Guest guest Posted January 7, 2004 Report Posted January 7, 2004 OK, some thoughts to help you analyze this situation: Assume that the patient is unconscious and unable to personally consent to treatment at all phases of his initial care. Would the physician's bill be payable? Would the hospital's bill be payable? Is there a public policy that favors provision of medical care to those who cannot consent in life threatening situations? Is there a concept in law called " implied consent? " What is the rationale for that concept? Does public policy favor allowing patients to commit suicide, or does it argue against it? If you get lost in the woods on U. S. Government land and require search teams to look for you for three days, including 50 mounted riders, 3 helicopters, 4 fixed wings, and 6 boats, not to mention 100+ rescuers on foot and 50 law enforcement officers, can you be made to pay the costs of your rescue even if you maintain that you would have found your way out alone if given time? GG Quote
Guest guest Posted January 7, 2004 Report Posted January 7, 2004 Well the consent would be him being unresponsive and not being capable nor competent to refuse treatment by EMS or the ED. Just what i would assume but I am most likely wrong. On Wednesday, Jan 7, 2004, at 15:26 US/Central, Ron Derrick composed: > > I have a question for the group. Let me set the scenario. EMS makes > a call > for an overdose/attempted suicide. Physician on scene called for > EMS. You > arrive to find patient A & O x 0 and a original GCS of 9. Patient took a > large amount of a variety of pills including Cardizem and Plavix. EMS > treated patient and was asked by physician on the scene to transport > to the > ER for gastric lavage. Now EMS has received a letter from the patient > stating " I did not request EMS or consent to the EMS services and I > will not > be held responsible for them " What would be the appropriate reaction > from > the EMS politically and legally to this person? > > > Ron A. Derrick, LP NREMT-P > Director of Emergency Services > City of Fredericksburg > Quote
Guest guest Posted January 7, 2004 Report Posted January 7, 2004 As far as consent, it was implied, based on information you provided. Someone initiated a call to the physician on behalf of that patient to provide care in the best interest of that patient. You have been called to continue care in the best interest of that patient. Since the patient had taken action that placed life in jeopardy, and had placed him/herself in a position where he /she could not make a sound decision, that decision was made based on what a rational person would most likely want. That patient is now obligated to pay for the services rendered. You must treat this patient as you would all other patients that you bill. It is politically correct to treat all citizens the same. It is legally correct to expect compensation for this patient just as you would any other patient. If this patient had presented to our service, we would bill. If the patient refuses to pay, then the bill will be processed according to the City policy in regard to bad debt. , Director Seminole EMS Seminole, TX. 79360 (432)758-8816 (432)758-6533 fax Refusal of Payment I have a question for the group. Let me set the scenario. EMS makes a call for an overdose/attempted suicide. Physician on scene called for EMS. You arrive to find patient A & O x 0 and a original GCS of 9. Patient took a large amount of a variety of pills including Cardizem and Plavix. EMS treated patient and was asked by physician on the scene to transport to the ER for gastric lavage. Now EMS has received a letter from the patient stating " I did not request EMS or consent to the EMS services and I will not be held responsible for them " What would be the appropriate reaction from the EMS politically and legally to this person? Ron A. Derrick, LP NREMT-P Director of Emergency Services City of Fredericksburg Quote
Guest guest Posted January 7, 2004 Report Posted January 7, 2004 Ed, If you are purely a private, for profit ambulance service, you can pick and choose your patients and refuse at will so long as issues like abandonment are not involved. But accept a 911 contract and you accept a contractual duty to respond to all callers and furnish care and transportation. The contracts spell that out in detail, and you are usually granted some sort of consideration in the form of a subsidy or payment guarantee situation to pay you for serving the non-payers. Gene Quote
Guest guest Posted January 7, 2004 Report Posted January 7, 2004 That's a tough one, but my guess would be if this is a blatant suicide attempt and PD has put the patient under section 26, you can treat and transport said patient without worry. If this wasn't the case and the patient had a GCS of 9, I would imagine s/he would fall under the implied consent category to treat/transport. The only out of hospital paperwork we honour is the TDH OOH DNR as far as advance directives are concerned. So I'm thinking you still would be in the clear for treating/transporting the patient even with that letter onscene. Regards, Alfonso R. Ochoa, NREMT-P > > I have a question for the group. Let me set the scenario. EMS makes a call > for an overdose/attempted suicide. Physician on scene called for EMS. You > arrive to find patient A & O x 0 and a original GCS of 9. Patient took a > large amount of a variety of pills including Cardizem and Plavix. EMS > treated patient and was asked by physician on the scene to transport to the > ER for gastric lavage. Now EMS has received a letter from the patient > stating " I did not request EMS or consent to the EMS services and I will not > be held responsible for them " What would be the appropriate reaction from > the EMS politically and legally to this person? > > > Ron A. Derrick, LP NREMT-P > Director of Emergency Services > City of Fredericksburg > > > > Quote
