When Not To Transport

[Tigger]

We have to call every refusal in. The ED RN who answers the phone will usually accept it "per xyz physician's approval." It's silly.

 

[Handsome Robb]

She had called at least 4 times in the same day, from the hospital parking lot she was just discharged from wanting to go to a different hospital. The 3rd or 4th time I saw her, can't remember how many it was, pd whisked her away when we got to where she requested to go, I never heard anything about it after that though.

EMS Abuse is one of those charges that is nearly impossible to stick.

We have a patient here who has their own protocol and calls nearly daily. They'll do it for a month or two then disappear for a little while then start doing it again. Actually pulled a gun on one of our crews a few years back, lucky PD didn't put them in a wooden box.

They've tried to get them for EMS Abuse but its never stuck since they "have a medical complaint."

 

[Akulahawk]

Here you go 18 million awarded in a lawsuit with no telemetry contact for RMA

"The next day Mullings was beset by agonizing pain and numbness and called 911 twice. FDNY medics did not take her back to the hospital."

Read more: http://www.nydailynews.com/life-sty...9m-settlement-article-1.1033059#ixzz2VAomgm2h


http://malpractice.burgsimpson.com/...l-malpractice-suit-against-city-hospital.html


This has nothing to do with your clinical assessments or your knowledge or anything of that nature. I assume you like to sleep under a roof and I also believe your certification provides the income for that so if you enjoy keeping it you better cover all your bases.

There is nothing routine about RMA, and certainly something else could have caused precipitous decline in a diabetic, asthmatic, etc. You don't have the diagnostic tools nor the knowledge to check for that. See in the case the development of sepsis with dg of kidney stone and given painkillers upon discharge.

Additionally if the case does go to court, you will have no defense outside your EMT scope and your paperwork on top of never contacting medical control. You will look stupid and they will most certainly get the compensation that they seek. 2 minute conversation with MD if that gets them to go is absolutely not wasted time. They get paid to answer to phone, utilize your resources.

It's not only documentation 101 those things need to be explained to the patient so he is willingly consenting to them, preferably with a witness present to get both signatures. You also need to show that you made full effort to take him to the facility and consequences of his refusal. Read it carefully patient consent IS NOT A PRODUCT! You need to explain things thoroughly, clearly and objectively.

Like I said it's easier to take them to the hospital. However if you feel confident your 3 months emt course has giving you all the knowledge of all the possible pathologies then certainly do your thing.

With all that, I still didn't see where you answered the question about a case being lost due to the crew not calling OLMC? I saw nothing in that article or anything linked to that article that said that the FDNY crew refused to provide care and did not contact OLMC for this refusal. I saw that Brooklyn Hospital and FDNY settled out of fear that a sympathetic jury would award more. To me, that sounds more like the beancounters making a decision to settle rather than the lawyers.

 

[Ecgg]

With all that, I still didn't see where you answered the question about a case being lost due to the crew not calling OLMC? I saw nothing in that article or anything linked to that article that said that the FDNY crew refused to provide care and did not contact OLMC for this refusal. I saw that Brooklyn Hospital and FDNY settled out of fear that a sympathetic jury would award more. To me, that sounds more like the beancounters making a decision to settle rather than the lawyers.

This case was presented by FDNY OLMC physician at a CME siting the reason for settlement was lack of defense due to no telemetry contact. Continuing to state all the cases that are pending all have one major theme in common which is lack in OLMC contact for RMA.

 

[ExpatMedic0]

And to those working outside the US, is there as much of a risk of getting sued for something like this? Are there any laws protecting from lawsuits that arn't obvious or gross neglegence?

To be honest I never looked into that until recently. I found out in some cases, in the middle east, depending on your employer, no. As a result I am also trying to find an insurance plan which will cover me over there.

 

[Akulahawk]

This case was presented by FDNY OLMC physician at a CME siting the reason for settlement was lack of defense due to no telemetry contact. Continuing to state all the cases that are pending all have one major theme in common which is lack in OLMC contact for RMA.

Now that's more like it. Pointing to a news article that says NOTHING about the above as proof that they settled because OLMC wasn't done in a refusal isn't proof at all, and you said NOTHING like the above in prior posts.

It also very well could be that the crew understood that pain is expected in kidney stone cases. That's one reason why people are sent home with pain meds and a strainer. What would have been interesting would have been to see if that instance was documented properly... and who initiated the refusal.

If the refusal wasn't documented well, regardless of who initiated the refusal, that would be a reason why the beancounters would have wanted to settle as there'd be little defense, regardless of whether OLMC was contacted or not.

 

[DrParasite]

oh good, at least I wasn't the only one who read the two articles and saw that they had nothing to do with the topic.

Nothing in the articles mentions OLMC, so I am failing to see how a simple phone call would have changed anything.

And only 8 million was billed to the city, not all 18 million. And I am guessing that was because the patient lost her hands and feet, and because FDNY reported "refused" to transport the patient.

If the FDNY doc said the reason they settled was because OLMC wasn't contacted, well, that might be right, but I am not seeing that written anywhere. In fact, I'm pretty sure FDNY doesn't require OLMC for all RMAs, but I could be wrong on that. In fact, I'm betting he said that was a common theme, but didn't say that the lack of OLMC for an RMA was the cause of the lawsuit, or would have saved the department fro a lawsuit (or would have change the outcome from a win to a loss).

In fact, I would wager that if OLMC was contacted, and the patient still refused to be transported, their would still be a lawsuit. With a sympathetic jury, having the phone call with the OLMC (who also suggested the PT go to the ER), and the patient still refusing to go would result in a different outcome, or the lawsuit would go away. after all, the city settled, and that wasn't always done because they did something wrong, only that it was cheaper and a smaller risk that a long dragged out jury trial.

