Re: NWTHS money woes stri ke paramedics

[Guest guest]

Personal opinion. The hospital, and I am talking at the corporate level; has

systematically eliminated EMS from all of their other hospitals, or so I have

been told. Amarillo is a strange bird (Talk to Terry B. about that).

NWTH wants to have someone else do EMS, but they want to keep their " hand in

the pie " so to speak as well. This is probably a move to help the management

in Amarillo change their way of doing things by hitting the troops.

I don't believe that failure to take care of a patient at your certification

level can be defended by " But I am only paid as a Basic and told that I don't

have to do anything other than Basic duties. "

It will be interesting to see how EMS here in the panhandle changes as things

progress.

Danny L.

Owner/NREMT-P

Panhandle Emergency Training Services And Response

(PETSAR)

Office

FAX

[Guest guest]

Personal opinion. The hospital, and I am talking at the corporate level; has

systematically eliminated EMS from all of their other hospitals, or so I have

been told. Amarillo is a strange bird (Talk to Terry B. about that).

NWTH wants to have someone else do EMS, but they want to keep their " hand in

the pie " so to speak as well. This is probably a move to help the management

in Amarillo change their way of doing things by hitting the troops.

I don't believe that failure to take care of a patient at your certification

level can be defended by " But I am only paid as a Basic and told that I don't

have to do anything other than Basic duties. "

It will be interesting to see how EMS here in the panhandle changes as things

progress.

Danny L.

Owner/NREMT-P

Panhandle Emergency Training Services And Response

(PETSAR)

Office

FAX

[Guest guest]

BSA operates a 911 service for the City of Canyon and the surrounding Randall

County area. They are allowed to do certain transfers only per an

arrangement with AMS/NWTH per my understanding. BSA is not allowed to run 911

within

the city limits of Amarillo.

Danny L.

Owner/NREMT-P

Panhandle Emergency Training Services And Response

(PETSAR)

Office

FAX

[Guest guest]

In a message dated 5/14/2004 11:27:10 AM Central Daylight Time,

jerry.findley@... writes:

If I understand correctly, a paramedic can only function as a basic. Mr.

Gandy, how does this effect liability?

Jerry S. Findley BS, LP

This is an interesting question. I haven't researched this but I do not

recall ever seeing a case where a medic was sued for failure to perform

paramedic

skills when prevented from doing so by the employer.

Issues that come to mind immediately are these:

1. Standard of Care is generally stated to be " that sort of care that would

be rendered by a reasonable and prudent Paramedic with the same or similar

level of training and experience, in the same or similar circumstances. "

However, since Paramedics are unlicensed (regardless of what we call them) and

have

only that scope of practice delegated to them by their medical director, if the

MEDICAL DIRECTOR sees fit to limit them to certain skills, how can the medic

be held responsible?

Would the medical director face liability? Possibly. I would sue the

medical director along with medics, the service's administrators, the hospital

administrator, and the corporation and its board of directors individually.

Sue em all and let God sort em out, or in this case, the jury. The theory would

be that they adopted a system designed to discourage the standard of care

from being delivered, and that they formed a conspiracy to violate the patient's

rights to receive standard of care by creating an environment in which the

medic could not function at his level of certification.

The defense would counter that medics can only practice those skills that

the medical director allows them to practice and that there is nothing in law

that requires any level of care to be provided, period; that the rendering of

Paramedic level care is purely optional and not required.

The counter-defense would be that the public has a right to expect

certain standards, that the public lacks the power or the expertise to determine

the

standards that are provided by a service, and that they rely upon the service

to provide the best care available, and that the service does have the

control and expertise to determine the level to be provided, and that level

should

be the same whether in Amarillo or Beaumont. This is a theory based upon the

principal of estoppel, which basically says that if you encourage someone to

rely upon a certain performance and fail to render that performance, you're

liable.

2. If the Medical Director sees fit to allow Paramedics to function at their

level of certification regardless of their pay status, then I would expect

that the Paramedic would function at that level.

The defense that " I didn't intubate the patient because I'm not being

paid to do it, although I had the skill to do it and could have " is rather lame,

in my judgment. The " not being paid defense typically inflames the jury. "

However, the medic might attempt to throw all the blame on the administrators of

the system and inflame the jury against them. Possibly a winning tactic.

3. If the company seeks to limit the procedures that could be done by

Paramedics being paid at the basic EMT level, might they be liable for breach of

standard of care? A good argument could possibly be made here. I'd bring in

experts to show that Paramedic level of care often requires two Paramedics; I'd

cite Jack Stout's insistence on two medics on each truck, and so forth. Of

course, there are many, many examples of great service from Basic/Paramedic

crews, so that's not a terribly strong argument. In the end, the jury is the

body

that determines what standard of care really is and what standard to hold the

defendants to.

