Consent Concerns

not to mention that a person may not want to pursue legal action against a kidnapper out of the goodness of their heart. right up until they see that $500+ bill and are so insulted that you want them to pay for a service they refused. could very well be the cherry on top.

theres the standard "if you get treatment, you might die. no? sign here" speech and then theres belligerently browbeating a patient into accepting tx/tp. sometimes you just have to let people make their own mistakes there bossy.
 
I figured i would let some comments come in before addressing them...

With this patient, as soon as the SO informed the father we would be transported he quit adamently refusing, stating simply, "Fine, but I am not paying this bill."

Upon arrival at the ED, the physician was informed of all the issues including the parents refusal of transport. The mother was there by then and after hearing the report to the physician, expressed her displeasure to her husband for his actions. She thanked us for being so insistant her son is cared for.

Our company has a follow up process on patients (complicated to explain, but it involves a supervisor contacting the pt, and inquiring as to how teh service was, how they are ect....). During the follow up call, the father still was only concerned about the cost of the ambulance ride.

The dad, rather than a neglectful parent only concerned about the possible bill from the ambulance/er sounded more to me like a parent, worried about their child and selling themselves on the 'he's just faking' scenario to avoid the panic associated with an injured child.
Being understanding of the parent's anxiety isn't going to violate protocols and may simplify the whole process. Its very difficult to see eye to eye when you are on your high horse.
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Not the case here. As the mother of 2, you can be assured I also react differently when its my child injured. This particular father was ONLY CONCERNED about the cost. When he got to the school the first words out of his mouth were "I am not paying this bill!" He went on about how much the amublance cost the last time they needed one, and he isn't going to pay for this one. Never once did he show any concern for the actual welfare of his son. Multiple attempts, by multiple people, were made to explain to him what happened and the injuries. He did not care what was being said, just that he would have another ambulance bill.
 
I do hope this does not go to court. Reporting such statements as "neglectful" is a legal description and labeling. If this was a Supervisor's report, I recommend some administration and supervisor training immediately!

Albeit, I do NOT agree with the father or his actions, and I understand the actions that was taken on behalf of the child's welfare, I would be VERY cautious on my follow up with just stating the facts, and documentation as such. Any internal interoffice follow up or incident reports can be subpoenaed and one has to be VERY CAUTIOUS on painting a description and labeling anyone.

Simply stating that "after internal investigation; it was found that the medics errored on behalf of the child's welfare and in agreement of the licensed emergency physician", would pull more weight and less deception in a potential legal matter.

Remember, slandering (even if it is true) will never win anything.

R/r 911
 
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Ridryder911 said:
I do hope this does not go to court. Reporting such statements as "neglectful" is a legal description and labeling. If this was a Supervisor's report, I recommend some administration and supervisor training immediately!

Albeit, I do NOT agree with the father or his actions, and I understand the actions that was taken on behalf of the child's welfare, I would be VERY cautious on my follow up with just stating the facts, and documentation as such. Any internal interoffice follow up or incident reports can be subpoenaed and one has to be VERY CAUTIOUS on painting a description and labeling anyone.

Simply stating that "after internal investigation; it was found that the medics errored on behalf of the child's welfare and in agreement of the licensed emergency physician", would pull more weight and less deception in a potential legal matter.

Remember, slandering (even if it is true) will never win anything.

R/r 911
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you and me have to stop agreeing on stuff. its just getting freaky....
 
KEVD18 said:
not to mention that a person may not want to pursue legal action against a kidnapper out of the goodness of their heart. right up until they see that $500+ bill and are so insulted that you want them to pay for a service they refused. could very well be the cherry on top.

theres the standard "if you get treatment, you might die. no? sign here" speech and then theres belligerently browbeating a patient into accepting tx/tp. sometimes you just have to let people make their own mistakes there bossy.
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hmmm I thought I was agreeing with you... you can't treat the unwilling..

I do think though that too many take the browbeating into tx or the standard might die.. yada, yada, when a third option is to seriously and personally address your concerns to the parent. Not going to work in all cases but if you feel its important to transport, I don't think a standard speech of "let me please outline all the details I need to keep me out of court and then sign this and I'll be on my way".. is sufficient.
 
Ridryder911 said:
I do hope this does not go to court. Reporting such statements as "neglectful" is a legal description and labeling. If this was a Supervisor's report, I recommend some administration and supervisor training immediately!
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I have not used the word "Neglectful" in regards to this father. That came from members here, on our forum.

