I assume different states address this issue with a state law or code. In Alabama, when a MD signs the letter of necessity, the MD is legally stating the pt is unable to be transported by a lesser means; the pt is non ambulatory. (& yes I know docs that fib their way thru it every day) What some one else does after I place them in bed & leave is not relevant...what I did to ensure the Pt's safety is relevant. I can not leave a bed bound Pt alone "hoping" someone will check on him....If a tragic event occurred, I would be held liable.