Paramedic under investigation for death of schizophrenic patient

DrParasite

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I did a search, and didn't find any previous threads on this topic. In a nutshell, EMS gets called for an EDP, EDP doesn't get transported, and a few hours later gets hit by a car and dies.

Taking the emotional outrage out of the picture (person leave ambulance, and is now dead), as well as removing the benefit of hindsight being 20/20, I'm having issues with this entire situation.

1) should every potential mental health patient be forced to be transported by EMS? don't think so. We can encourage it, but force them to go if they don't want to? people have the right to make stupid decision regarding their healthcare.
2) Does EMS have the legal authority do make this decision? In most places, no; this is a decision that is made by law enforcement.
3) While the patient wasn't speaking, he was responding to them. Apparently they performed a less than stellar exam on the patient. But did this result in his death? doubtful.
4) There are a lot of inaccurate statements being made in the media. If the "patient" refuses to be transported, that is his right (people have the right to make stupid choices). just because an ambulance is called, doesn't mean the person is supposed to be transported to the hospital. if the person isn't transported, it isn't the responsibility of EMS where he goes after he leaves the ambulance.
5) the paramedic's boss tells her "shut up or i'll send you home," and she responds "go ahead and send me home," which gets her fired. I would have told the boss "I'm going to have a chat with human resources about how you are treating your subordinates", and gotten up and left. That's grossly disrespectful for a supervisor to say to a subordinate.

It's likely this patient was abandoned by the EMS crew. That's what the state found, and it was likely appropriate, and she was disciplined appropriately. And now you have SJW getting involved, and she's going to be put through hell again....

I do have an issue with the deputy taking a man with no shirt, shoes, or wallet, driving 18 miles, and dropping him off at a closed gas station in the middle of the night. and while the paramedic got a week's suspension for her role in this incident, there has been no action taken against him.

And now the South Carolina Law Enforcement Division is supposedly investigating a paramedic, who was already investigated by the state? I didn't know a LE enforcement agency has authority over EMS personnel

 

CCCSD

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LE has jurisdiction over the death and what led up to it. Why is that hard for you to understand? EMS has NO authority to investigate past disciplinary procedures.
 

Seirende

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I remember watching some body cam and being disturbed by how the EMS provider was speaking to her psych patient. She was definitely not helping the situation with her communication.
 

Seirende

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I see body cam of the interaction is in the article you shared. The paramedic either failed to recognize that the patient was having a legitimate health crisis or she straight up did not care. Either one is a huge problem.
 
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DrParasite

DrParasite

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LE has jurisdiction over the death and what led up to it. Why is that hard for you to understand?
sure... they can investigate the cops involved, not the EMS personnel.... it would be like the department of health investigating and disciplining the officer for his role in this incident...
EMS has NO authority to investigate past disciplinary procedures.
not quite sure what you are trying to say here...
I remember watching some body cam and being disturbed by how the EMS provider was speaking to her psych patient. She was definitely not helping the situation with her communication.I see body cam of the interaction is in the article you shared. The paramedic either failed to recognize that the patient was having a legitimate health crisis or she straight up did not care. Either one is a huge problem.
yeah, I just watched it. it was... disturbing? unprofessional? they were exhausted, and it showed? I'm not making excuses for what she said, however nothing she did (other than not forcing this man against his will) to go to the hospital resulted in him dying.

We now know the person was having a mental health crisis, and had a history of such (information that was not available to the crews at the time). No one knew if him not speaking was normal for him or not.

No arguments from me that this could have gone differently, but what if his baseline was being non-verbal? she did a half assed assessment, and found nothing acutely wrong with him. he didn't want to go (and indicated as such when asked). Does EMS have the authority to force him against his will? or is that authority left in the hands of law enforcement?

Let me put it another way.... assuming they were able to get his demographics off his DL, and he communicates (using non-verbal methods) that he doesn't want to go and is wiling and able to sign a refusal form, and the same situation occurs, is EMS still wrong for letting this man walk out of the ambulance?
 

Seirende

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If I was having a mental health crisis and the crew that showed up swore at me and treated me in a demeaning way, I would probably refuse transport too. Obviously the patient's death was directly due to being struck by a motor vehicle, so no line can be drawn back directly to the crew, but their treatment of the patient was the opposite of beneficial.
 

CCCSD

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Nope. A death occurred and SLED has the authority and jurisdiction to investigate the actions of EMS at the scene. Just like they will review the Officers actions and the patients actions.