 

[Melclin]

If you're talking about a patient being reasonable or the lawyer who is going to sue you, no. There's no reason anymore. Everyone in this country is sue happy and therefore we all have to cover our asses. Hence the trend of convincing people they need to go to the hospital for simple stupid things.

To those of you who have procecuted someone for EMS abuse, how is that done? We had a lady once that called pretty much every day. She was no longer accepted as a patient in any ER within 20 miles of her house because she was there so often. I went on her twice within a 12 hour period and we caught her dashing to get into her bed when we walked in the door. Our chief had a meeting with our medical director, the city attorney, the local ER staff, and some reps from law enforcement and they concluded that when she called and wanted to go, we took her. Luckily she moved after a few months.

And to those working outside the US, is there as much of a risk of getting sued for something like this? Are there any laws protecting from lawsuits that arn't obvious or gross neglegence?

I don't expect reason from every single member of the public or every single lawyer. I do expect some semblance of reason from the law and the courts interpretation of that law. Not a completely reasonable approach, not even a lot. Just a little.

EMS abusers
My experience of it is limited. I haven't seen a lot of consistent abuse. Most of our frequent flyers have some combination of acopia and legitimate chronic health issue. Only one of our frequent fliers at my last location was considered malign enough to do something about.

The issue got bumped up to my direct manager and he, with his manager, organised for any case created by that patient in the future to be given the lowest possible priority, and made some other more complex adjustments to dispatch. It seemed to be effective. What the legal implications of it were are beyond me.

Other legal stuff
I'm a little sketchy on some of the details. Its been a while since I cranked out my health law textbook. In general, most of the laws about these sorts of things revolve around what the reasonable paramedic put in the same position could reasonably be expected to do, when acting in good faith. So if you caused harm to a patient, as long as you were acting in a way that was roughly what everyone else would do and you genuinely had the best interests of the patient at heart, then you are, more often that not, going to be fine.

The culture of suing for health issues is considerably different here, for many reasons, I'm sure. IMHO it has a bit to do with the fact that we have reasonably good universal healthcare and a fairly good welfare system. There has traditionally been little (although not no) need to sue for cost of disability or further medical treatment. Followup is on the system's dime, just like the original treatment. If for some reason temporary or permanent disability resulted, the disability support pension system covers that to some degree although serious disability sometimes see people suing doctors for loss of quality of life and more complex issue that aren't covered in some way. I don't know a lot about it though. We also have, from what I can tell, a better system of sick leave from work and so forth.

In regards to some of you having personal insurance, isn't that covered by the employer? The public doesn't sue the paramedic, they sue the organisation. The organisation has the insurance.

There was, for example, a case recently where a man was considered to be dead but was inaccessible due to the nature of the MVA. The crew cleared to go to another job and were called back a few hours later when the coroner's team realized he was still alive. There has been an internal inquiry into the causes of the event and I believe some supportive education for the paramedic's involved. Events like this a multi-factorial; much like aviation disasters. Sure the paramedics cleared prematurely but there was pressure put on them by the work load in the area and a desire to be out responding to other sick patients. Fatigue, under-resourcing in the area and pressure from duty managers in the comms centre were also thought to be issues contributing to the mistake. I'm not aware of any law suit pending. If there was, it would be directed at the service as a whole. An internal review was completed identifying a number of causes and corrective action such as changes to the relevant guideline to clarify requirements in addition to a learning package on the topic.

 

[sir.shocksalot]

In regards to some of you having personal insurance, isn't that covered by the employer? The public doesn't sue the paramedic, they sue the organisation. The organisation has the insurance.

I do not have personal medical liability insurance and personally don't see the need for a paramedic to have any. If I get sued after doing everything according to my employer's protocols and policies then the fault lies with my employer. They are the ones who told me what to do and allowed me to do so, as such they bear the responsibility for whatever I am getting sued for. If I didn't act according to my employer's rules then they will still sue my employer for letting me break the rules and I will likely get fired.

There is no reason or incentive to sue me because I have absolutely no money. Do they wish to garnish my wages to the tune of $9 million? Good luck! It will take me 225 years to pay that if they take every penny I earn at my current pay rate. My employer has over $500 million in annual revenue, if you are looking to have your long term disabilities paid for which is the better cash pile to go after? $500,000,000 or $40,000? If I carry liability insurance they can sue me for whatever my insurance will cover, but why give them the incentive?

 

[DrParasite]

If I get sued after doing everything according to my employer's protocols and policies then the fault lies with my employer. They are the ones who told me what to do and allowed me to do so, as such they bear the responsibility for whatever I am getting sued for. If I didn't act according to my employer's rules then they will still sue my employer for letting me break the rules and I will likely get fired.

Oddly enough, if you get sued, odds are you will be sued personally, as well as your employer, and anyone even remotely related to this incident. Lawyers use the shot gun approach most of the time: sue anyone remotely involved, and them let them convince the judge they aren't involved. It take time, and lawyers are expenseive.

As for just following the employer's rules, I agree; however, on EMTlife, I said the same thing, and the response from someone on here was "the nazi's defense of just following order's didn't save them during the Nuremberg trails."

Lastly, your employer's lawyer's job is to get the employer off the hook. if they can place all the blame on you, they will. they will hang you out to dry, fire you, and make it all your fault (even if it's not), because it is in the best interest of the employer, not you as the employee. It has happened before, and it will happen again. your agency might be the exception, but don't think just because you don't have money that you won't get sued.