Drunk and Disorderly

BossyCow

Forum Deputy Chief
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Just checking to see if anyone else has found a way to deal with this. We have a frequent flier. She has been responsible for over 70 calls in the past 6 months with sometimes 4+ calls in a 24hr period. She's elderly, recently lost her husband, living alone and really likes her wine. She gets drunk, falls down, pushes her lifeline button and has us come pick her up off the floor.

90% of the time, she is unhurt. Often, we find that she is not only unhurt but has pushed the lifeline button, reset the machine and then 'fallen' across the room.

She has recently become verbally abusive to our volunteers as we become less invested in making her feel loved and adored at 3am.

Our MPD has told us that if she is A&Ox3, and is refusing medical treatment, we are under no obligation to pick her up from the floor and can leave her there.

The last call, she was lying on the floor of her kitchen, with her walker about 3 feet away. When I asked her what she called us for, her response was... "expletive meaning female dog I'm on the floor!" I said "I can see that, but we are EMS, we are here to help people who are hurt, are you hurt?" She says she isn't hurt, then attempts to talk to another person on the scene about how worried she is about her dogs being outside. I ask the other responder to leave the room and tell her that we are not there to take care of her dogs, we are EMS, (bear in mind, this is our third call to her address in 4 hours) I ask if she wants me to examine her for possible injuries, at which points she makes several points about my lineage and gives me several suggestions about some actions she would like me to take. I ask her to tell me her name, she does. I ask her if she knows what day it is, she does, I ask her if she knows where she is "I'm on my f:censored:ing floor you :censored::censored::censored:" I ask her if she wants medical treatment, she says no, I tell her that if she wants no medical treatment to sign the release and we will leave. She refuses to sign the release. I document that the pt refused to sign the release but had repeated refused treatment.

In the meantime, she has sat up, moved around the kitchen floor, even though she has said she can't move. We've even seen her pull herself into a chair after saying she has been down for 1 hour plus and can't move.

I have now reported her multiple times to Adult Protective Services as an Adult at Risk for Self Neglect. The local sheriff's office has also had multiple dealings with her. We have had her ITA'd more than a few times, due to injuries sustained from falls, including one major subdural bleed that had her airlifted out for a 2 month stay in Seattle. She signed herself out of the nursing home AMA and is now back in our district.

She is very well off financially and has great medical insurance. She doesn't care how many times she calls us. We are a volly agency and only bill for ALS calls on what is called a third party payer system. She is abusing the system, our volunteers and everyone she knows. We have to respond because there have been times when she was seriously hurt. There are currently about 5 different agencies trying to deal with this woman.

Any suggestions?
 

Epi-do

I see dead people
1,947
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I would think that if you have been to her house 3 times in 4 hours, you could make a case with the police that she needs to be placed into protective custody because she obviously isn't able to take care of herself. Take her to the hospital, and then along with the run reports, write up an incident report detailing the non-medical issues of the multiple trips to her address. Turn it all in together and keep copies for your records.

We had a similar incident with a patient in one of our neighborhoods. It got so bad that some of the hospitals refused to accept her because she was abusing the system. We had to notify our EMS Chief every time we would transport her. In the meantime, he was working with adult protective services. We recieved a directive from the EMS Chief stating that we did have to evaluate her each time she calls, and transport her if she wished to go to one particular hospital or if she truly was having an issue. The rest of the time we could give her the number to a private service and tell her to call them because we were not transporting her.

It took several months of documenting the abuse of the system, a Chief that was willing to step up to the plate for us, and working with several different agencies to get the issue resolved. Since she has been told we will only take her to the hospital under certain circumstances, she has gotten much better about calling. I think they have been on her a couple times since all of this came down, but she was truly having some issues.

I know how frustrating it can be to have to deal with something like this. I hope you are able to get it resolved.
 

bonedog

Forum Lieutenant
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As she has already had a major head injury, and as we know alcholics are predisposed to cerebral bleeds, I would be requesting police each time I responded to insure she goes to the hospital.

