Wrongful Transport?

[10-Buff-4 0]

I apologize for opening a seeming pandora's box, it's just a subject that I find curious/want to hear the views from this board's EMS veterans.

ABout a year ago, some college EMT's (I'll omit specifics to protect the innocent), apparently at the direction of campus security, took a patient who was not intoxicated and with no other symptoms against their will from a legitimate university function to a local hospital against their will.

My question is: Is this ethical/legal? I usually keep my politics separate from my interest in the Fire Service, but I can't help but wonder if these EMT's severely got it wrong and possibly violated this patient's 4th Amendment rights and or, in the words of Judge Benjamin Cardozo, "Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient's consent commits an assault." Did the EMT's commit assault? I've batted the issue around with all the physicians I know (I come from a family of physicians, my Dad is, so is my Uncle, and I know many others), and they have supported EMS' actions. What are your thoughts?

And I apologize for raising a contentious issue, it has just bothered me since it happened.

Thanks.

-Joe DA BUFF

[ny10570 745]

I have a couple questions. Did the pt go with protest or were they forcibly taken against their will? Did PD go with the Pt? If the person was taken against their will you must have PD present assume decision making responsibility. The whole idea being you are protecting the pt from themselves. The pt is placed into the custody of PD and transported with PD's consent. Campus security does not count unless they are a police agency.

[gss131 212]

what was the extent of injury,or illness?

[IzzyEng4 427]

10-Buff-4,

Firsts off I think I know where you area talking about, very ugly situation. The question I have is did this patient get "papered" by the police / security department for psychological evaluation? If so, the EMT's are covered but the problem is why the person was papered by the pd / security and if it was wrongful, they they area liable.

If there is no injuries and the patient refuses treatment, then they are in the wrong. If they are put on a watch paper by the PD then that is a whole other can of worms.

[Guest alsfirefighter]

You didn't open a pandora's box, you asked a very legitimate question. Problem is you left too many questions open. Also I don't know what fire service politics this has to do with, so that comment in your post is a bit perplexing.

Here's what questions I have:

1. What were they called for?

2. Did they ask specifically if the person wanted to go to the hospital and did he say no?

3. What was there to suggest or counter that the person may have been "intoxicated?"

4. Did you know this person directly (the person transported)?

5. Did the person leave the hospital when he/she arrived? Did they sign themselves out or refused to be admitted?

EMS personnel are not trained appropriately to determine whether or not someone is "intoxicated." EMS personnel should only operate with a suspicion of such and back it up with medical symptoms of alcohol or drug ingetstion.

If this person didn't want to go, why did he/she not put up a bigger stink. Try getting my to get in an ambulance when I don't want to go if there is absolutely nothing wrong with me. If you are led to an ambulance and you get in, that could be considered implied and/or informed consent.

Just the opposite, whenever someone states they do not want to go to the hospital, I always ask at a minimum of 3 times and I explain in detail what the refusal statement they are going to sign implies and that I have offered to take them to the hospital. I also am sure to document that I advised them of all worse case scenarios with what their presenting problem is and that if anything changes to "seek the closest medical facility or activate the EMS system via 911."

[Scottyk107 9]

With-out more information its hard to say or make a decision. Here in Florida you can Baker-Act a patient who may do harm to themselves or others and PD must be present and agree with the medics/emts that is it the best choice.

[firemoose827 324]

I am actually surprised that no one asked this...if you did, sorry.

Was the pt AOX3? Were they a risk to themselves or others or just drunk? I work PT for an ambulance service and we transport quite a few "Drunks" from the college, and we sign off 3x that amount because they are AOX3. Another question is were they 18? Or were they younger? Because once the ambulance is called and it is a minor, and that minors parents are 200 miles away...that changes things. We either have to talk to the parents on the phone or transport to the hospital. Implied Consent.

Lots of rules and laws that EMS people have to follow. Hope this helps your concerns brother.

Be Safe

[10-Buff-4 0]

Hey Board. Thanks. To clarify:

1. The Campus Security is not Police, they are private security (through Summit, with University hired supervisors.). I am uncertain as to the extent of their powers; some guards carry handcuffs, many of the supervisors are ex-cops

2. I wasn't a first hand witness to this, I only heard about it through a Letter to the Editor in the School Paper.

3. So far as I know, a Campus Security Supervisor called for EMS and the person was not displaying any symptons of intoxication. (The person had consumed two beers, according to their letter. The person was also of legal age, to consume alcohol.l)

4. The person did vocally refuse to be transported; the Security Supervisor said that she would be kicked out of Fordham if she refused.

