Crew obtained refusal but no vitals?

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chickj0434

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So crew got dispatched to a 32 year old male with fever. Crew gets there. Pts girlfriend called 911, the boyfriend didn't want her to call. Pt stated he feels like he has a fever and chest pain. No cardiac hx. Pt has not taken his temp nor any Tylenol, etc. Says he can't sleep cause his chest hurts. Crew says they can take him to the hospital or girlfriend can drive. Crew states pt will most likely go to waiting room. If not to take a pain reliever and drink water. Crew obtains no vitals and obtains refusal. If pt has some type of cardiac episode could the crew be held liable?
 
Could be, yes, but probably won’t.

The scenario you described plays out way more than you think.
 
Did he want his vitals checked? A patient with capacity can certainly refuse that.
 
If the patient refused vitals and/or 12 lead, hopefully that is documented in the report's narrative.
 
Lets ask two questions:

1) did the patient say he wanted nothing to do with EMS, and slammed the door in their face?
1a) do you expect the EMS crew to force their way in, and force the patient to have his vitals checked?

2) was the crew being lazy, and not doing their job, and made the assumption that it was not cardiac related based on the patient's age?

liability is a funny thing... to be found liable, you need to meet the 4 components of negligence, which can be described by the following source https://www.law.cornell.edu/wex/negligence
Four elements are required to establish a prima facie case of negligence:
  1. the existence of a legal duty that the defendant owed to the plaintiff
  2. defendant's breach of that duty
  3. plaintiff's sufferance of an injury
  4. proof that defendant's breach caused the injury (typically defined through proximate cause)
Click to expand...
If those 4 requirements were met, a claim of liability due to negligence could be made.

So, based on how you describe the call, I think it would be a stretch to say the crew could be liable, esp since the bf didn't want the ambulance, signed a refusal, and didn't suffer a cardiac episode (at least you didn't mention it).

But liability is one of those words that EMS bosses like to throw around to scare newbie providers, despite successful EMS lawsuits being very few and far between.
 
If the patient befell some sort of harm then sure, they could be held liable. But failing to do a proper assessment as gauged by peers on a patient that consents to it and then obtaining a refusal is not good practice even if they can't be held "liable." I would bet your guidelines have a patient determination section that helps determine a) who a patient is and who isn't and b) what constitutes a refusal.
 
I’ve been teaching a continuing education class on refusals and medical decision making capacity for a while, and it’s amazing how many providers are totally in the dark on capacity assessments.

I am lucky that I have access to vast amounts of regional data for the QI projects that I’m involved with… and I can tell you that there are a HUGE number of improperly documented refusals processed every day. No assessment. No demographics. No vitals. No signatures.

The refusal is designed to serve one purpose. To limit liability for your agency, and indirectly, the provider. And yes, there are few EMS liability lawsuits litigated. Most are immediately settled by insurance. Anyone that thinks differently or minimizes the need for well documented refusals is simply misinformed.
 
NomadicMedic said:
I’ve been teaching a continuing education class on refusals and medical decision making capacity for a while, and it’s amazing how many providers are totally in the dark on capacity assessments.

I am lucky that I have access to vast amounts of regional data for the QI projects that I’m involved with… and I can tell you that there are a HUGE number of improperly documented refusals processed every day. No assessment. No demographics. No vitals. No signatures.

The refusal is designed to serve one purpose. To limit liability for your agency, and indirectly, the provider. And yes, there are few EMS liability lawsuits litigated. Most are immediately settled by insurance. Anyone that thinks differently or minimizes the need for well documented refusals is simply misinformed.
Click to expand...
To take this a step further.

When our folks are required to document the 4 prongs of patient capacity for refusal, it forces them to actually think through the potential outcomes and understand that it’s a big deal to be the last medical professional to assess someone.

There needs to be an entire block in the paramedic curriculum regarding patient medical literacy and patient capacity.
 
Run into this question a lot;

Document the crap out of it in your narrative: cause when the guy goes to bed, and doesn't wake up in the morning the girlfriend isn't going to say "EMS tried to get him to go to the hospital, but he refused" she is going to say something like "EMS didn't do anything and they just left him and he died" which one sounds better in the lawsuit.

Document the crap out of it, and get the girlfriends signature on the refusal.
 
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