There actually has not been a "formal" investigation into this, yet. It only has come to light as an issue now, because the patients father has been on a public forum for about our county making his compliant known. I didn't know about it until a couple days ago when one of my FF friends was talking about the rather lengthy discussion that has taken place about it. Realizing, that it was my call they were talking about I went to the forum and read it.

The father has posted multiple posts, full of lies, about the call. This call was actually probably 6 months ago or so, and he has just now started complaining. While he touches on his "refusal" the main theme of his complaint in the disscussion forum is, the bill.
 
we're sort of agreeing and sort of not. you want to hang around on scene and try to explain the nitty gritty details to a lay person. im a basic emt. im not a professor of medicine. i cant lecture intelligently on much. while i may understand it, based on my education adn personal study, that doesnt mean i can explain it well enough to persuade an unwilling person to take my advice. in that case, my cya speech cover everything im trying to say in thirty seconds. its all i feel i need to say on the matter. for a more in depth, detailed, and eloquent explanation, they need to speak to someone farther up the medical food chain than me. my version of the cya speech:

sir/ma'am: im required to inform you of the following. at this time, i am unable to completely establish whether or not you are suffering from a potentially life threatening illness/injury. the only person able to make that determination is a physician at the hospital. while i can not force you to go or take you against your will, i can strongly recommend that you allow me to transport you their for further evaluation. should you choose to refuse treatment or transportation, you accept full responsibility for any further progression of your injury or illness. you understand that this could include permanent disability or death. do you wish to be treated and transported and do you wish to refuse the services offered?"
 
First step - I'd do everything I could to cajole the parent to accept transport. Once it became clear I was in a circular argument, where the parent kept returning to cost... then I'd ask myself this question:
"Does the parent understand the patients condition, and does he understand the risks associated with refusal?"

If I had any concern with his understanding, I'd explain the situation to my doc, and explain that I really feel the patient needs medical care ASAP. Then the doc would almost certainly try to talk to the parent.

If the responsible party isn't able to understand and comprehend the patient's current condition, as well as possible/likely consequences, they CAN'T refuse, can they?
 
Jon said:
First step - I'd do everything I could to cajole the parent to accept transport. Once it became clear I was in a circular argument, where the parent kept returning to cost... then I'd ask myself this question:
"Does the parent understand the patients condition, and does he understand the risks associated with refusal?"

If I had any concern with his understanding, I'd explain the situation to my doc, and explain that I really feel the patient needs medical care ASAP. Then the doc would almost certainly try to talk to the parent.

If the responsible party isn't able to understand and comprehend the patient's current condition, as well as possible/likely consequences, they CAN'T refuse, can they?
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Yes, they can. How hard is it to tell them the worse consequence is death and other is you are unsure of what is occurring at the time that it may lead to something possibly bad. That is not too hard to comprehend... By law, you are to inform of their risks (potential) and alternatives.

R/r 911
 
Ridryder911 said:
Yes, they can. How hard is it to tell them the worse consequence is death and other is you are unsure of what is occurring at the time that it may lead to something possibly bad. That is not too hard to comprehend... By law, you are to inform of their risks (potential) and alternatives.

R/r 911
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Rid... I guess what I'm saying is that, from what I'm getting from Princess - the parent didn't seem to grasp the medical consequences of a refusal... he was only worried about the financial consequences.
 
see i read it differently. he knew the risk, weighed that against what he considered the likelihood that this was a real emergency and the cost of a false alarm and declines service. regardless of how the individual emt feels about the "quality" of the decision, its their decision to make.

"if you dont come with us, you might die. no? press hard, three copies". pretty much sums it up.

i dont see the need for browbeating, cajoling, arguing or anything else of the sort. make your case clearly and without confusion. they either saddle up and ride or they dont. at then end of the day, it makes no difference to me.
 
One only can do so much... if they state they are aware, so be it and get plenty of witnesses to state that they said "they understood fully".. sign here, ready for the next one. The child is damned for having such a parent, but one only can lead to the water....

R/r 911
 
Wow, great thread and responses. I was dreading reading the responses and was pleasantly surprised. Is Rid entirely correct in his assessment? Yes. You kidnapped the kid and are open to litigation. Then again, you would be open to being sued if you didn't transport. People can sue for anything. A brilliant doctor once advised me to ask myself a question when faced with a dilemma. What would you rather explain to people on television? Would you rather explain why you transported the child against the fathers will or why you left the child in poor condition? Answering this question isn't designed to avoid litigation 100% of the time; that would be impossible. It is designed to produce the best answer. From my experience, it works.
 
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