Re: Suicidal pts. revisted....

February 14, 2003

It just so happens that the CE article in the next Texas EMS will be a

further exploration on the subject of consent and refusal and in it I address

the problem of the patient threatening suicide who otherwise appears to have

an OK present mental capacity.

The bottom line is that these patients do NOT have the requisite present

mental capacity to refuse treatment and transport, and if you fail to

transport them you run the risk of civil liability for damages if they go out

and hurt themselves or somebody else. Remember that we're taught to think

that suicide patients can also be homicidal, and without a complete history

we don't usually have a good idea just what's bothering them to the point of

wanting to harm themselves. It's quite likely that they may also be planning

to take somebody else with them.

Texas law provides a remedy for that patient and it is Health and Safety Code

Chapter 573 which allows a law enforcement officer to arrest without a

warrant just this sort of person. That's where we get the legal power to

deal with them.

If your SO is reluctant to get involved, perhaps a gentle reminder that civil

liability extends to them individually also might get their attention. The

downside for SO and other LE officers is that an arrest under 573 starts a

series of events in motion which is long and involved, and I don't blame them

for not being thrilled about it, but there are lots of things about almost

any job that we may like less than other aspects. That doesn't mean that we

don't do our job.

A little research into the psychiatry and psychology books or websites will

soon show how the experts would testify against you if you got sued for such

a blunder. A patient who has suicidal ideation is sick and needs treatment

just as much as the acute renal failure patient needs treatment. Mental

disorders may be harder for some of us to sort out than purely somatic

disorders, but that doesn't mean they're not real disorders. In fact there

may be and probably is an organic element in the disorder. So we cannot

abandon a mental patient any more than we can abandon a physically sick

patient.

Hope this helps.

Gene

Gene Gandy, JD, LP

EMS Educator and Consultant

HillGandy Associates

POB 1651

Albany, TX 76430

cell:

wegandy@...

wegandy1938@...

February 15, 2003

Thanks Gene, that's what I needed.

Kathi

February 18, 2003

So, this brings up my question Gene--what if Law Enforcement refuses to arrest

the suicidal pt and you feel they ARE a danger to themselves, but they do not

want to go to the hospital via EMS or call anyone to take them? I've ran into

this situation more than once around here, even to the point of a suicidal pt

pulling a gun on me when the scene was " secured " by police before we ever

entered. I can't physically restrain someone who doesn't want to go to the

hospital, so what happens then? I've got a REAL problem with leaving someone

there because they are drunk and the cops dismiss them as " just an old drunk "

when they are threatening to harm themselves. Any help here would be greatly

appreciated because we run to this person's house a couple times a month.

Thanks...Dana

In a message dated 2/15/2003 12:06:40 AM Eastern Standard Time, wegandy1938

writes:

> It just so happens that the CE article in the next Texas EMS will be a

> further exploration on the subject of consent and refusal and in it I address

> the problem of the patient threatening suicide who otherwise appears to have

> an OK present mental capacity.

>

> The bottom line is that these patients do NOT have the requisite present

> mental capacity to refuse treatment and transport, and if you fail to

> transport them you run the risk of civil liability for damages if they go out

> and hurt themselves or somebody else. Remember that we're taught to think

> that suicide patients can also be homicidal, and without a complete history

> we don't usually have a good idea just what's bothering them to the point of

> wanting to harm themselves. It's quite likely that they may also be planning

> to take somebody else with them.

>

> Texas law provides a remedy for that patient and it is Health and Safety Code

> Chapter 573 which allows a law enforcement officer to arrest without a

> warrant just this sort of person. That's where we get the legal power to

> deal with them.

>

> If your SO is reluctant to get involved, perhaps a gentle reminder that civil

> liability extends to them individually also might get their attention. The

> downside for SO and other LE officers is that an arrest under 573 starts a

> series of events in motion which is long and involved, and I don't blame them

> for not being thrilled about it, but there are lots of things about almost

> any job that we may like less than other aspects. That doesn't mean that we

> don't do our job.

>

> A little research into the psychiatry and psychology books or websites will

> soon show how the experts would testify against you if you got sued for such

> a blunder. A patient who has suicidal ideation is sick and needs treatment

> just as much as the acute renal failure patient needs treatment. Mental

> disorders may be harder for some of us to sort out than purely somatic

> disorders, but that doesn't mean they're not real disorders. In fact there

> may be and probably is an organic element in the disorder. So we cannot

> abandon a mental patient any more than we can abandon a

> physically sick

> patient.

>

> Hope this helps.

February 18, 2003

This is a problem that should be worked out between your highest level and

the PD or SO's highest level. In this instance LE is endangering not only

you, your patient, and the public but they are setting themselves up for a

lot of grief if the patient were to actually suicide or hurt someone else.

The least would be terrible publicity, and depending on the circumstances

they might be liable for damages although there are several layers of

immunity that would have to be cut through before that might happen.

Nevertheless, this LE agency is displaying gross ignorance of its duty and

creating an intolerable situation. When you are on-scene, the only thing

you can do is try to pursuade, call a supervisor to the scene, ask for a

police supervisor, get your medical director directly involved by radio and

try to get the cop to talk to her or him, and document, document, document.

GG

In a message dated 2/18/2003 10:58:14 AM Central Standard Time,

nails504@... writes:

> Subj: Re: Suicidal pts. revisted....

> Date: 2/18/2003 10:58:14 AM Central Standard Time

> From: <A HREF= " mailto:nails504@... " >nails504@...</A>

> Reply-to: <A

HREF= " mailto: " > </A>

> To: <A

HREF= " mailto: " > </A>

> Sent from the Internet

>

> So, this brings up my question Gene--what if Law Enforcement refuses to

> arrest the suicidal pt and you feel they ARE a danger to themselves, but

> they do not want to go to the hospital via EMS or call anyone to take them?