You seem to think that EMS is this protected entity that only is responsible to itself. You profess to be an expert with years of experience, including Admin, yet you can’t understand basic legal concepts. EMS has no authority to arrest, detain, press charges, jail, or do anything beyond decertification and fines.
 
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DrParasite

DrParasite

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If I was having a mental health crisis and the crew that showed up swore at me and treated me in a demeaning way, I would probably refuse transport too.
And you have the right to do so. as an adult, you have the right to make stupid decisions regarding your healthcare. and if that is the case, you can also file an administrative complaint regarding their language.

but their language doesn't take away from the fact that you made the decision to refuse their care. that was your choice, and your choice alone.
Nope. A death occurred and SLED has the authority and jurisdiction to investigate the actions of EMS at the scene. Just like they will review the Officers actions and the patients actions.

You seem to think that EMS is this protected entity that only is responsible to itself. You profess to be an expert with years of experience, including Admin, yet you can’t understand basic legal concepts. EMS has no authority to arrest, detain, press charges, jail, or do anything beyond decertification and fines.
what on earth as you talking about? For someone who claims to have a LE background, you have a frequent habit of assuming facts that were not in evidence. or just making stuff up that no one ever said....

I'm no expert on how south carolina does anything, nor have I ever claimed to be. And EMS can't do any of those things...... that's kind of my point.... There was nothing criminal done here, at least not on the part of the EMS crew. On the other hand, the deputy involved likely has some explaining to do.....
 
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DesertMedic66

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So a naked man running around on the street climbing on vehicles who is refusing or not able to answer questions? No way in hell can this patient be competent to refuse medical care. This patient is clearly a danger to himself.
 

hometownmedic5

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So a naked man running around on the street climbing on vehicles who is refusing or not able to answer questions? No way in hell can this patient be competent to refuse medical care. This patient is clearly a danger to himself.

Bizarre behavior by itself does not justify the involuntary committal of a patient otherwise able to refuse. Whether this patient received a proper assessment or not it another issue. I'm not limiting myself to this case alone, but expanding on the greater issue based on your statement.

We don't do competency, we do capacity. It's not semantics, but a very specific legal distinction. A patient can clearly be a danger to themself and retain capacity.
 

Peak

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With the caveats that state laws vary and I only know what has been released publically I could easily have placed that patient on a mental health hold for grave disability. I don't know if in South Carolina the placement of emergency commitment falls upon EMS, PD, or both however if they are investigating this it would seem that EMS does carry some of burden.

I'm going to try to make this a bit easier for @DrParasite : law enforcement is investigating if there was a crime committed. I assume some kind of negligence or failure to act, I don't know the state laws of South Carolina.

EMS is not immune to the law nor medical staff in general. There are many ways that I could commit a criminal act in my daily practice. Patient abandonment, neglect for not reporting at risk abuse, criminally negligent care, and so on. Poor practice is not an excuse for criminal actions.
 
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DrParasite

DrParasite

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I'm going to try to make this a bit easier for @DrParasite : law enforcement is investigating if there was a crime committed. I assume some kind of negligence or failure to act, I don't know the state laws of South Carolina.
Sure. I guess my confusion is what the "South Carolina Law Enforcement Division" is, and what their role is in SC. If they are an administrative agency responsible for monitoring conduct and certifications of cops, than that's one thing. if they are the investigative division of the attorney general, that's quite different. Let them investigate.

I never claimed that EMS shouldn't be held accountable if crimes are committed. the SC department of health investigated their actions, and issued disciplinary action. I just don't think the EMS personnel committed any criminal acts, despite what the media seems to be implying. But sure, let everyone investigate to their heart's content.

Had the patient not gotten fatally struck by a vehicle, this would have all been a non-issue. Should the county be sued civilly? absolutely, and they should settle as fast as they can. But criminal charges against the paramedic? well, what was the overall opinions regarding the Vanderbilt nurse who gave the patient the wrong medication, which resulted in the patient dying?
 

Peak

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Sure. I guess my confusion is what the "South Carolina Law Enforcement Division" is, and what their role is in SC. If they are an administrative agency responsible for monitoring conduct and certifications of cops, than that's one thing. if they are the investigative division of the attorney general, that's quite different. Let them investigate.

I never claimed that EMS shouldn't be held accountable if crimes are committed. the SC department of health investigated their actions, and issued disciplinary action. I just don't think the EMS personnel committed any criminal acts, despite what the media seems to be implying. But sure, let everyone investigate to their heart's content.