Guest guest Posted January 7, 2004 Report Posted January 7, 2004 That's a tough one, but my guess would be if this is a blatant suicide attempt and PD has put the patient under section 26, you can treat and transport said patient without worry. If this wasn't the case and the patient had a GCS of 9, I would imagine s/he would fall under the implied consent category to treat/transport. The only out of hospital paperwork we honour is the TDH OOH DNR as far as advance directives are concerned. So I'm thinking you still would be in the clear for treating/transporting the patient even with that letter onscene. Regards, Alfonso R. Ochoa, NREMT-P > > I have a question for the group. Let me set the scenario. EMS makes a call > for an overdose/attempted suicide. Physician on scene called for EMS. You > arrive to find patient A & O x 0 and a original GCS of 9. Patient took a > large amount of a variety of pills including Cardizem and Plavix. EMS > treated patient and was asked by physician on the scene to transport to the > ER for gastric lavage. Now EMS has received a letter from the patient > stating " I did not request EMS or consent to the EMS services and I will not > be held responsible for them " What would be the appropriate reaction from > the EMS politically and legally to this person? > > > Ron A. Derrick, LP NREMT-P > Director of Emergency Services > City of Fredericksburg > > > > Quote
Guest guest Posted January 7, 2004 Report Posted January 7, 2004 I think the question is is s/he responsible for the bill at this point? Ed Walsh LP Re: Refusal of Payment That's a tough one, but my guess would be if this is a blatant suicide attempt and PD has put the patient under section 26, you can treat and transport said patient without worry. If this wasn't the case and the patient had a GCS of 9, I would imagine s/he would fall under the implied consent category to treat/transport. The only out of hospital paperwork we honour is the TDH OOH DNR as far as advance directives are concerned. So I'm thinking you still would be in the clear for treating/transporting the patient even with that letter onscene. Regards, Alfonso R. Ochoa, NREMT-P > > I have a question for the group. Let me set the scenario. EMS makes a call > for an overdose/attempted suicide. Physician on scene called for EMS. You > arrive to find patient A & O x 0 and a original GCS of 9. Patient took a > large amount of a variety of pills including Cardizem and Plavix. EMS > treated patient and was asked by physician on the scene to transport to the > ER for gastric lavage. Now EMS has received a letter from the patient > stating " I did not request EMS or consent to the EMS services and I will not > be held responsible for them " What would be the appropriate reaction from > the EMS politically and legally to this person? > > > Ron A. Derrick, LP NREMT-P > Director of Emergency Services > City of Fredericksburg > > > > Quote
Guest guest Posted January 7, 2004 Report Posted January 7, 2004 I think the question is is s/he responsible for the bill at this point? Ed Walsh LP Re: Refusal of Payment That's a tough one, but my guess would be if this is a blatant suicide attempt and PD has put the patient under section 26, you can treat and transport said patient without worry. If this wasn't the case and the patient had a GCS of 9, I would imagine s/he would fall under the implied consent category to treat/transport. The only out of hospital paperwork we honour is the TDH OOH DNR as far as advance directives are concerned. So I'm thinking you still would be in the clear for treating/transporting the patient even with that letter onscene. Regards, Alfonso R. Ochoa, NREMT-P > > I have a question for the group. Let me set the scenario. EMS makes a call > for an overdose/attempted suicide. Physician on scene called for EMS. You > arrive to find patient A & O x 0 and a original GCS of 9. Patient took a > large amount of a variety of pills including Cardizem and Plavix. EMS > treated patient and was asked by physician on the scene to transport to the > ER for gastric lavage. Now EMS has received a letter from the patient > stating " I did not request EMS or consent to the EMS services and I will not > be held responsible for them " What would be the appropriate reaction from > the EMS politically and legally to this person? > > > Ron A. Derrick, LP NREMT-P > Director of Emergency Services > City of Fredericksburg > > > > Quote