> I've ran into this situation more than once around here, even to the point

> of a suicidal pt pulling a gun on me when the scene was " secured " by police

> before we ever entered. I can't physically restrain someone who doesn't

> want to go to the hospital, so what happens then? I've got a REAL problem

> with leaving someone there because they are drunk and the cops dismiss them

> as " just an old drunk " when they are threatening to harm themselves. Any

> help here would be greatly appreciated because we run to this person's

> house a couple times a month.

>

> Thanks...Dana

>

> In a message dated 2/15/2003 12:06:40 AM Eastern Standard Time, wegandy1938

> writes:

>

> >It just so happens that the CE article in the next Texas EMS will be a

> >further exploration on the subject of consent and refusal and in it I

> address

> >the problem of the patient threatening suicide who otherwise appears to

> have

> >an OK present mental capacity.

> >

> >The bottom line is that these patients do NOT have the requisite present

> >mental capacity to refuse treatment and transport, and if you fail to

> >transport them you run the risk of civil liability for damages if they go

> out

> >and hurt themselves or somebody else. Remember that we're taught to think

>

> >that suicide patients can also be homicidal, and without a complete

> history

> >we don't usually have a good idea just what's bothering them to the point

> of

> >wanting to harm themselves. It's quite likely that they may also be

> planning

> >to take somebody else with them.

> >

> >Texas law provides a remedy for that patient and it is Health and Safety

> Code

> >Chapter 573 which allows a law enforcement officer to arrest without a

> >warrant just this sort of person. That's where we get the legal power to

> >deal with them.

> >

> >If your SO is reluctant to get involved, perhaps a gentle reminder that

> civil

> >liability extends to them individually also might get their attention.

> The

> >downside for SO and other LE officers is that an arrest under 573 starts a

>

> >series of events in motion which is long and involved, and I don't blame

> them

> >for not being thrilled about it, but there are lots of things about

> almost

> >any job that we may like less than other aspects. That doesn't mean that

> we

> >don't do our job.

> >

> >A little research into the psychiatry and psychology books or websites

> will

> >soon show how the experts would testify against you if you got sued for

> such

> >a blunder. A patient who has suicidal ideation is sick and needs

> treatment

> >just as much as the acute renal failure patient needs treatment. Mental

> >disorders may be harder for some of us to sort out than purely somatic

> >disorders, but that doesn't mean they're not real disorders. In fact

> there

> >may be and probably is an organic element in the disorder. So we cannot

> >abandon a mental patient any more than we can abandon a

> >physically sick

> >patient.

> >

> >Hope this helps.

>

February 18, 2003

I had a patient refusing transport (not suicidal) for himself and his minor

child after an auto accident. LE refused to step in despite the child

having visible injuries and a decreased LOC. Our on-line medical control

had us put the LE on the phone and informed him that if he did not at least

put the child in protective custody to allow us to transport, that the doc

himself would charge the LE with child endangerment. (BTW, the parent then

agreed to go and turned out to have C-3 and C-4 fractures. He later

thanked us for being insistent.) There are ways your on-line docs can help.

At 06:59 PM 2/18/2003, you wrote:

>This is a problem that should be worked out between your highest level and

>the PD or SO's highest level. In this instance LE is endangering not only

>you, your patient, and the public but they are setting themselves up for a

>lot of grief if the patient were to actually suicide or hurt someone else.

>The least would be terrible publicity, and depending on the circumstances

>they might be liable for damages although there are several layers of

>immunity that would have to be cut through before that might happen.

>

>Nevertheless, this LE agency is displaying gross ignorance of its duty and

>creating an intolerable situation. When you are on-scene, the only thing

>you can do is try to pursuade, call a supervisor to the scene, ask for a

>police supervisor, get your medical director directly involved by radio and

>try to get the cop to talk to her or him, and document, document, document.

>

>GG

>

>In a message dated 2/18/2003 10:58:14 AM Central Standard Time,

>nails504@... writes:

>

> > Subj: Re: Suicidal pts. revisted....

> > Date: 2/18/2003 10:58:14 AM Central Standard Time

> > From: <A HREF= " mailto:nails504@... " >nails504@...</A>

> > Reply-to: <A

> HREF= " mailto: " > </A>

> > To: <A

> HREF= " mailto: " > </A>

> > Sent from the Internet

> >

> > So, this brings up my question Gene--what if Law Enforcement refuses to

> > arrest the suicidal pt and you feel they ARE a danger to themselves, but

> > they do not want to go to the hospital via EMS or call anyone to take

> them?

> > I've ran into this situation more than once around here, even to the

> point

> > of a suicidal pt pulling a gun on me when the scene was " secured " by

> police

> > before we ever entered. I can't physically restrain someone who doesn't

> > want to go to the hospital, so what happens then? I've got a REAL problem

> > with leaving someone there because they are drunk and the cops dismiss

> them

> > as " just an old drunk " when they are threatening to harm themselves. Any

> > help here would be greatly appreciated because we run to this person's

> > house a couple times a month.

> >

> > Thanks...Dana

Jo Bell EMT-P

February 18, 2003

I suggest that if the pt actually refuses to allow transport and the officer

will not arrests them that the pt with a god lawyer could prove you unlawfully

restrained him you are not bound or protected by Vernon's civil code as an

officer of the law. So document that the officer refused to arrest the pt and

politely ask the pt to sign the refusal form after advising him of the

consequences and document document document. you could wind up in court either

way. Remember the local county judge in Texas sets protocol for altered mental

status forced transportation so your agency might want to meet with him before

hand and find out exactly how the judicial agency is going to stand with or

against you in a given situation in your county.