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What would you do?


medicgirl05

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What specifically was the patient charged with, and was it enough to force him to actually spend any time in jail, or simply be bonded out? You certainly do NOT need to file charges on this guy. If the hospital cleared him and felt he was not a suicidal risk, then your and their job is done. You had the professionals evaluate him, and apparently they were not worried about him following through in his threat. If he did-still not your problem. Not sure why LEO's are forcing this issue. If they want to keep the guy locked up, then they need to come up with something to hold him, and not rely on some trumped up charges and forcing you to get involved in this.

I've had countless drunk folks who claim they want to kill themselves, and while I am certainly not a shrink, I think it's pretty easy to tell which ones are actually serious about it, and which ones are talking through their booze. Regardless- anyone who says those magic words(I want to kill myself) ALWAYS gets a ride and an evaluation at an ER. That said, in your case, if a guy was sitting there with a gun, that elevates the situation, so he's not only is he expressing suicidal thoughts, he has the means to accomplish his goal. He must have done a great job convincing folks he was not really suicidal.

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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.

Ahhh, gotcha. But no matter how this worked out it would not have been your fault if he went home and blew his head off unless you're going to be responsible for this guy for the rest of his life. You had an obligation to transport him, an obligation to treat him appropriately, and an obligation to make sure that the ER knew that he had, in your presence, made threats to his own life, and an obligation to make sure that you were heard. That is the end of your role.

I believe that you went off into the ditch when you played the role asked of you by the LEOs. How would you feel about your decision if you'd discovered that he was arrested, jailed, and forced to register as a sex offender because of that decision?

There is not a single thing about your post that leaves a bad taste in my mouth. I think you did the best that you knew how to do, and in hindsight have decided that maybe you should have done differently. That, right there, is an epic win. Good on you girl.

A million times after a call I've thought, "God damn it! What the hell was I thinking when I did that?" Questioning yourself is good, being willing to change your mind based on new info is exceptional. Don't you spend on friggin' second looking at your shoes on this because you wish you would have made a different decision.

But we do have to stay in our lane on some things. When you stepped out of yours you set in motion some processes that would have your name on them but that you would have no control over. A position that you really, really don't want to be in especially after the cops and the hospital proved that they were unwilling to do their jobs. Can't you hear the cops and the hospital when this dude files his law suit.."We didn't want to keep him, but the medic insisted on pressing charges so we couldn't let him go!"

Defib. I truly get your arguments about letting him go in the police car, but it only holds true if we assume that this guy is truly, and only drunk, and then not so drunk as to have no chance of a need of medical care during the transport. We don't get to choose our patients, even when their assholes.

Dwayne

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The hospital wouldn't keep him because he wouldn't tell them that he wanted to kill himself. They were releaseing him.
Here, police is in charge if someone clearly is suicidal. They have to get him to a psychiatric hospital (they may request the help of EMS if needed). So if making this statement in front of a police officer or if a medic/doctor can witness it and tell to a police officer, the next station will be a psych ward (maybe after treating injuries or intoxication somewhere else). There the psychiatrist is in charge. They can hold a patient for 24hrs, until then a judge has to decide even against patient's will.

All in all it's the police's obligation, then the psychiatrist's and then the judge's. NEVER the EMS's or other medical staff's. The others are either legally or medically experts enough to find out what really will help the patient.

If they decide to let him go, it's on their decision. Again, not on anyone else's.

That may be not the case in your state, or the LEOs simply forgot this (or fear the paperwork involved). By the way, I think that they at least have the power to decide someone is too drunk to let alone. But in any case it is your decision to file a charge. If you want to file charges as an insulted medic, then do it or don't do it - on your own will. Not let you press yourself into something, even not by feeling responsible for someone else. Your job was to treat and transport him, you did this well and all afterwards is the responsibility of either the target hospital or the police who was involved from the beginning.

I am still unsure if the right thing was done.

If you choosed to file a charge, that's perfectly OK also. Just remember it was you who decided this, and not the police woman. Don't worry too much, next time you can base your decision on more experience and may have another view on things. And you may point out alternatives - maybe read your law about such things again. Over here LEO's don't always remember their obligation for some reasons, too, and sometimes need a decent pointer...

EDIT: spelling and some things cleared up (EMS may help in transport, injuries/intox will be treated first before psych).

Edited by Bernhard
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It always amazes me, the differences between states and the laws that govern them. Here in NY, a person that threatens to commit suicide, is taken to the ED. If its said in front of a law enforcement officer, they fill out the mental health paperwork and sometimes we transport them and sometimes they do. If they are bad enough to require handcuffs AND medical transport, I always have an officer ride in the back with me. 2 witnesses to what is said is better than "he said, she said", altered or not. But if we transport a person that has threatened harm to themselves or others, they automatically get a 72 hour psych hold. I'm sure its the same if LE transports them.

I must say that I have never been asked to file charges to keep someone in the ED for a few hours. All that is taken care of by LE and the ED.

edited for spelling...again :)

Edited by nypamedic43
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Medicgirl. This is a different tangent but I am curious. When the policeperson boarded your ambulance; What did they do with their firearm?

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It was me that said the officer gets in the back with me but anyhoo. The officer has their firearm with them and they sit between me and the back door. That way I have an out to go forward toward the cab if there's an altercation. I haven't had any altercations though. Once the patient sees the officer get in the back, they usually are quiet as church mice and most cooperative....usually.

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Dwayne-The patient was transported via ambulance because he told someone(not me) that he took more than his prescribed metformin. The bottle had been filled over 6 months ago and was missing 12. He told me he took the med for two weeks but stopped because it made him sick. He never told me he took any pils and when I asked he denied. Ambulance transport was necessary in my opinion because sometimes you just never know.

DFIB- No apology necessary. I had already run that scenario and several like it in my head. The deputy on this occasion gave his weapon to another deputy on scene before climbing aboard. Policy states that we lock it in our narc box if they choose that route.

The actual charge was something like "interfering with my duties." I'm not sure what that means but it came as a result of me refusing to file sexual harrassment charges as I was afraid of the label that may be forever attached to the patient.

The laws in my area change depending on who the current sheriff is. :whistle: I have never had them force a suicidal patient into going to the hospital, so the whole experience was new to me. We don't have any psych facilities in our area so all psych patients are difficult. They have someone come and evaluate the patient and determine the need for a hold. This takes time and the ER usually gets stuck holding the patient until someone shows up. Usually this takes 24-48 hours so the ER is careful about who they deem may need an evaluation. After they declare that a patient may need psych care a transfer must be lined up as the closest facility is at least 100 miles away. All these factors contribute to the local ER's not wanting to deal with these types of patients.

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Research your state law, as laws should not change when the sheriff changes on something like this. Your state should have something that guides all jurisdictions on how mental health patients are admitted against their will. I understand the deputy not wanting to transport the patient 100 miles, but that is their (or your's) job when someone is homicidal or suicidal. A good lawyer would eat you alive if you had left this patient and he later did commit suicide, so even if your sheriff refuses to change policy, your service should have a policy that guides you if you do not already. My personal policy is to transport all drunks regardless of complaint, because the few times I have been burned, it was a drunk patient that did it.

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