The Gray Zone: Drunks Refusing Care

JPINFV said:
Darn it, sniped with the "5150 = mental disorder, no more, no less" rant.
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BOOM, headshot!

Anyway, since "A&Ox4" is clearly not thorough enough of an assessment to decide if someone is competent enough at the time to provide him/herself with a safe environment in which to sober up and not further injure themselves, what is?

Is it our job to make sure they don't hurt themselves further? After all, they put themselves in their inebriated state, is responsibility for all actions absolved after one reaches a certain BAC level?
 
socalmedic said:
I am fortunate to be working in a state and county with a well defined health and welfare system as it relates to this call. in this situation he may understand the ramifications of his actions but does he fully comprehend them. I think not. if there is any slurring of speach or ataxic gate PD here has no problem putting the patient on a 72 hour health and welfare hold (in CA called a 5150). if for any reason the officer has a problem with that i have two options, i can call the base hospital and get a 5150 order from the MD which forces the sheriff to effect a hold, note EMS will not arrest or detain the pt only LEO's as they are now legally bound to holding the pt. or I can call the PET (psychiatric evaluation team) which is on duty 24 hours a day to place the hold.
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God am I glad I dont live in cali.
 
I am not about to search court documents but I am sure use of an intoxicating substance to the point of not being able to care for them self warrants a hold. this has been used way too many times for it to not have been challenged by now. besides if not a 5150, then they will be arrested for drunk and disorderly or disturbing the peace or drunk in public, all of which I have no problem with. if your going to get drunk do so responsibly and dont get 911 called. the sheriff will take them to jail if they can walk and stand un assisted other wise they are placed in custody and taken to the hospital.
 
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socalmedic said:
I am not about to search court documents but I am sure use of an intoxicating substance to the point of not being able to care for them self warrants a hold.
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No it doesn't. Falling over and knocking your head because you're drunk =/= a psychiatric disorder. Therefore, they do not fit the criteria of "as a result of a mental disorder, a danger to others, or to himself or herself, or gravely disabled,"

We've provided citation for our argument. Provide some for yours or it's moot. I could tell you that asteroids are made of cheese, even if it's true, you probably wouldn't believe me without some evidence backing that claim.

Don't take that last paragraph as a personal attack, it's not, I would genuinely like to see a case where the 5150 was utilized on someone who was intoxicated with no mental disorder, and then that hold held up in court as justified.
 
socalmedic said:
I am not about to search court documents but I am sure use of an intoxicating substance to the point of not being able to care for them self warrants a hold. this has been used way too many times for it to not have been challenged by now. besides if not a 5150, then they will be arrested for drunk and disorderly or disturbing the peace or drunk in public, all of which I have no problem with. if your going to get drunk do so responsibly and dont get 911 called. the sheriff will take them to jail if they can walk and stand un assisted other wise they are placed in custody and taken to the hospital.
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A plain reading of WIC 5150 should be clear enough on this one. Drunk in public or some other misdemeanor or infraction (which always has the opportunity to be plead out to a suspended sentence) is more appropriate of a charge than sticking someone with the stigma (along with other associated legal issues, such as firearms prohibition) of having a mental illness. Playing around and abusing the legal system should not be an option.
 
adamjh3 said:
We've provided citation for our argument. Provide some for yours or it's moot. I could tell you that asteroids are made of cheese, even if it's true, you probably wouldn't believe me without some evidence backing that claim.
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The problem is that there isn't. WIC 5150 is being used as a substitute for simply saying a patient doesn't have capacity and treating under implied consent. If a patient lacks capacity due to intoxicating substances, than a 5150 hold doesn't provide any footing not already available. What I find more horrific, though (and as seen in other threads), is the reported use simply because the provider doesn't like the prospect that a patient that in no way lacks capacity doesn't want care.

Don't take that last paragraph as a personal attack, it's not, I would genuinely like to see a case where the 5150 was utilized on someone who was intoxicated with no mental disorder, and then that hold held up in court as justified.
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It generally won't because the evaulating physician is going to drop it. The problem is that if a 5150 is written for DTO or DTS then that patient faces a loss of rights (specifically a firearms ban) for 5 years or until appealed. This is, of course, in addition to the cost of any treatment that the patient did not want in the first place.