The abuse she is showing may be due to a head injury, another reason to transport. Also may help convince the police to arrest the patient.

Once in the hospital the mental health act would help the physcian, who can detain her for further psych assesment.

Share the fun I says.... guys with sheepskins make way more money to make decisions on potential head injuries.;)
 

firetender

Community Leader Emeritus
2,552
12
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There's really nothing for me to share except my condolences.

This is one of those cases where to do what would seem appropriate would be easily misinterpreted as abuse. As medics we don't have the backing to "call them like we see them." We have a duty to respond regardless of our interpretation of the need of the person.

This will run its own course, and in my humble opinion, the best you can do is to act as silent witness, offer NO resistance to anything and above all, remember Time Wounds All Heels!

Unfortunately, there really are people out there who by design or mistake it's hard to tell, focus every moment of their lives on tormenting others. If you'll notice, they themselves don't seem to get eaten up by the reaction. In fact, they revel in the negative energy they create. It is why they do it. It is the only way they know to nourish themselves.

People who feed off of the negative emotions they create in others are just one form of a class of illnesses that could only be called spiritual. These are things not taught about in our classes or clinicals but anyone in the field long enough knows that a significant percentage of the people ambulance medics treat suffer from maladys like this.

All the classifying in the world does not teach a street medic how to protect him or herself from getting sucked into the energy vacuum that surrounds these people. The question isn't about how to get them away from abusing the system, off the streets, into a program, out of our hair or into another county. The hub of the wheel is us learning how, when, and how much to use our personal life force to "help" others.

The aftermath of such contacts often live inside the medics involved for a long time. Since no one else teaches us what to do in situations like this (other than applying and seeking layers of "red tape"), it's up to us to begin dialogue so we can teach each other.

BossyCow, do you not agree that the primary conflict you face is the draining of your own strength as you invest more and more into trying to solve this problem?

I honestly don't expect a whole lot of talking going on here about subjects like this. After all, these are on the esoteric side and (Heavens Forbid!) sound a little New Agey, but you know what?

Stuff like this needs to be looked at, too.
 

Ridryder911

EMS Guru
5,923
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Unfortunately, we will see more and more of these situations of those that "fall into the crack" of bureaucracy. I would be persistent of adult protective services. It is obvious she is endangerment to herself and potentially others, thus requiring psychological evaluation as well.

The Adult Protective Agency needs to be called out to do their job. I have encountered apathy from some and great working relationship from others, but of those that do not want to do their job, I inform them that I will document my findings ..."multiple falls resulting in numerous potential injuries , with repeated medical requests, irrational behavior, etc".. and to be sure that when an occurrence does occur that their name will be listed as to whom to contact.

Your operational director needs to make contact and take action as well. Each time you will respond, that they (APS) will be notified if there is suspicion. Each person has a boss and work upwards, until action occurs.

Remember, a squeaky wheel gets oiled.

Good luck,
R/r 911
 

Anomalous

Forum Lieutenant
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The first thing to do is to check her list of Lifeline responders. You should not be first on the list. If her other responders get called 4 times in 3 hours, THEY will do something about her. Obviously, he needs some kind of help.

Second thing to do is bill for a refusal. Of course that is only when the person refusing treatment is the one who called. If she really is well off and doesn't mind paying every time you are called, use the money to do something for your crews. Buy them some burgers or something.

Third choice- If she can't move....take a piece of furniture everytime you go there. :wacko:
 
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BossyCow

BossyCow

Forum Deputy Chief
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BossyCow, do you not agree that the primary conflict you face is the draining of your own strength as you invest more and more into trying to solve this problem?

No, I'm pretty adept at determining how much of myself I invest into situations. This is not 'draining my strength' but I see it as a problem, which must have a solution.

The cops have told us that there is no law against getting drunk in one's own home and falling down. They have ITA'd her so many times now they have her name and address memorized. As do we.

I have taken the following steps in our response to her address, please feel free to critique and add suggestions.
We no longer will pick her up if she is uninjured, we call a friend for her and have them pick her up. We leave her lying on the floor until the friend arrives and we leave when the friend shows up.

