Patient Refusal Forms of Little Value

[Guest guest]

City to pay $100,000 in death

Medics should have advised woman to go to hospital

By Mark Ferenchik

The Columbus Dispatch

Tuesday, September 19, 2006 12:01 AM

More than six years ago, 37-year-old Goldie Beck woke up in the middle of

the night in her Hilltop home with chest pains and shortness of breath.

Her husband called Columbus paramedics, who ran tests that proved

inconclusive. She signed a waiver declining to go to the hospital. The

medics told her to eat some bread and take Rolaids, her attorney said.

Beck died of a heart attack less than an hour after medics left. Now the

city will be paying $100,000 because medics did not follow correct protocol,

City Attorney C. Pfeiffer said.

The Columbus City Council approved the lawsuit settlement to her husband,

Beck, yesterday.

After paramedics arrived at 3:52 a.m. on May 27, 2000, they ran an

electrocardiogram, which showed nothing, Columbus Public Safety Director

J. Brown said.

Beck's attorney, Blue, said paramedics told her she didn't need to go

to the hospital. Pfeiffer told the council yesterday that Mrs. Beck did sign

a refusal to transport, but that medics should have advised her to go to the

hospital.

" That was not done, " Pfeiffer said.

Jack Reall, president of the Columbus firefighters union, said he's not

familiar with the case. But he said that medics do not refuse

transportation.

" If it doesn't show anything on the EKG, it's very difficult to give someone

a definitive answer, " Reall said.

" It's up to you. If you want to go to the hospital, we'll take you to the

hospital of your choice. It's not a position where we want to strong-arm

anyone. "

[Guest guest]

I believe that I have written extensively on this topic recently. I think

it was also on this list, but if not, let me know and I will repeat it.

Refusals must contain certain specific factual information or they are no good.

Most of them are conclusionary only.

Gene G.

>

> She signed a patient refusal form and the city still had to pay $100,000.00.

> She refused treatment it would appear. I have seen, on many occasions,

> patients sign refusal forms only to say later they did not understand them,

> were coerced into signing them, or similar reasons. In every case, including

> one not that long ago in Dallas, the jury or judge sided with the patient.

> The US legal system goes to great lengths to protect idiots from signing

> away their rights.

>

> _____

>

> From: texasems-l@yahoogrotexasem [mailto:texasems-l@yahoogrotexasem] On

> Behalf Of Danny

> Sent: Friday, September 22, 2006 8:31 AM

> To: texasems-l@yahoogrotexasem

> Subject: Re: Patient Refusal Forms of Little Value

>

> Where is it that the Patient refusal forms were the failure?

>

> The medics, just from the news article; appear to have not done a proper

> assessment and then gave advice they should have refrained from giving.

>

> This would be another reason for writing a narrative with the refusal form,

> in my opinion.

>

> Here is the problem as I see it:

>

> 1) All patients should go to the hospital who wish to.

>

> 2) All patients should have a proper assessment every time. Complacency is

> where the problem begins.

>

> 3) All patients should have the ability to refuse treatment.

>

> 4) All EMS personnel should understand that not everyone we see will tell us

> everything everytime. Suspect the worst and hope for the best.

>

> 5) Supervisors should do just that, SUPERVISE.

>

> My Opinion this morning which is probably not everyones.

>

> Why do we blame the equipment when it appears to be an operator problem?

>

> " Bledsoe, DO " <bbledsoe@earthlinkbb<mailto:bbledsoe%mailto:bbledmai>

> net> wrote:

> City to pay $100,000 in death

>

> Medics should have advised woman to go to hospital

>

> By Mark Ferenchik

>

> The Columbus Dispatch

>

> Tuesday, September 19, 2006 12:01 AM

>

> More than six years ago, 37-year-old Goldie Beck woke up in the middle of

> the night in her Hilltop home with chest pains and shortness of breath.

>

> Her husband called Columbus paramedics, who ran tests that proved

> inconclusive. She signed a waiver declining to go to the hospital. The

> medics told her to eat some bread and take Rolaids, her attorney said.

>

> Beck died of a heart attack less than an hour after medics left. Now the

> city will be paying $100,000 because medics did not follow correct protocol,

> City Attorney C. Pfeiffer said.