5. Apparently, a physician saw the person at the hospital and determined that there was nothing wrong with her.

I have one more question: What is papered? Papered as in the officers have documentation attesting to the fact that the patient is a danger to themselves? If so, I doubt that paperwork exists.

I hope this helps clarify the situation. Thank you all for your thoughtful responses and for all your help.

-Joe DA BUFF

[10-Buff-4 0]

Hey Board. Thanks. To clarify:

1. The Campus Security is not Police, they are private security (through Summit, with University hired supervisors.). I am uncertain as to the extent of their powers; some guards carry handcuffs, many of the supervisors are ex-cops

2. I wasn't a first hand witness to this, I only heard about it through a Letter to the Editor in the School Paper.

3. So far as I know, a Campus Security Supervisor called for EMS and the person was not displaying any symptons of intoxication. (The person had consumed two beers, according to their letter. The person was also of legal age, to consume alcohol.l)

4. The person did vocally refuse to be transported; the Security Supervisor said that she would be kicked out of Fordham if she refused.

5. Apparently, a physician saw the person at the hospital and determined that there was nothing wrong with her.

I have one more question: What is papered? Papered as in the officers have documentation attesting to the fact that the patient is a danger to themselves? If so, I doubt that paperwork exists.

I hope this helps clarify the situation. Thank you all for your thoughtful responses and for all your help.

-Joe DA BUFF

[khas143 13]

Well if the person was "blackmailed" into going to the hospital by security guards that is not your concern. As an EMS provider if the patient wants to go to the hospital (despite the reason) you should provide transport. It sounds to me like the issue the patient has is with security. Sounds like on the EMS side of things, there is no liability.

On a side note, these sort of things tend to happen with private security who owe their allegiance to school administration.

Edited November 25, 2006 by khas143

[IzzyEng4 427]

"Papered" is a term used by certain PD and EMS agencies up here when a police officer feels the patient is of unsound mind and might pose a threat to them self or others. They are basically being forced legally to be checked out. Usually this is only done in the case if a patient is violent, severely intoxicated or under the influence of drugs and needs to go through detox. It is a legal document used, not often so that it does not get abused, for implied help.

That is about the best I cane explain it.

[Guest alsfirefighter]

EMS did nothing wrong if that person took what the Security Supervisor said to heart and got on that ambulance. If anything they may have done her a favor to get her away from there and diffuse a situation that could have escalated. It sounds completely as someone mentioned security had an issue with something. For whatever reason, the crew also didn't want to say anything, but I would have looked right at them and told security he/she doesn't want to go and I can't make them. Period. If they don't like it, they can do whatever is in their powers to remove them.

It may not be textbook, but then again I'm not a cookbook medic, but if she really didn't want to go and security is being a d!ck, I would even let the person in the ambulance if they fit the criteria I would have RMA's and let them out.

[10-Buff-4 0]

I apologize if perhaps this wasn't clear before, but EMS was seemingly ordered by the Security Supervisor to act. I hope this clarifies things; I'm sorry, the whole thing seemed fishy to me. And the patient did not want to go to the hospital. Perhaps I should come back with more details, and the like. Thank you though for your fortrightness and willingness to talk to me about it.

-Joe DA BUFF

[Guest]

Very interesting topic and great question. Having not been involved in a situation similar to this i would have to say the following: security has no authority over EMS - IE: they cannot demand or order them to act. They likely did the right thing to call an ambulance if the person presented as an EDP, intox, user or having some other ailment. Thing is, EMS isnt a "you call we haul" service. If the pt. is presenting as such and meets the criteria for transport then we transport, if a pt is presenting normally and no life threats are apparent then its really up to both the EMS provider and the pt, with the pt having the ultimate last word. I'm usually upfront with pt.'s, i do my best to persuade them to go to the hospital letting them known that i'm not a dr and my knowledge is limited, ill offer to get them a paramedic assessment (if the call is dispatched as BLS only), and i of course inform them they have the right to refuse care, and they can exercise that with the stroke of the pen. At the same time, however, I don't see it as my place, as an EMS provider, to pass judgment as to why an ambulance was called. Regardless, the fact of the matter is that while EMS has a clear job to do, patients do also have rights and if they don't want to go, and they are in normal mental state, they don't have to go. After that RMA is signed, it turns back into a police/security matter and things should have gone from there. Its not our responsibility to preform selective crowd control, thats why you have paid security and i'm sure, if it was on a college campus, that they had some sort of jurisdictional privilege (for lack of a better term) and could have easily escorted the person off the premises or away from the event.