Had the patient not gotten fatally struck by a vehicle, this would have all been a non-issue. Should the county be sued civilly? absolutely, and they should settle as fast as they can. But criminal charges against the paramedic? well, what was the overall opinions regarding the Vanderbilt nurse who gave the patient the wrong medication, which resulted in the patient dying?

From their website:

SLED Mission Statement

The primary mission of the State Law Enforcement Division is to provide quality manpower and technical assistance to law enforcement agencies and to conduct investigations on behalf of the state as directed by the Governor and Attorney General.

Just for the record based on the facts that were reported I think that radonda crossed the line of malpractice into criminal liability and deserved a criminal investigation.
 

johnrsemt

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So did they seem him jumping on cars? or did someone call that in?
I have been dispatched to someone doing something that sounded crazy and when we got there the person was acting normally so there was no reason to put a pysc hold on the patient.
Person acting weird so that means he is crazy: so that means 90% of the high school and college students should be forced to go to the hospital.
If his VS are normal and he is non verbal, but answering yes no questions appropriately then there is no reason to force him to go to the hospital.
EMS crew was rude to him: they were tired, they were mad because he wasn't verbally answering them. Yes they were rude, but that doesn't mean they didn't do their job. If they evaluated the patient, asked questions and took vital signs and got a signed refusal and the officer refused to put a hold on the patient then the EMS crew wasn't at fault except for being rude. I didn't watch the entire 20 minute plus video on Facebook a couple of months ago, but skimmed it.

Have most of us let someone refuse that 'could have been a little too crazy', or a 'little too drunk or too high'; probably all of us.
Where I work the police have to put a hold on a patient, EMS can't and the police won't do it cause then they are out of service for 2-5 hours with round trip. and paperwork.

Could it have been handled differently? Yes; does the EMS crew need counseling and training? Yes for their attitude; Did they make the guy walk in front of a car and get hit hours later? No.
Would he have died if they took him to the hospital? Possibly when the ED released him 2 hours later, and he walked in front of a car in front of the hospital.
 

DesertMedic66

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So did they seem him jumping on cars? or did someone call that in?
I have been dispatched to someone doing something that sounded crazy and when we got there the person was acting normally so there was no reason to put a pysc hold on the patient.
Person acting weird so that means he is crazy: so that means 90% of the high school and college students should be forced to go to the hospital.
If his VS are normal and he is non verbal, but answering yes no questions appropriately then there is no reason to force him to go to the hospital.
EMS crew was rude to him: they were tired, they were mad because he wasn't verbally answering them. Yes they were rude, but that doesn't mean they didn't do their job. If they evaluated the patient, asked questions and took vital signs and got a signed refusal and the officer refused to put a hold on the patient then the EMS crew wasn't at fault except for being rude. I didn't watch the entire 20 minute plus video on Facebook a couple of months ago, but skimmed it.

Have most of us let someone refuse that 'could have been a little too crazy', or a 'little too drunk or too high'; probably all of us.
Where I work the police have to put a hold on a patient, EMS can't and the police won't do it cause then they are out of service for 2-5 hours with round trip. and paperwork.

Could it have been handled differently? Yes; does the EMS crew need counseling and training? Yes for their attitude; Did they make the guy walk in front of a car and get hit hours later? No.
Would he have died if they took him to the hospital? Possibly when the ED released him 2 hours later, and he walked in front of a car in front of the hospital.
Does someone only saying yes or no or just shaking their head allow us to really make sure they are oriented enough to refuse care? Possibly but you need to ask a lot more questions aside from your normal AO questions. For my system the patient needs to be able to articulate the risks of refusing care and not just saying yes and no questions.

I only watched a very compressed video of the incident and the first part of it was body camera footage of him naked on top of a vehicle. I doubt the officer would not have told the EMS crew about it.
 

Tigger

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LE has jurisdiction over the death and what led up to it. Why is that hard for you to understand? EMS has NO authority to investigate past disciplinary procedures.
Why would the state EMS office, the one responsible for the certification/licensure of providers not have the authority to investigate providers accused of patient abandonment?

This is a standard function of state EMS offices.
 

FiremanMike

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I think we’re getting all wrapped up in circumstances that might have been and ignoring the facts of this incident.

1. This man was wandering around naked playing on a semi truck like it’s a jungle gym and is now refusing to answer questions. This should have been key signs to the medics that something very abnormal was going on. This was not a slightly weird guy who’s just being annoying, this was pretty obviously a significant mental event.

