AMA question?

[sportygirl]

When I was in EMT school I was told that if a patient wants to AMA you have to tell them all the risks ect... and I was also told that if they sign and they do get worse or die you are not liable for that. Today some one else was telling me I was taught wrong and no matter what you are liable for them. Is this right? and why?

[funkytomtom]

Wrong...if they are coherent they can literally sign their life away. This can become a tricky situation, but for all intensive purposes, if they are oriented and sign AMA, they could explode one second later and you would only be responsible for cleaning them off yourselves.

[Lone Star]

First thing you're going to want to do is to check your local protocols to see what they say about a 'RMA" (Refused Medical Attention).

As it has been explained to me, under GA and MI protocols, if the patient meets the requirements for even being able to refuse medical attention, then you have to allow them to do so.

That being said, when they're refusing medical attention and/or transport; you have to be very thorough about explaining the risks, your medical findings and reccomendations. By doing so, you're enabling the patient to make an informed decision about refusing care/transport.

Be sure to tell your patient that is refusing care that if 'anything changes', they are more than welcome to call and request another rig.

If the patient meets all requirements and fully understands the risks of not going to the hospital, there is really nothing that you can do. Further, it's my understanding that if they DO refuse medical care (and have met all the requirements to be able to refuse care), that's it. They're pretty much on their own at that point.

While every service I've ever been associated with has a 'RMA form', be sure to document each refusal completely and be sure to get a signature from a family member, police officer,.....anyone other than your partner.

By doing this, it protects you and your partner from the family/staff, etc from coming back and making the charge that you and your partner made up the whole refusal.

Remember, documentation is your best friend!

LS

[emtpro87]

When I was in EMT school I was told that if a patient wants to AMA you have to tell them all the risks ect... and I was also told that if they sign and they do get worse or die you are not liable for that. Today some one else was telling me I was taught wrong and no matter what you are liable for them. Is this right? and why?

All patient have the right to refuse medical attention regardless of their severity, otherwise its considered kidnapping, assault and battery. the only way around this is with patient who are under the influence of drugs or alcohol ( and this you would require police to take custody) and those who are not oriented X3, juvenile must try attempt of contact a parent or guardian. And if the patient is unconscious and/or unresponsive , which would fall under the implied consent. when they sign a liability waiver (which every patient that goes AMA should sign) it doesn't remove liability of the from emts, but it shows that the patient officially refused medical attention. this goes back to document everything to CYA (cover your a$)

Also, remember when informing a patient of potential risk of going AMA, don't leave out info. IE when dealing with a patient with probable spinal compromise , let the patient know on top of the mortality risk , they can also become paralyzed.

this reminds me of a story out of the New Jersey shore , a woman dives into shallow water at a sand bar and impacts at the top of her head , she is collared and board by emts and lifegaurd at the scene, the woman begins to refuse medical treatment. During the liability and risk notification of the waiver the emt stated , that the woman could potentially die from a spinal compromise. The woman understood and was released, and as should stood up and walked 10 feet and looked to her side ,instantly collapse and is permantly paralyze. the EMTs re-collared and board her and transport to the hospital. Later on litigation procceedings are brought against the township and the EMTs at the for failure to inform her of the potential of possibility of paralysis , the kicker of this story is that she wins her law suit against the township and the EMTs.. lesson learned is Document everything and inform the patient of all risk especially since everyone nowadays are sue happy.....

[funkytomtom]

All patient have the right to refuse medical attention regardless of their severity, otherwise its considered kidnapping, assault and battery. the only way around this is with patient who are under the influence of drugs or alcohol ( and this you would require police to take custody) and those who are not oriented X3, juvenile must try attempt of contact a parent or guardian. And if the patient is unconscious and/or unresponsive , which would fall under the implied consent. when they sign a liability waiver (which every patient that goes AMA should sign) it doesn't remove liability of the from emts, but it shows that the patient officially refused medical attention. this goes back to document everything to CYA (cover your a$)

Also, remember when informing a patient of potential risk of going AMA, don't leave out info. IE when dealing with a patient with probable spinal compromise , let the patient know on top of the mortality risk , they can also become paralyzed.

this reminds me of a story out of the New Jersey shore , a woman dives into shallow water at a sand bar and impacts at the top of her head , she is collared and board by emts and lifegaurd at the scene, the woman begins to refuse medical treatment. During the liability and risk notification of the waiver the emt stated , that the woman could potentially die from a spinal compromise. The woman understood and was released, and as should stood up and walked 10 feet and looked to her side ,instantly collapse and is permantly paralyze. the EMTs re-collared and board her and transport to the hospital. Later on litigation procceedings are brought against the township and the EMTs at the for failure to inform her of the potential of possibility of paralysis , the kicker of this story is that she wins her law suit against the township and the EMTs.. lesson learned is Document everything and inform the patient of all risk especially since everyone nowadays are sue happy.....

Holy HELL! Not calling you out or anything, but is there somewhere I can read about this story? THAT is the definition of insane litigation.

[sportygirl]

Ok so i was right as long as the patient is oriented and all requirements are fully understood and know the risks of not going your not liable.