4. If the company says it will " allow " the medic to perform at the Paramedic

level but only wants to pay as a basic EMT, can the Paramedic refuse to

render care above that level? Would the fact that she's only being paid at the

Basic EMT level be a defense in a suit for failure to provide the standard of

care required if the patient's well-being required an advanced airway procedure,

for example, and the other medic was unable to do it?

This would not be a sympathetic position to take. Juries don't like people

who make decisions about human life based upon monetary considerations. This

is why juries return ridiculous awards sometimes, because they are enraged at

the defendant's conduct and wish to punish and send a message. The medic would

be well advised to find a job functioning at her Paramedic level of skills.

5. Will TDH or whatever it will be called seek to discipline a medic who

refused to do an advanced procedure needed by the patient because he is only

being paid as a Basic?

If you fail to do something needed, and that failure results in harm to the

patient, I think the Rules certainly allow for discipline. Will they do it?

Will they do ANYTHING after September 1?

6. Will a Paramedic who elects not to perform advanced skills because he is

filling a Basic slot be liable for breach of standard of care if a patient can

prove injury?

Unless he is prevented from doing so by the medical director, I would say

there's a decent chance that liability could be found.

7. If a Paramedic is found to be liable for breach for failing to function

beyond the Basic level, can he win a 3rd party suit against the service if the

service has demoted him the Basic level for pay purposes?

He would undoubtedly join the company as a 3rd party defendant and allege

that the company's policies were the reason and cause of his actions or

inactions. It's a tough case to win, but one might win it. The community would

make

all the difference and the sentiments of the jury pool would be the deciding

factor.

8. Would any Paramedic agreeing to work as a Basic and refusing to perform

higher level skills without pay be liable for failure to deliver standard of

care? Would the fact that he was only being paid as a basic be a defense?

I doubt the validity of that defense. Better to find another job.

These and about 50 other issues that we could come up with in the next few

minutes are troublesome and difficult to sort out. I know of other services

that have restricted Paramedics to lower performance levels based upon

availability of Paramedic slots. I have never heard of these issues being

litigated.

I would hope that someone would sue the hospital corporation if an incident

occurs where it can be proved that had the Paramedic performed an advanced

skill the injury would not have occurred. This is a novel theory and should be

litigated for an answer. A very difficult fact situation to prove, however; and

not a fact situation that arises often.

Would I accept a job doing only Basic EMT skills? No way. I would not

advise any Paramedic to do so, for the obvious reasons as stated above. I think

that a Paramedic who wants to function at the Basic EMT level should give up his

Paramedic certification or license and revert to Basic certification. Then

he would have a legal reason for failure to function at a higher level.

On the other hand, as I have recently written, it is my considered judgment

that we will see much more of this kind of cost cutting. However, if I were an

employer, I would be sure that I only hired people certified at the Basic

level if that's the level that I intend to pay for.

No Paramedic should agree to work under such circumstances. The risks are

just too great. If I chose to do that, I'd buy as much malpractice insurance as

I could afford; at least enough to try to buy a settlement.

The hospital administrator is, of course, correct that many patients do not

need Paramedic level care. They only need transport. Thus, the proliferation

of so-called " Gurney Cars " in Texas. These have been used extensively in

California and Arizona for many years, and they are now coming to Texas. I

personally abhor the very thought and wouldn't allow my pet tomcat to be

transported

in one of them, but there are plenty of people who don't know any better and

most of the time the transports can be done without incident. This is the

familiar " horizontal taxi " service.

Bottom line for me: A Paramedic has no business limiting his functions to

the Basic level. I would not do so, and I think that good arguments can be

made that breach of standard of care has occurred if a patient suffers injury

from failure of the EMT to use his advanced skills; however, that's a big IF,

because it's hard to prove the negative in court: that is, that the patient

would have benefited from an advanced procedure. We can hardly prove that

anything we do makes any difference from a scientific standpoint.

This is a very difficult problem. It's a non-sequitor to compare Paramedic

practice with that of a Physician in a hypothetical situation where the

Physician chose to function at a lower level. The Physician has the power to

practice independently and is held to the general standards of a physician of

his

type. I think any physician who chose to practice at the same level as an LVN,

for example (no offense to LVNs) could easily be shown to have violated the

SOC. But Paramedics have only the SOC determined by the medical director. So

what if the medical director refuses to allow the Paramedic to use advanced

skills? A big, terrible can of worms. I don't know the answer.

We'll all stay tuned for the next exciting episode, which I would hope would

be a legal challenge from somebody or other. A court ruling one way or

another might give us some guidance.

Gene G.

[Guest guest]

Thanks for the info Danny. From the article it seemed like the AMS was a

transfer only service, for which the QA hit of a split crew may have been

more paletable. But, if they are also doing the 911 then that's a duck of

different color.

