Rma for minor via cell phone (nj)

[PTB]

Hello everyone I have just joined this forum in the hope that you may help to settle a dispute I had with one of my fellow EMTs. PLEASE NOTE THIS TOOK PLACE IN NJ. Here is the scenario:

We are at a standby for an annual 5K run when we are told that a minor has "popped her knee out." The minor, whom was brought to us, is placed on the stretcher and we begin to assess her. The patient reports that her knee had "popped out of its socket" but she was able to put it back in place and now it "just hurts." As we proceed to ice the knee she informs us that she is 17 years of age and is from New York State.When we ask where her parents are she informs us that her parents are home and she came here with a friend's parents. As the friend's parents come over we inform the patient that we will be taking her to our local hospital. The patient begins to refuse care (keep in mind this is a minor and legally has no right to do so seeing as she is neither emancipated nor a parent) and the friend's parents agree that they do not want her going to the hospital. At this point my lieutenant was about to hand over the RMA form when I pulled him aside and stated that we cannot accept the refusal seeing as they are not her parents/ legal guardians. He acknowledges this and proceeds to ask if he may contact the patient's parents. My lieutenant proceeds to call the patient's supposed mother and receives consent for the RMA. Now here arises the dispute. I stated that I do not believe that consent for a Minor's RMA may be given via telephone while my Lieutenant and Captain, who were uncertain but acted in good faith, said said it could be. My questions to you all is, in the state of New Jersey, may a minor receive parental consent to RMA via telephone and if so on what grounds? Thanks in advance.

 

[OnceAnEMT]

Can't really speak for NJ specifically, but here's my opinion.

Who do you work for? I'm assuming the city/county?

I believe you are correct in that consent can't be given over the telephone. As well, unless the friend's parents presented proof that they were guardians, they are even more useless for consent. That said, assuming it is like many races in which registration of some kind is necessary, being a minor she should have to have filled out a medical release that releases liability from the event, and possibly automatically gives consent for treatment by healthcare providers hired by the event.

Now, the moral side of it. I would not consider it fair for concerned, non-related parents to bring a minor to your staging location for assistance and then be forced to transport the minor. They had no clue that there would be no choice. My position here is you were right to not make a major fuss about it, because you really don't have anything to fall back on but policy. That said, depending on how your system works, a call to a higher up couldn't hurt. But it sounds like he was already there.

 

[PTB]

Thanks for your quick reply. To Clarify, we are an entirely volunteer run organization that receives an annual insurance subsidy from the town. Thanks again.

 

[Handsome Robb]

There's no reason you can't take a refusal over the phone, there's lots of ways to determine if you're actually talking to a parent. Use their cellphone and have them call "mom" or "dad" or watch them as they pull the number, ask specific questions that only a parent would know that can be confirmed by the patient.

Our job is to be a patient advocate, that doesn't mean forcing everyone to go to the hospital. She didn't dislocate her knee and pop it back into place. A patella...maybe. Knee dislocations are extremely painful even after reduction since there's generally associated soft tissue damage. Also, an emergency department isn't going to do much for her besides give her some pain meds, maybe, if she's in a lot of pain, shoot an x-ray and then discharge her with a followup with ortho if the pain or problem persists.

I would've called them, explained the situation and then asked who their daughter was supposed to be with and then asked if they wanted me to transport her or release her to the parents who're on scene.

Done it hundreds of times.

Our minor protocol mandates we attempt phone contact with a guardian and also states we can take over the phone refusals for minors.

I'm not sure about NJ but I'd bet it's similar.

 

[mycrofft]

Enter the concept of the "mature minor".

http://www.jlgh.org/JLGH/media/Journal-LGH-Media-Library/Past%20Issues/Volume%204%20-%20Issue%202/v4_i2_OConnor.pdf

http://www.ncbi.nlm.nih.gov/pubmed/23530175

http://en.wikipedia.org/wiki/Mature_minor_doctrine

To summarize: there have been multiple rulings that a minor with mental competence, the ability to comprehend the consequences of actions, and at least 16 y/o (lower if specially described) can approve or refuse care.

Interestingly, there was found in once case no constitutional right to refuse care (!!!), period.

BUT all articles say while there have been rulings, the rules have not been set down firmly and so everyone is left working case to case.

Try this for one baseline: if the subject is likely to fight and poses no other hazard to others, and is apparently mentally sound, where is the benefit of struggling to impose treatment or transport?

And as for parental care over the phone: have them read their driver's license card number to you over the phone. (If law enforcement is there, they may actually be able to run it STAT).

 

[Tigger]

I do it all the time. Call the parents, make sure they're ok with who the child is being left with, and be done with it. If the child is at camp or some sort of event with a release, I will have them sign the refusal as well.

 

[Rialaigh]

At my current service I have no issue at all taking a refusal from 16 and 17 year olds who appear mentally competent and alert and oriented.

Also if you are concerned about minor refusals you can make it very simple. "

Ma'am, Before I assess or treat you at all I want you to know that once I start you will not be able to refuse treatment and transport to the hospital without a parent or guardian, are you seeking medical care by me? do you want me to check you out?"

