Thoughts

[Tigger]

It’s a possibility. Can’t Dx it in the field now, can you? By all means, pull over and dump the pt with all the treatments you’ve started pulled out and off. Leave them by the side of the road.

The Attorneys love this… That piece of paper they “signed”…yeah.

Doesn’t matter what I think. I could suspect the patient does in fact have an intracranial hemorrhage but at the end of the day if they want to refuse and have the capability to do, that’s their prerogative. If I suspect this I’m of course going to pull out all the stops to convince them to go, but at the end of the day if I am not successful, they can refuse.

You can go ahead and quote the part where I said I would leave someone on the side of the road. Or the part where I talked about all the “treatments” I provided to this patient. We can wait.

 

[FiremanMike]

Fully aware of that. Seems the gist is that some are so godlike in their Dx skills that they KNOW what’s going on with every pt…

Jump all you want: I’ve NEVER been sued by a pt, nor had my care questioned.

At the end of the day, if a patient has capacity to refuse, understands the implications of refusal, and can explain them back to you in their own words, they legally have the right to refuse anything.

“Hey man, you were in a crash, you may not think it but it’s possible you could have a head injury. I can’t diagnose a head injury with any certainty, and if you have one and aren’t treated, you could die” “yeah man I get it, I could have a head injury that will kill me, I still don’t want to go”.

That’s really the end of the discussion.

 

[FiremanMike]

I had a dude at the ER one day with a penis injury that resulted in us putting in a Foley cath. He had no family, no friends, and was coming from a nursing home that he felt was so bad, he flat out refused to go back. He literally had nowhere else to go and was going to just go live on the streets, forgot to mention he was in a wheelchair.

We spent hours trying to convince him to go back, that he could probably try to be transferred, social workers spent time trying to find him somewhere to go but were unsuccessful. At the end of the day, he refused the ambulance transfer back to his ECF and signed out AMA. He was fully aware of the risks of a UTI and what that can lead to and that nursing care of his Foley was critical to get him through and still refused.

Patients have rights.

 

[DrParasite]

But at the same time, you can’t just dump them on the side of the road right?

Why not? they don't want to go to the hospital, and are refusing care. pull over, and open the door, if that is their wish (that's what the supervisor told me to do). Just ensure you have everything documentation on your run book. People have a right to make stupid decision regarding their healthcare. What are you going to do, restrain them to keep them there, and force them to accept your interventions?

That being said, in 25 years, I've never had this happen to me, nor have I ever been sued. more often than not, telling them you want to let you go at the ER for their safety, not at the side of the road, gives them a reason they will understand. or telling them "we are almost there, while I understand you no longer want to go, I'm going to get jammed up by my boss if I don't leave you somewhere safe. You don't have to stay in the ER, but our policy is not to drop anyone off at a location other than an ER." if we are a few blocks from the scene, I have no issues turning around.

Or just call your boss on the cell phone, explain the situation for a few minutes, and by the time you hang up the phone, your arriving at the ER, and it's a non-issue.

The Attorneys love this… That piece of paper they “signed”…yeah.

OK, I'll call your bluff on that... how many attorneys have won judgements against EMS providers for following the wishes of their patients? Provided they have the capacity to make their own decisions, a patient can refuse care. The threat of litigation in EMS is SOOOO overblown it's not even funny; it's even worse that people continue to use the big bad attorney boogie man as a reason to do something stupid (like saying a properly documented refusal will not protect you from a negative patient outcome).

That's also why a PCR is a legal document, and the refusal section has been approved by an attorney. The ambulance chasing lawyers might sue you for anything, but it's very rare that the jury will award them any money.

 

[Tigger]

I’m also not sure how saying “I’ve never been sued or questioned” validates care being adequate. I have also not faced legal action but I don’t think that actually says anything about me or my care.

This is an issue of patient consent. If they are making their own decisions, you don’t get to just disagree.

While not common I‘be done refusals in grocery store parking lots on IFTs, three blocks from the scene after a fire department bullied a patient to go and they changed their mind, and in the ED parking lot. If they refuse before the end of the trip and we don’t get paid, that’s the cost of business.

 

[NomadicMedic]

Another check on the plus side of the ledger for body worn cameras.