Involuntary Consent?

[speedygodzilla]

You are called to the middle of a bridge to transport a violent patient who is suicidal. Per local police, the patient threatened to jump from the bridge and needs a psychiatric evaluation. The patient refuses transport threatening to sue anyone who touches him. You transport this patient against his will based on:

A. Informed consent

B. Implied consent

C. Expressed consent

D. Involuntary consent

Explanation (D) This patient can be treated and transported against his will under involuntary consent. Law enforcement personnel can direct transport and treatment of a patient who is threat to himself or others.

Above is a test question from Barron's Paramedic Exam 2nd Edition

I was taught that involuntary consent does not even exist.

There is nothing in law called involuntary consent. Some EMS personnel have been taught the concept of involuntary consent, a term that has been incorrectly applied to describe the permission granted by law enforcement or a legal guardian to treat someone who is under arrest (or otherwise in custody), incapacitated, a minor, or for other reasons. This term is an oxymoron, because consent can never be involuntary.

From emergency Care in the Streets, Nancy Caroline, 6th Edi

Both books copyrighted in the same year.

I agree with Nancy on this one, but still find my self think

What do you think?

[johnny5fire]

Above is a test question from Barron's Paramedic Exam 2nd Edition

I was taught that involuntary consent does not even exist.

From emergency Care in the Streets, Nancy Caroline, 6th Edi

Both books copyrighted in the same year.

I agree with Nancy on this one, but still find my self think

What do you think?

In Wisconsin it is called a Chapter 51 (Police use this for those who may harm them selfs or other)

[Happiness]

I have had pts under the Mental Health act in BC. I dont know how it works in other provinces

[JPINFV]

The most common form of those in California is called a 5150 hold and in Massachusetts it's called a Section 12. To the best of my knowledge, psychiatric holds is a form of implied consent. An important note, though, is that a psychiatric hold does not give carte blanche to do anything and everything and even some forms of psychiatric treatment (e.g. ECT and psychiatric surgery) can require consent to be performed.

Edited March 17, 2010 by JPINFV

[pinkemsprincess]

We have something similar to this in Texas. I am not sure if it is involuntary consent or under implied consent, but basically if the patient threatens to harm themselves or is deemed as a potential threat to themselves, they forfeit the right to make decisions regarding their own well being. I have used this many times. We do not require the patient to be in police custody unless we feel they may be a threat to us or our crew. Also, putting them in custody can cause additional unnecessary distress to the patient. They may become uncooperative, when they otherwise would not have.

[rock_shoes]

I was taught that involuntary consent does not even exist.

Though not neccessarily a legally defined term in all jurisdictions involuntary consent exists in practice. In BC Canada for example, under section 28 of the Mental Health Act, a patient can be arrested by a peace officer and transported to hospital by either police cruiser or ambulance. If required these patients can be restrained physically and or chemically.

Emergency procedures

28 (1) A police officer or constable may apprehend and immediately take a person to a physician for examination if satisfied from personal observations, or information received, that the person

(a) is acting in a manner likely to endanger that person's own safety or the safety of others, and

( B ) is apparently a person with a mental disorder.

(2) A person apprehended under subsection (1) must be released if a physician does not complete a medical certificate in accordance with section 22 (3) and (4).

(3) Anyone may apply to a judge of the Provincial Court or, if no judge is available, to a justice of the peace respecting a person if there are reasonable grounds to believe that section 22 (3) (a) ( i i ) and © describes the condition of the person.

(4) On application under subsection (3), the judge or justice may issue a warrant in the prescribed form if satisfied that

(a) the applicant has reasonable grounds to believe that subsection (3) applies to the person respecting whom the application is made, and

( B ) section 22 cannot be used without unreasonable delay.

(5) A warrant issued under subsection (4) is authority for the apprehension of the person to be admitted and for the transportation, admission and detention of that person for treatment in or through a designated facility.

(6) On being admitted as described in subsection (5), a patient must be discharged at the end of 48 hours detention unless the director receives 2 medical certificates as described in section 22 (3).

(7) On the director receiving 2 medical certificates as described in subsection (6), section 22 (6) and (7) applies to the patient.

In addition any licensed physician can enforce involuntary consent via section 22 of the BC Mental Health Act. Due to the colour of the form that must accompany patients transported under this section of the MHA, the patient is typically referred to as having been "pinked." It might sound like harsh slang but most patient's respond better to having been "pinked" than having been arrested under the MHA.

Involuntary admissions

22 (1) The director of a designated facility may admit a person to the designated facility and detain the person for up to 48 hours for examination and treatment on receiving one medical certificate respecting the person completed by a physician in accordance with subsections (3) and (4).

(2) On receipt by the director of a second medical certificate completed by another physician in accordance with subsections (3) and (5) respecting the patient admitted under subsection (1), the detention and treatment of that patient may be continued beyond the 48 hour period referred to in subsection (1).