Another question may be, and I'm sure it's been addressed before, what is

the liability in limiting a paramedic to their BLS skills? Particularly when

the employee was working as a paramedic and thusly approved by the employer

to provide that level of care. It would seem that would be a possible

concern since the downgrade is due to finances and not questions of clinical

competency for the individual employees. Could they downgrade an MD to a PA

or Nurse Practioner? Or MDs to RNs and RNs to LVNs as part of a cost

containment strategy?

Personally, I like split crews (speaking as an EMT). It seems as a cost

effective option when growing a service or for specific applications (some

transfers, stand-bys, special events, etc). It's also a good tool in

developing staff because your basics are exposed to the ALS and can assist

in certain instances, which can make them hungry for more, thus leading them

towards the paramedic patch. But I'm not too hip on creating split crews by

downgrading positions that are currently filled at a higher level. Other

than saving dollars I can't see too many up sides to this kind of move.

Just my $0.02 worth. Barry

[Guest guest]

Thanks for the info Danny. From the article it seemed like the AMS was a

transfer only service, for which the QA hit of a split crew may have been

more paletable. But, if they are also doing the 911 then that's a duck of

different color.

Another question may be, and I'm sure it's been addressed before, what is

the liability in limiting a paramedic to their BLS skills? Particularly when

the employee was working as a paramedic and thusly approved by the employer

to provide that level of care. It would seem that would be a possible

concern since the downgrade is due to finances and not questions of clinical

competency for the individual employees. Could they downgrade an MD to a PA

or Nurse Practioner? Or MDs to RNs and RNs to LVNs as part of a cost

containment strategy?

Personally, I like split crews (speaking as an EMT). It seems as a cost

effective option when growing a service or for specific applications (some

transfers, stand-bys, special events, etc). It's also a good tool in

developing staff because your basics are exposed to the ALS and can assist

in certain instances, which can make them hungry for more, thus leading them

towards the paramedic patch. But I'm not too hip on creating split crews by

downgrading positions that are currently filled at a higher level. Other

than saving dollars I can't see too many up sides to this kind of move.

Just my $0.02 worth. Barry

[Guest guest]

Thanks for the info Danny. From the article it seemed like the AMS was a

transfer only service, for which the QA hit of a split crew may have been

more paletable. But, if they are also doing the 911 then that's a duck of

different color.

Another question may be, and I'm sure it's been addressed before, what is

the liability in limiting a paramedic to their BLS skills? Particularly when

the employee was working as a paramedic and thusly approved by the employer

to provide that level of care. It would seem that would be a possible

concern since the downgrade is due to finances and not questions of clinical

competency for the individual employees. Could they downgrade an MD to a PA

or Nurse Practioner? Or MDs to RNs and RNs to LVNs as part of a cost

containment strategy?

Personally, I like split crews (speaking as an EMT). It seems as a cost

effective option when growing a service or for specific applications (some

transfers, stand-bys, special events, etc). It's also a good tool in

developing staff because your basics are exposed to the ALS and can assist

in certain instances, which can make them hungry for more, thus leading them

towards the paramedic patch. But I'm not too hip on creating split crews by

downgrading positions that are currently filled at a higher level. Other

than saving dollars I can't see too many up sides to this kind of move.

Just my $0.02 worth. Barry

[Guest guest]

If I understand correctly, a paramedic can only function as a basic. Mr.

Gandy, how does this effect liability?

Jerry S. Findley BS, LP

Re: NWTHS money woes stri ke paramedics

BSA operates a 911 service for the City of Canyon and the surrounding

Randall

County area. They are allowed to do certain transfers only per an

arrangement with AMS/NWTH per my understanding. BSA is not allowed to run

911 within

the city limits of Amarillo.

Danny L.

Owner/NREMT-P

Panhandle Emergency Training Services And Response

(PETSAR)

Office

FAX

[Guest guest]

If I understand correctly, a paramedic can only function as a basic. Mr.

Gandy, how does this effect liability?

Jerry S. Findley BS, LP

Re: NWTHS money woes stri ke paramedics

BSA operates a 911 service for the City of Canyon and the surrounding

Randall

County area. They are allowed to do certain transfers only per an

arrangement with AMS/NWTH per my understanding. BSA is not allowed to run

911 within

the city limits of Amarillo.

Danny L.

Owner/NREMT-P

Panhandle Emergency Training Services And Response

(PETSAR)

Office

FAX

[Guest guest]

If I understand correctly, a paramedic can only function as a basic. Mr.

Gandy, how does this effect liability?

Jerry S. Findley BS, LP

Re: NWTHS money woes stri ke paramedics

BSA operates a 911 service for the City of Canyon and the surrounding

Randall

County area. They are allowed to do certain transfers only per an

arrangement with AMS/NWTH per my understanding. BSA is not allowed to run

911 within

the city limits of Amarillo.

Danny L.

Owner/NREMT-P

Panhandle Emergency Training Services And Response

(PETSAR)

Office

FAX