Tougher penalties for health care assaults

[MS Medic]

I know some states have it, but ALL states should have it. Being altd or etoh should not be an excuse. Lets get the whole nation under the same rules!

I don't think the point behind this was "Lets start busting postical pts" as much as it was the guy who is drunk, hopped up on dope, or is a psych pt who refuses to stay compliant with meds and then goes into an "episode".

The general public is protected by law against people in these last three catagories, so why shouldn't we be as well?

Did I read the link correctly in that this pettion was to effect CA law?

Not sure, but I think it is a misdemeanor to assault on duty service personnel here.

 

[zephers]

I don't think the point behind this was "Lets start busting postical pts" as much as it was the guy who is drunk, hopped up on dope, or is a psych pt who refuses to stay compliant with meds and then goes into an "episode".

The general public is protected by law against people in these last three catagories, so why shouldn't we be as well?

Did I read the link correctly in that this pettion was to effect CA law?

Not sure, but I think it is a misdemeanor to assault on duty service personnel here.

Yes, This is for CA, but hope that it spreads to every state. No it's not for postictal pts, they're not intentionally assaulting. The courts have been excusing drunks and psych pts. Laws should be the same for police and health care workers period.

 

[MS Medic]

Yes, This is for CA, but hope that it spreads to every state. No it's not for postictal pts, they're not intentionally assaulting. The courts have been excusing drunks and psych pts. Laws should be the same for police and health care workers period.

Well then since I don't live in CA, I can't sign the petition though. Best of luck though and I hope it passes.

 

[mycrofft]

PARSE: "Assault" versus "Battery".

ASSAULT: an attempted battery.
BATTERY: an unwanted touching.

Assault strictly speaking would mean no bodily contact. "Assault" came to mean "battery' through the media not using the homonym of the thingee that stores or creates electrical energy. Also, sexual battery was delicately referred to as assault in the old days to preserve the victim's (and the public's) tender sensibilities, and this slopped over.

If a patient touches you on purpose and without your consent, it is a battery and battery is a felony in every state. A serious assault -say, baseball bat- also known as ADW (assault with a deadly weapon) is a felony as well. Check your state for their penalties for classes of battery and assault, but if someone intentionally whacks you or tries to whack you enough to cause bodily injury and they are compose mentis, then their life as a civilian is basically over.

Like any other industrial area of risk, employers ought to to be held accountable if repeated instances occur. How about three fines then jail time for the boss?

 

[MS Medic]

addiction is an illness.

But I think there is something more important to consider here.

If somebody is being "punished" it means something has already gone wrong.

Perhaps less money and effort should be spent on after the fact and more on prevention?

I missed this post the other day or I would have commented on it then.

This is nothing but a bunk cop out. It may be an illness but that does not excuse personal choice. By that very argument we should excuse drunk drivers who kill people in wrecks or junkies who rob or kill others to get a fix. And while it can be legitimately said that psych pts aren't able to make rational choices, they were able to when they were properly medicated and treated but they decided they didn't like the way meds "made them feel." At that point the whole its an illness argument doesn't hold water

 

[Veneficus]

I missed this post the other day or I would have commented on it then.

This is nothing but a bunk cop out. It may be an illness but that does not excuse personal choice. By that very argument we should excuse drunk drivers who kill people in wrecks or junkies who rob or kill others to get a fix. And while it can be legitimately said that psych pts aren't able to make rational choices, they were able to when they were properly medicated and treated but they decided they didn't like the way meds "made them feel." At that point the whole its an illness argument doesn't hold water

umm... Actually it was meant to point out that more education, training, and possibly procedures need to be put in place by employers in order to prevent employees from getting assaulted or battered.

But I would just like to point out some things about psychs discontinuing psych meds because of how they feel.

Many is the US discontinue because they cannot afford them.

The purpose of psych meds is to make life better by reducing pathological effects of psychiatric illnesses. If the medication causes debilitating side effects or degrades quality of life in some way, then it is not a good choice of medication for that patient.

Most medications, psych or otherwise have a disclaimer that if serious side effects occur, to stop taking it immediately. I wouldn't take a medication that makes me feel worse than when I wasn't on it. Psych or otherwise. That sort of defeats the purpose of medicine doesn't it?

As for choices, you make a choice to eat food that is bad for you. If a person eats unhealthy food, has an MI behind the wheel, and in an altered mental state from lack of cerebral blood flow punches a paramedic should they be held responsible for their conscious choice to ingest McDs over a period of decades?

Don't answer that, it was rhetorical. I am not impressed by personal morals in deciding what types of altered mental status constitute prior intent and responsibility.

