Paramedic charged with fracturing patients skull

[x134 46]

DENVER (AP) — A paramedic has been charged with assaulting a seizure patient in an ambulance, fracturing the man's skull and breaking his nose and an eye socket.

Alan Miller, 30, was arrested Thursday on suspicion of second-degree assault. He was being held on $50,000 bail.

Police said Miller was taking Tim Smith, 39, to Denver Health Medical Center after Smith suffered a seizure and hit his head on Jan. 3. Smith's wife, Suzanne Smith, told police her husband didn't have the skull, nose and eye socket injuries when he was loaded into the ambulance.

www.pojonews.com

[Guest]

What? I find this very hard to believe, I'm want to see more details.

[ny10570 745]

http://www.vaildaily.com/article/20090206/...izure%20patient

He's in a wee bit of trouble.

[JM15 386]

Once again the second article paints a very different picture. It does sound like he is some trouble.

[64FFMJK 21]

http://www.vaildaily.com/article/20090206/...izure%20patient

He's in a wee bit of trouble.

what is more disterbing is not only the lack of cooperation between the police and ems but what almost looks like an atempt at a cover up due to the refusal to hand over an internal investigation. :angry:

from the second article:

When police requested a copy of the report, Denver Health officials said they wouldn't hand it over without a court order, according to a search warrant in the case.

Edited February 8, 2009 by 64FFMJK

[helicopper 1,050]

what is more disterbing is not only the lack of cooperation between the police and ems but what almost looks like an atempt at a cover up due to the refusal to hand over an internal investigation. :angry:

from the second article:

It's not uncommon to require court orders before releasing records of any kind. That doesn't mean cover-up or anything more than them protecting themselves.

[Guest alsfirefighter]

No one gets a PCR without a proper subpoena and that's the proper procedure. Chris might be able to add to this a little more, but I believe if asked it cou0ld be proper for it to be reviewed but not a copy turned over without it.

The thing to keep in mind with this is you always have to be prepared for the unexpected when dealing with patients with AMS. the issue isn't whether or not he had the right to protect himself and/or the patient from the patient themselves, but the manner and degree to which he did.

Also I don't know why anyone would make the quote...that there is no way anybody could get out of those restraints or something to that degree when they referred to the legs being out. First off, I have seen a very few amount get out of handcuffs (and I'm not talking magicians or el cheapo handcuffs) or get them in front of them despite starting with them in the back (particularly women). So where there is a restraint device there is always someone who will be able to defeat them, or without fully knowing if they were even put on correctly. You are only able to do the minimum amount of response necessary to protect yourself and again the patient if need be. Nothing more, nothing less and rarely is a blow to the head necessary for "restraint" unless your life is extreme danger and that isn't restraint at that point, its flat out self defense and you for the most part better be flat on your back or in flat out combat with another person.

This points out again the importance of proper training in dealing with AMS patients, the right to restrain, the proper way to restrain by policy (both state and agency), how to utilize commercial restraints or how to use them. Where to do so on on a stretcher and the patient so as to not compromise breathing and how to maximize your position in the small area of an ambulance to maximize leverage and to place yourself in the safest position possible. These are aspects of many scene safety, street smarts curriculums like the one I deliver.

[crcocr1 8]

You cannot even review a PCR without a signed authorization or court order. NY Public Health Law restricts access to health records, including PCRs, even to the Police. Further, even if a subpoena is issued, one still would have trouble accessing medical records. NY Pub. Health Law 18 (2008)(allowing physicians to refuse release of patient records if release would cause harm to patient's health and well being). Remember, people share their most intimate secrets with medical professionals, including paramedics, EMTS, and CFRs.

Edited February 8, 2009 by crcocr1

[Bnechis 3,961]

Remember, people share their most intimate secrets with medical professionals, including paramedics, EMTS, and CFRs.

I thought that people share their most intimate secrets with their escort....Remember Client #9.......

[ny10570 745]

If someone can remove a fully inflated foley someone can defeat anything. No such thing as perfectly restrained. I am damn proud that I have never had to thump a patient. I have had my bus trashed on 3 occasions, but restocking and cabinet repair is always preferred to throwing down with someone who may not be all that perceptive to any pain you might inflict. I have also had one family member complain about the nature in which I restrained patient, however I backed up by everyone involved and everyone went home without injury. I am fully confidant that as long as you treat your patient with the same care and respect your family would receive you will be all right.

