Court: Impaired man’s conversation with EMT after crash not privileged

[ArcticKat]

CARSON CITY – An injured person in an ambulance might not want to tell his or her legal troubles to a paramedic.

The Nevada Supreme Court ruled that such conversations are not privileged, as they would be between a doctor and a patient.

http://www.lasvegassun.com/news/2011/jun/02/court-impaired-mans-conversation-emt-after-crash-n/

 

[IAems]

Ummmm . . .

So if EMT's and Paramedics aren't acting "under the . . . direction of a doctor", what exactly is a Medical Director?:blink:

 

[abckidsmom]

What's your opinion here?

I disagree firmly that the medic was not acting under the supervision or direction of a physician, and that's why he was not covered under the doctor patient privelege.

I acknowledge the moral dilemma that the medic was dealing with, but I think he was mistaken by reporting the drug use to the cops. If they had suspicion, which they should have, they could subpoena drug tests and not have the testimony of the medic be the key to their case.

 

[CAOX3]

"Sorry I don't recall"

That simple, if you betray the trust it will become impossible to treat patients.

 

[HotelCo]

"Sorry I don't recall"

That simple, if you betray the trust it will become impossible to treat patients.

Lying/perjury... Great idea.


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[MasterIntubator]

Some areas, the ALS folks have their own malpractice insurance. Not sure of that plays a role or not.

If I ask a pt recreations drug use questions, or if they offer it, I document it. Then it can be subpoenaed for court and walla... its now evidence. HA.

In my narrative, If word that the "characteristic smell of an alcoholic beverage was present on the patients breath"... then its up to the reader to figure that one out. Same goes for odd behavior, etc.

I'm gonna do my part no matter how buddy buddy the pt gets. Been in court many times, and the narratives are clear as day so that the next person reading it can get the same picture.

What the courts do with it is out of my arena.

 

[Shishkabob]

The court said the decision of whether to expand privileged conversations to include someone other than doctors would be up to the Legislature, not the courts.

Whether or not you agree with what the Paramedic did is irrelevant. The issue at hand is in this quote, and for once the court got something right.

 

[CAOX3]

Lying/perjury... Great idea.


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I should have phrased that better.

I wasn't talking about court, I was talking about on scene, I don't tell the cops anything they can subpoena the report if they like.

I'm not the police, what they say to me on scene is confidential. They want to call me as a witness that's fine, but they can wait until court, or receive my report to fill in the blanks

I don't betray the confidentiality of any patient.

 

[usafmedic45]

That simple, if you betray the trust it will become impossible to treat patients.

Nah, just a little more difficult. Personally, if you're doing something stupid and/or illegal that has ended up with you in my ambulance and aren't willing to own up to it, any bad outcome that results from your inability to face the consequences of your choices is your own damn fault.

 

[IAems]

Medical & Legal Ethics

I did not read the actual court ruling, but the article stated, "[the EMT] was not acting under the supervision or direction of a doctor". All I'm saying is that, at least in the US, EMTs and Paramedics are acting under the direction and supervision of a Medical Director. That's exactly what a Medical Director is! If the court's decision was based on that idea of no physician supervision, the court's decision was wrong. All we gain from this is loosing the trust of our patients, who already regularly lie to us about what drugs they've taken (so this surely won't help, especially if it becomes standard practice). Who needs the doctor's testimony, I'll just talk to the guy that brought him to the doctor!?! Although, I will admit, it would be easier to make that argument if there was still an institution of delegated practice. . .

 

[HotelCo]

Keep in mind that this decision effects only Nevada. This isn't a federal court.


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[MasterIntubator]

On the betray part... most of these calls we have police with us, and we work very well together. Many times, the pt only has 2 choices... come with me... or go with the police ----> to the hospital. If we suspect bad stuff, all we have to do is tell the police, and choices will be made for the pt.
We have many legal ways to deal with the pt, TDO, ECO, Implied and so on. And none of them have been difficult in the past, they have screamed, kicked, threatened to sue, etc. Just document well, very well and be justified in everything you do without over-doing it. And be on the same page as the police.

 

[abckidsmom]

Keep in mind that this decision effects only Nevada. This isn't a federal court.


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It's still a meaningful precedent, set by people who are obviously pretty ignorant of how EMS systems work. Either we are a *para*medic, operating under the umbrella of the medical director, or not.

If not, it could be a real breakthrough for our profession.

 

[bstone]

In the ambulance, Rogers told paramedic Jeff Friedlander he had smoked marijuana, but asked him not to tell police. Friedlander relayed the information to a Nevada Highway Patrol trooper.

That's a HIPAA violation. We have been instructed to reveal no medical information about our patients to law enforcement. The state supreme court is wrong on this one.

 

[bstone]

There was no doctor present at the scene and Friedlander wasn't acting under the supervision or direction of a doctor. Instead, he was an independent emergency medical technician.

This is extremely confusing. We are not independent practitioners. We operate under medical direction and the license of our physician directors. It appears that the state supreme court has created a new legal reality for EMTs, one which did not previously exist and serves to confuse.

 

[BEorP]

That's a HIPAA violation. We have been instructed to reveal no medical information about our patients to law enforcement. The state supreme court is wrong on this one.

In Ontario, from what I was taught about PHIPA (our version of HIPAA), this would be a violation as well. The patient said something in relation to his care, so we can't go telling the police what he said. Of course, they can go through the proper procedures to get our paperwork afterwards.

 

[281mustang]

This is the entire reason HIPAA was created, so people could devulge sensitive information without having to fear social or (direct)legal judgement.

Nothing wrong with documenting it, but he deserves to get rung out by HIPPA and more importantly the pt via a private suit.

 

[JPINFV]

That's a HIPAA violation. We have been instructed to reveal no medical information about our patients to law enforcement. The state supreme court is wrong on this one.

Permitted Uses and Disclosures. A covered entity is permitted, but not required, to use and disclose protected health information, without an individual’s authorization, for the following purposes or situations:

...

(5) Public Interest and Benefit Activities.
...

Law Enforcement Purposes. Covered entities may disclose protected health information to law enforcement officials for law enforcement purposes under the following six circumstances, and subject to specified conditions: (1) as required by law (including court orders, court-ordered warrants, subpoenas) and administrative requests; (2) to identify or locate a suspect, fugitive, material witness, or missing person; (3) in response to a law enforcement official’s request for information about a victim or suspected victim of a crime; (4) to alert law enforcement of a person’s death, if the covered entity suspects that criminal activity caused the death; (5) when a covered entity believes that protected health information is evidence of a crime that occurred on its premises; and (6) by a covered health care provider in a medical emergency not occurring on its premises, when necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime.

http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html

So, could this fall under law enforcement exemption 1 (administrative request) or 6 (commission of a crime)? All of a sudden this being a HIPAA violation isn't quite as clear cut.

 

[TheMowingMonk]

With looking at the law I would even say (5) would apply, since the guys committed a crime, its like when you pick up a Alcohol DUI patient that just got in a wreck, usually the cops pick up on the DUI right away but if not they find out about the alcohol anyways and they get arrested for it, and from what that portion of the law says HIPPA would allow for it.

 

[JPINFV]

5 stipulates that the crime occurs on the premises. Unless the DUI suspect was driving an ambulance, I find it hard to say that 5 would work.