Guest guest Posted January 7, 2004 Report Posted January 7, 2004 Alfonso, the difference is that a private hospital that maintains an emergency department is covered by EMTALA. EMS is not. So you can have an ambulance service that does not hold itself out as providing care to anyone. It's the " holding out " of a promise to serve that requires your acceptance of patients. Take, for example, private substance abuse hospitals. They are under no obligation to accept patients who cannot pay unless they advertise that they will do so. So a truly private service has no duty to serve anybody, but it's relatively easy to place yourself into a position of assuming a duty. GG Quote
Guest guest Posted January 7, 2004 Report Posted January 7, 2004 Contact your local justice of the peace for help in dealing with this person, or just drop it all they are saying is don't worry about your money cause you aren't never going get it, this is a game that these people play to keep from paying the ambulance bill. I don't know what they tell the hospital. This person is not the kind you want to get evolved with after the trans port if she was going to sue you she would have already had an attorney contact you not her, but if you have an attorney on retainer now would be a time to ask them for help with the client . Re: Refusal of Payment > That's a tough one, but my guess would be if this is a blatant suicide > attempt and PD has put the patient under section 26, you can treat and > transport said patient without worry. If this wasn't the case and the > patient had a GCS of 9, I would imagine s/he would fall under the > implied consent category to treat/transport. The only out of hospital > paperwork we honour is the TDH OOH DNR as far as advance directives > are concerned. So I'm thinking you still would be in the clear for > treating/transporting the patient even with that letter onscene. > > Regards, > > Alfonso R. Ochoa, NREMT-P > > > > > > I have a question for the group. Let me set the scenario. EMS > makes a call > > for an overdose/attempted suicide. Physician on scene called for > EMS. You > > arrive to find patient A & O x 0 and a original GCS of 9. Patient > took a > > large amount of a variety of pills including Cardizem and Plavix. > EMS > > treated patient and was asked by physician on the scene to transport > to the > > ER for gastric lavage. Now EMS has received a letter from the > patient > > stating " I did not request EMS or consent to the EMS services and I > will not > > be held responsible for them " What would be the appropriate > reaction from > > the EMS politically and legally to this person? > > > > > > Ron A. Derrick, LP NREMT-P > > Director of Emergency Services > > City of Fredericksburg > > > > > > > > Quote
Guest guest Posted January 7, 2004 Report Posted January 7, 2004 My guess would be yes, since she was treated/transported under the implied consent statute. Regards, Alfonso R. Ochoa, NREMT-P > > > > I have a question for the group. Let me set the scenario. EMS > makes a call > > for an overdose/attempted suicide. Physician on scene called for > EMS. You > > arrive to find patient A & O x 0 and a original GCS of 9. Patient > took a > > large amount of a variety of pills including Cardizem and Plavix. > EMS > > treated patient and was asked by physician on the scene to transport > to the > > ER for gastric lavage. Now EMS has received a letter from the > patient > > stating " I did not request EMS or consent to the EMS services and I > will not > > be held responsible for them " What would be the appropriate > reaction from > > the EMS politically and legally to this person? > > > > > > Ron A. Derrick, LP NREMT-P > > Director of Emergency Services > > City of Fredericksburg > > > > > > > > Quote
Guest guest Posted January 7, 2004 Report Posted January 7, 2004 Interesting concept, and it brings to mind an issue I had a conversation about not too long ago, with regards to refusals.... What happens to services who charge for refusals, when the patient didn't call? We get it all the time regarding 10-50 minors, family members spastic about other family members and calling 911 despite the repeated requests not to do so of the presumed patient? Who gets billed? Do you separate the billed vs. not billed according to who called? I look at it from a patient perspective, I didn't call you, didn't think I needed you and you came out here to tell me that you agreed with my own personal assessment of myself, and then sent me a bill for it? Not!! Just curious about other services perspective on this. Mike " Some days you're the dog, and some days you're the hydrant; pretty easy to figure out which is which. " Hatfield EMT-P Re: Refusal of Payment OK, some thoughts to help you analyze this situation: Assume that the patient is unconscious and unable to personally consent to treatment at all phases of his initial care. Would the physician's bill be payable? Would the hospital's bill be payable? Is there a public policy that favors provision of medical care to those who cannot consent in life threatening situations? Is there a concept in law called " implied consent? " What is the rationale for that concept? Does public policy favor allowing patients to commit suicide, or does it argue against it? If you get lost in the woods on U. S. Government land and require search teams to look for you for three days, including 50 mounted riders, 3 helicopters, 4 fixed wings, and 6 boats, not to mention 100+ rescuers on foot and 50 law enforcement officers, can you be made to pay the costs of your rescue even if you maintain that you would have found your way out alone if given time? GG Quote
