Question about Refusing Care

[CAOX3]

Ok maybe I should have stated in my opinion.

I think the majority of cases our do to incompetency in providing pt care.

Ok what other derivitive could possibly be the cause of litigation besides incompetency.

Actually there our quite a few sites where you can review litigation cases against EMS providers.

Are you looking for a case study? All cases once closed are made public and are not that difficult to find.

Review some of them. Im sure you will come to the same conclusion. Maybe not.

 

[medic417]

Ok maybe I should have stated in my opinion.

I think the majority of cases our do to incompetency in providing pt care.

Ok what other derivitive could possibly be the cause of litigation besides incompetency.

Actually there our quite a few sites where you can review litigation cases against EMS providers.

Are you looking for a case study? All cases once closed are made public and are not that difficult to find.

Review some of them. Im sure you will come to the same conclusion. Maybe not.

If I were to review I would find large number of settlements because most cases the companys and insurance providors settle rather than risk losing. So the fact that the plantif got money does not prove guilt. People sue all the time because they know that odds are they will never have to go to court to prove anything.

 

[CAOX3]

I had a link here, I cant find it, I wrote a paper on not this exact topic, a few years back for school.

To read some of the case files it was astonishing some of the things people were sued for, pt refusals headed the list. Some of the others ones were unbelievable

If I find it i will post it. It was really interesting.

 

[BossyCow]

Ok maybe I should have stated in my opinion.

I think the majority of cases our do to incompetency in providing pt care.

Huh??? Did you mean that the majority of cases 'are due' to incompetency?

Ok what other derivitive could possibly be the cause of litigation besides incompetency.

A 'derivitive' is not a cause. See this link. http://dictionary.reference.com/browse/derivative
If you are going to use big words, know what they mean.

Actually there our quite a few sites where you can review litigation cases against EMS providers.

Again... there our a few? Did you mean are?

Are you looking for a case study? All cases once closed are made public and are not that difficult to find.

Also inaccurate. Many cases have the records sealed as part of the settlement conditions.

 

[CAOX3]

Oh attack of Webster and I was an english major. How unfortunate, at least I have you to translate.

Maybe I could explain the word derivative for you, or you could do your own homework. Let me help "not original, secondary to" hence a derivative would be another cause. Thank you anyway though.

Settlements and judgements ARE two diffrent things.

 

[BossyCow]

Oh attack of Webster and I was an english major. How unfortunate, at least I have you to translate.

Maybe I could explain the word derivative for you, or you could do your own homework. Let me help "not original, secondary to" hence a derivative would be another cause. Thank you anyway though.

Settlements and judgements ARE two diffrent things.

Its important if you want to be taken seriously to be articulate.

I understand that a settlement and a judgement are two different things. You stated that once a case is closed, it is made public.. this is inaccurate. A case can be closed for many reasons, because a settlement has been reached, a judgement has been made, either or both parties ended the litigation or failed to file documents with the court in a timely fashion etc.

Incompetence would not be a derivative in the context you presented. Incompetence can be derived from a lack of education, a poor work ethic.. but Incompetence would not be a derivative causing an action. In the example you cite in your reply to me, justifying your use of the word, you are using the adjective form of the word to defend your use of it as a noun... English Major? I doubt it!

I certainly hope you are a bit more concise in your language on your reports.

 

[DevilDuckie]

If weren't not supposed to diagnose, wouldn't refusing care be diagnosing them in some way?

 

[HasTy]

Okay, they refuse to be treated, and your doing what? Remember, before you are to touch someone (if they are awake) you ask to help them (consent?) If they refuse treatment ask the simple questions to obtain they are competent and orientated enough to make decisions. Advise, risk, alternatives, and sign refusal, get witness if possible.. then by-by to another call.

R/r 911

IMHO that is best thing to do...the way I was taught in CA if you lay hands on a patient without there consent then you are in effect assaulting them...

 

[medic417]

If weren't not supposed to diagnose, wouldn't refusing care be diagnosing them in some way?

You have to diagnose to treat, why could an properly educated Paramedic not also diagnose that they are not in need of an ambulance and say no. We do it all the time. There is no law in any state that says we can not deny, only some local protocols and policys.

 

[exodus]

Why not just transport? I am sure if you refuse to transport they will have A LOT more paperwork to do, than if you just transported. All I see this is a way for a huge liability gap to come into place.

 

[medic417]

Why not just transport? I am sure if you refuse to transport they will have A LOT more paperwork to do, than if you just transported. All I see this is a way for a huge liability gap to come into place.

Why not educate people by saying no then in the long run it saves time?

 

[exodus]

Why not educate people by saying no then in the long run it saves time?

I doubt telling someone, "You don't need an ambulance for this, and it will be much cheaper for you to just take a cab if you want to go." will really help very much. If they call already, they have made up their mind most of the time and that is what they are going to do.

Sure maybe 2 out of 10 people may actually listen and take it to heart, but I doubt the majority would.


Not working yet, but from my impression of what I read here, is most bs calls are psychiatric, so with that, telling them that they don't need an ambulance won't help them at all.