[Goose 188]

I like what ALS said - there is a difference between restraint and self defense. I have never had a problem with a combination of appropriate sternness, a few cravats and compassion (once the situation is diffused). I almost got punched in the face once, though...was able to dodge the punches, grab the guys arms and hold his torso down while my partner grabbed his feet....we were able to control him without any use of force until the a few officers were able to back us and give us a hand. Like NY10570 said, i think thats something to be proud of.

[64FFMJK 21]

I agree that no medical information should be released with out a court order however this is two city agencies that need to work togeather and withholding the findings of an internal investigation sounds very bad to me .

As for EMS using force lets put it this way Police Officer will be draged onto the stand any time force is used and a lawsuit is filled and the first thing that will happen is training records will be magicly produced by both sides trying to show the level of training the the officer has in "Use of Force". Last I knew there is no such training as part of the NYS EMS certification.

[INIT915 1,119]

No one gets a PCR without a proper subpoena and that's the proper procedure. Chris might be able to add to this a little more, but I believe if asked it cou0ld be proper for it to be reviewed but not a copy turned over without it.

You cannot even review a PCR without a signed authorization or court order. NY Public Health Law restricts access to health records, including PCRs, even to the Police. Further, even if a subpoena is issued, one still would have trouble accessing medical records. NY Pub. Health Law 18 (2008)(allowing physicians to refuse release of patient records if release would cause harm to patient's health and well being).

This is not entirely true. The law does make exceptions (see 45 C.F.R. § 164.512), and PHL § 18 is not as clear cut as one might like to believe, as when we issue some Grand Jury Subpoenas, directives are often included that prohibit certain persons from even being made aware of the existnace of the Subpoena or the Grand Jury investigation, meaning the provider may not even be made aware of the request.

[Guest alsfirefighter]

I agree that no medical information should be released with out a court order however this is two city agencies that need to work togeather and withholding the findings of an internal investigation sounds very bad to me .

As for EMS using force lets put it this way Police Officer will be draged onto the stand any time force is used and a lawsuit is filled and the first thing that will happen is training records will be magicly produced by both sides trying to show the level of training the the officer has in "Use of Force". Last I knew there is no such training as part of the NYS EMS certification.

64...you make an excellent point. But lets keep in mind that as you mentioned, your training record would come out and you would have to discuss (and unfortunately in today's soceity) justify why you utilized the level of force as outlined your force continuum policy that you used. As an EMS provider I wouldn't have a right to "use of force" but I do have a right to use the minimal amount of response necessary to protect myself and the patient if I felt they were a threat to themselves until I received additional assistance or distanced myself adequately from the threat. Additionally your training puts you in more liability then the fact that most ems providers have little to no training themselves. Whether that is right, again I defer that those in emergency services or walked the blue line know that we're not supermen and despite training are times when you feel that your life is downright in danger and respond within the force continuum as you see it at the time only to be judged that you should have done this or that. The difference between most of us that have experienced this on EMS calls and the jack butt in Denver is knowing where restraint stops and abuse or assault begins. I'd have no problem explaining myself if I had to defend myself or restrain a patient as I know where that line is and would do no further harm unless my life was truly in danger.

[crcocr1 8]

First, the disclosure of medical records has to be made to someone within the medical institution. The government cannot march into an office and take records. This, however, does not mean that the individual providing such records is not instructed to keep the disclosure private.

Finally, as a save all to the patient, grand jury proceeding minutes are not subject to disclosure without notice to any affected party.

[INIT915 1,119]

First, the disclosure of medical records has to be made to someone within the medical institution. The government cannot march into an office and take records. This, however, does not mean that the individual providing such records is not instructed to keep the disclosure private.

Finally, as a save all to the patient, grand jury proceeding minutes are not subject to disclosure without notice to any affected party.

First off, if you think the government doesn’t on occasion take volumes of records from offices, you've obviously never been involved in a large scale Medicare/Medicaid fraud investigation.

Secondly, your earlier point wasn't about ultimate disclosure, it was about PCR's being reviewed. So, those are two different matters.

[crcocr1 8]

QTIP

I do agree that exceptions to NY Pub Health Law 18 do exist; but they are strictly construed, as public policy dictates that medical records be kept private. However,

1. Medicaid/Medicare investigations are made pursuant to an Agency exception to the NY Public Health. The review and release of records is limited to what is absolutely necessary.

2. Your earlier point related to grand jury subpoenas with directives prohibiting certain persons from knowing of their existence. My reply merely corrected an inaccuracy in your statement, which is that papers must be served on the custodian of the records. The custodian may be given a directive not to disclose the release of those records; but if the grand jury minutes were to be disclosed to the public, the affected party, often the patient, will be noticed that the grand jury minutes are to be disclosed. It is a rare occurrence; but occurs from time to time.