 

[MS Medic]

umm... Actually it was meant to point out that more education, training, and possibly procedures need to be put in place by employers in order to prevent employees from getting assaulted or battered.

Wow, really! We're all such a bunch of idiots that we can't do anything without someone holding our hands and telling us what to do, including avoiding someone attacking us.
Maybe your right. I guess more training would have helped me in these situations:

1. I was dispatched for CP but the caller failed to mention the following information to dispatch: he had CP because he was smoking crack all day and was tachycardic. He also failed to mention that he had paranoid schizophrenia from long term drug use and was at that time having auditory hallucinations and suicidal ideations. I learn these after arriving on scene, identifing myself, and being invited in at which point he pulled a knife on us.

2. I'm dispatched out to a fall. What the caller fails to mention to dispatch this time is that the pt didn't fall, he passed out after drinking a fifth of Wild Turkey. What they failed to mention to me on scene is that the passenger seat of his car they set him in was right next to where he kept his pistol. I learned that after I had to fight with him to keep from letting him shoot me.

3. I'm dispatched to an unresponsive. Get on scene to find the pt flopping around on the ground in someone's yard. Load him in the truck (didn't package because incident description precluded the need), check CBG and find him hypoglycemic. Gave D50 and started transport when he didn't come to. Bystanders failed to mention that he had been smoking a formaldehyde laced joint and when he woke while going down the road, he immediately went into a psychotic rage.

I'm not going to even bother to quote any of your misinformed diatribe about pt on psych meds. While not always the case, the majority of the psych pts I referred to have received phycological treatment, usually involving being held on a secure ward while being managed by a psychiatrist. On release, they are remanded to the care of mental health services, where they are seen by psychiatrists and clinical psychologists. Thier psych meds are prescibed and given to them by metal health because of the very reason about cost you mentioned, so that isn't an issue.

I am not impressed by personal morals in deciding what types of altered mental status constitute prior intent and responsibility.

I'm not impressed by you attempt at pontificating by derogatorily dismissing what is a very real safety issue to field personnel as a minor point of contention in a philosophical debate.

 

[Veneficus]

Wow, really! We're all such a bunch of idiots that we can't do anything without someone holding our hands and telling us what to do, including avoiding someone attacking us.
Maybe your right. I guess more training would have helped me in these situations:

1. I was dispatched for CP but the caller failed to mention the following information to dispatch: he had CP because he was smoking crack all day and was tachycardic. He also failed to mention that he had paranoid schizophrenia from long term drug use and was at that time having auditory hallucinations and suicidal ideations. I learn these after arriving on scene, identifing myself, and being invited in at which point he pulled a knife on us.

2. I'm dispatched out to a fall. What the caller fails to mention to dispatch this time is that the pt didn't fall, he passed out after drinking a fifth of Wild Turkey. What they failed to mention to me on scene is that the passenger seat of his car they set him in was right next to where he kept his pistol. I learned that after I had to fight with him to keep from letting him shoot me.

3. I'm dispatched to an unresponsive. Get on scene to find the pt flopping around on the ground in someone's yard. Load him in the truck (didn't package because incident description precluded the need), check CBG and find him hypoglycemic. Gave D50 and started transport when he didn't come to. Bystanders failed to mention that he had been smoking a formaldehyde laced joint and when he woke while going down the road, he immediately went into a psychotic rage.

So there is nothing that could have been done prior to these incidents that may have helped prevent them?

There is nothing during these actual incidents that may have made them safer for you?

There is nothing restrospective that you wish you had or would have done differently?

I'm not going to even bother to quote any of your misinformed diatribe about pt on psych meds. While not always the case, the majority of the psych pts I referred to have received phycological treatment, usually involving being held on a secure ward while being managed by a psychiatrist. On release, they are remanded to the care of mental health services, where they are seen by psychiatrists and clinical psychologists. Thier psych meds are prescibed and given to them by metal health because of the very reason about cost you mentioned, so that isn't an issue..

Misinformed on psych meds?

Where did you get your information on them?

I'd like to think my education on them is rather sufficent.

I'm not impressed by you attempt at pontificating by derogatorily dismissing what is a very real safety issue to field personnel as a minor point of contention in a philosophical debate.

Being assaulted and battered in the field is a serious issue. Trying to decide who and how people should be punished after the fact based on whether or not they knew they would be altered before hand really is rather trivial.

Do you believe that anyone who would drink or drug themself into a stupor would really pause for a moment and consider that they may assault/batter a police officer, firefighter, or ems worker and then decide not to drink that much?

It doesn't make any scene less dangerous, it doesn't undo any injury you may sustain.

