# Ethical crisis



## SnigySnackJack (Feb 16, 2017)

So without naming any names, I'm currently on a 24 hour shift today on a private bls rig. I just cleared a call, but felt extremely worried and uneasy about the whole thing. And its got to do with balancing job protection and patient advocacy. And I fear it also delves into legal aspects of both sides.

So here's the sitrep:

Dispatched call for nursing home, going to a doctors appointment. Routine at first, get pt, bus them to the doc. 
When I get there I already know what's going to go down.
Pt is bed ridden so wheelchair transferring and leaving them with family is out of the question. But here's the thing. The insurance company will not pay for our crew to sit around waiting for the patient any longer than 15 minutes so what the company has decided is that we are to transfer the patient onto the exam table and then transfer care and leave. But as any normal person and expecially private EMS EMTs in such should know is that exam tables in doctors offices are not acceptable to leave a bedridden patient on they have no rails and they are unattended. Especially here, the exam tables are actually chairs that recline slightly. So transferring the patient onto there is out of the picture. 
But the patient has to be seen for their appointment but they can't leave the gurney and the doctor's office will not allow us to transfer the patient on to the chair nor will I do that anyways because that's just not safe for the patient. But the company is giving us an ultimatum saying that we either transfer the patient onto the chair or we leave without the patient being seen all because the company won't get paid while we wait but they're doing it under the guise that they'll be held liable if something were to go wrong during the examination on the company's gurney.

So while I have the facility call my dispatch the doctor sneaks into the patient's room and start going about the examination with the patient, at this point we've already been at this place for over an hour just waiting to be seen. And I can hear the head clerk/office rn tell my dispatcher the pt is already being examined by the doc. At this point the rn just tells dispatch that it'll be less than 15 till the exam is over. They accept this and hang up.

The unethical part here is that the company would have me drive the pt FROM an exam room, waiting for the doc to see them, and have the pt miss an extremely important appointment thats been set up a long time in advance. Just ignoring the pt needs. Placing company profits above the pt they agreed to help by taking and dispatching their call.

So what do I do. I feel like I have ethics morality on my side, but I also fear backlash from the company for letting the exam to take place. This isn't the first time they've done this. They do this all the f'ing time. And its the same situation almost every time. And yet THEY JUST CONTINUE TO ACCEPT These CALLS. it makes Us, emt's look HORRIBLE, the company even WORSE, and as far as I know, this is the only company that does it.


What do I do? Should I legitimately consult with legal help? I've been in this situation many times before, and it always goes this way. But every time I feel sick to my stomach that this is even a situation that could come out of ems. I feel like I compromise my moral and ethical ideals every time it happens.
Help. Me.
I can't be the only one.


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## Kevinf (Feb 16, 2017)

Leave without patient being seen. Your company will stop getting called eventually. Move away from that company while you can. Contact whatever your governmental EMS oversight is, whether that's your Dept of Health or Regional EMS council and speak with a representative there about it.

The company is poorly run, as this shouldn't even be an issue.


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## hometownmedic5 (Feb 19, 2017)

Decide right now whether this is ultimately worth your job; because if you take on the company, right wrong or indifferent, you're probably going to end up looking for work. They hate rabble-rousers, especially when they're right. Leaving non ambulatory patients in unsafe environments is clearly unacceptable.

If you are willing to sacrifice your job, then the next step is to demand, in writing, with specific details regarding the lack of rails and so forth, the policy requiring you to do this. This memo must have a name at the bottom and that name must be a senior member of the management. If you get them to provide this, it's your get out of jail free card. It turns a bad decision into an institutional failure.

Most likely, they'll refuse to put this insanity on paper. If that happens, tell them that you believe this is unsafe and violates proper patient care and so on and that you'll need to seek an opinion on the matter from your states EMS agency. This is where things are going to go bad for you. Nobody likes dealing with a state investigation. 

They either need to stop taking these calls or suck it up and pay the crew to sit around waiting for the patient; but what they can't do is set you up to take the fall. If you decide this isn't the most appropriate time for you to be out of work, then you need to make damn sure that you document whom you transferred care to, get them to sign that they received the patient, and I would suggest you put in your narrative the exact circumstances under which you left them and that you raised this concern with the receiving facility and that this nurse specifically assumed patient care.

If you let them(your company) walk all over you, they are eventually going to force you into a situation where your license is at risk. I have always said that a job isnt worth my back or my license. You can get another job...


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## Jdog (Feb 19, 2017)

That is terrible on your company's part. I've run many "wait and return" Dr's appointment calls, and we would wait in the lobby with the patient on the gurney until they could be seen by the doctor, or if there was an available room, most of the time, it was perfectly acceptable to transfer care and leave the patient secured in the gurney (obviously in a lowered position, with rails up, seatbelts on, and wheel brakes on) while we wait in the lobby until the patient is ready to go back to the SNF. I've waited in doctors office lobbies for several hours (the most I've waited is 4 hours). Sometimes dispatch would be kind of upset that it was taking so long, but it was their fault for taking the call, and we absolutely could not leave the patient at the Dr's office unless they had a suitable bed for the patient (which, most do not) and it would be at least an hour plus.

Fortunately, the supervisors are my company are very approachable and all have years of field experience. Is there any way you can bring this up in a professional and non-aggressive manner to the field supervisors and get their opinion? Maybe email them and if they respond by email, you have a response in writing.

Ultimately, you may want to begin looking for a new company if this is a major problem.


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## johnrsemt (Feb 20, 2017)

Wait til you get  to the doctors office that the way the door way is designed going from waiting room to exam rooms you can't get the cot through.  no other entrances.   Staff had to move all patients from waiting room into exam rooms.  we had to hang a sheet over the door and window,  receptionist went outside to the hallway to keep people out  and doc and nurse did exam on patient on cot in the waiting room.
With dispatch telling us to leave patient and mark back in service.

That was fun;    helped that the doctor called our company and said he only wanted my partner and I to transport patients to his office;   and only our company


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## johnrsemt (Feb 20, 2017)

Made us wonder what happens if they have to call 911 on a patient back in the exam rooms.    
When we had time we went by with an empty cot and tried everything we could to get cot into back,  short of standing it on its end It couldn't happen


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## akflightmedic (Mar 3, 2017)

"The doctor SNEAKS in and starts the exam..." yeh...in his own office, his own practice, he snuck in. Sneaky critter that doc....did he at least hunch over, tip toe and avoid eye contact?


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## Handsome Robb (Mar 3, 2017)

akflightmedic said:


> "The doctor SNEAKS in and starts the exam..." yeh...in his own office, his own practice, he snuck in. Sneaky critter that doc....did he at least hunch over, tip toe and avoid eye contact?



You should've seen it... he was tactical AF! A real life Sam Fisher from Splinter Cell. 


Sent from my iPhone using Tapatalk


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## exodus (Mar 8, 2017)

Why not just bill for wait time? It's a perfectly acceptable medicare billing code.


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## hometownmedic5 (Mar 8, 2017)

Is medicares wait time rate comparable to what that truck is not making by being tied up on that call, or is it some nonsense like 10/hr?


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