Willing to a Non-Willing patient

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DesertMedic66

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One of the guys at my station and I started talking about this:

Let's say you are transporting a patient who is Alert and Orientated x4. The patient is a 25 year old female. When you start transporting she is willing and wants to go to the hospital. Half way thru the transport the patient does not want to go to the hospital anymore and wants you to either turn around or drop her off right where you are.

What would you do?
Is it considered kidnapping and battery if you keep transporting the patient?
Can you have the patient sign AMA and then turn around?
Would you just drop the patient off on the side of the road like they want?
 
JPINFV

JPINFV

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1. Depends on the situation. I'm not going to pull over to the shoulder of a freeway and drop the patient off right then and there. Also, is there any way to finagle implied consent?

2. In California, refusing to pull over would, in my mind "install fear" since leaving would me jumping from a moving vehicle into traffic. Thus, yes, I think it could be considered kidnapping. Now whether or not a prosecutor and judge (who can dismiss any charge 'in the furtherance of justice' under California Penal Code 1385) will let a trial like this go forward is anyone's guess.

207. (a) Every person who forcibly, or by any other means of instilling fear, steals or takes, or holds, detains, or arrests any person in this state, and carries the person into another country, state, or county, or into another part of the same county, is guilty of kidnapping.

2 and 3. Sure, why not as long as it's safe. I would ask the patient if she wouldn't mind simply going to the hospital and signing out AMA once we arrive there.
 
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DesertMedic66

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Would you turn around and drop the patient back off at her house if that's what she wanted?
 
JPINFV

JPINFV

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firefite said:
Would you turn around and drop the patient back off at her house if that's what she wanted?
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Depends. If it's 5 minutes? Sure. If it's 20? Nope. Are there a lot of calls waiting? Nope. Am I still in my response area? Do I need to drive back? Is the patient willing to get out immediately if we catch a run while returning to the patient's point of origin? Any place besides the point of origin or a health care facility? Nope.


EMS isn't a cab service, but I have no qualms about providing a little customer service.
 
abckidsmom

abckidsmom

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firefite said:
Would you turn around and drop the patient back off at her house if that's what she wanted?
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We leave our response area and drive half an hour to the closest hospital. I once had this happen and we just drove the patient back to his house and dropped him off. We notified the dispatcher when we turned around, and then cleared the call from his address, in our first due.

It was QA'd, but there was no big deal, he just changed his mind.
 
mycrofft

mycrofft

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"Are we at Fifth and Main yet? I changed my mind, let me off".

Take 'em home or to the hospital. If they insist, then drop them where you are, but they need to sign and give you info if possible. Home would be better, safer, and would not reward them with a free taxi ride, and would allow more time for mental assessment.
 
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medicdan

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Is there any merit to saying "let us take you to the hospital, if you want to leave after seeing the triage nurse, it's up to you", or at least getting them onto hospital grounds (so it becomes an EMTALA thing)?
 
JPINFV

JPINFV

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Medically? Sure. Legally? Not really. EMTALA? Well, EMTALA doesn't prevent someone from leaving the ED after showing up.
 
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medicdan

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JPINFV said:
Medically? Sure. Legally? Not really. EMTALA? Well, EMTALA doesn't prevent someone from leaving the ED after showing up.
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I agree, it doesn't prevent them from leaving, but it could be argued that it removes liability from us-- it becomes the hospital's problem within 200 feet, theoretically.
 
JPINFV

JPINFV

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Where's the hospitals problem if the patient simply walks out of the lobby? Where's the hospital's liability for that? If the patient lacks capacity, then sure there can be liability, but the same could be said for EMS.

Sorry, but I'm just not seeing how liability applies to either the ambulance crew or the hospital if the patient changes his or her mind provided they have capacity.
 
bstone

bstone

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It's a "no-win" situation. What if they decide not to be transported 1 block from the ER? Do you simply drop them off? How do you document this? What if they croak on the side of the road after you dropped them off?
 
JPINFV

JPINFV

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bstone said:
It's a "no-win" situation. What if they decide not to be transported 1 block from the ER? Do you simply drop them off? How do you document this? What if they croak on the side of the road after you dropped them off?
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1. So what?

2. Sure, if that's what they want.

3. "Patient decided to refuse care. Risks of refusing care explained. Patient offered to be transported the rest of the way to the hospital. Patient told to call 911 if anything changes or if he would like to be transported to the hospital."

Press hard, 2 copies.

4. Provided the patient has capacity, then he made his choices.
 
DrankTheKoolaid

DrankTheKoolaid

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While still moving towards the ED get your OLMC on the radio/telephone to talk to patient. Let them work it out and do what Med Control says. Have patient sign AMA and billing form and put em out on the street
 
JPINFV

JPINFV

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Ask the Germans about how much protection "superior orders" provides.

More important, what sort of "profession" sits there and punts the hard questions to someone else. If EMS providers can't make tough decisions, than EMS providers definitely aren't underpaid. Furthermore, I definitely don't find this to be a tough decision. Would you contact medical control if the patient wanted to refuse care before transport? What difference does it make now that the patient is in a van?
 
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Aidey

Aidey

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We have similar guidelines to call medical control when a patient refuses before transport but meets certain criteria. It isn't punting, so much as allowing someone with more education and knowledge give the patient a better idea of the risks.
 
DrParasite

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JPINFV said:
More important, what sort of "profession" sits there and punts the hard questions to someone else. If EMS providers can't make tough decisions, than EMS providers definitely aren't underpaid.
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are firefighters a profession? what about police officers? are corrections officers a profession?

The reason I ask is all these professions have the ability to "punt", as you put it, the hard questions to someone else. They can ask for a supervisor (Sgt/Lt/Captain/etc) to make the decision, or in the case of the corrections officers, go as high a the Attorney General's office (and yes, I did have a situation where the phone call went from the CO, who called the Sgt, who called the Shift Lt, who called the Court Captain, who called the AG to decide on a plan of action).

kicking a questionable decision up the chain of command is a good thing, because it allows someone with more authority, education and experience to make the final call. go to a supervisor for an operational question, go to a medical director for a clinical question.
 
JPINFV

JPINFV

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Is the police officer going to call up in the middle of a call and ask the captain if he should be conducting a felony stop?

Is the fire fighter going to as the captain if he should be using a saw or an axe to ventilate a roof?

Is the corrections officer going to ask his superior if he should be shackling the inmate in the SHU?

The problem I see in EMS is often it's not a "I'm honestly not sure," but a "Well, I don't want the liability, therefore call medical control." Alternatively, it's the system saying, "Our EMTs or paramedics are too stupid/incompetent/etc to make this decision, therefore we will require them to call in.

No one has yet explained how an AMA in the middle of transport is any different than an AMA at the destination or at the point of origin. No one has yet explained why, unless otherwise required, initiating transport should require an AMA to have medical control contact. No one has yet explained how getting superior orders provides a legal protection agaisnt battery and kidnapping in a patient where a competent provider would have properly assessed the patient as having capacity to make decisions.


...and yes. If a fire fighter, police officer, or corrections officer requires every little move to be laid out by direct order from a superior or by a policy or protocol book, then they aren't a professional. What's the point of things like having commanding a unique body of knowledge if the individual provider isn't allowed to utilize that body of knowledge to make decisions? What's the purpose of requiring paramedics to have 1000 hours of training (or more) if in the end the only thing that matters is what the cookbook-ocol says? It doesn't take 1000 hours to teach someone to read and implement a rank order list.
 
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