If you have no patient there is no one to refuse...If a minor is not seeking medical care when I come in contact with them then they are not my patient, not my responsibility, and I have no liability by not treating unless it is something obvious.

 

[NJEMT95]

I had a similar incident last summer, also in NJ. Our chief was there and spoke to the pt's mother over the phone. We had police sign off as a witness on the RMA.

 

[Medic Tim]

I have done this over the phone more than once... In Canada and the USA .

It seems ridiculous to force this pt to go by ambulance to a hospital and stick her( family) with a bill.

Were you actually working as an EMT ( under medical direction) or were they using EMTs to volunteer as first aiders?
Did the pt actually call or ask for help or did a stranger call? If the pt did not initiate contacting you and denies needing medical attention that is a no pt contact/ unfounded call.

Not saying that was the case in this situation but I see it a lot .

 

[mycrofft]

At my current service I have no issue at all taking a refusal from 16 and 17 year olds who appear mentally competent and alert and oriented.

Also if you are concerned about minor refusals you can make it very simple. "

Ma'am, Before I assess or treat you at all I want you to know that once I start you will not be able to refuse treatment and transport to the hospital without a parent or guardian, are you seeking medical care by me? do you want me to check you out?"

If you have no patient there is no one to refuse...If a minor is not seeking medical care when I come in contact with them then they are not my patient, not my responsibility, and I have no liability by not treating unless it is something obvious.

Actually if at any point during treatment or assessment the pt, while competent, states she or he's had enough, it applies. Unless you shoot some mind altering stuff on board promptly.

This is the little bother to "Just wait until they lose consciousness, then you can do whatever you want and hang the AMA form".

 

[Rialaigh]

Actually if at any point during treatment or assessment the pt, while competent, states she or he's had enough, it applies. Unless you shoot some mind altering stuff on board promptly.

This is the little bother to "Just wait until they lose consciousness, then you can do whatever you want and hang the AMA form".

Im talking about a 8 year old with a obviously fractured leg does not get to make his/her own decision about going to the hospital, now he/she does not have to go with me but theres a police car if they don't want to. Now a 16 year old with leg pain but can bear weight and has a ride home....



Don't you hate protocols that go against the LAW....:glare:

 

[mycrofft]

Hate being in the middle of them.

 

[mycrofft]

From Boston Coop web page

NOT sure if this was compiled by lawyers or the date. Sort of reminds me of the old Whole Earth Catalog days:

Main page, seems to indicate it was created at least in conjunction with a credible law school:
http://www.bostoncoop.net/lcd/final/index.html


State by state chart:
http://www.bostoncoop.net/lcd/final/mature_minor/mature_minor.html

Key to the chart:
http://www.bostoncoop.net/lcd/final/mature_minor/mature_minor_key.html

 

[mycrofft]

Im talking about a 8 year old with a obviously fractured leg does not get to make his/her own decision about going to the hospital, now he/she does not have to go with me but theres a police car if they don't want to. Now a 16 year old with leg pain but can bear weight and has a ride home....



Don't you hate protocols that go against the LAW....:glare:

Once had a mom who asked her 8 year old if he thought he needed to go to the hospital (back pain radiating to legs after scrimmage mashup)…he went.

 

[Handsome Robb]

Once had a mom who asked her 8 year old if he thought he needed to go to the hospital (back pain radiating to legs after scrimmage mashup)…he went.

I've had that happen plenty of times. Only they know how bad they feel. Hell I've had parents ask kids younger than 8 that question. Seen them say both yes and no. Also seen the parents do what the kid says. If the kid says no and they start to say no but I think they need to go I'll obviously talk to them and explain my position but I'm not in the business of forcing transport on patients who don't need it.

 

[shfd739]

I don't see a problem with taking a refusal over the phone.

I document the phone number called and who I spoke with then have the responsible adult that was with the patient sign the refusal with the parents consent in their absence.

 

[EMSchic092]

minor RMA

I am a nj emt with a solely volunteer organization. I spoke to my captain about this scenario and the information he gave me actually made sense. He told me that when this situation comes up, yes you can take a verbal RMA from a parent over the phone. I also asked him how we protect ourselves just in case it wasn't really a parent on the phone. he says you need to get all the parents information including birthday, address, social security number, and also have them confirm the information that the pt has given you. You also have to have a police officer talk to the parent and also have the same officer sign off as the witness.

 

[BandageBrigade]

Let's say you couldn't get ahold of a parent.. or the kid refuses to give you a number? Did you plan on taking them against their will? I'd love to see how that would have played out for you.

 

[EMSchic092]

Let's say you couldn't get ahold of a parent.. or the kid refuses to give you a number? Did you plan on taking them against their will? I'd love to see how that would have played out for you.

that's where PD comes into play.

 

[Rialaigh]

Let's say you couldn't get ahold of a parent.. or the kid refuses to give you a number? Did you plan on taking them against their will? I'd love to see how that would have played out for you.

Absolutely not. I would advise the person that if I check them out they then become my patient and if they are my patient things might get complicated. If they would like to refuse being checked out all together and they are never under my medical care then there is no problem...Its totally up to the person if they want to become my patient in the first place. If they don't the report gets written as no patient found with an LEO signature stating the person on scene didn't want to be checked out or be a patient at all.