 

[VentMedic]

Why not educate people by saying no then in the long run it saves time?

See below.

I doubt telling someone, "You don't need an ambulance for this, and it will be much cheaper for you to just take a cab if you want to go." will really help very much. If they call already, they have made up their mind most of the time and that is what they are going to do..

This can also back fire for discrimination. They may perceive what you say as indicating their inability to pay and not worthy of your ambulance.

Sure maybe 2 out of 10 people may actually listen and take it to heart, but I doubt the majority would.

Those that listen to all the the education about when not to call an ambulance will be someone who may actually need one. It will give those who are high risk for heart attacks a few extra arguments for fueling their denial especially if the call was may by a friend or family member who witnessed symptoms and do have concerns. If you are called and have not witnessed the symptoms that family and friends did, you may tend to side with the patient who is in denial about their own health.

Not working yet, but from my impression of what I read here, is most bs calls are psychiatric, so with that, telling them that they don't need an ambulance won't help them at all.

Does this mean psychiatric patients don't need medical care? Do you know that some psychiatric patients must have regular cardiac screenings because of the meds they are on and the systemic symptoms they can cause while controlling the psych problems?

 

[medic417]

I doubt telling someone, "You don't need an ambulance for this, and it will be much cheaper for you to just take a cab if you want to go." will really help very much. If they call already, they have made up their mind most of the time and that is what they are going to do.

Sure maybe 2 out of 10 people may actually listen and take it to heart, but I doubt the majority would.


Not working yet, but from my impression of what I read here, is most bs calls are psychiatric, so with that, telling them that they don't need an ambulance won't help them at all.

I disagree with that. Many people call for the ambulance because they have been taught that abuse will not have consequences and they will get to where they want for free. There are some with mental issues but most that do not need the ambulance in my experience are more sane than you or I and have been educated to save money by taking the free ambulance. Free as they will not pay.

By doing a proper exam then informing them they are not going by ambulance then leaving they have no choice but becoming educated to find another ride.

 

[exodus]

See below.

This can also back fire for discrimination. They may perceive what you say as indicating their inability to pay and not worthy of your ambulance.



Those that listen to all the the education about when not to call an ambulance will be someone who may actually need one. It will give those who are high risk for heart attacks a few extra arguments for fueling their denial especially if the call was may by a friend or family member who witnessed symptoms and do have concerns. If you are called and have not witnessed the symptoms that family and friends did, you may tend to side with the patient who is in denial about their own health.



Does this mean psychiatric patients don't need medical care? Do you know that some psychiatric patients must have regular cardiac screenings because of the meds they are on and the systemic symptoms they can cause while controlling the psych problems?

I'm against telling people they don't need an ambulance and would much rather just transport everyone, takes a lot of stress off of my shoulders worrying about someone I denied transport to, and having something happen to them later that day.

I disagree with that. Many people call for the ambulance because they have been taught that abuse will not have consequences and they will get to where they want for free. There are some with mental issues but most that do not need the ambulance in my experience are more sane than you or I and have been educated to save money by taking the free ambulance. Free as they will not pay.

By doing a proper exam then informing them they are not going by ambulance then leaving they have no choice but becoming educated to find another ride.

You do not know the patients history 100%, they could be lieing about something, but just because you don't find anything in your exams does not mean that there "isn't" something there.

How is it going to hurt "you" to just transport them? 99.9% of the time there will be another ambulance to take care of another call when it comes in. So by doing this, you are going to have no liability at all for mis-diagnosis because you are not the one judging them. You don't show your training, but I am pretty sure you are a paramedic / rn, which is about 7 years / 5 years respectively, short of being a doctor in terms of education. As a paramedic / RN , you do not have the proper education to say someone does not need an ambulance 100%.

 

[AJ Hidell]

I'm against telling people they don't need an ambulance and would much rather just transport everyone, takes a lot of stress off of my shoulders worrying about someone I denied transport to, and having something happen to them later that day.

The whole point here is that, if the provider is properly educated, he is likely to be comfortable with his assessment, relieving him of any stress or worry associated with the decision process. Obviously, when in doubt, transport. However, there are a lot of undeniably black-and-white scenarios where it is clear that EMS transportation is neither indicated nor warranted. And a properly educated medical professional should have the ability to make that call.

 

[VentMedic]

I disagree with that. Many people call for the ambulance because they have been taught that abuse will not have consequences and they will get to where they want for free. There are some with mental issues but most that do not need the ambulance in my experience are more sane than you or I and have been educated to save money by taking the free ambulance. Free as they will not pay.

By doing a proper exam then informing them they are not going by ambulance then leaving they have no choice but becoming educated to find another ride.

Before making a blanket statement, I would have to look at the complaint. A broken finger is one thing but medical problems are much more difficult to pinpoint. If is hard to tell if a patient's sodium is a little off that is causing their abnormal "psych" issues. Or, if they have been compliant or maybe their medication dosage needs adjusting or it could even be at toxic level. Maybe another organ such as the kidneys or liver is starting to show signs of failure from long term psych med use. Can you check the BUN and Creatine? Can you check the lytes? Liver enzymes? Lactate? Lipid panel? ANA? Do you take a temp on every patient? Assess lymph nodes?

