What would you do?

[medicgirl05]

The hospital wouldn't keep him because he wouldn't tell them that he wanted to kill himself. They were releaseing him. One of our deputies had stayed with him and ws bringing him back to the county. They didn't want to take him home because he was drunk and we just made his problems about $8000 worse(ER trip and ambulance ride) and he was still drunk. The desicion that was presented to me was either file charges and keep him safe or don't and if he kills himself it is your fault. I was afraid of the guilt associated with not filing charges. I didn't feel it was the right thing but I was afraid of having to live with not filing. I am still unsure if the right thing was done.

[DwayneEMTP]

...At what point does the responsibility to the patient end and the responsibility to self begin?...

At the point that I am put in physical danger, something which I didn't see any indication of in the OP.

...Dwayne, amigo, I have to tell you that I am kinda freaked out about what I am fixing to write because you are probably gonna hand me my butt. ...

Yeah, that's never a likely outcome. You're posts are always well considered in both thought and spirit.

...I am calling BS on this statement. Just because a woman decides to work in EMS does not mean that the laws and rules that regulate our society are suspended because the offender is a patient...

What rule or law was broken? I can come up to you at any time and ask you to have sex or inquire as to whether or not someone has tried to do so in the past and not be arrested for it, right? I'm not aware of any crime that has been committed here. You have the right to walk away.

This patient didn't ask to be transported, per the OP. He was offered the choice of ways to be removed from his home against his will and took the lesser of two evils. At that point, if you believe that he should be transported, you are in fact obligated to put up with his shit if you are unable to find a way to mitigate it, regardless of your sex.

... Nor does being intoxicated of sick suspend a patient’s responsibility to civility...

Of course it does, in many, if not most cases. Altered is altered whether one chose to bring it on themselves or not. We can pretend that a self initiated altered mentation should be treated differently than say, an altered diabetic, or as mentioned earlier a postictal patient, but that's just simply not the case.

...We put up with a lot of crap and bad behavior because we choose to do so. It is not our obligation to do so...

What is your obligation to this patient then, as his patient advocate? If you've decided that he has a medical need to be transported, as I believe that a (possibly) drunk suicidal patient does, then what are your options? Are you going to forgo your moral and ethical obligations as a medical provider because you've been offended? Will you then put your medical patient into the back of the police car instead because the police ARE obligated to put up with people talking dirty to them when our delicate sensibilities are offended?

...The right to act or not to act, legally or otherwise, when assaulted, wither it be verbal or otherwise, is a personal choice but not an obligation that comes with the job. It will not suffice for me to simply say well that is EMS. I would think not...

But it IS EMS. We deal very often with altered people. That is a huge part of the job. I certainly wasn't implying that she has no right to pursue legal consequences if she feels that they are warranted, I just have no idea what they would be in this case. And if an apparently drunken patient asking her to have sex with him, or inquiring as to whether or not another medic has done so before is what sends her over the edge, then I would be uncomfortable with her as my partner. That is simply, like it or not, a situation that is predictable, and expected from many altered people, and should in fact be accepted as part of the job.

I once had a postictal patient struggling and fighting yelling at me, "Let me go your motherfucker! Let me go or I'm going to kill you and everyone you know!!" Should I then have filed charges against him despite his being meek as a kitten once he was fully restored to normal?

...I am surprised none of the ladies have pointed this out.

I'm even more surprised by what appears to be your feeling that a woman is less emotionally able to put up with this kind of verbal nonsense from a patient than a man would be. The opposite has been my experience.

I did notice that MG mentioned several times that the LEOs didn't intervene, as if there was an expectation that they should have. But they shouldn't have, in my opinion. This is now my medical patient. In my experience officers attempting to help only makes it difficult for me to work whatever mojo I may have to be able to calm the situation down. It's my patient, and all that comes with it is now my responsibility. I don't expect, nor need anyone to help me deal with this verbally offensive patient...mainly because I'm not going to be offended by an altered patient to begin with. (With rare exceptions)

A healthy person would not rather be with me in my ambulance, drunk and escorted by police, than in their own home watching TV. Offensive as we may find it, the intoxication is another symptom, and that makes it my responsibility.

What other choice is there?