We limit the number of responders to two. More than that becomes an audience and less than that leaves us open to her laying charges against us She's already tried saying we hurt her, hurt her dogs (two gianormous barking mutts)

Every single call we respond to gets a report sent to Adult Protective Services.

We are no longer being nice. We are being professional, curt and efficient.

These steps are what I believe has caused her to ramp up the abusiveness. She never used to do that. At this point, we are waiting for Adult Protective Services to finish their report and make their recommendation. Oh.. and as an aside, she has no family other than a mother in a nursing home two states away.

Her doctor has terminated her as a patient, the local nursing home will not take her back. The ER is telling us, don't bring her here unless she's hurt. And none of this makes any sense to the pt. because she's generally too lit to understand it.
 

MedicineMan975

Forum Crew Member
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Just an Idea...

She is lonely. Plain and simple. All the other posts I've read give really good advice on how to handle it from an service/agency standpoint but, I think if the root of the problem were to be exposed it would show a pattern of behaviors that directly relate to depression and alcohol abuse as an out growth of her feelings of isolation. I know, I know. I sound like a bleeding heart who gives out hugs at the drop of a hat.:rolleyes: Well, I can honestly say I have never been accused of that not even by folks who would rather see me in less than perfect health.

With that being said, I just want to throw this out there. Talk to her. Talk to her family, neighbors, church members, who ever. Just start a dialog to try and find out WHY she feels the need for EMS to be her main form of social interaction. Now I know all about scene times. But what about during down time? What's to stop anyone from paying a visit "just to check in" on her? An ounce of prevention goes a long way. And I think it's also important to remember that people don't usually contact us unless they FEEL they are having a bad day. And we all know that feelings are the most subjective thing in the world.

I don't want anybody to think I'm preaching here. But I ran across this thread and felt I should impart a little advice based on my past experiences in dealing with situations like the one described above. It's taxing, exhausting, and not anything you're going to get too much outside recognition for. But in the long run, it pays for itself in spades.
 
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BossyCow

BossyCow

Forum Deputy Chief
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Yeah, been there, tried that. She has burnt all those bridges. There is currently one person in the community who is still willing to visit her. That person has a Power of Atty only for financial matters. I think she's hanging in there hoping to benefit when the gal croaks.

The woman is definitely lonely. We tried the sending people over to help her feel accepted and welcome, just to play cards etc. But she sees these people as vehicles for buying her booze. When you show up, taking time out of your day to spend some time with a poor lonely shut in and all she wants to do is have you leave her and run to the store and buy her a bottle of wine, you start to question which is higher priority, getting the buzz, or curing the loneliness.

She had quite a wide circle of friends initially. She has burned them all out with her abusiveness, manipulation and supreme self centeredness.

And don't feel badly about the warm fuzzy response, we were that way initially. I think we all want to start there.
 

MedicineMan975

Forum Crew Member
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Well like I said before, not trying to preach. And while I do have success stories with that type of situation, they are scattered at best. I live in a rural area as well, and have run into the same problem many times before. Just thought I'd throw my two cents into the kitty.

In the end, I guess you've hit the wall with this particular lady. You can't force a person to realize that they have a problem. Best of luck in the future.
 
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BossyCow

BossyCow

Forum Deputy Chief
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The first thing to do is to check her list of Lifeline responders. You should not be first on the list. If her other responders get called 4 times in 3 hours, THEY will do something about her. Obviously, he needs some kind of help.

Second thing to do is bill for a refusal. Of course that is only when the person refusing treatment is the one who called. If she really is well off and doesn't mind paying every time you are called, use the money to do something for your crews. Buy them some burgers or something.

Third choice- If she can't move....take a piece of furniture everytime you go there. :wacko:


She no longer has a list of lifeline responders. She has burned them all out. We are now her first responder. Yes, they can do that, and they do pretty regularly around here. I used to be the lifeline coordinator for the local hospital so I've faced that from the other side of the coin
 
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