(3) Each medical certificate under this section must be completed by a physician who has examined the person to be admitted, or the patient admitted, under subsection (1) and must set out

(a) a statement by the physician that the physician

( i ) has examined the person or patient on the date or dates set out, and

( i i ) is of the opinion that the person or patient is a person with a mental disorder,

( B ) the reasons in summary form for the opinion, and

© a statement, separate from that under paragraph (a), by the physician that the physician is of the opinion that the person to be admitted, or the patient admitted, under subsection (1)

( i ) requires treatment in or through a designated facility,

( i i ) requires care, supervision and control in or through a designated facility to prevent the person's or patient's substantial mental or physical deterioration or for the protection of the person or patient or the protection of others, and

( i i i ) cannot suitably be admitted as a voluntary patient.

(4) A medical certificate referred to in subsection (1) is not valid unless both it and the examination it describes are completed not more than 14 days before the date of admission.

(5) A second medical certificate referred to in subsection (2) is not valid unless both it and the examination it describes are completed within the 48 hour period following the time of admission.

(6) A medical certificate completed under subsection (1) in accordance with subsections (3) and (4) is authority for anyone to apprehend the person to be admitted, and for the transportation, admission and detention for treatment of that person in or through a designated facility.

(7) A patient admitted under subsection (1) to an observation unit must be transferred to a Provincial mental health facility or psychiatric unit within the prescribed period after a second medical certificate is received under subsection (2) by the director of the observation unit unless the patient is

(a) discharged, or

( B ) released on leave or transferred to an approved home under section 37 or 38.

[Richard B the EMT]

Could it be said that a suicidal person, who would be called an Emotionally Disturbed Person (EDP), could be declared to be in altered mental status, therefore making them incapable of proper decisions? In that instance, the LEOs, "acting on the patient's behalf", could "order" the EMS crew to transport the patient, who would be in LEO "Protective Custody" which is NOT under arrest, to the local Psychiatric ER for an evaluation.

If the patient decides to sue, as the LEOs had our patient in the Protective Custody status, the onus would fall on the LEOs, not the EMS providers, for transporting against the patient's will (at least as far as I recall the FDNY EMS Command protocols. I'll get an advisement on how this works by asking an instructor of mine on facebook, and post here).

[JPINFV]

Though not neccessarily a legally defined term in all jurisdictions involuntary consent exists in practice. In BC Canada for example, under section 28 of the Mental Health Act, a patient can be arrested by a peace officer and transported to hospital by either police cruiser or ambulance. If required these patients can be restrained physically and or chemically.

In addition any licensed physician can enforce involuntary consent via section 22 of the BC Mental Health Act. Due to the colour of the form that must accompany patients transported under this section of the MHA, the patient is typically referred to as having been "pinked." It might sound like harsh slang but most patient's respond better to having been "pinked" than having been arrested under the MHA.

First off, I don't see the term "involuntary consent" used in that section of code at all. In the end, the question comes down largely to semantics of what we call this type of "consent," and not whether the medical and legal establishments have been granted the power to put someone into protective custody.

Second off, "pinked" doesn't sound harsh. Ever hear of the term "5150" that's so popular in some pop culture circles?

[rock_shoes]

First off, I don't see the term "involuntary consent" used in that section of code at all. In the end, the question comes down largely to semantics of what we call this type of "consent," and not whether the medical and legal establishments have been granted the power to put someone into protective custody.

Second off, "pinked" doesn't sound harsh. Ever hear of the term "5150" that's so popular in some pop culture circles?

Exactly. That's why I used the BC MHA as an example. In BC "Involuntary Consent" is not the legally defined term used. "Involuntary Consent" is a concept used to describe the medical and legal actions that can be taken should a patient be incapable of making prudent medical decisions due to injury or illness. The idea is that the patient in question would submit to medical care if they were of sound mind. Somewhat similar to "Implied Consent" where it is assumed a patient would agree to lifesaving care if they were able to communicate. A concept does not always require a legal definition to be valuable in explaining how something works.

Is "arterial" in reference to a bleed a legal term used in law? I doubt it. It's still rather useful when describing the severity of a patient's injuries to the triage nurse is it not?

I have heard the term 5150 in the past. Originally it was used because 5150 described the section of a particular code or act correct? Local slang that caught on. Nothing unusual about that.

Edited March 18, 2010 by rock_shoes

[Richard B the EMT]

OK, I got my first response on Facebook, via a page for my EMS station.

Me: I have a Medical/Legal question I am researching for another site, "EMT City" (EMTCity.com). I figure I am amongst friends on this page, therefore I feel free to ask.

Allowing that anybody can sue anybody else for almost anything, can a suicidal EDP, already in Police "Protective Custody" in the middle of the bridge he attempted to jump from, successfully sue the EMS team for transporting him, against his expressed will and wishes, to the psychiatric ER for evaluation?

I'll be putting your answer(s) onto the string at EMT City, but leave your names off for your privacy. Thank you in advance for your assistance on this question.

By the way, if you are active in a system other than FDNY EMS, name the system and state, as local protocols around the world have been known to differ.

Answer: The answer is in your question- "SUICIDAL EDP", So, its a no because at that point he has no decisional capacity, he is a suicidal EDP...this is why he is under poilice protective custody...he is a danger to himself and others...and therefore you are obligated to protect,treat and tranport this patient. even though he might be AOx3 and has an expressed will no to be transported to a hosp, and the fact that he attemped suicide makes him irrational and must seek help at a appropriate psych facility..the fact that he is alert doesnt preclude him to harm or killing himself.