Dwayne

[DFIB]

The hospital wouldn't keep him because he wouldn't tell them that he wanted to kill himself. They were releaseing him. One of our deputies had stayed with him and ws bringing him back to the county. They didn't want to take him home because he was drunk and we just made his problems about $8000 worse(ER trip and ambulance ride) and he was still drunk. The desicion that was presented to me was either file charges and keep him safe or don't and if he kills himself it is your fault. I was afraid of the guilt associated with not filing charges. I didn't feel it was the right thing but I was afraid of having to live with not filing. I am still unsure if the right thing was done.

There are a lot of things we are responsible for, other people's behavior is one of the things we are not responsible for. Ask yourself this question; Why didn't the police let him leave the hospital on foot and pick him up for Public Intoxication?

I think they are dumping a lot on you that is not your fault or responsibility. You put up with his crap, took him to a place of definitive care and made a lawful transfer. Why would you be responsible for his actions beyond this juncture? Why would you hazard yourself by harassing an already unstable individual?

Think of this. He gets out of jail, goes to the closest liquor store where he looks in the phonebook for where the station is. He goes home for his gun and car and drives to within a block of the station and waits .... drinking and sulking about the medic that put him in jail. All his shortcomings are now compounded and focused on a single person that messed up his plans. Waiting, drinking, sulking, getting more angry by the drink, planning the extraction of vengeance as a means to calm his frustration. He already said what he would like to do to you and he didn’t have a grudge then. Waiting, drinking, planning ...

Pretty spooky. Our wellbeing does not end with scene safety and the call. I say you did the right thing for you and have nothing to feel guilty about.

Edited December 17, 2011 by DFIB

[medicgirl05]

Dwayne-I didn't necessarily expect the deputies to correct the mans language, however I find it ironic that at the time it was occuring they didn't have a problem with it and then I was asked to press charges for it. I have been in many similiar situations where charges were not ever considered. This very same night I had a dementia patient who came onto me even stronger, to the point of stroking my leg as I was trying to get a line. I wasn't offended by him and didn't press charges. I realize that there are patients who aren't exactly in control of themselves.

The charges were dropped the next day as they were just intended to help him sleep off the alcohol.

[DFIB]

The charges were dropped the next day as they were just intended to help him sleep off the alcohol.

Oh crud medicgirl05. Are you saying you did press charges? I was under the impression you did not.

Edited December 18, 2011 by DFIB

[medicgirl05]

Yes I did. I didn't know what the right thing was. I am OK with people not agreeing, as I still don't know what I should have done. I knew I did not want to live with feeling like it was my fault that he killed himself. This was a few weeks ago and since it still heavily weighs on me I'm guessing I didn't do the right thing.

Thanks for everyones input.

[nypamedic43]

I get verbally assaulted every day of the week, by patients and co-workers alike. How I handle that is up to me and only me, most of the time my co-workers are blowing off steam and I let them, because there are days that I need that same consideration. We dont take it personally and keeps our sanity intact for the next patient or even our families.

I cannot take offense to something an altered patient says to me, whether is drugs, alcohol, dementia or being postictal. They don't know what they are saying or doing and so cannot be held accountable for thier words or actions.

When I first started in EMS, I was once told to "grow a set". I toughened up and let things roll off me. I got my medic and I got even tougher, not much bothers me anymore, where this issue is concerned.

DFIB, I know that you meant no offense by your statement but lets not assume that just because we are women, in a man's occupation, that we bury our face in out hands and run for the corner, where we curl up in the fetal position because the bad drunk man asked us to have sex with him. I usually tell them not to let thier wife or girlfriend hear them ask me that or when he gets home, she's gonna beat the hell out of him

And mg, I can understand why you pressed charges. I'm not sure I would be able to live with the guilt if I was in this same situation. You just have to follow your gut sometimes.

Edited December 18, 2011 by nypamedic43

[DFIB]

Yes I did. I didn't know what the right thing was. I am OK with people not agreeing, as I still don't know what I should have done. I knew I did not want to live with feeling like it was my fault that he killed himself. This was a few weeks ago and since it still heavily weighs on me I'm guessing I didn't do the right thing.

Thanks for everyones input.

Oh, my. I am sorry for my hypothetical stalker scenario. I was under the impression that you had not pressed charges. It is a dichotomous thing. I am in the middle of a dissertation in response to Dwayne and have pretty much talked myself out of all the arguments.

I am sure that you didn't hurt the patient, you might have even saved him. You probably did the right thing although it was not your responsibilty to do so.I think it is remarkable that even though at this point this guy was no longer your responsibility you still went out all the way for him. And if it has been a few weeks the guy has already forgotten you and you shouldn't have to worry about that whole stalker scenarion thing I was just stressing a point.