Edited February 9, 2009 by crcocr1

[helicopper 1,050]

Not that the discussion about access to municipal and/or health records isn't interesting but the point of this thread is that a paramedic is being charged with assaulting a patient. Not a banner day for EMS. It will be interesting to see if his claim is self-defense especially in light of his partner's comments in the news article.

What are your agency's policies on the use of force (in EMS or the FD, obviously not PD)?

How about restraints?

[INIT915 1,119]

QTIP

I do agree that exceptions to NY Pub Health Law 18 do exist; but they are strictly construed, as public policy dictates that medical records be kept private. However,

1. Medicaid/Medicare investigations are made pursuant to an Agency exception to the NY Public Health. The review and release of records is limited to what is absolutely necessary.

2. Your earlier point related to grand jury subpoenas with directives prohibiting certain persons from knowing of their existence. My reply merely corrected an inaccuracy in your statement, which is that papers must be served on the custodian of the records. The custodian may be given a directive not to disclose the release of those records; but if the grand jury minutes were to be disclosed to the public, the affected party, often the patient, will be noticed that the grand jury minutes are to be disclosed. It is a rare occurrence; but occurs from time to time.

I take very little personally, I assure you.

1. My only point was there are no absolutes, there are exceptions to everything. (Which you conceeded in your reply.)

2. I still do not see my "inaccuracy". I deal with Grand Jury records everyday. I'm pretty sure I understand how they work.

[Goose 188]

Not that the discussion about access to municipal and/or health records isn't interesting but the point of this thread is that a paramedic is being charged with assaulting a patient. Not a banner day for EMS. It will be interesting to see if his claim is self-defense especially in light of his partner's comments in the news article.

What are your agency's policies on the use of force (in EMS or the FD, obviously not PD)?

How about restraints?

I doubt many agencies have an actual policy or protocol on restraint signed off by their medical director. It's probably one of those things that every agency really should have in writing.

I think its pretty obvious when restraints are indicated. Use soft restraints - commercial ones if you have, if not roller gauze, sheets, cravats. Use only the appropriate force to safely restraint, get PD to back you if possible. Once patient is secure re-evaluate your patient, contact the ED and let them know what you've got and make sure they were aware that restraint was required. Thats basically the guideline i follow personally.

As far as use of force. Never had to do it but know people who have and there was never any issue with it. Granted, we are not talking taking a D tank and bludgeoning the patient over the head with it over and over. The most violent i have heard of is where a buddy of mine got punched in the face a few times and it got a bit hairy in the back. Took his partner and a few cops to get the guy squared away.

[WAS967 97]

What are your agency's policies on the use of force (in EMS or the FD, obviously not PD)?

How about restraints?

I have yet to work for an EMS entity that had/has any clearly defined policy regarding the use of restraints (that I am aware of).

I have also yet to receive any formal training as an EMS provider in the use of restraints to control a patient.

Any techniques that I use as an EMS provider in restraining a patient I learned from experience both in and out of hospital.

I've been an EMS provider since 1991.

Comments?

[Guest alsfirefighter]

I have yet to work for an EMS entity that had/has any clearly defined policy regarding the use of restraints (that I am aware of).

I have also yet to receive any formal training as an EMS provider in the use of restraints to control a patient.

Any techniques that I use as an EMS provider in restraining a patient I learned from experience both in and out of hospital.

I've been an EMS provider since 1991.

Comments?

I know I've also learned by experience and also through reading/research. The problem is most experienced learning comes on the things going wrong end and some providers may not know the risk they are putting the patient or themselves in with improper restraining even with PD presence.

I for one have been trying to get different and accepted for safety and access restraint concepts and positions out there when I do my street smarts for EMS provider lecture I made. I also discuss at length positional/restraint asphyxia in my "Medical Aspects of Less Lethal Weapons".

Edited March 15, 2009 by alsfirefighter

[WAS967 97]

Recently I took a violent psych from point A to point B. Upon picking the patient up (heavily sedated mind you) from point A, I found the patent in leather restraints. I kindly asked security if we could borrow them and they agreed since we were taking "trouble" off their hands. My partner noted to me that he had been told in the past we cant use leather restraints. I had never heard of such a thing. Comments?

[Guest alsfirefighter]

I can't remember the exact specifics and I'm too tired to try to research it Chris...but I believe I remember hearing something about the use of soft restraints only...but again don't know if that is a state thing...or something left up to agency policy. The only thing most people do not account for are there are few points of attachment to a stretcher that is actually that secure or allow for movement.