Guest guest Posted January 7, 2004 Report Posted January 7, 2004 I would like to through out a question here. A doctor has the right to refuse treatment in his office if the patient has outstanding bills. Can an ambulance service, if it is a private corporation, providing 911 responses refuse the transport of a patient for the same reason? I assume no. I know about the duty to act, abandonment, and etcetera. I find it interesting that hospitals that do not accept government assistance can turn people away that are unable to pay and EMS can not. Ed Walsh LP Re: Refusal of Payment OK, some thoughts to help you analyze this situation: Assume that the patient is unconscious and unable to personally consent to treatment at all phases of his initial care. Would the physician's bill be payable? Would the hospital's bill be payable? Is there a public policy that favors provision of medical care to those who cannot consent in life threatening situations? Is there a concept in law called " implied consent? " What is the rationale for that concept? Does public policy favor allowing patients to commit suicide, or does it argue against it? If you get lost in the woods on U. S. Government land and require search teams to look for you for three days, including 50 mounted riders, 3 helicopters, 4 fixed wings, and 6 boats, not to mention 100 rescuers on foot and 50 law enforcement officers, can you be made to pay the costs of your rescue even if you maintain that you would have found your way out alone if given time? GG Quote
Guest guest Posted January 7, 2004 Report Posted January 7, 2004 I'm not so sure about that. Private, for-profit hospitals that provide emergency medical care cannot turn down a patient on the sole terms of their ability to pay. They can stick them in triage for 12 hours, but they still have to been seen. On the same token, if a private, for-profit ambulance service does not provide emergency, 911 services, they can deny whoever they want to be transported. If they do provide emergency services to a particular area, they have to care for them regardless of their ability to pay. Doctor's offices are a different story. The services they provide are generally not in emergency situations, so they can pick and choose their clientele. Regards, Alfonso R. Ochoa, NREMT-P > I would like to through out a question here. A doctor has the right to refuse treatment in his office if the patient has outstanding bills. > > Can an ambulance service, if it is a private corporation, providing 911 responses refuse the transport of a patient for the same reason? > > I assume no. I know about the duty to act, abandonment, and etcetera. > > I find it interesting that hospitals that do not accept government assistance can turn people away that are unable to pay and EMS can not. > > > Ed Walsh LP > > > Re: Refusal of Payment > > OK, some thoughts to help you analyze this situation: > > Assume that the patient is unconscious and unable to personally consent to > treatment at all phases of his initial care. > > Would the physician's bill be payable? > Would the hospital's bill be payable? > > Is there a public policy that favors provision of medical care to those who > cannot consent in life threatening situations? > > Is there a concept in law called " implied consent? " What is the rationale > for that concept? > > Does public policy favor allowing patients to commit suicide, or does it > argue against it? > > If you get lost in the woods on U. S. Government land and require search > teams to look for you for three days, including 50 mounted riders, 3 helicopters, > 4 fixed wings, and 6 boats, not to mention 100 rescuers on foot and 50 law > enforcement officers, can you be made to pay the costs of your rescue even if > you maintain that you would have found your way out alone if given time? > > GG > > > Quote
Guest guest Posted January 9, 2004 Report Posted January 9, 2004 implied consent - the assumtion that, in a true emergecny where a patient who is unresponsive or unable to make a retional decision is at significant risk of death, diability, or deterioration of condition, that patient would agree to emergency treatment. Ron Derrick wrote: I have a question for the group. Let me set the scenario. EMS makes a call for an overdose/attempted suicide. Physician on scene called for EMS. You arrive to find patient A & O x 0 and a original GCS of 9. Patient took a large amount of a variety of pills including Cardizem and Plavix. EMS treated patient and was asked by physician on the scene to transport to the ER for gastric lavage. Now EMS has received a letter from the patient stating " I did not request EMS or consent to the EMS services and I will not be held responsible for them " What would be the appropriate reaction from the EMS politically and legally to this person? Ron A. Derrick, LP NREMT-P Director of Emergency Services City of Fredericksburg Irlynda , EMT-P Random acts of kindness can profoundly affect someone's life, maybe even your own. Quote
