a breath test, but if we are going to lower the standard for actions that automatically result in removal of my civil rights to presence of any intoxicants would have to include these medications.
What about the use of an alcohol wipe on a cut?
What about pouring some alcohol from a half liter bottle of isopropyl alcohol on a cut?
Where does presence of any intoxicants end?
Is there any medication that a patient can take that does not have the potential for intoxication?
Please provide an example.
Intoxicants include everything.
Death by water intoxication.
Gardner JW.
Mil Med. 2002 May;167(5):432-4.
PMID: 12053855 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/12053855
Should we consider the presence of water to be the presence of any intoxicant?
We are made of water.