[VentMedic]

Ok so i was right as long as the patient is oriented and all requirements are fully understood and know the risks of not going your not liable.

No. Not totally true. You can be summoned to court to recall and answer any questions about the care you did or did not provide. That piece of paper is not magic. There is a reason why surgeons make patients write what they believe the doctor just told them before surgery and while they are signing the consent.

Several factors will be involved. Who placed the 911 call? The nature of the call? Is there alcohol or drugs (legal or illegal) involved? Does the call concern a safety issue for the patient or others? Are you the one who talked the patient out of transport for whatever reason and is using the "refusal" form to cover your own butt for not wanting to transport?

You can make notes on the form and have the patient sign by them as well as on the dotted line. Have witnesses sign the form especially if you are leaving the patient with that person.

Sit down and read the AMA form yourself which may include some fine print. Some EMT(P)s have never read it and don't actually know themselves what the patient is signing.

Document! Document! Document!

[HERBIE1]

A key question to ask people who want to refuse- especially someone who you may not feel comfortable allowing to refuse(assuming the meet all the above listed criteria- oriented, competent, age appropriate, unimpaired, etc) is WHY they want to refuse. Most of us DO ask that question, but you need to allow them to answer that question and expand on it as much as possible.

Once they articulate that to you- they want to see their own doctor, they want to wait, they don't think their problem is serious, they feel better, they don't like doctors- the actual reason can shock you. But, at that point you can address their stated reason, show them the possible flaws in their thinking, they may change their minds. I have found that this technique works well, because often times they really cannot express a valid reason and if you show them the potential for harm in their point of view, they tend to change their minds.

Personally I much prefer to transport a person- properly handled refusals take far more effort, documentation, and "CYA'ing" than simply giving them a ride. I have known providers who pride themselves on talking people out of transports and I have never understood that mentality. Most of them also do not properly document their encounters- or probably do creative report writing to cover themselves, but too often that can come back to haunt you.

Another "trick"- tell them that after they get to the hospital, they can tell the same things to the triage nurse and/or doctor, and sign themselves out if that's what they still want. At that point, several possibilities present themselves- they can think about their refusal/reluctance and maybe change their minds, especially if they do have a problem that needs attention, their complaints return and they are reminded why they called for EMS, or they still refuse care, but you simply transfer responsibility for that patient to the hospital staff and cover your own arse.

[Just Plain Ruff]

A key question to ask people who want to refuse- especially someone who you may not feel comfortable allowing to refuse(assuming the meet all the above listed criteria- oriented, competent, age appropriate, unimpaired, etc) is WHY they want to refuse. Most of us DO ask that question, but you need to allow them to answer that question and expand on it as much as possible.

Once they articulate that to you- they want to see their own doctor, they want to wait, they don't think their problem is serious, they feel better, they don't like doctors- the actual reason can shock you. But, at that point you can address their stated reason, show them the possible flaws in their thinking, they may change their minds. I have found that this technique works well, because often times they really cannot express a valid reason and if you show them the potential for harm in their point of view, they tend to change their minds.

Personally I much prefer to transport a person- properly handled refusals take far more effort, documentation, and "CYA'ing" than simply giving them a ride. I have known providers who pride themselves on talking people out of transports and I have never understood that mentality. Most of them also do not properly document their encounters- or probably do creative report writing to cover themselves, but too often that can come back to haunt you.

Another "trick"- tell them that after they get to the hospital, they can tell the same things to the triage nurse and/or doctor, and sign themselves out if that's what they still want. At that point, several possibilities present themselves- they can think about their refusal/reluctance and maybe change their minds, especially if they do have a problem that needs attention, their complaints return and they are reminded why they called for EMS, or they still refuse care, but you simply transfer responsibility for that patient to the hospital staff and cover your own arse.

Any patient can refuse. Even a minor but they can't really refuse but they can get their parents to refuse for them.

I do believe the story about the diving woman, I've heard it before and having it based in the ocean area. Maybe an urban legend though.

When I document a refusal I document the following

Their loc

why they want to refuse and their reasons

I document on our refusal form the risks and benefits (are there any benefits) of refusing. I always put down the word DEATH.

I also sometimes when the reason is stupid such as "I don't like doctors" I have the patient write that on the refusal form.

I also get either my partner or the patients spousal unit or someone on the scene not affiliated with my ambulance service such as a cop or the person who called 911 in the first place. I put their name and address printed out under their signature.

If you document completely then your risk of getting sued is less once the lawyer looks at the form. Sure the lawyer might take the case anyway but at least I have crossed my t's and dotted my i's

There is another resource I use quite a bit. I don't even think it's in print any more. It's by Kate Dernocour (sorry about spelling) and it's on how to write a legally defensible report. You may be able to find it in a used book website.

[spenac]

There is another resource I use quite a bit. I don't even think it's in print any more. It's by Kate Dernocour (sorry about spelling) and it's on how to write a legally defensible report. You may be able to find it in a used book website.

http://www.themissingprotocol.com/site/bookcorner.pdf

http://www.themissingprotocol.com/site/educational_program.htm