2. Being tired and burnt out DOES NOT excuse being an *******. It explains it, but it doesn’t make it right and we need to move away from that mindset at all costs.. Yes, I’ve had times where I was grumpy and took it out on the patient, but never once have I said “oh it’s ok that I was a ****, I was tired”. I’ve said it in another thread, I say it to our new guys during orientation, and it’s worth mentioning here - you are not better than our patients.. you took this job to help people, not get your own personal enjoyment from making fun of them in their moment of need.

3. In this case, there could be evidence to suggest that the snarky attitudes of the medics contributed to the patients unwillingness to open up, which contributed to the medics inability to fully assess him and realize this was a significant event (although I still maintain that naked jungle gym time on the semi should have been enough of a clue). This failure of assessment led to the turf to the cop which then (consciously or subconsciously) set him up to make another terrible decision to drop the dude off alone (well hey, the medics think he’s fine, classic groupthink)..

We seem to want to focus on the actions of the patient and their causality to his ultimate death, while ignoring the role that the actions of the medics and cops played in his death. The medics could have chosen to knock it off and actually properly assess the patient, instead they chose to come in with a “how dare you disturb my sleep” attitude and did a piss poor job of helping this man. Again, we’re not talking about a quirky guy who’s family thinks he’s a little off today, but a naked man sliding down the windshield of a semi at night. For the record, I also think the cop made a terrible decision by dumping the dude, and I’m sure he’s being investigated too.

It boils down to this, and I’m not even sure how you can debate otherwise: This patient needed help and everyone involved in the incident failed to recognize it.

As for the side issue of why it’s being investigated by law enforcement? Obviously they are trying to determine if what occurred that night rose beyond just being terrible medics and into the level of criminal negligence.

If you are reading this thinking “man this is scary, it could happen to any of us!” Then allow this to be your wake up call. Take every patient seriously until absolutely proven otherwise and when you recognize your partner is being an ******* and a terrible medic, step up, stand in, and take over.
 
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DrParasite

DrParasite

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Let me be clear on one thing: No one is defending the actions of the paramedics. Their attitude and demeanor was both unprofessional and embarrassing. They did a half assed assessment. The DOH investigated and concluded that they abandoned the patient, and they were disciplined for it.
3. In this case, there could be evidence to suggest that the snarky attitudes of the medics contributed to the patients unwillingness to open up,
No sir, there isn't, because he didn't talk to the officer before the medics even got on scene. the paramedics didn't cause the situation, but they didn't make it any better. That's all clearly stated in the video.
which contributed to the medics inability to fully assess him and realize this was a significant event (although I still maintain that naked jungle gym time on the semi should have been enough of a clue).
No sir. They were tired, and wanted to go back to bed. He wasn't answering questions, however was shaking his head yes and no when asked. They took that to mean he was answer questions appropriately, and just being difficult by not providing his name. I guess they were called to "check him out." They found nothing acutely wrong with him, and left him in the care of PD.

He was reportedly acting crazy. the EMS crew didn't take him to the hospital. no one disagrees. Is the right and responsibility to involuntarily take someone to the hospital fall on EMS, or fall on law enforcement? Most places don't allow EMS to take people without consent, only law enforcement (and judges, doctors, etc, but they aren't in the field) can make that call and enforce it by force.
This failure of assessment led to the turf to the cop which then (consciously or subconsciously) set him up to make another terrible decision to drop the dude off alone (well hey, the medics think he’s fine, classic groupthink).
I think the cop messed up big time here. But having EMS find nothing acutely wrong with the person't doesn't excuse the cop dropping him off miles from where he was picked up, at a closed gas station in another town 15+ miles away with no shirt or shoes on in the middle of the night. And remember, the medic was disciplined, the news reported that the cop wasn't.
It boils down to this, and I’m not even sure how you can debate otherwise: This patient needed help and everyone involved in the incident failed to recognize it.
We are in agreement. and the DOH took appropriate action. and I'm sure a civil suit will follow. For abandonment, sure, but it's unlikely the EMS crew could be found of negligence (but don't take my word for it, hear what an attorney has to say at https://www.ems1.com/legal/articles...deo-Are-they-liable-for-their-patients-death/ )
As for the side issue of why it’s being investigated by law enforcement? Obviously they are trying to determine if what occurred that night rose beyond just being terrible medics and into the level of criminal negligence.
the DOH already investigated this. Law enforcement should have investigated this when it first occurred. And should have investigated the officer for his actions, which led to the patient's death much moreso than the horrible paramedics. This "investigation" is the result of a SJW's emotional letter writing.