Edited November 26, 2006 by 66Alpha1

[IzzyEng4 427]

I apologize if perhaps this wasn't clear before, but EMS was seemingly ordered by the Security Supervisor to act. I hope this clarifies things; I'm sorry, the whole thing seemed fishy to me. And the patient did not want to go to the hospital. Perhaps I should come back with more details, and the like. Thank you though for your fortrightness and willingness to talk to me about it.

-Joe DA BUFF

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Definitely does not sound right, something is fishy......

[mlfcemt093 0]

ok i looked over all of ur posts and it seems as if the security guards @ the university and u metioned forham university and they have thier own ambulance ordered ems to take the pt away so the possibility exists that the university emts../students...in order to save them selves the hassel took the pt to the hospital as ordered instead of doin a proper exam.....and by the way ny state says legaly any persons to have ingested any alcholic beverage is said to be "altered mental status" but like any good emser will tell u use ur clinical judge ment buts sds as if the scared techs just did as ordered because of security i really don't know the story and yes u left to many details out....sorry.....

[Guest alsfirefighter]

How do we know if they did a proper exam or not? Thats judgemental completely. Even if they did or didn't do a proper exam, they did not drag that person into the ambulance, so then that is considered consent for them, it falls back on security if the statement they made was true by telling the person if they didn't go with the ambulance they would be kicked out.

mlfcemt...brother please next time for our eyes sake, type full english not interent abbreviations. wow that was hard to read and absorb.

[helicopper 1,050]

.....and by the way ny state says legaly any persons to have ingested any alcholic beverage is said to be "altered mental status" ...

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Perhaps you can clarify this statement, too. I'm not aware of any statute or regulation that makes such a broad generalization. An actual citation to where you're obtaining this info would be greatly appreciated!

If the patient was of age, alert and oriented x3 and made the informed decision to refuse transportation but was transported anyway, it sounds like there could be a problem. And regardless of the setting, EMS does not take orders from security guards.

It does sound fishy!

[Guest paramedico987]

AWSOME POST!

This has been an ongoing problem for myself [and many others] @ Empress where all of our RMAs have to be "approved" by the road boss who is almost never present to assess the patient for themselves. I've been told on many occasions that I "can't let that patient RMA." [and sure enough, the patient still refuses to go]

To which I usually reply that "while another's ignorance of the seriousness of thier illness is not my fault if I tell them their going to die, FALSE IMPRISONMENT IS A VERY SERIOUS CRIME."

So far I haven't heard of anyone getting burned by "forcing" someone to go to the hospital, but one of these days someone's going to throw what they think is an "intox" onto a stretcher and get served a subpeona a month or two later...

[khas143 13]

    To which I usually reply that "while another's ignorance of the seriousness of thier illness is not my fault if I tell them their going to die, FALSE IMPRISONMENT IS A VERY SERIOUS CRIME." 

    So far I haven't heard of anyone getting burned by "forcing" someone to go to the hospital, but one of these days someone's going to throw what they think is an "intox" onto a stretcher and get served a subpeona a month or two later...

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Section 135.05 Unlawful imprisonment in the second degree

A person is guilty of unlawful imprisonment in the second degree when he restrains another person.

Unlawful imprisonment in the second degree is a class A misdemeanor.

"Restrain" means to restrict a person's movements intentionally and unlawfully in such manner as to interfere substantially with his liberty by moving him from one place to another, or by confining him either in the place where the restriction commences or in a place to which he has been moved, without consent and with knowledge that the restriction is unlawful. A person is so moved or confined "without consent" when such is accomplished by (a) physical force, intimidation or deception, or b. any means whatever, including acquiescence of the victim, if he is a child less than sixteen years old or an incompetent person and the parent, guardian or other person or institution having lawful control or custody of him has not acquiesced in the movement or confinement.

A couple of issues here.... first, there is (in my opinion) a very definitive line between strongly suggesting that a patient go to the hospital and unlawful imprisonment... it still sounds to me like the patient was "convinced" to go. (to what extent it took to "convince" the patient may never be known)

Second.... the law states that the person who "Restrains" the victim (patient) must have knowledge that the restraint is unlawful. This brings about a question of the state of mind of the EMS crew on the call and a secondary question of training. What were the EMT's told about the legal authority of the security guards on campus? What kind of legal aspects training are EMT's (CFR's, EMT-P's) getting during their training courses? In my experience this varies greatly with the course provider and may be something that should be stressed more given the liability aspects involved.