Guest guest Posted January 9, 2004 Report Posted January 9, 2004 My question did not have to do with whether we can treat her or not. We did treat and transport her under implied consent. The question was that now the patient has refused to pay her bill stating she neither requested nor gave consent for treatment or transport, so she is not paying. How would you respond to this and what legal grounds do we have to stand on? Ron A. Derrick, LP NREMT-P Director of Emergency Services City of Fredericksburg Quote
Guest guest Posted January 9, 2004 Report Posted January 9, 2004 My knowledge has been that in a case like this you go to the person who initiated the call. If the doctor refuses to pay, which he probably will, then it will be a fight between her and her doctor. If he is her personal physician then there might be something there. I know the company I work for will not bill a call if the patient refuses to pay and the patient did not initiate the call or the call was not initiated from the residence. You may just have to write it off at the end of the year. RE: Refusal of Payment My question did not have to do with whether we can treat her or not. We did treat and transport her under implied consent. The question was that now the patient has refused to pay her bill stating she neither requested nor gave consent for treatment or transport, so she is not paying. How would you respond to this and what legal grounds do we have to stand on? Ron A. Derrick, LP NREMT-P Director of Emergency Services City of Fredericksburg Quote
Guest guest Posted January 9, 2004 Report Posted January 9, 2004 I believe there is also a new law that will allow you to place a lien on any property owned by the patient. I am not sure when it applies though, but it should be worth looking into. RE: Refusal of Payment My question did not have to do with whether we can treat her or not. We did treat and transport her under implied consent. The question was that now the patient has refused to pay her bill stating she neither requested nor gave consent for treatment or transport, so she is not paying. How would you respond to this and what legal grounds do we have to stand on? Ron A. Derrick, LP NREMT-P Director of Emergency Services City of Fredericksburg Quote
Guest guest Posted January 13, 2004 Report Posted January 13, 2004 Classic don't worry about your money client. You will never get paid, but go forward in the normal process that you usually go. I am assuming that this is what your question is about I thought we covered this last week. Next step is turn this particular case / client over to your attorney. Don't get involved your self , use caution. Re: Refusal of Payment > implied consent - the assumtion that, in a true emergecny where a patient who is unresponsive or unable to make a retional decision is at significant risk of death, diability, or deterioration of condition, that patient would agree to emergency treatment. > > Ron Derrick wrote: > I have a question for the group. Let me set the scenario. EMS makes a call > for an overdose/attempted suicide. Physician on scene called for EMS. You > arrive to find patient A & O x 0 and a original GCS of 9. Patient took a > large amount of a variety of pills including Cardizem and Plavix. EMS > treated patient and was asked by physician on the scene to transport to the > ER for gastric lavage. Now EMS has received a letter from the patient > stating " I did not request EMS or consent to the EMS services and I will not > be held responsible for them " What would be the appropriate reaction from > the EMS politically and legally to this person? > > > Ron A. Derrick, LP NREMT-P > Director of Emergency Services > City of Fredericksburg > > > > > > > Irlynda , EMT-P > > Random acts of kindness can profoundly affect someone's life, maybe even your own. > > > > > > > > Quote
Guest guest Posted January 13, 2004 Report Posted January 13, 2004 The lien can only be filed if the pt signs for approval of transport, billing, and agreement to pay section of the run ticket and this can not be wavered by friend medical support or next of kin family . RE: Refusal of Payment My question did not have to do with whether we can treat her or not. We did treat and transport her under implied consent. The question was that now the patient has refused to pay her bill stating she neither requested nor gave consent for treatment or transport, so she is not paying. How would you respond to this and what legal grounds do we have to stand on? Ron A. Derrick, LP NREMT-P Director of Emergency Services City of Fredericksburg Quote
Guest guest Posted January 14, 2004 Report Posted January 14, 2004 We have been filing liens for years, I have never heard of that, where did you get your information from? We file liens in MVC's and have increased our collection in that area to well over 90%, signatures or no signatures. RE: Refusal of Payment > > > My question did not have to do with whether we can treat her or not. We did > treat and transport her under implied consent. The question was that now > the patient has refused to pay her bill stating she neither requested nor > gave consent for treatment or transport, so she is not paying. How would > you respond to this and what legal grounds do we have to stand on? > > > > Ron A. Derrick, LP NREMT-P > Director of Emergency Services > City of Fredericksburg > > > > Quote
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