This isn't a criminal act on behalf of EMS, although it makes it look like someone is investigating the EMS providers to right this great wrong (who were already investigated by their employer and the EMS agency and disciplined for their actions)..... It should be a civil suit against the entire county, but criminal charges would be grossly inappropriate.
 

FiremanMike

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No sir, there isn't, because he didn't talk to the officer before the medics even got on scene. the paramedics didn't cause the situation, but they didn't make it any better. That's all clearly stated in the video.

No sir. They were tired, and wanted to go back to bed. He wasn't answering questions, however was shaking his head yes and no when asked. They took that to mean he was answer questions appropriately, and just being difficult by not providing his name. I guess they were called to "check him out." They found nothing acutely wrong with him, and left him in the care of PD.

He was reportedly acting crazy. the EMS crew didn't take him to the hospital. no one disagrees. Is the right and responsibility to involuntarily take someone to the hospital fall on EMS, or fall on law enforcement? Most places don't allow EMS to take people without consent, only law enforcement (and judges, doctors, etc, but they aren't in the field) can make that call and enforce it by force.

I think the cop messed up big time here. But having EMS find nothing acutely wrong with the person't doesn't excuse the cop dropping him off miles from where he was picked up, at a closed gas station in another town 15+ miles away with no shirt or shoes on in the middle of the night. And remember, the medic was disciplined, the news reported that the cop wasn't.

Everything you've said here comes back to patient assessment. A patient assessment that was piss-poor and further hampered by a terrible attitude by the medics. It's worth discussing whether or not a more calm and compassionate approach would have engaged the patient into the assessment which would have made it easier for the medics to see that was an acute crisis and not just Grandpa Joe acting odd lately.

We can't ignore the fact that there ACTUALLY WAS an acute issue going on here that was completely missed. What occurred was a failure to assess this patient which was ultimately fatal. Your EDP patient at 0300hrs with the cops deserves the same level of attention to detail as the nice old man at 1000hrs in church. We all knew this job involved getting up in the middle of the night to take care of patients, we should choose not to be grumpy when that happens. While you may view their horrible attitude and mocking behavior as a distracting issue and unrelated to this poor assessment, I have seen how the attitude of the medic in charge DIRECTLY influences patient engagement in the assessment and transport process.

Again, this wasn't just an isolated "check a prisoner", this dude was running around naked, climbing on a semi truck and is now only semi engaged in your assessment and refusing to answer questions. This is not normal behavior, not even close to it. You can't honestly tell me it's appropriate to hear this scenario as an HOPI and then be content with your assessment skills when the patient refuses to answer your questions appropriately. "Eh, seems to be breathing, I'm sure he's good". That just doesn't fly..

Imagine a little old lady complaining of generalized weakness and shortness of breath for 2 days, we show up and turf her because we did a palped blood pressure and pulse ox which were normal and told her she's probably fine.. Turns out she was having a big STEMI that we never assessed for and she dies at home 3 hours later, we'd all be in agreement that the poor assessment led to a situation where she died at home instead of potentially receiving life-saving intervention at the ED. I would assert that the same thing occurred on this run.

We are in agreement. and the DOH took appropriate action. and I'm sure a civil suit will follow. For abandonment, sure, but it's unlikely the EMS crew could be found of negligence (but don't take my word for it, hear what an attorney has to say at https://www.ems1.com/legal/articles...deo-Are-they-liable-for-their-patients-death/ )the DOH already investigated this. Law enforcement should have investigated this when it first occurred. And should have investigated the officer for his actions, which led to the patient's death much moreso than the horrible paramedics. This "investigation" is the result of a SJW's emotional letter writing.

This isn't a criminal act on behalf of EMS, although it makes it look like someone is investigating the EMS providers to right this great wrong (who were already investigated by their employer and the EMS agency and disciplined for their actions)..... It should be a civil suit against the entire county, but criminal charges would be grossly inappropriate.

The DOH doesn't have the expertise or authority to investigate criminal matters. Whether or not the cop faced internal discipline or law enforcement should have investigated sooner is irrelevant. And neither one of us can say with any honest authority that this was or wasn't a criminal act, because we know a very small amount of this story. All I'm saying is it doesn't surprise me that it is being investigated and I offered my thoughts on why.

One last point, I may agree that the cop is more responsible for this death, but only slightly so. Group dynamics and social psychology play a huge role here. The cop should have stepped up and taken the patient to the hospital, but on the flip side he has the medics telling him the patient is fine.. Medics he's possibly known and worked with for years and trusts.. "They say he's fine, they don't see he's in crisis, he's probably fine"..

He wasn't.
 
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