[Guest]

from the EMT side of things, we are taught some legalities, IE: Duty to Act, , documentation, Abandonment, how to and when to utilize restraints, protective custody etc. We aren't taught specific legal codes - and frankly, that isn't part of our job description. Any time i had a question on an issue, i've always consulted with the PD asset o/s and they have been more than welcome to offer their legal advice. As far as getting RMAs approved, i cant speak to that as i've never worked for an agency which requires that, but i do recall a friend who works for FDNY*EMS complaining about having telemetry approve their RMAs, i suppose its a liability issue. Maybe more legal training would be good? Who knows, but it sounds to me as if security just didn't want to be bothered with this person and decided to have EMS haul them off

[khas143 13]

from the EMT side of things, we are taught some legalities, IE: Duty to Act, , documentation, Abandonment, how to and when to utilize restraints, protective custody etc. We aren't taught specific legal codes - and frankly, that isn't part of our job description. Any time i had a question on an issue, i've always consulted with the PD asset o/s and they have been more than welcome to offer their legal advice. As far as getting RMAs approved, i cant speak to that as i've never worked for an agency which requires that, but i do recall a friend who works for FDNY*EMS complaining about having telemetry approve their RMAs, i suppose its a liability issue. Maybe more legal training would be good? Who knows, but it sounds to me as if security just didn't want to be bothered with this person and decided to have EMS haul them off

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I have had the opportunity to work both sides of the fence on this one and you make a good point 66Alpha... It is great to be able to consult with the PD asset on scene but given the particular situation discussed in this thread I would think it would be important to discuss (aka training) legal issues in depth since there were no PD assets on scene (as is the case in most college EMS environments)...

I volleyed as an EMT when I was in college and to be honest, if I was confronted with a situation such as this it would have taken a lot of ba**s to go against the organization (administration) that oversaw the VAC on campus.

Sorry for the side note but even though it appears that the EMT's did nothing wrong this is a huge problem with having an EMS program in a college environment... There is obviously an appearance of authority by a security department that legally does not have as much "say" as the EMT's on the ambulance.

[Guest]

it would be interesting to see their bylaws, sops and protocols...

[mlfcemt093 0]

ok......sorry.......i got burned @ work and the vollys so i pretty much stick like glue to the u drink ur not of sound mind to make an informed decision....and thats pretty much Dr. Dario Gonzalaz med dir for ems div 2 and sorry about my writing skills i know they have much to be desired i will work on that.

[helicopper 1,050]

ok......sorry.......i got burned @ work and the vollys so i pretty much stick like glue to the u drink ur not of sound mind to make an informed decision....and thats pretty much Dr. Dario Gonzalaz med dir for ems div 2  and sorry about my writing skills i know they have much to be desired i will work on that.

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If I read this correctly you're saying that if someone has a glass of wine with dinner and is a passenger in an MVA later, you're going to treat them as though they have an altered mental status?

I think that is a faster way to get burned... IMHO!

And you're saying that this is the policy in NYC as per Dr. Dario Gonzalez?

[ny10570 745]

while Dr. Gonzalez will hammer you for RMA's with intox pt's, the same does not apply to just because the person had been drinking. He gently explained it in the way only he can the practice of RMAing an intox because they are home and not sick or injured is not allowed. If they are drunk enough to that someone felt the need to call 911 then they are to be transported. If the call is not related their level of intoxication (ie: injury, MVA, etc) and their RMA is not AMA they can be bombed out of their tree and still RMA. The catch is most of those events could be covered under 10-90 or 10-91 (unfounded).

[mlfcemt093 0]

while Dr. Gonzalez will hammer you for RMA's with intox pt's, the same does not apply to just because the person had been drinking.  He gently explained it in the way only he can the practice of RMAing an intox because they are home and not sick or injured is not allowed.  If they are drunk enough to that someone felt the need to call 911 then they are to be transported.  If the call is not related their level of intoxication (ie: injury, MVA, etc) and their RMA is not AMA they can be bombed out of their tree and still RMA.  The catch is most of those events could be covered under 10-90 or 10-91 (unfounded).

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yes thank u I have now realized the can i have opened up so thank u for explaining his methods better than i could u have saved me