Is somebody with an altered mental status because of alcohol or drugs less dangerous than somebody lwith a disease like dementia, hypoglycemia, etc?

It is simply an argument for vengence, which in the justice system must be weighed against the plea for mercy.

Do you think being in a protected class of people, above that of a normal citizen, somehow makes a "give 'em the chair" argument more persuasive?

 

[MS Medic]

Misinformed on psych meds?

Where did you get your information on them?
I'd like to think my education on them is rather sufficent.

Does it exceed the professionals who say these people should be on those meds.

Do you think being in a protected class of people, above that of a normal citizen, somehow makes a "give 'em the chair" argument more persuasive?

Once again, your trying to make this into a debate where you can show how smart you are. I suspect you probably have very little if any prior field experience, and what you might have was probably spent in an area where these issues didn't affect you much.

 

[Veneficus]

Does it exceed the professionals who say these people should be on those meds..

I am not quite sure that is how psychiatry works.

I was under the impression the purpose of psych meds was to restore as much functionality as possible while limiting the side effects.

Generally, "a patient might benefit" from a given medication. There is no perfect psych med. The more potent they are, the less benefit that can be expected.

resistant patients might have electroconvulsive therapy added, and those in such extreme that nothing helps get a permanant bed somewhere.

As just a point of trivia, the original psych med was an antihistamine.

I would suggest that if you are regularly seeing outpatients, thier deficits are not so bad.

Once again, your trying to make this into a debate where you can show how smart you are. I suspect you probably have very little if any prior field experience, and what you might have was probably spent in an area where these issues didn't affect you much.

What has how smart I am or not have to do with anything?

I asked what I thought were some fairly reasonable questions for the sake of discussion which you ignored in order to attack my credibility.

I am sure everyone will agree that you really told me.

 

[Sasha]

Does it exceed the professionals who say these people should be on those meds.


Once again, your trying to make this into a debate where you can show how smart you are. I suspect you probably have very little if any prior field experience, and what you might have was probably spent in an area where these issues didn't affect you much.

Are you really questioning Vene? He has more field experience then most. Plus med school.

 

[Anjel]

Does it exceed the professionals who say these people should be on those meds.


Once again, your trying to make this into a debate where you can show how smart you are. I suspect you probably have very little if any prior field experience, and what you might have was probably spent in an area where these issues didn't affect you much.

Don't insult vene. He has more knowledge that half the members on the site combined. Plus in a year or so he will be a doc. So shh.

 

[Smash]

Once again, your trying to make this into a debate where you can show how smart you are. I suspect you probably have very little if any prior field experience, and what you might have was probably spent in an area where these issues didn't affect you much.

Absolute nonsense. Veneficus is asking us to consider the root cause of why EMTs get assaulted, which is absolutely the right why to go about the issue, rather than just increasing punishment for those who carry out the assault. It's never as simple as "patient woke up and hit me"

Once again we should look to the air travel industry as a model of how to approach investigation and management of critical incidents. Planes are the safest way to travel exactly because they always look at every incident happens with the goal of finding out not just what went wrong, but why it went wrong. EMS on the other hand can't seem to get past a knee-jerk reaction and a piss-poor excuse that scenes and patients are dynamic.

 

[MS Medic]

Just because someone is a doctor does not make them beyond questioning. That is nonsense. I've never questioned his MEDICAL knowledge but it does not change the stance he takes when adressing people on threads where the common theme is that people are uneducated and don't know what they are doing. Even, esecially, in the moments when he is right, the behavior is unexcusable. People care enough about their profession to come here in their free time and rather than being told why they are wrong and giving them words of encouragement, they get their feet kicked out from under them.

As far as why EMS personnel get assaulted, thats pretty easy. We regularly deal with the lower "socioecomic" sections of society. This includes drug addicts, criminals and gang members who are prone to such behavior and yes even certian people with mental illness. If an EMT can be charged with felony assault for touching a pt without permission, who called them, then why can't the pt be held to the same standard.

 

[Tigger]

But I would just like to point out some things about psychs discontinuing psych meds because of how they feel.

Many is the US discontinue because they cannot afford them.

The purpose of psych meds is to make life better by reducing pathological effects of psychiatric illnesses. If the medication causes debilitating side effects or degrades quality of life in some way, then it is not a good choice of medication for that patient.

Both of these points, especially the financial one, cannot be emphasized enough. Few psych patients are going to voluntarily discontinue meds that are working. Having to choose between putting the food on the table and having the proper amount of medication however is a real choice faced by thousands of Americans. Say what you will about lifestyle choices but remember that not everyone suffering from mental illness is a drugged out degenerate.

