island emt Posted October 11, 2012 Posted October 11, 2012 There is a difference between "giving up on your pt and abiding by there wishes. Last time I checked this is still a country where we are free to make informed decisions about what healthcare we choose to receive or deny. By your logic a DR could force me to have cardiac surgery or amputate a limb in order to prolong my life. YOU CANNOT FORCE A PERSON TO HAVE CHEMO TO MAYBE PROLONG THEIR LIFE THAT IS FULL OF CANCER. Nowhere did we give the state or any members thereof the right to make that decision for others. as long as said person makes it knowing the repercussions of refusing and is not under the protection of the court or guardian ad litum. Just because a person is in a facility doesn't mean they are incompetent or incapable of making their own decisions for healthcare.
Bieber Posted October 11, 2012 Posted October 11, 2012 Ok first off I take no offense but I think people are reading to much into my answer. I am an ex cop and ex PI, I have worked with the law and know the law. I am very well aware of consent. However I feel that people are treating this as a "emergency" call which it is not. Look at the facts. You keep bringing this up and I'm still not sure what you're trying to get at. A call is a call. The patient is in a SNF. Now it has been my experience that most patients in SNF's have medical issues that require constant care and they cannot care for themselves. What documentation is in the patients file regarding their mental status? Do they have a Power of Attorney. This is NOT a 911 call. What does it matter whether or not the patient has a DPOA, that doesn't take effect until the patient becomes incompetent. Also, still not sure what your fixation with this not being a "911 call" is. Involuntary Consent can be applied when dealing with a mentally incompetent individual. Further, someone has ordered this evaluation. The order either came from a doctor or a court. At that point the liability is on them, not on me or my agency. You assume liability for your actions regardless of who ordered them. Thinking otherwise is the same as saying you would have no liability for performing heart surgery under a doctors orders. Furthermore doctors authority is limited by the law. Just because a doc gave you an order doesn't mean it's legal or that you give up liability by performing it. The "van" the patient was alleged to have jumped from was most likely an "official" transport van. Likely some sort of paperwork would have been generated on this incident. This is an indication of the patients' mental status. A reasonable and competent person would not jump from a moving vehicle. Likely, this is the incident that prompted the order for the evaluation. Just because someone jumps out of a vehicle that doesn't mean they're a psych patient. There could be any number of medical causes for that behavior. Not every "psych evaluation" is used to determine if someone is incompetent. More often they are used to determine if a person is competent and mentally stable. Not to be a stickler, but you just said the same thing twice. It is in WA State Protocols that we can transport a "behavioral emergency" (which this would fall under) against their wishes IF we gain consent per local protocol. A doctor's order or court order would constitute consent and would suffice. Doctors can place competent, non-suicidal people under arrest in Washington? As I mentioned prior, this patient would be transported and it would be legal for us to do here in WA in this situation. Patient would be placed in 4 point restraints and transported for a mental health violation. Paramedics can place competent, non-suicidal patients under arrest in Washington too?! If this was a 911 call and NOT an order for eval, then I probably would not transport unless circumstances presented themselves to indicate patient was not mentally competent. I guess they must do things differently in Washington, because no where else that I can think of can doctors or paramedics take people against their will without either a court order or without the patient being in protective custody due to suicidal ideation. Bottom line is the mental health eval was ORDERED by a competent entity (doctor or court). We would be protected under RCW 71.32.170 if we transported this patient. In fact we would likely be guilty of negligence if we didn't transport him. That's crazy to me, man. Seriously, I can't believe that physicians are allowed to authorize the involuntary commitment of competent, non-suicidal patients who don't present a danger to themselves or others. Understanding and interpreting your State law will keep you out of trouble. It is not Kidnapping. Maybe not in Washington. I know I couldn't do that here, though.
island emt Posted October 11, 2012 Posted October 11, 2012 I think Dr Mengele had those same powers to detain folks against their will. But that was in a different time and a different place. WAIT maybe NOT ! Are they building ovens in washington????
ERDoc Posted October 11, 2012 Posted October 11, 2012 Mike, you need to stop thinking like a cop and to start thinking like an EMS provider. We are not law enforcement officers and do not have the same rights/responsibilities that LEOs do. A doctor's order is not a legal order and no one is obligated to follow it. You are under no obligation to follow the SNF physician's order. The only one you have to follow is your medical director/medical control as it is their license that you are operating under. If the pt has a court order to be evaluated, that is a legally binding order. However, it is a legal order and an the only ones that must abide by it are LEOs. Once they contact you to transport, your duty to act goes in to effect. Just because the pt tried to hurt himself 2 day ago does not mean that he is looking to hurt himself today. You cannot force him to go based on this.
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