>

> The Columbus City Council approved the lawsuit settlement to her husband,

> Beck, yesterday.

>

> After paramedics arrived at 3:52 a.m. on May 27, 2000, they ran an

> electrocardiogram, which showed nothing, Columbus Public Safety Director

> J. Brown said.

>

> Beck's attorney, Blue, said paramedics told her she didn't need to go

> to the hospital. Pfeiffer told the council yesterday that Mrs. Beck did sign

> a refusal to transport, but that medics should have advised her to go to the

> hospital.

>

> " That was not done, " Pfeiffer said.

>

> Jack Reall, president of the Columbus firefighters union, said he's not

> familiar with the case. But he said that medics do not refuse

> transportation.

>

> " If it doesn't show anything on the EKG, it's very difficult to give someone

> a definitive answer, " Reall said.

>

> " It's up to you. If you want to go to the hospital, we'll take you to the

> hospital of your choice. It's not a position where we want to strong-arm

> anyone. "

>

>

[Guest guest]

I suspect you're talking about Dallas. I could buy my own private island

with a 747 to transport me back and forth with all them money they have paid in

damages.

Paramedic instituted refusals are a recipe for lawsuit.

Gene G.

>

> Paramedic lead refusals always fail. There is an urban EMS in North

> Texas that provides paramedic lead refusals which have lead to many

> deaths and lawsuits, but they are still carried out. Just transport -

> it's just easier that way...

>

> -MH

>

> >>> Danny <petsardlj@sbcglobalpets> 9/22/2006 8:31 am >>>

> Where is it that the Patient refusal forms were the failure?

>

> The medics, just from the news article; appear to have not done a

> proper assessment and then gave advice they should have refrained from

> giving.

>

> This would be another reason for writing a narrative with the refusal

> form, in my opinion.

>

> Here is the problem as I see it:

>

> 1) All patients should go to the hospital who wish to.

>

> 2) All patients should have a proper assessment every time.

> Complacency is where the problem begins.

>

> 3) All patients should have the ability to refuse treatment.

>

> 4) All EMS personnel should understand that not everyone we see will

> tell us everything everytime. Suspect the worst and hope for the best.

>

> 5) Supervisors should do just that, SUPERVISE.

>

> My Opinion this morning which is probably not everyones.

>

> Why do we blame the equipment when it appears to be an operator

> problem?

>

>

> " Bledsoe, DO " wrote:

> City to pay $100,000 in death

>

> Medics should have advised woman to go to hospital

>

> By Mark Ferenchik

>

> The Columbus Dispatch

>

> Tuesday, September 19, 2006 12:01 AM

>

> More than six years ago, 37-year-old Goldie Beck woke up in the middle

> of

> the night in her Hilltop home with chest pains and shortness of

> breath.

>

> Her husband called Columbus paramedics, who ran tests that proved

> inconclusive. She signed a waiver declining to go to the hospital. The

> medics told her to eat some bread and take Rolaids, her attorney said.

>

> Beck died of a heart attack less than an hour after medics left. Now

> the

> city will be paying $100,000 because medics did not follow correct

> protocol,

> City Attorney C. Pfeiffer said.

>

> The Columbus City Council approved the lawsuit settlement to her

> husband,

> Beck, yesterday.

>

> After paramedics arrived at 3:52 a.m. on May 27, 2000, they ran an

> electrocardiogram, which showed nothing, Columbus Public Safety

> Director

> J. Brown said.

>

> Beck's attorney, Blue, said paramedics told her she didn't need

> to go

> to the hospital. Pfeiffer told the council yesterday that Mrs. Beck did

> sign

> a refusal to transport, but that medics should have advised her to go

> to the

> hospital.

>

> " That was not done, " Pfeiffer said.

>

> Jack Reall, president of the Columbus firefighters union, said he's

> not

> familiar with the case. But he said that medics do not refuse

> transportation.

>

> " If it doesn't show anything on the EKG, it's very difficult to give

> someone

> a definitive answer, " Reall said.

>

> " It's up to you. If you want to go to the hospital, we'll take you to

> the

> hospital of your choice. It's not a position where we want to

> strong-arm

> anyone. "

>

>

[Guest guest]

Where is it that the Patient refusal forms were the failure?

