Input from a former Texas District Atty and NREMT-P and taken from another public site:
"I have debated whether or not to weigh in on this discussion since I'm now a
permanent resident of Arizona, not Texas. However, it might be useful for
you in Texas to know Arizona's experience with field blood draws for DUI (here
it's called Driving Under the Influence rather than Driving While Intoxicated
(DWI).
Legally, anybody can draw blood in Arizona. However, typically, EMS
services and EMS certificants have not been involved in DUI blood draws. Usually,
suspects are transported to a hospital for the blood to be drawn. However,
for a number of years certain counties have trained police officers to draw
blood for DUI investigations.
Although they have a big van that's outfitted as a phlebotomy lab, and they
use it during their "DUI sweeps where they block the road and stop every car,"
most blood draws are done in the back seat of a squad car or with the arrestee
leaning against the car.
Which has led the DUI attorneys to develop special tactics and weapons to use
against blood draws. Among them: Attacking the sanitation of the blood
draw site. Wouldn't it be great to have a bunch of lawyer's investigators
going over our ambulances pursuant to subpoena, doing swabs and looking for
microbes? That is sure to happen if we get involved. The blood drawers will be
subjected to cross examination on every aspect of their actions, in court.
The cops go through a 5 day course in phlebotomy and a minimum of 100 blood
draws here. Can you imagine the questions that might be asked of an EMT-I
about training, number of draws, and so forth? Can you imagine the subpoenas
for training records, patient records, and such? Imagine it.
Unless the defendant agrees to the blood evidence being admitted in evidence
(fat chance of that ever happening) the person who drew will have to be called
to testify. She/he will be asked every question the lawyer can think of
about the training, experience, procedures, and so forth. Every step in the
procedure will be gone over in an attempt to prove contamination. The chain of
custody will be attacked.
When one is called to testify in a criminal case, generally speaking the
subpoena requires the witness to be present at the start of the trial. Some
experts who are VERY important get the courtesy of being called an hour prior to
the time they will testify, but for other witnesses, that just doesn't happen.
You can expect to be sitting in the hall all day for one or two days for
each case. Who will pay for that? Not the state. Witness fees are generally
$10 or $15 dollars. If the state calls you, you don't get anything. Who
pays for your time? What if it's overtime? What if your appearance causes
another employee on overtime to have to cover your shift?
Suffice it to say that if EMS folks in Texas are required to draw the blood,
the defense attorneys will apply the same arguments and techniques to them as
they have to police officers who draw blood.
Next, what happens when you get sued? There is currently a case in the
courts in Tucson filed by a man who claims that he got an MRSA infection in his
arm as the result of a sheriff's deputy drawing his blood in the field. He
claims disability, medical expenses, and asks for lost wages, medical expenses,
future medical expenses, future wages, and $500,000.00 in punitive damages.
What if it takes multiple sticks for the EMT to get the blood? What if
she/he sticks himself and gets hepatitis or HIV because the defendant becomes
uncooperative? What happens if the stick goes badly and there's an arterial
stick, et cetera? This is an invitation to lawsuits.
Who will pay for the defense of such cases? I do not believe that
malpractice policies as currently written will cover these cases, since they do not
involve medical care. Therefore, the medic individually and/or the service will
have to pay for the defense of such cases. This can be huge. If there's a
judgment against you, who will pay that? Your insurance won't.
We have also discussed the disruption it will cause to EMS if cops can call
us out to draw blood, or worse yet, order us to draw blood when it would
interfere with patient care. The law seeks to prevent this, but when emotions are
high such as at the scene of a horrible MVC, the law doesn't always get
carried out to the letter.
Last, we should not become involved in moral and emotional issues as
healthcare providers. Our job is to render prehospital medical care to patients, not
to become law enforcement surrogates. Once we cross that line, we will lose
our perspective, our independence, and our neutrality.
I have no objections whatsoever to a law that PERMITS EMS certificants to do
the blood draws voluntarily. If one wants to sign on as an employee or
contractee of law enforcement to do this, he should have that right. But it
should be outside the EMS system. Just as we each have our own notions about
unpopular patients, we nevertheless treat them equally well (I hope) and put our
personal feelings aside. We are starting down a slippery slope if we use
emotional and moral issues as a reason to begin doing a procedure that's best left
to others.
This is an emotional issue for some, and I recognize that. I have been in
law enforcement as a District Attorney and prosecuted many DWI cases. They
need to be prosecuted. But the methods do not need to involve EMS. There are
other and better ways to do it than tying up EMS personnel and causing them
the extra burden of cost and expenses that this will inevitably bring.
People mention "the CSI" factor in criminal cases. There is no doubt that
it exists. But, when one looks carefully at the law, the limits set are only
"prima facie" evidence of intoxication and can be overcome by testimony. In
fact, one does not even have to be over the limit to be charged with DWI or
driving under the influence of drugs. One of the best tools is the video tape
of the defendant's actions. It requires no expert testimony. It allows the
jury to see the same thing the officer saw and come to the same conclusion.
Videotape evidence is not something that can cause reversal in a case easily.
Blood and breath evidence can and does.
All in all, I believe that law enforcement should be left to law enforcement
and medical care left to medical professionals. I recognize that others will
strongly disagree. I have attempted to state some of the events that we can
expect to happen if we allow EMS to become involved in DWI blood draws. I
am sure there are others as well.
Gene Gandy, JD, LP, NREMT-P"