Another question, if a patient's medication is creating or worsening acts of violence, is it it still the patient's fault. If they were prescribed medication that changed their personality and actions, can they really be held responsible for their actions?

If mental illness is no different than physical illness (and it isn't), why the distinction between violent psych patients and violent postictal patients?

 

[Tigger]

Are you really questioning Vene? He has more field experience then most. Plus med school.

Superior levels of education or experience does not make one above questioning, ever. If something has not been explained to my satisfaction, you can be damned sure I'll continue to question them until I am satisfied whether it be a doctor or the pope. This isn't North Korea, if you put something out for discussion or argument, you should be prepared to defend it.

 

[Anjel]

He asked questions. She attacked his credibility.

 

[Sasha]

What anjel said.

 

[Smash]

Just because someone is a doctor does not make them beyond questioning. That is nonsense. I've never questioned his MEDICAL knowledge but it does not change the stance he takes when adressing people on threads where the common theme is that people are uneducated and don't know what they are doing. Even, esecially, in the moments when he is right, the behavior is unexcusable. People care enough about their profession to come here in their free time and rather than being told why they are wrong and giving them words of encouragement, they get their feet kicked out from under them.

No-one was kicking any feet out from any people. Veneficus stated that it already is a felony to assault paramedics in the states he has worked in. He also seemingly wanted to point out that it is not a clear cut issue when it comes to intent, competency and so on when these assaults happen. There is also the extremely important point that the ambulance at the bottom of the cliff scenario (prosecuting the hell out of people) is a less effective way of dealing with issues than working out why they happen in the first place. An ounce of prevention and all that... I would have thought that that would be self evident. Obviously not.

Veneficus is certainly not someone who places himself above others; I have had very robust discussions with him in the past, and no doubt will in the future, and there has never been any suggestion that he considers himself better than anyone else on these boards. I would speculate that your feelings about that reflect more on you than on Veneficus.

As far as why EMS personnel get assaulted, thats pretty easy. We regularly deal with the lower "socioecomic" sections of society. This includes drug addicts, criminals and gang members who are prone to such behavior and yes even certian people with mental illness. If an EMT can be charged with felony assault for touching a pt without permission, who called them, then why can't the pt be held to the same standard.

Ah, I see, it's the poor people's fault. Sorry about that, I should have realised. Funnily enough, in over 14 years on the street I have not once been assaulted by any of these groups you mention. In fact, I have not been assaulted at all. I've had some confused, aggressive people who needed managed, but I've never been assaulted. (Cue the "you obviously haven't worked in X area" comments...)

Taking that ridiculous, bigoted stance is not going to reduce assaults. Working out how and why assaults happen and putting in place plans to avoid them will.
No-one has argued that people who assault EMTs shouldn't be held accountable, in fact almost everyone has confirmed that it is a felony in most places to assault someone in uniform. That doesn't detract from the fact that the points Veneficus raised are valid, and very important.

 

[abckidsmom]

1. I was dispatched for CP but the caller failed to mention the following information to dispatch: he had CP because he was smoking crack all day and was tachycardic. He also failed to mention that he had paranoid schizophrenia from long term drug use and was at that time having auditory hallucinations and suicidal ideations. I learn these after arriving on scene, identifing myself, and being invited in at which point he pulled a knife on us.

2. I'm dispatched out to a fall. What the caller fails to mention to dispatch this time is that the pt didn't fall, he passed out after drinking a fifth of Wild Turkey. What they failed to mention to me on scene is that the passenger seat of his car they set him in was right next to where he kept his pistol. I learned that after I had to fight with him to keep from letting him shoot me.

3. I'm dispatched to an unresponsive. Get on scene to find the pt flopping around on the ground in someone's yard. Load him in the truck (didn't package because incident description precluded the need), check CBG and find him hypoglycemic. Gave D50 and started transport when he didn't come to. Bystanders failed to mention that he had been smoking a formaldehyde laced joint and when he woke while going down the road, he immediately went into a psychotic rage.

In my experience in urban, suburban and rural systems with varying degrees of law enforcement back up, it is up to you to determine how the drama will play out. If you approach people with respect, intending to find a workable resolution for their problems (to HELP them) they almost always respond favorably to you direction.

If you are dispatched to reject losers whose drug-induced mental illness obviously has turned them into hardened criminals (in your mind, from the tone of your descriptions above), I can reasonably predict that things are going to go poorly.

I don't fight people, I subdue them. I don't go to subdue people without adequate resources to do so. And, I don't get myself pinned down where the only option is for me to get into a stupid fight that I am definitely going to lose.

All of these are things I have learned from people far more experienced than I am at self defense and de-escalating of incidents.

That is to say, education.