The medics, just from the news article; appear to have not done a proper

assessment and then gave advice they should have refrained from giving.

This would be another reason for writing a narrative with the refusal form, in

my opinion.

Here is the problem as I see it:

1) All patients should go to the hospital who wish to.

2) All patients should have a proper assessment every time. Complacency is

where the problem begins.

3) All patients should have the ability to refuse treatment.

4) All EMS personnel should understand that not everyone we see will tell us

everything everytime. Suspect the worst and hope for the best.

5) Supervisors should do just that, SUPERVISE.

My Opinion this morning which is probably not everyones.

Why do we blame the equipment when it appears to be an operator problem?

" Bledsoe, DO " wrote:

City to pay $100,000 in death

Medics should have advised woman to go to hospital

By Mark Ferenchik

The Columbus Dispatch

Tuesday, September 19, 2006 12:01 AM

More than six years ago, 37-year-old Goldie Beck woke up in the middle of

the night in her Hilltop home with chest pains and shortness of breath.

Her husband called Columbus paramedics, who ran tests that proved

inconclusive. She signed a waiver declining to go to the hospital. The

medics told her to eat some bread and take Rolaids, her attorney said.

Beck died of a heart attack less than an hour after medics left. Now the

city will be paying $100,000 because medics did not follow correct protocol,

City Attorney C. Pfeiffer said.

The Columbus City Council approved the lawsuit settlement to her husband,

Beck, yesterday.

After paramedics arrived at 3:52 a.m. on May 27, 2000, they ran an

electrocardiogram, which showed nothing, Columbus Public Safety Director

J. Brown said.

Beck's attorney, Blue, said paramedics told her she didn't need to go

to the hospital. Pfeiffer told the council yesterday that Mrs. Beck did sign

a refusal to transport, but that medics should have advised her to go to the

hospital.

" That was not done, " Pfeiffer said.

Jack Reall, president of the Columbus firefighters union, said he's not

familiar with the case. But he said that medics do not refuse

transportation.

" If it doesn't show anything on the EKG, it's very difficult to give someone

a definitive answer, " Reall said.

" It's up to you. If you want to go to the hospital, we'll take you to the

hospital of your choice. It's not a position where we want to strong-arm

anyone. "

[Guest guest]

She signed a patient refusal form and the city still had to pay $100,000.00.

She refused treatment it would appear. I have seen, on many occasions,

patients sign refusal forms only to say later they did not understand them,

were coerced into signing them, or similar reasons. In every case, including

one not that long ago in Dallas, the jury or judge sided with the patient.

The US legal system goes to great lengths to protect idiots from signing

away their rights.

_____

From: texasems-l [mailto:texasems-l ] On

Behalf Of Danny

Sent: Friday, September 22, 2006 8:31 AM

To: texasems-l

Subject: Re: Patient Refusal Forms of Little Value

Where is it that the Patient refusal forms were the failure?

The medics, just from the news article; appear to have not done a proper

assessment and then gave advice they should have refrained from giving.

This would be another reason for writing a narrative with the refusal form,

in my opinion.

Here is the problem as I see it:

1) All patients should go to the hospital who wish to.

2) All patients should have a proper assessment every time. Complacency is

where the problem begins.

3) All patients should have the ability to refuse treatment.

4) All EMS personnel should understand that not everyone we see will tell us

everything everytime. Suspect the worst and hope for the best.

5) Supervisors should do just that, SUPERVISE.

My Opinion this morning which is probably not everyones.

Why do we blame the equipment when it appears to be an operator problem?

" Bledsoe, DO " <bbledsoe (AT) earthlink (DOT) <mailto:bbledsoe%40earthlink.net>

net> wrote:

City to pay $100,000 in death

Medics should have advised woman to go to hospital

By Mark Ferenchik

The Columbus Dispatch

Tuesday, September 19, 2006 12:01 AM

More than six years ago, 37-year-old Goldie Beck woke up in the middle of

the night in her Hilltop home with chest pains and shortness of breath.

Her husband called Columbus paramedics, who ran tests that proved

inconclusive. She signed a waiver declining to go to the hospital. The

medics told her to eat some bread and take Rolaids, her attorney said.