What I would like to see is a case where a provider or law enforcement officer faces professional, civil, and/or criminal liability for blatantly misusing the statute.
 
your absolutely right, you cannot believe anything that is not supported by fact.

so dont believe it, but it happens and continues to happen unopposed which leads me to believe that it is completely legal and upheld.

furthermore i just got off the phone with a LEO friend who directed me to look into WIC 5170 which specifically gives the officer the right to place a hold on someone who is inebriated.
 
socalmedic said:
furthermore i just got off the phone with a LEO friend who directed me to look into WIC 5170 which specifically gives the officer the right to place a hold on someone who is inebriated.
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WIC5150 hold and WIC 5170 holds are not the same. Write a 5170 then instead of abusing 5150.


Edit: Unlike a hold under 5150, a hold under 5170 does not bring about a prohibition of handling a firearm.
 
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I dont write either and shift the responsabiliy/blame to someone else. i just poke them with needles when the papers are done.

sorry linuss, we took a left turn at hypothetical street. I think we have all made our points, I will stay on your original topic from here out.
 
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Not directed specifically at you, but I see little difference between an EMS provider who calls law enforcement for the sole reason of a bogus 5150 hold and the law enforcement officer who is writing the bogus 5150 hold.
 
We call medical control. The RN asks the attending what to do. If he/she says have them sign AMA then we do. If he/she says bring em in we aren't happy (and neither is the drunk).
 
throwing this out there:

a drunk who is stopped by PD or who passes out and PD finds is often taken to the ER for evaluation by EMS, more often than not at the request of PD.

a drunk who is stopped while driving a car or who is found passed out in the front seat of a car is placed in handcuffs and arrested on charges of DUI.

just saying
 
If the person is under arrest and signs AMA, the officer will sometimes still take the person to the hospital.

If the person is not under arrest and is AOx4 then we have to call the hospital and see if it's ok with them that the patient signs AMA.

If the patient is not AOx4 then he is going.
 
Seems like it takes y'all long enough to get anything done that a smart patient would just walk off while y'all are getting authorization for the 5150.
 
"if the patient becomes agitated anywhere in the process of being taken into custody they are getting versed."

That can get you into a lot of trouble. Do your protocols even allow you to chemically sedate someone because they are agitated? And with Versed?
 
zzyzx said:
"if the patient becomes agitated anywhere in the process of being taken into custody they are getting versed."

That can get you into a lot of trouble. Do your protocols even allow you to chemically sedate someone because they are agitated? And with Versed?
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yes they do actually, in fact the protocol is called "agitation/behavioral" and if the person is agitated to a point which puts them or myself in jeopardy you better believe I wont hesitate to sedate. i would rather them sleep for a bit then run the risk of the cops beating the :censored::censored::censored::censored: out of them...
 
It might have been brought up here, but I'm too lazy to look through this thread.

Anyway, the Brady Emergency Care states: (paraphrased) patients that are under the influence of alcohol and drugs are considered altered mental status and are not able to refuse care. They must be treated as implied consent.

However, you should be completely sure that they are under the influence and if you suspect it and have police on scene, you may want to consider a sobriety test. If they have a portable breathalyzer, that would help.
 
1. What's the blood alcohol level 'legal limit' for capacity? Is it the same or different from the limit for driving? Is the problem with people driving once they pass a certain limit an inability to understand the consequences of their actions or a depressed reaction time?

2. Define "under the influence." Is 1 beer enough? If so, for how long? 2 beers 5 minutes ago? 50? Same with drugs. If I'm using an opioid pain reliever (legality being irrelevant), do I lose the right to control my body for 1 pill? 2 pills? Prescribed dosage? For how long?
 
traumaluv2011 said:
It might have been brought up here, but I'm too lazy to look through this thread.

Anyway, the Brady Emergency Care states: (paraphrased) patients that are under the influence of alcohol and drugs are considered altered mental status and are not able to refuse care. They must be treated as implied consent.

However, you should be completely sure that they are under the influence and if you suspect it and have police on scene, you may want to consider a sobriety test. If they have a portable breathalyzer, that would help.
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Good luck with that line of thinking...

Not everyone needs to go to the hospital because they've consumed alcohol. How are you as an outside party going to decide whether or not they are fit to make decisions for themselves? Surely you cannot have any idea on how much a person's judgement is affected based purely on how many drinks they have had alone. If a patient admits they've had one beer, do you immediately force them onto the stretcher and take them to the hospital? Seems like a bit of waste to me...

Also, if I asked a LEO to write a psych hold for me to have an intoxicated individual taken to the hospital, I bet I'd be in for a fairly long lecture on the purpose of Section 12s, that is once the officer got done laughing at me.
 
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