Also, the public information messages have involved "see a doctor" and don't wait if "A, B or C" symptoms appear.
If the patient takes the paramedic for his/her word that there is nothing serious, they may take your assessment at the same value as that of a doctor and delay going to a clinic.

Do you know how many patients have entered the ED with "general malaise" and left the hospital with a diagnosis of some cancer?

How about the young drug user who gets written off because his symptoms are not specific but later gets the diagnosis of ALS? I saw two patients like that last month who are only in their 20s. I will continue to see them because their disease is advancing so quickly they will probably die within the next few months on a ventilator in the sub-acute part of our hospital system. The ED doctors at our hospital also almost wrote them off also but decided to check a couple more things that the other doctors didn't bother to do.

 

[medic417]

How is it going to hurt "you" to just transport them? 99.9% of the time there will be another ambulance to take care of another call when it comes in. So by doing this, you are going to have no liability at all for mis-diagnosis because you are not the one judging them. You don't show your training, but I am pretty sure you are a paramedic / rn, which is about 7 years / 5 years respectively, short of being a doctor in terms of education. As a paramedic / RN , you do not have the proper education to say someone does not need an ambulance 100%.

Heck doctors can not be 100% sure a patient does not need an ambulance. Its in the news way to often someone sent home after seeing the doctor just to die. Life is not 100%.

As to my liability by doing a consistant exam I can determine with reasonable certainity whether they have a real life threatening emergency in need of ambulance transport or could be treated by their regular doctor w/o the use of an ambulance.

"99.9% of the time there will be another ambulance to take care of another call when it comes in."

Wow I want to live in your dream world. Or should I ask you to pass what ever you are smoking? Sorry even in big citys calls start stacking frequently, yes eventually an ambulance will come but might be hours rather than minutes. In my area if I take a patient to the hospital the community has to wait an hour for mutual aid if they are available.

As to paperwork I would rather do paper work than continue to be used as a horizontal taxi. I am a medical professional not an ambulance driver.

 

[medic417]

Before making a blanket statement, I would have to look at the complaint. A broken finger is one thing but medical problems are much more difficult to pinpoint. If is hard to tell if a patient's sodium is a little off that is causing their abnormal "psych" issues. Or, if they have been compliant or maybe their medication dosage needs adjusting or it could even be at toxic level. Maybe another organ such as the kidneys or liver is starting to show signs of failure from long term psych med use. Can you check the BUN and Creatine? Can you check the lytes? Liver enzymes? Lactate? Lipid panel? ANA? Do you take a temp on every patient? Assess lymph nodes?

Also, the public information messages have involved "see a doctor" and don't wait if "A, B or C" symptoms appear.
If the patient takes the paramedic for his/her word that there is nothing serious, they may take your assessment at the same value as that of a doctor and delay going to a clinic.

Do you know how many patients have entered the ED with "general malaise" and left the hospital with a diagnosis of some cancer?

How about the young drug user who gets written off because his symptoms are not specific but later gets the diagnosis of ALS? I saw two patients like that last month who are only in their 20s. I will continue to see them because their disease is advancing so quickly they will probably die within the next few months on a ventilator in the sub-acute part of our hospital system. The ED doctors at our hospital also almost wrote them off also but decided to check a couple more things that the other doctors didn't bother to do.

Vent if there is any doubt about mental condition patients are transported. Mental illness is not something we joke around with. Many patients physical S/S turn out to be related to mental conditions.

As to the general weakness calls often those do turn out to be the most critical. It is surprising how many of those actually are in the downward spiral of decompensated shock of one form or the other.

We do not ever tell them that it is not serious but that it does not need an ambulance. We do explain to them where the should go such as ER right now and we call ahead, or to their doctor and we will call their doctor so they will get worked in.

We do not abandon patients. I always love this discussion because so many freak out that we are just saying no to everyone when in reality it is not used but on a small number of calls.

 

[AJ Hidell]

This all comes down to one simple question:

Does this patient require medical care, assessment, or observation enroute to immediate definitive care?

Yes = Transport
No = No transport

Even Medicare addresses this in their reimbursement, so this is not a new concept of screening. Simply being ill or injured does not necessarily mean that you need EMS care and/or transportation. A great many people call 911 not because they believe they need -- or even want -- EMS care or transportation, but simply because they believe that is what they have to do to get seen in an ER. Those people are quite happy to make alternative arrangements when they are educated about the process.

Of course, this is all a very theoretical discussion. The number of medics (and certainly no EMTs) in this country educated and experienced enough to competently make these sorts of decisions intelligently, and consistently without error, is so microscopic as to be statistically insignificant. So this discussion is not so much about what we should be doing, but what EMS should be doing in the future. We can't continue to forever keep doing things this way simply because it's the way we've always done it. That is a recipe for professional failure.