Patient kidnapping - The cowtipping of EMS

I've been sitting on this post for months and recent discussions on the facebook and around the interwebs are leading me to revisit it.

 

In an old You Make the Call we discussed when to take people to a  certain medical facility versus another and, sure enough, the topic of kidnapping came up.

It was reinforced in a (not so) recent story out of Florida about a man who claims to have been transported against his will.

 

Much in the same way Country kids sell the legend of cow tipping to City kids, I believe kidnapping of patients is an urban legend perpetuated by EMS managers and Chiefs alike to keep us from making waves and doing the right thing.  They need transport dollars to survive and taking people to their hospital of choice is an easier bill than not.

Are you confused with the definition, both of the word and the action?

 

kidnapping n. the taking of a person against his/her will (or from the control of a parent or guardian) from one place to another under circumstances in which the person so taken does not have freedom of movement, will, or decision through violence, force, threat or intimidation. Although it is not necessary that the purpose be criminal (since all kidnapping is a criminal felony) the capture usually involves some related criminal act such as holding the person for ransom, sexual and/or sadistic abuse, or rape. It includes taking due to irresistible impulse and a parent taking and hiding a child in violation of court order. An included crime is false imprisonment. Any harm to the victim coupled with kidnapping can raise the degree of felony for the injury and can result in a capital (death penalty) offense in some states, even though the victim survives. Originally it meant the stealing of children, since "kid" is child in Scandinavian languages, but now applies to adults as well.

Gerald N. Hill and Kathleen T. Hill.

Hmmm...

Taking someone to a hospital where they will receive medical care is not kidnapping as far as I can tell.  I've been looking at many different definitions of kidnapping over the week and keep coming back to the same definitions at heart.

If you do it for the right reasons, how can it be the wrong thing to do?

If you are doing it to get back to dinner, get off duty on time, or because your manager tells you to, THEN we have an issue since your position of authority could be interpreted as intimidation, but taking someone having an MI to a proper facility instead of local band aid ER is not kidnapping as far as I can find.

This discussion started when we discussed a patient who did not want to be taken to the appropriate medical facility for his presentation.  The discussion that followed revolved around him being "alert and oriented" "not intoxicated" and "I'm not going to kidnap him."

In that situation YOU AREN'T!

You may do some research and find a term called "simple kidnapping" which appears to cover a slew of false imprisonments, holding without permission, and similar crimes, but in no definition do I find an example of a kidnapping being taking someone to the hospital.

Keep in mind your jurisdiction may have their own definition and you need to be familiar with it, but let me extend this one hypothetical step further.  If a person claims they need a transport and take me against my will, since I don't think they need to go, is THAT kidnapping?  I'm being forced to go somewhere by fraud and could suffer harm as a result.

That more closely fits the definition of kidnap than taking a person to an appropriate medical facility, conscious & alert or not.

 

We are told not to disobey the patient and do what they say, take them where they want, and 95% of the time that works out just fine.  Your stomach hurts?  Sure we can goto St Farthest.  Your leg itches again? Kaiser patient, not a problem.  Trauma patient wants to goto St Farthest?  Aren't we supposed to be patient advocates and do everything we can for them?

Isn't EMS supposed to be patient centric?  So why aren't we teaching EMTs and Paramedics what the definition of kidnap really is?  Probably the same reason we avoid teaching them what liability really means.

There are a lot of problems that will come bubbling to the surface if we started acting in our patients' best interests and none of them are ours OR theirs.

A common practice in my jurisdiction is the art of hospital shopping.  A person will identify as a member of a hospital they rarely attend because they believe the doctors there to be superior, or that the nurses are prettier, or the other place "kicked me out" but in actuality they are simply trying to get someplace new, or clean, or where lunch is served at 1 and it's 12:45.

In the pilot episode of Beyond the Lights & Sirens, I had a conversation with a regular named Val.  She presented with chest pain, 10/10, radiating, with history, a mere 10 blocks from an appropriate facility.  Her requested facility, 2 hospitals and 25 minutes away was on saturation divert, or no longer accepting patients by ambulance.  I transported her, per chest pain protocol, to a hospital that was not her requested facility.  No kidnapping charges were filed.

Many of you would argue I kidnapped her.  I moved her from one place to another without her consent using intimidation (My position of authority).  But looking at the situation unfold, I did not kidnap her, but get her to the appropriate facility for her chief complaint, as defined by my Medical Director, County EMSA, State EMSA, Chiefs and Captains.

Don't default to the stories the Anchors tell you about kidnapping charges being brought against a long lost co-worker for taking Erma to the wrong hospital.  That case likely had a different, more shady reason for leading to termination, not kidnapping.

Perhaps we should spend less time worrying about vague definitions that don't apply and spend more time in the airway lab?

 

And I hate that I have to remind you of all this, but these words are my opinion and are not those of my employer, a lawyer, an expert, my daughter, the crossing guard or the guy at Sears who stocks the vacuum bags.  Before you act on these words, consult with your local system administrators for the rules and laws applicable in your area.