I work for a private ITF and occasionally we take people back to their residences and leave them alone. Is this legal? My partner told me that it is illegal to leave them at home as we can only leave patients in the care of someone with equal or higher medical training.
Is it abandonment to leave a patient at home by themselves?
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HappyParamedicRN
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That applys if you are bringing them TO A MEDICAL FACILITY.
If you are bringing them home and they are alert and oriented x 3, then yes, unless you have some wierd laws where you live, you can leave them alone.
Happy
If you are bringing them home and they are alert and oriented x 3, then yes, unless you have some wierd laws where you live, you can leave them alone.
Happy
"pt was left in care of his/herself."
No. Some actually have them sign the release of care themselves, but I don't. In my report I document that pt was left in care of self at the end.
Definitely not illegal. Lol. At facilities you can't do that, though.
No. Some actually have them sign the release of care themselves, but I don't. In my report I document that pt was left in care of self at the end.
Definitely not illegal. Lol. At facilities you can't do that, though.
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JPINFV
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Quick clarification, release as in the AMA, or release as in "person accepting responsibility" box?
I was talking about accepting responsibility. I don't have them sign there, but I know some do. (ours says "recieving staff signature")
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Can we draw a division here for a moment, please? Are we talking about release after refusal of medical treatment or transport, or release after discharge from a hospital-- or return from dialysis. In the later cases, you are functioning under the order of a MD (Discharge order home), Discharge Planner, etc-- they have cleared the patient to return home-- and discussed resources required when the patient gets there.
Of course if the patient is oxygen dependent, and they have no home system, that's a problem-- or if the home is unfit for habitation-- also important. If you are working IFT, I recommend calling a supervisor and returning the patient to an ER (or the sending facility).
Of course if the patient is oxygen dependent, and they have no home system, that's a problem-- or if the home is unfit for habitation-- also important. If you are working IFT, I recommend calling a supervisor and returning the patient to an ER (or the sending facility).
Aidey
Community Leader Emeritus
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Or not, if the patient left the hospital AMA.
We transported a patient who was diagnosed with pneumonia and multiple PEs at the ER, on top of his pre-existing lung cancer. Went AMA from the ER, who called us to take him home, citing the need for "medical supervision" on the transport back.
I made it very clear to them the patients living conditions were crappy, and that he lived there alone, where he would have no medical supervision. I discussed it with them and my supervisor, and in the long run we ended up transporting him home.
I got a copy of the hospital's AMA form. I gave him a through AMA lecture prior to leaving the hospital, gave him another lecture before bringing him up to his apartment and had him sign our AMA form saying that it was a very bad idea for him to stay at home.
And just for those of you who are thinking "He is terminally ill, he deserves to spend his final days how he wants". His hygiene was severely lacking, the apartment was a disaster, and the only food was milk and cereal. We called elder services, but I don't think anything came of it.
Sasha
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And if the supers give you an answer you don't like, document the hell out of it. However, problem solved if the patient is a/o and they tell you they want to stay home alone. You can't kidnap them.
I once took a patient home, he told us that there was someone there. There wasn't. He was completely bedconfined, bilat BKA and blind. He told us to leave him there. He was O2 dependent but didn't want his O2 on, no AC in the middle of a hot Florida summer, and didn't have a phone to leave with him in case he needed help. Supervisor said just leave him.
He told us to leave, just leave the front door open so he could yell for help.
We went to go knock on neighbors doors to ask them to keep an ear out for him, and no one was home. We lingered around for 15 minutes finishing report, cleaning the stretcher, etc, and thank god a family member wandered in. We grabbed him, had him sign for the patient, documented, and left. Had a whole bunch of bad scenarios running through my head (Like the house catching on fire as we drove away and him trying to crawl out on his nubs. Charred remains found on the floor with an outstretched hand towards the open door... or a raccoon wandering in through the wide open door and giving him rabies...)
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Hypochondriac
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Please correct me if I'm wrong. If the patient is Alert and orientated times three. You have to do what the patient says otherwise you open it's considered kidnapping? If the patient signs the AMA or RMA card, your no longer liable.
Why did you partner think it wasn't allowed? Was the patient not competent? If it was something like that he shouldn't have been allowed to leave the hospital
Why did you partner think it wasn't allowed? Was the patient not competent? If it was something like that he shouldn't have been allowed to leave the hospital
Shishkabob
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Incorrect.
A person not only has to be alert and oriented, but other nuances as well (such as age) and also have to have the ability to refuse care.
I've met many high-functioning mentally retarded people who can't refuse, among other things.
Hypochondriac
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Ok, but are you allowed to make that determination? Aren't you supposed contact your agencies medical director to declare a patient incompetent if they are otherwise alert and oriented?
Shishkabob
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No.
firetender
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If you don't drop them off as requested, it's kidnapping. Your choice over which you agonize.
It is not like we would decide to keep the patient in our ambulance forever for fun. It is a question of whether or not I should refuse these runs completely.
JJR512
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Getting legal advice on the internet can be a risky proposition, and what you are asking effectively boils down to legal advice. That being said, I think it's pretty clear what the overwhelming majority response is. However, what you should really do is ask this question of your supervisor, because if it ever actually does come up in court, "I acted in good faith based on what my supervisor instructed me to do" is a much better defense than "I acted in good faith based on what some people on the internet told me was right".
As long as the person seems, in your judgement, to be physically and mentally able to take care of his or her self, then it should be fine to leave that person alone.
After all, if it's abandonment to leave a person home alone, then once someone goes to a medical facility, they'd never be able to leave. Technically, once the discharge order is signed, the care has ceased, therefore there is no longer a transfer of care to worry about. On these runs, you are just a fancy taxi service. It isn't abandonment for you to leave the person home alone any more than it would be abandonment for an actual taxi driver to leave that person home alone after driving a patient home from a hospital, or any more than it's abandonment for the nurse who wheeled the patient out to the curb in a wheelchair to leave the patient in the "care" of the taxi driver.
As long as the person seems, in your judgement, to be physically and mentally able to take care of his or her self, then it should be fine to leave that person alone.
After all, if it's abandonment to leave a person home alone, then once someone goes to a medical facility, they'd never be able to leave. Technically, once the discharge order is signed, the care has ceased, therefore there is no longer a transfer of care to worry about. On these runs, you are just a fancy taxi service. It isn't abandonment for you to leave the person home alone any more than it would be abandonment for an actual taxi driver to leave that person home alone after driving a patient home from a hospital, or any more than it's abandonment for the nurse who wheeled the patient out to the curb in a wheelchair to leave the patient in the "care" of the taxi driver.
I have dropped patients off about a dozen times in apartments I find to be unfit for habitation-- due to squalor, lack of food, etc. Each time, I speak to the hospital, and/or a supervisor, document carefully, and leave when asked to. Sometimes, I follow up with elder abuse paperwork... other times, not.
I also recognize what I have the power to change or effect and what I do not...
I also recognize what I have the power to change or effect and what I do not...
firetender
Community Leader Emeritus
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This is a business enterprise, remember that. Refusing something that helps you save a life now and again is not good for your career. In the absence of an extreme situation, that's what you're paid for, Kiddo!
JPINFV
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1. Not all Physician Declaration of Medical Necessity is because the patient is bed bound.
2. Not all patients who are non-ambulatory are unable to care for themselves.
3. Even if a patient is non-ambulatory with a physician declaration, that declaration does not mean that they are unable to make decisions for themselves.
KillTank
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Sometimes I wish we could. "Pt left in ER hallway"