Scenario-4 wheeler accident

[pyroknight]

I am pretty sure the Constitution guarantees each of us certain rights. I would expect that the right to choose your hospital (provided there is a choice, I feel your pain spenac) is one of those rights. I have never worked in a state (and I have worked in four) where patient preference did not trump all protocols unless you could damn well prove beyond a reasonable doubt that the patient was incapable of making their own decisions. If I remember correctly, is there not a federal law requiring health care providers to honor patient preference? Regardless, an educated, coherent patient has the right to make decisions about their health care regardless of what the provider thinks.

[Dustdevil]

This discussion is taking an interesting and worthwhile turn that is probably worthy of its own thread.

The patient's right to choose his or her own destination, as well as the medic or the system's right to choose against the patient's wishes is definitely a hot topic, with lots of special conditions, that should be discussed a lot more amongst us.

There are more situations than the simple, "hospital A is more medically appropriate than hospital B" scenario. Many systems simply have blanket rules that say you must transport to the closest facility, that you cannot transport out of the city limits, and other such operational limitations that are not necessarily based upon medical priorities. Obviously, you have to draw the line somewhere, whether it is the city limits, the county line, or the state line. And, since limits can and must be drawn, it seems to set a precedent for choosing those limits based upon systemic concerns.

The laws (in most states) do not even mandate the existence of EMS. If a subdivision chooses to establish EMS, it would not stand to reason that any laws would tell them that they must take their patients anywhere the patient chooses. I know of no such laws. So then, what we are bound by are:

• 1. Laws against kidnapping and unlawful detention, which may apply when you take somebody somewhere against their will.

2. Laws or directives that direct specific conditions to specific facilities, and/or prohibit them from others.

3. Accepted standards of medical practice which advise the transport of specific conditions to specific facilities.

• Any of those three types of laws or standards can end us up in civil or even criminal court, should somebody decide to complain. I would sure be interested in seeing some legal statistics about how often and how many times there have been legal cases regarding these situations though. As well as how many were actually successful. I would be willing to bet that the number is pretty small. But, of course, that does not relieve us of the duty to do what is right for our patients.

[ERDoc]

VentMedic, I know I came off as very opinionated, but I think that is what broken was looking for. He was looking for someone's opinion on his care. I was basing my opinion on what I was given. I realize there are always 3 sides to a story (yours, mine and the truth), but I can only base my opinion on what I was told. I stand behind what I said. Those bystanders at the scene should have been removed by law enforcement as they were interfereing and were advocating for substandard care. They obvioulsy have no place at a medical emergency scene. The crew probably felt a little intimidated by the scene. They were grossly outnumbered by a bunch of people, pt included, who thought they had some medical training and were trying to dictate medical care. They were trying to do this in an adrenaline exaggerated state. This was a bad scene all around. The crew screwed up by not taking control of the scene and providing proper care. They also screwed up by not taking the pt to the requested destination. Like I said before, based only on the info given, no one at this scene made any good decisions. Bad case all around.

Dust, as usual, is right. We haven't had a good discussion on pt choice of care and desination. I won't hijack this thread to do that, but it would be a good topic.

[spenac]

Broken sorry you have had a rough time. I do wish you would have allowed them to backboard and traction splint. The earlier done the less damage and pain would have occurred. I will not judge anyone based on FF, LE, and other uneducated statements. If I was doing quality control and checking your complaint I would consider their statements but as not medical professionals they would have limited weight. Speaking of attitude given sounds like these medics stood no chance as you would not allow them to do what was needed. They should have tried not to allow your attitude to cloud their judgement, if if did. Based on your statements you allowed more harm to occur by your refusal of appropriate care. I do not pretend to know what is involved in allowing patients to choose another hospital as there is no other hospital here so will not say more than I hope they followed proper protocol and procedures in their choice of place they took you.

As far as sueing, not a wise choice as it is clear based on your statements that your choices and demands led to much of the problems, will probably be a split responsibility which means while you might win you would not get enough to cover your expenses. Just the fact that you refused appropriate care, i.e. backboard and traction splint, you opened yourself up to accepting the responsibility for all damages that occurred. Sorry dude not trying to rain on your parade but while your telling of things sounds like some things done may not have been the best it really sounds like your choices limited appropriate care. As far as rough rides sorry ambulances are rough. If this was a basic only crew can't give pain meds so slow driving is only way to limit the number of times you feel the road. Also since you did not allow them to properly package you they probably went slow to try and avoid any additional movement of your injury.

