Abandonment?

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human2k03Freakball1

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I work for a private company in Georgia. We deal with a lot of patients thar are incapable of moving around on their own. Recently we had a issue with a 45 yo m paraplegic due to an injury. Pt is also blind due to diabetes. Pt lives in a retirement/ rest home. Pt has 3 day a week appointmental athe a local medical center. Pt is provided with transport to and from appointments. While enroute to an apointment Pt demands to be let out of the ambulance. Pt is CAOx3. The rules state that a person who is CAOx3 must be let out of the ambulance otherwise you could be found guilty of kidnapping. If this Pt were to be left in a parking lot after a refusal of care is signed, could abandonment be construed? Pt has no history of mental health issues.

Also, could the medic in good conscious allow this to occur? Should LEO''s become involved?
 
In situations where a Pt doesn't want us to transport, and they are not under the influence of any substances and are fully alert, oriented and aware of situation we try to talk them into it, failing that we call our medical control and ask for a doctor to talk about getting an SOR. The doc will come on the radio, listen to us tell him/her what's going on, tell the Pt pretty much the exact same thing we've been telling them, Pt usually still refuses. Doc will say "okay, if you refuse transport understand it's AMA" and we get our SOR and leave, telling the Pt that we hope they reconsider, and that they should call 911 if they change their mind. Pts have the right to make bad decisions about their own health care. Us not transporting or them refusing a treatment may very well NOT be "the right" thing for them, but it's their choice.

Yes, I'd be leery of leaving Pt in a parking lot. Very leery. I'd probably offer to turn around and take them back to their retirement/rest home and get the SOR there, where at least they're inside a building! Try to get them to talk about what is going on today that they're suddenly not wanting to go to their regular appointment. But ultimately, they're allowed to make that decision. In that particular case, if the Pt does adamantly demand to be left in a parking lot, and the SOR is done there, perhaps a call or visit back to the Pt's residence would be advisable so that the staff knows the Pt's location.
 
No, I would not leave a paralized blind guy by the side of the road or in a gas station parking lot, no matter what he says. There will always be a better option, one that doesn't leave him in obvious danger.
 
If the patient wants to be let out and is incapable of caring for themselves stop transport and pull over to a safe location to park. Then discuss with him that you don't feel comfortable leaving him in the middle of a parking lot and will take him back to the sending facility. A patient who is incapable of getting around on their own should not be left alone. I would also notify dispatch so they are aware of the change in destination. You could notify LEO and see if they would put patient in protective custody until he is back at his facility.
 
Underoath87 said:
No, I would not leave a paralized blind guy by the side of the road or in a gas station parking lot, no matter what he says.
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This.

I actually am having a hard time believing this is even up for discussion.
 
Remi said:
Underoath87 said:
No, I would not leave a paralized blind guy by the side of the road or in a gas station parking lot, no matter what he says. There will always be a better option, one that doesn't leave him in obvious danger.
Click to expand...
This.

I actually am having a hard time believing this is even up for discussion.
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Exactly. If the competent adult wants to be let out of the ambulance, you can't refuse to do that, but nothing says you have to drive away ... You can let him out in a safe place and then stay with him and work on a solution. He can't force you leave if you're in a public place.
 
You're an IFT service, right?

Let him out and then the 911 service will have to iron it out while you eat lunch.... :D

Kidding aside, I'm with Remi on this. How is this even a discussion?


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Remi said:
I actually am having a hard time believing this is even up for discussion.
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I'm not, for two reasons:

1) People have the right to make stupid decisions about their health. It isn't a new onset of paralysis or blindness, it just happens to be how he is (IE, it/s his baseline condition). He also isn't necessarily in danger because he is blind or paralyzed.

2) I would absolutely let him out. There is no legal reason for you to keep him in the ambulance, especially since he is competent and makes his own decisions. I'd call my supervisor, and advise him of the situation, as well as the facility, but at the end of the day, I am not going to take a person anywhere they don't want to go. I'd probably wait with the person until my supervisor, a representative from the retirement home, and local LEO showed up.

Let me put it this way.... you have a patient who is having a STEMI.... midway through your 40 minute transport, he decides he doesn't want to go to the hospital, he understands the risks, but has changed his mind, and wants to be let out of the ambulance. He is alert and oriented, but doesn't want to go. Are you going to forcibly restrain him and force this competent individual to go to the hospital?

I don't like it, I don't agree with it, but if you have been in this business long enough, you will see people who insist on making stupid decisions regarding their own health, often to the detriment of their own health. Like it or not, forcing someone to go anywhere they don't want to go is the job of law enforcement, not EMS (unless your particular state has some statute that said otherwise)
 
I'd do an actual mental status exam and see if he has the capability to refuse. If he can, I'd stop, let him out, and try to work out a solution.
 
I'm dropping him off somewhere he has reasonable access to shelter, phones, and facilities. That might be back where he came from or at the medical center, but certainly not a random parking lot. If they want to leave the ambulance under their own power after I tell them this, that's their prerogative but I'm under no obligation to stop the ambulance immediately. There's no PD, prosecutor, or courtroom in the country that will consider returning a patient to their residence "kidnapping". Leaving one in a parking lot could certainly be considered "negligence" however.
 
DrParasite said:
I'm not, for two reasons:

1) People have the right to make stupid decisions about their health. It isn't a new onset of paralysis or blindness, it just happens to be how he is (IE, it/s his baseline condition). He also isn't necessarily in danger because he is blind or paralyzed.

2) I would absolutely let him out. There is no legal reason for you to keep him in the ambulance, especially since he is competent and makes his own decisions. I'd call my supervisor, and advise him of the situation, as well as the facility, but at the end of the day, I am not going to take a person anywhere they don't want to go. I'd probably wait with the person until my supervisor, a representative from the retirement home, and local LEO showed up.

Let me put it this way.... you have a patient who is having a STEMI.... midway through your 40 minute transport, he decides he doesn't want to go to the hospital, he understands the risks, but has changed his mind, and wants to be let out of the ambulance. He is alert and oriented, but doesn't want to go. Are you going to forcibly restrain him and force this competent individual to go to the hospital?

I don't like it, I don't agree with it, but if you have been in this business long enough, you will see people who insist on making stupid decisions regarding their own health, often to the detriment of their own health. Like it or not, forcing someone to go anywhere they don't want to go is the job of law enforcement, not EMS (unless your particular state has some statute that said otherwise)
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Sorry, but just because the law says something doesn't make it the right thing to do in every conceivable case. This is a perfect example of blindly following a policy with no regard for whether or not it makes sense in a given situation. Something we see far too much of these days.

So no, I'm not leaving a paralyzed blind man who requires 24 hour care on the side of the road with no assistance at all. I'll take him back to his home if he wants, sure, but my commitment to being a decent human being would disallow me from simply dumping him off at the nearest place to pull over. Perhaps there is no legal reason to keep him, but there certainly is a moral obligation to make sure he's safe.
 
I would let him out, and follow him. never "actually leave". He can't tell me to leave a parking lot. I would watch over him, call supervisor and a LEO, and let them take it from there when they arrive.
 
Call management for someone to show up to assist, call ECF where he lives to see if they will send someone. also call the police. They can assist also
 
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