Legal/ethical question

[Guest]

Alright, this is a call I had while precepting many months ago and it came up in casual discussion earlier tonight, so I'm curious how you all would handle it from the ethical/legal perspective.

Dispatched code 4 to active seizure. On your arrival, fire is already on scene and the captain lets you into the apartment building and directs you to the room upstairs. As you get off the elevator, you notice a very strong odour in the hallway of cannabis. As you approach, you can hear a commotion occuring in one of the apartments with raised voices. A firefighter sticks his head out the door and tells you that everything is okay, but hes bleeding like a son of a gun.

As you enter the apartment, there's 3 firefighters, your patient and the patients friend who called 9-1-1. The story from him is that they were just 'chillin' on the couch when his buddy all of a started acting funny, slid off the leather couch, smacked his head on the coffee table and 'started thrashing around like a fish out of water". After he tells you this, he disappears out of the apartment.

As of right now, your patient is lying supine on the floor yelling obscenities at the firefighter who's trying to hold c-spine and control the bleed on his forehead. Otherwise, physical exam is unremarkable and you working assessment is that he is truly post-ictal. Vitals are what to be expected and blood sugar is fine. He is completely immobilized as he does complain of neck tenderness on palpation and is transported without further incident. You find out during your history taking that his only medication is phenobarbital, which his prescription ran out 2 days ago.

Here's the catch ... the apartment is FULL of drugs and drug paraphenelia. Even the coffee table which he is laying beside on the floor has numerous powdered substances, used and new syringes, battery powered scales and baggies with different preparations in them.

How do you feel about this, and what do YOU do?

Zach

[vs-eh?]

How do you feel about this, and what do YOU do?

About the drugs? Nothing. Not my problem and not your problem. I would of course mention drug use during triage (just as I would for any concurrent substance issue), but I wouldn't mention anything about a house FULL of drugs or that he may be a dealer or something. I wouldn't mention it to the police either, unless they specifically asked.

I would tell the patient to make sure his friends at least clean up the place a bit if it was FULL of drugs though. On the off chance that police are there before/with you (especially if the patient info is combative) they would be vastly more interested in a place where the occupants are likely dealers, than a small amount for personal use.

On a side note...

"I want to get high... so high..." - Cypress Hill.

[noahmedic]

I would note the presence of drugs on my chart, it could be part of his history after all. I would ask the patient if they have recently used anything, and note that as well. I would not call the police in and report it.

[Guest]

Yes, I truly mean this bachelors apartment was FULL of drug stuff. Boxes stacked up against the walls with a multitude of substances, white/brown/yellow powders, green leafy things (oregano perhaps?) and pills galore. Neatly stacked piles of money 6 or 7 inches thick wrapped with elastic bands. When we walked into the apartment, my first thought was where are the cameras? Feels too much like a movie ...

Zach

[vs-eh?]

Yes, I truly mean this bachelors apartment was FULL of drug stuff. Boxes stacked up against the walls with a multitude of substances, white/brown/yellow powders, green leafy things (oregano perhaps?) and pills galore. Neatly stacked piles of money 6 or 7 inches thick wrapped with elastic bands.

Again, not your problem. You're a paramedic, not a police officer. I would not even make a note of it on the ACR. I would only note if the patient admitted to using drugs that night. Besides, if the place truly reeked, he would too anyway and I doubt I would even have to mention it at triage.

[xselerate]

i agree with noah... as an ems provider it is your job to be part detective in figuring out what is wrong with your patient. drugs on the scene is most definitely part of your history. it's your responsibility to your patient to get him the best care and a thorough history is a good way to do it.

[AnthonyM83]

Again, not your problem. You're a paramedic, not a police officer.

Is there any responsiblity as a citizen?

[vs-eh?]

Is there any responsiblity as a citizen?

You are not exactly a average citizen in the above example. You are a public servant, part of emergency services. This position allows you certain access and privileges that you, off the job as a citizen would not have. Do you report every suspect drug deal you see? Every person you believe may be under the influence on the street? Every person you believe may in fact be underage buying alcohol or having alcohol bought for them? This is on or off the job. I didn't think so...

Obviously there are certain cases where you may be legally obliged to report certain suspected activities (i.e. child abuse). Are you obligated to report picking up this patient in an apartment full of drugs? I don't think you are, but correct me if I'm wrong. Now obviously if the patient in the example say was totally obtunded, GCS 3, or in arrest or something then ya. The drug thing will be certainly more of an issue. The above patient had a pretty solid diagnosis - Seizure likely do to his underlying seizure disorder, because he ran out of phenobarb. I would not make an issue of the amount of drugs, would not note it anywhere, would not report it. I would only say something if the police specifically asked and I would say something to the affect of "appeared to be drugs". I would only note on my form if the patient specifically admitted to doing drugs that day. Just because he was in that environment does not necessarily mean he was in fact doing drugs.

My opinion.

[noahmedic]

I want to clarify and expand a little bit. The #1 reason I do not report everything to the police is patient-provider trust. If my patients think I'm going to run to the police with everything they tell me I doubt they would be willing to divulge much. Of course, we already have this problem, our patients already lie or withhold potentially important information, but why reinforce it?

[AnthonyM83]

You are not exactly a average citizen in the above example. You are a public servant, part of emergency services. This position allows you certain access and privileges that you, off the job as a citizen would not have. Do you report every suspect drug deal you see? Every person you believe may be under the influence on the street? Every person you believe may in fact be underage buying alcohol or having alcohol bought for them? This is on or off the job. I didn't think so...

Right, but the reverse of that is do you never report anything? License plates of injury hit-and-runs, a house down your block dealing drugs to neighborhood kids, someone breaking into your neighbor's car, recognizing a murder suspect from a wanted poster. Some you might, some you might not. So, even if you're in EMS, I think there's still a sliding scale.

I'm not saying to necessarily report it in this scenario, but whatever your decision, it should be based on a personal sliding scale. I don't think it's best for the community to refuse to report simply because you're not required.