# Patient refusal with bad outcome?



## mulana (Nov 13, 2017)

I recently had a call that I'm feeling pretty guilty about. My crew was dispatched to an elderly man who tripped while going for a walk. He was alert and oriented and had no loss of consciousness. There was a small hematoma on the side of his forehead, but he did not report any head pain, dizziness, or nausea. His vitals were absolutely normal. The pt expressed that he did not want to go to the hospital, so like I'd done with many simple fall victims before, I allowed my patient to refuse care. Only four hours later, my agency received a call for a stroke victim. It was my patient from that morning and he apparently lost consciousness after experiencing an excruciating head ache. The hospital said he had a brain bleed, most likely due to his fall that morning. I'm definitely feeling horrible about this. I think my assessment could've been much more thorough, and I can't stop thinking about how I could've done something different to prevent his poor outcome. Has anyone else had a refusal call go bad?


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## DesertMedic66 (Nov 13, 2017)

Oh, I’m fairly positive I have had some patients who I signed out AMA who passed away a short time later. I explained the risks or refusing further medical treatment/evaluation by the physician up to and including death. People are allowed to make their own choices about their healthcare. They are allowed to make stupid decisions (not saying hers was initially a stupid decision) for whatever reason they want.


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## mgr22 (Nov 13, 2017)

I'm with DesertMedic on this. Your job is to follow your system's rules about assessing patients, advising them of risks, possibly involving medical control in the process, then documenting everything. It's not your job to make decisions for patients who are capable of making informed decisions themselves. I'm guessing I've had a few dozen patients who died shortly after refusing transport. Those calls aren't among the ones stuck in my head.


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## VFlutter (Nov 13, 2017)

When getting a Refusal you should be explaining the risks including an unrecognized condition that could cause serious harm or death and make sure they  truly understand. I would also have them verbilize it, more then just saying “yes”.


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## NomadicMedic (Nov 13, 2017)

Another reason I think EMS should be wearing body cams. A perfect way to document that adamant refusal and show the paramedic explained the risks clearly.


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## DrParasite (Nov 20, 2017)

Did you deny transport?  No
When offered transport, did the patient chose to refuse to go to the hospital?  Yes
Did the patient have any obvious sign of a brain bleed?  I'm guessing no.
Are you going to kidnap every fall victim and drag them kicking and screaming to the hospital, because they might have a brain bleed?  I hope not

People are allowed to make stupid decisions about their healthcare.  And (unfortunately in some cases), parents are able to make stupid decisions about their kids.  At the end of the day, when its their time, you can't do anything about it.

Even if he had a bleed, even if he had a skull fracture, even if his pupils were unequal (three clear signs of badness), they still have the right to refuse.  As long as you did your job, I wouldn't worry about it.


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## E tank (Nov 20, 2017)

A bad outcome doesn't mean a mistake was made.


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## Tigger (Nov 21, 2017)

Through a mental status examination, was the patient deemed capable to understand and accept the risks or refusing transport and further care? If yes, that's how it goes, provided it was documented as such.


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