I hope your surgery goes well and you return to normal. Live and learn.

[flight-lp]

Spenac - You took the words right out of my mouth! 8)

Broken - It is tragic that this chain of events has taken away from your livelihood and has altered your quality of life, but as previously mentioned, you DID refuse treatment. As the acceptable norms of spinal motion restriction were not placed due to this refusal, your acknowledgement of being conscious, alert, oriented, and of sound mind, and the non argued aspect of the incident itself, you really have no civil recourse, definitely no criminal recourse. The only recourse that is feasible would be throughout the EMS provider's company. Will the EMT be fired? Maybe. Decertified? No chance, you refused treatment plain and simple. I am sympathetic to your situation, but not of your actions. You are not an EMS professional, you do not know what care you need, we do.

As far as the transport goes, I answered that one. Yes you should be able to go to hospital "c". Now if it wasn't a trauma center, then no, it would not have been appropriate. But just as you refused treatment from EMS, you could have very well refused treatment from the hospital and demanded a transfer. So, in essence, you can't have your cake and eat it too. You were not forced to receive substandard care, if that is in fact what you received.

Again, as stated, if the crew was BLS then no pain meds for you. If this is not acceptable to you , then be proactive and involved. Tell your community leaders that this is substandard and that you deserve ALS responders who can adequately address your pain needs. Most of us know that ALS is a neccessity, but local communities are the ones who are not willing to pay for them. After being a patient, do you believe the cost is justified? I would hope so...

Transport to the hospital with lights and sirens is clearly not indicated in your case. You were hemodynamically stable with no neuro deficits. Not worth the risk. I'll let you in on a little trade secret...............the safety of the crew will ALWAYS precede the care of a patient. Dead or injured crew members tend to greatly reduce the capabilities of any EMS system and are prone to cause bad patient outcomes.........

My advise, as both a Paramedic and a legal consultant, rehabilitate yourself and enjoy your life. Legally, you are wasting your time based off of what we read here. If this is remotely complete or truthful, you'll never see the courtroom and I don't see too many insurance companies just handing you a check either.........

Good luck!

Flight

[spenac]

Just to add a little more to mine and flights comments. You will find a lawyer that will tell you otherwise. That said lawyer will tell you he only gets paid when you do. The fine print on contract will mention except for expenses. Surprise you lose then you get stuck owing court costs and your lawyers reasonable( :evil: ) expenses. Now your further in the hole. If lawyer tells you it's open and shut case that your bond to get paid, and heres a loan against your future settlement, run out of his door.

[skippy]

you advise him off the risk and how much blood can be lost from breaking his femur and that if he does not get to a trauma orthopedic surgeon within a very resonable amount of time that he could bleed to death and die.

[p3medic]

I can't imagine what kind of a patient you were, sound like a candidate for the SPIT protoco'l

1.Sedate

2. Paralyze

3.Intubate

4.Transport

Problem solved Just Joking :wink:

Sounds like you have an axe to grind with the EMT's. You can argue protocol v.s. ethics all day long, without actually being there, you could argue both sides of this story successfully. Maybe you can prove the ortho staff at the hospital screwed you up, you might try to own them.

[whit72]

Sorry to hear of your injury.

First off as of treatment:

You would have had traction splint applied. Then fully immobilized to a LSB. Hear the term distracting injury? Ifthere was enough force applied to break your femur. Then we will be sure to fully protect your c-spine even if you don't believe its injured. You might walk with a limp, its better then not walking at all. If you wish you can refuse, I would have definitly advised aginst it, but thats up to you.

As far as transport to appropriate facility, if your hemodynamically stable you can go wherever you like, If your not, you got to the closest facility if the birds not available. I am sorry its life over limb. You also will be advise that with the severity of your injury I can not gaurentee you will stay hemodynamically stable throughout the trip.

I am all for pts decision to be treated at a certain facility. However when your dead its going to be tough for me to prove why I drove by three hospitals, with a life threatening traumatic injury.

Again I hope your feeling better and your treatment is going well.

[broken]

If you were the patient and were told right off the bat that you were going to the crappy hospital,no if and or buts,WOULD YOU THINK THE EMT'S HAD YOUR BEST INTEREST AT HEART?NO SIR.

I had surgery Monday morning.Full range of motion right out of surgery(pre surgery 100*)Most of the pain is gone.Only thing hurting is the incisions and the bone graft.