Input on SOP "gray area" call

[paramedicmike]

Yeah. I gotta agree with VS on this. Based only on what you've provided you kidnapped this woman.

Nothing about what you presented gives any indication that she should have been forced into going. Completely disregarding what the doctor and family had to say, she was her own POA. If she says she's not going then she's not going no matter how much you think she needs to go. This is one of the unfortunate facts of EMS.

I hope you followed your medical command's suggestion and documented the hell out of this call. Because if she's as sharp as you make her out to be she's probably got a lawyer on retainer.

Good luck.

-be safe

[JPINFV]

Ok, question time for the kidnap folks.

Can a person who refuses to answer any questions, period, be deemed rational or irrational? Does such an assessment need to be made to determine if a person can sign out AMA, and if not, which side do you sway to?

[paramedicmike]

Like I said, based on the info the OP provided, she sounds like she's well within her rights to refuse.

Is she refusing to answer questions? Not exactly. When asked how old she is she gives a reasonable response. Looking in her chart would give the answer to the age question. By maintaining the line of it's within her right to not answer any questions it sounds, again based only on what's presented here, that she's with it enough to know what's going on.

Does an assessment need to be completed? Yes. Does failure to cooperate with that assessment suddenly mean she's incompetent and need to be taken against her will? No.

Couple that with the fact that she's still in a legal position to make her own decisions. The doctor and/or family don't have the POA. As such we have to take this lady at her word. And for now, her word is "No!".

I've been in similar situations before. If there's nothing to indicate that the patient might be even the slightest bit unable to make his/her own decisions then what they have to say in terms of going stands. Even if it means that the patient could die by not going. (Which, coincidentally, happened in one particular case that stands out in my head.)

Calls like this suck. We know just by looking that they need medical attention. However, the patient is well within his/her rights to take any action even if that means they may die. If patient injury/death is such a concern then, as VS noted, the doc and/or family needs to take action to have the patient declared a danger to self in which case the patient's refusal can be overruled.

Unless the OP is holding out on some crucial piece of the puzzle here, the information posted pushes me to agree with the idea that she was taken against her will.

Hope this helps.

-be safe

[irme]

Based on the limited info provided by the OP this was a sure fire case of kidnapping!! Every pt has their autonomical right to be left alone. The difficulty in this scenario is the fact the pt refuses to commnunicate in a way that can correctly score her mental capacity.

I would have:

- Calmed the situation, everyone leaves the room so I can have a chat with the pt. Remove the individuals that are inflaming the situation and hopefully this will leave me with a patient willing to be more rational!

- Had my partner assatain her normal level of compliance and compared it to this

- Explained that if the pt wished to stay here she would need to speak to me properly; failure to do so would mean i couldnt help her gain the outcome she wanted, and she would have to do what everyone else had chosen for her!

- Failing that she would need to be transported if she still refused to speak properly to me *You are more likely to have legal action brought against you from a family yelling negligence) and I could assatain from staff and family the pt was not being her normal self.

[Richard B the EMT]

The initials POA are used here, but, as I may have a different way of saying the same thing, please define what you mean by POA, before I enter the discussion more fully. Thanks in advance.

[vs-eh?]

- Explained that if the pt wished to stay here she would need to speak to me properly; failure to do so would mean i couldnt help her gain the outcome she wanted, and she would have to do what everyone else had chosen for her!

- Failing that she would need to be transported if she still refused to speak properly to me *You are more likely to have legal action brought against you from a family yelling negligence) and I could assatain from staff and family the pt was not being her normal self.

Huh? You still can't do that...

I'm old, cranky, I've lived a good life (or bad one), and I don't want any more help from anyone. I want to die and this is the route I am taking (no meds, not eating, etc...). While it may not seem like the most rational choice to a person who is not in the other's situation, it is the patients decision in the end (all things being equal).

The doctor obviously is not willing to deem this patient a danger to themselves (probably for good reason) and they are looking to EMS to somehow be a more convincing party (120 hours of education is obviously more convincing). Totally passing the buck on the doctor's and families part, at the very least it is grossly unprofessional and puts people in an unfortunate legal bind. I would be furious if I was on this call.

I'd get the doctor to sign the form and leave.

I'd like to know how you eventually managed to "convince" the patient to go to the hospital.

EDIT - POA I assume means power of attorney.

[mshow00]

Based on the limited info provided by the OP this was a sure fire case of kidnapping!! Every pt has their autonomical right to be left alone. The difficulty in this scenario is the fact the pt refuses to commnunicate in a way that can correctly score her mental capacity.

I would have:

- Calmed the situation, everyone leaves the room so I can have a chat with the pt. Remove the individuals that are inflaming the situation and hopefully this will leave me with a patient willing to be more rational!

- Had my partner assatain her normal level of compliance and compared it to this

- Explained that if the pt wished to stay here she would need to speak to me properly; failure to do so would mean i couldnt help her gain the outcome she wanted, and she would have to do what everyone else had chosen for her!

- Failing that she would need to be transported if she still refused to speak properly to me *You are more likely to have legal action brought against you from a family yelling negligence) and I could assatain from staff and family the pt was not being her normal self.

done three different times, once by me, once by my partner, and once with her son in the room and her Dr on the phone. all to no avail. The only part I left out was that in between answering "It is my right not to answer your questions" she would call out to Jesus. She would utter phrase like "the Lord will take care of me" and "the Lord watches out for me" so on and so forth. After attempting to talk her into going with the family and her Dr, her son stood up and started to shout for the devil to leave his mom. (funnest part of the call in a messed up way). We were on scene for well over two and half hours working with her. After her son's little episode my partner the medic took him out to the hallway and i sat next to her and started talking about how God only helps those willing to help themselves and Jesus was not going to call her 'home' until he was ready, and that with her being the way she was she was interfering with God's work. She finally broke down and said, "Do what is best, do what you have to" and she did not say another word to anyone until we got to the hospital and said "I forgive you, I know you are just doing your job, and may the Lord bless you for it"

POA is power of attorney

[mshow00]

PS the DON at the SNF was highly upset we did not just come in throw her on our strecher and leave regardless of her mental status. I personally feel as though I could not trust what she was saying due to the fact that she was hell bent on the pt leaving. The nursing home is not a 'nice' one and has a hx of bending/breaking rules.

[vs-eh?]

done three different times, once by me, once by my partner, and once with her son in the room and her Dr on the phone. all to no avail. The only part I left out was that in between answering "It is my right not to answer your questions" she would call out to Jesus. She would utter phrase like "the Lord will take care of me" and "the Lord watches out for me" so on and so forth. After attempting to talk her into going with the family and her Dr, her son stood up and started to shout for the devil to leave his mom. (funnest part of the call in a messed up way). We were on scene for well over two and half hours working with her. After her son's little episode my partner the medic took him out to the hallway and i sat next to her and started talking about how God only helps those willing to help themselves and Jesus was not going to call her 'home' until he was ready, and that with her being the way she was she was interfering with God's work. She finally broke down and said, "Do what is best, do what you have to" and she did not say another word to anyone until we got to the hospital and said "I forgive you, I know you are just doing your job, and may the Lord bless you for it"

This is a joke right?

[paramedicmike]

She finally broke down and said, "Do what is best, do what you have to" and she did not say another word to anyone until we got to the hospital and said "I forgive you, I know you are just doing your job, and may the Lord bless you for it"

POA is power of attorney

That sounds like consent for transport to me. This might've been good to include from the very beginning as this changes everything.

Granted, you spent more than two hours browbeating her until she submitted which is questionable in and of itself. In fact, I'm so baffled that you spent so much time on this one call that I rather at a loss for words.

-be safe