Suicidal patient refusal?

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Jim37F

Jim37F

Forum Deputy Chief
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Meanwhile, I've had LACo Fire pull patients out of the back seat of squad cars to put them in the ambulance, even though the Deputy was saying that it's alright, they'd take them in themselves, it's just a clear to book, and they would still have to follow to the hospital and wait there until the pt was cleared so they can go to jail anyway, and LACoFD saying "No, you called us and we had to check them out, that makes them our patient, now we HAVE to transport by ambulance because there's a one in a million chance it's a stroke or something instead....but we're clearing and going back to station, McCormick you're transporting to the psych hospital code 2 BLS, see ya in a few hours" (at least up until the ellipses, that was almost verbatim.....)

(One time a Deputy was leading a guy out to us in Compton, we were on scene first, Deputy was about to sit the guy on the gurney when CFD walks up and shouts to not do that if it's just a clear to book.....the Compton guys said that as soon as they sit on the gurney they become a patient that HAS to be transported via ambulance to the hospital but if they didn't sit down the Deputy could take them to the hospital or straight to jail or whatever they wanted to do instead.....)
 

Akulahawk

EMT-P/ED RN
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Government funded and government- run are the same thing for purposes of 1983 complaints and civil rights law. Plus most "County" hospitals are owened in part by the government. eighth amendment law is also not necessarily restricted to criminal punishment- it has been expanded over the years via court decisions to include civil torts involving any case in which a person is placed on involuntary hold via a court order for a non-criminal reason, such as contempt of court and psych holds. The legal test is whether or not the patient is subject to conditions which are tantamount to "incarceration" of any kind. If a facility doesn't have beds available, then the reasonable and prudent thing to do is to refer a patient to a facility that has a bed available within a reasonable amount of time, provided the patient is stable. (which again, under our circumstances, the law doesn't consider our patient "stable" by definition of mental health practice.) Your confusing the mental health definition of "stable" with the ordinary meaning of the terminology, and the two are not the same in the eyes of the law. For purposes of law, a suicidal patient is just as "unstable" as a patient in cardiac arrest- as a suicidal patient can be just as much on death's doorstep without relatively immediate intervention- the difference is that there's quite a bit more time before the crap hits the fan. The question really is "how much" - and the reasonable and prudent person doesn't gamble. Hence waiting 20-30 minutes is reasonable. Waiting 1 to 2 hours is not.
What you're now suggesting is that a hospital violate EMTALA by referring a patient to another facility without conducting a medical screening exam, performing any and all necessary testing to determine the patient is actually medically stable for said transfer, and without the receiving facility's acceptance of said patient. A suicidal patient that's in restraints for their own safety (let alone mine) while waiting for an appropriate bed, appropriate MSE and testing, and appropriate referral, while "unstable" isn't in an unsafe situation while waiting. No hospital that I'm aware of is going to violate EMTALA because they don't want to have a patient hold a wall for more than an hour or two. Sure, while the suicidal patient needs relatively immediate intervention, the time scale for "immediate" can be quite different from other ESI 1 patients because the patient is not in a physically unsafe situation.
 

DrParasite

The fire extinguisher is not just for show
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I don't trust PD all to often.. they handcuffed our patient to the gurney on scene.. never met us at the ER.
If PD has our patient handcuffed to the gurney, they WILL be transporting in the truck with us. It's not even up for debate, my truck isn't leaving the scene without LEO in the back with us. If needed, I'll have my supervisor speak to their supervisor, and if my supervisor can't convince their supervisor to send a cop with us, than he can take the ride in the back with the patient to the hospital and I will take his car back to base and we can discuss it with administration.
 

DrParasite

The fire extinguisher is not just for show
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Meanwhile, I've had LACo Fire pull patients out of the back seat of squad cars to put them in the ambulance, even though the Deputy was saying that it's alright, they'd take them in themselves, it's just a clear to book, and they would still have to follow to the hospital and wait there until the pt was cleared so they can go to jail anyway, and LACoFD saying "No, you called us and we had to check them out, that makes them our patient, now we HAVE to transport by ambulance because there's a one in a million chance it's a stroke or something instead....but we're clearing and going back to station, McCormick you're transporting to the psych hospital code 2 BLS, see ya in a few hours" (at least up until the ellipses, that was almost verbatim.....)
sounds like another reason to not work in the LA area.....
(One time a Deputy was leading a guy out to us in Compton, we were on scene first, Deputy was about to sit the guy on the gurney when CFD walks up and shouts to not do that if it's just a clear to book.....the Compton guys said that as soon as they sit on the gurney they become a patient that HAS to be transported via ambulance to the hospital but if they didn't sit down the Deputy could take them to the hospital or straight to jail or whatever they wanted to do instead.....)
why makes the patient NEED to go to the hospital once he sits on the stretcher? Is that a local policy thing? medical director's call? a Cali regulation?

I would argue that why even send an ambulance a?t all? just have the FD do it with no ambulance or stretcher present, so there is no risk of them getting on the stretcher.

Even better, what makes the FD qualified to clear a patient for booking? I mean, don't your jails have medical staff who handle stuff like this?
 
OP
Jim37F

Jim37F

Forum Deputy Chief
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Yeah....I've asked those exact same questions myself.....never really got much of a better answer than "Oh that's not PDs job" or "That's just the way it is....that's your job, if you don't like, the door is over there" -_-

(Though we were all fairly certain some of the other departments that actually had to transport and deal with wall holding and being out of service for such patients were more than happy to let LE transport in those cases.....)

If I hadn't won the proverbial lottery when I did, I would have already been looking at exit routes (I already knew that if I hadn't passed my interview back in Feb I'd have been applying to medic school for this fall at the least.....would still have gone thru the proverbial revolving door even if my exit wasn't to come up till next spring or whatever I was already looking towards it....)
 

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