Negligence (What would you do)

[r22beta]

Hi all, I'm new to the forums here and actually signed up just to get some feedback on this topic. I want to know what others would do in this type of situation.

I'm a fairly new EMT and I was working with a partner I had just met for the first time a couple of days ago. She has a couple of years of experience and as such was not interested in anything I would say or do for the duration of the tour. There were quite a few times when I thought her clinical decision making skills were questionable but one incident in particular has prompted me to find out what more experienced people in the industry would do. I brought the subject up with my supervisor but he played the politician, trying to to say anything for or against either one of us or our point of views.

Here's what happened;

We had a long haul transfer, two hours between cities. Our pt had dementia and was highly confused but when I was attending on the way to the city he was in good spirits, friendly and talkative. After we picked the patient back up from the hospital to take him to his original hospital was when we first began to have issues. First off, my partner completed 100% of her paperwork prior to getting patient contact back. I have no problem with someone filling out demographic information but how can you write in a legally binding document what you found on assessment when we have yet to get a patient to assess? Second, for the first hour and a half of the trip back to the hospital I didn't hear my partner ask the patient a single question. She even later bragged about how great her nap was. Third was when things got serious. Shortly before arriving home our patient got violent and the two of them got in a fight in the back of the unit. No one was injured but she was shaken up pretty bad. I pulled over, helped out and we switched rolls. Since our patient was 80 and I'm in my 20s there was not much of an issue restraining him, and since we were only minutes from the hospital we decided to continue as that was were the closest help was. After the incident we had tremendous support from our company. But the issue that she did not even attempt to assess or monitor our patient is still of great concern to me. I tried speaking with her about it but she blew me off. I tried speaking with her and our supervisor about it but he didn't want to commit either way and she was trying to make me look like an over eager rookie. In my opinion this is absolutely negligence, and the fake documentation is forgery. Since it was written before any of the aggression took place non of that appears on the patient care report. According to our legally binding paper work this looks like a smooth and uneventful transfer. I'm scheduled to work with this individual again in a couple of days but now fear our work atmosphere will be even more hostile because of it.

There are several other events that took place over this tour as well that made me question her decision making skills but I won't get into them for now.

What would you do in this situation?

[ERDoc]

I don't see a problem with filling out the paperwork before the transport, as long as it is accurate, especially on pts you know. If something changes, then the paperwork should be documented appropriately. Obviously vitals can not be filled in beforehand. Back in the dark ages before HIPAA, we used to keep copies of the PCRs for dialysis pts so that we didn't have to bother them every time getting their history.

As for the nap, I have a problem with that. If you are in the back with a pt, you should be awake at all times. Are you sure she acutally napped and wasn't just trying to joke around?

If she turned care over to you once the pt became aggressive, you should have been the one doing the documenting at that point. What did you document on that legally binding paperwork?

As for the issue of not doing an assesment/monitoring, what is required by your company/protocols? What was the pt transported for? Something benign like a routine doctor's visit or a wound care appointment doesn't really require much.

You have created the environment that you think you will be in. You have to decide how to handle it as an adult. I'm not saying you shouldn't say anything when there is something that puts the pt in jeopardy, but as the FNG you need to pick your battles wisely. Learn from the experience, young padawan. Always observe other providers and see what they do right and wrong and learn from it. Not everything needs to be made an issue out of.

[scubanurse]

I'll ditto what Doc said. It really depends on the type of transfer done, company policy, and personal practice. There are frequent fliers where I work that I don't go through every single part of the admission history with them because we all know it well, we click through that part of the record. Yeah you should always do a full assessment, but again that's dependent on personal practice and your company policy. Some companies allow for a focused assessment only and VS.

I also agree that once you assumed patient care, you assumed the documentation for that patient and should have documented the violent outburst in the record. Sorry kid, you can be at fault for that one. I would try and wipe that transport out of your mind, you did your due diligence and talked with the partner and supervisor and neither seemed concern. Try to move on and not let it affect future shifts.

As for the new partner not listening to the FNG, unfortunately that happens a lot in this field. Doesn't make it right or ok, but it happens. Slowly she'll start to realize you know your stuff, or not, and a partnership will develop. When I was a new ED nurse, my charge nurse wouldn't listen to me one bit, she would but in on my patients and give her opinion constantly. Eventually she learned that I knew my shit and left me alone. Sometimes the more experienced providers feel responsible for your actions as a FNG and that's why it may seem like they aren't listening to you. Rather they just want to make sure nothing gets f'd up.

[triemal04]

I think you're confusing what actually constitutes negligence (hint: this wasn't it), what level of an exam was required of this patient, and forgetting that just because you believe something should have been done a certain way, doesn't mean that is the only way.

In all honesty, you need to make sure that this:

There are several other events that took place over this tour as well that made me question her decision making skills but I won't get into them for now.

isn't completely coloring your opinions of this specific situation. (I say that without knowing what those other things were, obviously) Because what you described here, without having all the facts, really isn't all that bad.

[mikeymedic1984]

Did the patient die, or end up negatively impacted by what you perceive is a failure ? I worked with an ER Doc who started every shift by filling out several patient assessments that fit into the 5 most common ER diagnosis's ---- the paperwork is a required chore, just because he got a head start which allowed him more time to see all patients does not make him negligent or a failure.

Did her lack of assessment skills cause the patient to become violent ?

[paramedicmike]

You have created the environment that you think you will be in. You have to decide how to handle it as an adult. I'm not saying you shouldn't say anything when there is something that puts the pt in jeopardy, but as the FNG you need to pick your battles wisely. Learn from the experience, young padawan. Always observe other providers and see what they do right and wrong and learn from it. Not everything needs to be made an issue out of.

+1

[1EMT-P]

It is totally unacceptable for her to be napping while she has a patient on board under her care. She had no way of knowing what was going on with her patient. What if her patient had stopped breathing while she was napping? A case could be made for elder abuse & neglect. It is also inappropriate for her to document in advance about her patient's condition during the transport. That could be considered fraud & neglect as well.

[1EMT-P]

The legal definition of negligence according to Black's Law Dictionaty is as follows. " The failure to exercise the standard of care that a reasonably prudent person would have exercised in a similar position." I would have completed an incident report and documented everything and given it to my supervisor and asked to be assigned another partner.

[ERDoc]

The legal definition of negligence according to Black's Law Dictionaty is as follows. " The failure to exercise the standard of care that a reasonably prudent person would have exercised in a similar position." I would have completed an incident report and documented everything and given it to my supervisor and asked to be assigned another partner.

But the legal definition of medical negligence is when the medical practitioner fails to provide the care which is expected in each case thus resulting in injury or death of the patient. (http://definitions.uslegal.com/m/medical-negligence/) So, in this case there is no medical neglicence as nothing happened to the pt. Is it bad care, absolutely. Is it negligence, nope.

[1EMT-P]

There are different types of abuse & negligence. When she assumed care of this patient from the hospital staff she assumed legal responsibility for the patient's health, safety & well being. A case could be made that she had a duty to act & that she breached that duty & the standard of care by failing to monitor her patient, sleeping while the patient was under her care & then filing false medical documentation. " The act speaks for itself."