I also think LE could have found another way to keep him other than having you press charges.

[DFIB]

What rule or law was broken? I can come up to you at any time and ask you to have sex or inquire as to whether or not someone has tried to do so in the past and not be arrested for it, right? I'm not aware of any crime that has been committed here. You have the right to walk away.

I don’t know but I don’t think so. Verbal sexual assault does not exist. Lewd and lascivious behavior refers to intercourse with a minor, Sexual Harassment refers to the workplace more than public places and obscenity laws probably would not apply because the dude was in his house.

You see, I knew this was not going to go well

This patient didn't ask to be transported, per the OP. He was offered the choice of ways to be removed from his home against his will and took the lesser of two evils. At that point, if you believe that he should be transported, you are in fact obligated to put up with his shit if you are unable to find a way to mitigate it, regardless of your sex.

I don’t think he should have been transported in an ambulance and at least in this particular case I don’t think she was obligated to put up with this guy. I think it would have been proper for medicgirl to get a refusal signature on this guy and allow LE to deal with him unless there is some legal nuance I am missing.

Of course it does, in many, if not most cases. Altered is altered whether one chose to bring it on themselves or not. We can pretend that a self initiated altered mentation should be treated differently than say, an altered diabetic, or as mentioned earlier a postictal patient, but that's just simply not the case.

The big difference between a medical AMS and a self induced AMF is that the person that voluntarily provoked their altered mental status is liable and responsible for their actions. Does the drunk guy get the same pass as the guy with dementia? It appears that he does get the same pass, but he definitely doesn’t deserve it. There are a couple of reasons that come to mind First, this condition is self induced and voluntary and secondly Do we really believe he couldn’t control himself? I see a part of this argument that I am not going to be able to get over. There are three crucial factors here. 1. The guy is in his own house. 2. He refused transport and 3. He did not touch or threaten the medic.

I could play the devil’s advocate but what is the use. I hate defeating my own arguments.

What is your obligation to this patient then, as his patient advocate? If you've decided that he has a medical need to be transported, as I believe that a (possibly) drunk suicidal patient does, then what are your options? Are you going to forgo your moral and ethical obligations as a medical provider because you've been offended? Will you then put your medical patient into the back of the police car instead because the police ARE obligated to put up with people talking dirty to them when our delicate sensibilities are offended?

I am my patients advocate but I am also an advocate for myself. In this particular case The police could have handled him but in other more medically complicated and emergent cases I can see your point.

I once had a postictal patient struggling and fighting yelling at me, "Let me go your motherfucker! Let me go or I'm going to kill you and everyone you know!!" Should I then have filed charges against him despite his being meek as a kitten once he was fully restored to normal?

I helped restrain a pschotic that kept screaming she was going to get her machete and cut our nuts off. We worked her case anyway.

I'm even more surprised by what appears to be your feeling that a woman is less emotionally able to put up with this kind of verbal nonsense from a patient than a man would be. The opposite has been my experience.

I just thought they would have picked up on it and at least made an argument but I guess they were smart enough to see that it was going to be a non-starter.

The real point is that if the medic has the right to turn the care over to LE because of his behavior and at what point does this become a possibility.

Do you think we put up with verbal abuse because there really isn’t a legal recourse as long as they don’t threaten us or because the alternative would be too much of a hassle and would make us look like wimps?

I still conclude that we choose and accept certain hardships out of a sense of duty or vocation or who knows really why. Since it is a choice it would ultimately lie in the judgment of the individual medic based on life experience. If individuals have to make the decision then I am hard pressed to accept the statement that we have to take it because this is EMS.

I would like to be able to more adequately substantiate prior claims but I just can’t think of anything smart to say. I guess I was pretty far in the ditch on this one.

Maybe next time.

Edited December 18, 2011 by DFIB

[DFIB]

DFIB, I know that you meant no offense by your statement but lets not assume that just because we are women, in a man's occupation, that we bury our face in out hands and run for the corner, where we curl up in the fetal position because the bad drunk man asked us to have sex with him. I usually tell them not to let thier wife or girlfriend hear them ask me that or when he gets home, she's gonna beat the hell out of him

I think all medics are tough but I think you ladies are tougher than the guys. You put up with more crud than men and do it with grace. I have been groped and poked a few times on the job. It would be flattering if it were not so distasteful and insulting. I guess i was referencing a more ideal and just world.

I do put on my white hat when working with you gals wither you appreciate it or not. Just can't quit being me.