Beck died of a heart attack less than an hour after medics left. Now the

city will be paying $100,000 because medics did not follow correct protocol,

City Attorney C. Pfeiffer said.

The Columbus City Council approved the lawsuit settlement to her husband,

Beck, yesterday.

After paramedics arrived at 3:52 a.m. on May 27, 2000, they ran an

electrocardiogram, which showed nothing, Columbus Public Safety Director

J. Brown said.

Beck's attorney, Blue, said paramedics told her she didn't need to go

to the hospital. Pfeiffer told the council yesterday that Mrs. Beck did sign

a refusal to transport, but that medics should have advised her to go to the

hospital.

" That was not done, " Pfeiffer said.

Jack Reall, president of the Columbus firefighters union, said he's not

familiar with the case. But he said that medics do not refuse

transportation.

" If it doesn't show anything on the EKG, it's very difficult to give someone

a definitive answer, " Reall said.

" It's up to you. If you want to go to the hospital, we'll take you to the

hospital of your choice. It's not a position where we want to strong-arm

anyone. "

[Guest guest]

Remember that we are getting facts from the media, certainly not the most

accurate source.

Who is to say that it was the medics fault? Who is to say that they didn't

do a proper assessment, inform her that she should go to the ER and be

checked out? That it was her idea to eat bread and follow up with her PMD?

We'll never know now, all we have is 3rd party information, and a settled

lawsuit so the facts will never be played out in court. She can't testify or

vote now (unless she's democrat..SORRY couldn't resist that!!!), so we will

never know what happened 6 years ago...

As long as there are attorneys who are behind in the car payments...there

will be frivolous lawsuits settled out of court.

Hatfield FF/EMT-P

www.canyonlakefire-ems.org

" Ubi concordia, ibi victoria "

Re: Patient Refusal Forms of Little Value

Where is it that the Patient refusal forms were the failure?

The medics, just from the news article; appear to have not done a proper

assessment and then gave advice they should have refrained from giving.

This would be another reason for writing a narrative with the refusal form,

in my opinion.

Here is the problem as I see it:

1) All patients should go to the hospital who wish to.

2) All patients should have a proper assessment every time. Complacency is

where the problem begins.

3) All patients should have the ability to refuse treatment.

4) All EMS personnel should understand that not everyone we see will tell us

everything everytime. Suspect the worst and hope for the best.

5) Supervisors should do just that, SUPERVISE.

My Opinion this morning which is probably not everyones.

Why do we blame the equipment when it appears to be an operator problem?

" Bledsoe, DO " <bbledsoe (AT) earthlink (DOT) <mailto:bbledsoe%40earthlink.net>

net> wrote:

City to pay $100,000 in death

Medics should have advised woman to go to hospital

By Mark Ferenchik

The Columbus Dispatch

Tuesday, September 19, 2006 12:01 AM

More than six years ago, 37-year-old Goldie Beck woke up in the middle of

the night in her Hilltop home with chest pains and shortness of breath.

Her husband called Columbus paramedics, who ran tests that proved

inconclusive. She signed a waiver declining to go to the hospital. The

medics told her to eat some bread and take Rolaids, her attorney said.

Beck died of a heart attack less than an hour after medics left. Now the

city will be paying $100,000 because medics did not follow correct protocol,

City Attorney C. Pfeiffer said.

The Columbus City Council approved the lawsuit settlement to her husband,

Beck, yesterday.

After paramedics arrived at 3:52 a.m. on May 27, 2000, they ran an

electrocardiogram, which showed nothing, Columbus Public Safety Director

J. Brown said.

Beck's attorney, Blue, said paramedics told her she didn't need to go

to the hospital. Pfeiffer told the council yesterday that Mrs. Beck did sign

a refusal to transport, but that medics should have advised her to go to the

hospital.

" That was not done, " Pfeiffer said.

Jack Reall, president of the Columbus firefighters union, said he's not

familiar with the case. But he said that medics do not refuse

transportation.

" If it doesn't show anything on the EKG, it's very difficult to give someone

a definitive answer, " Reall said.

" It's up to you. If you want to go to the hospital, we'll take you to the

hospital of your choice. It's not a position where we want to strong-arm

anyone. "

[Guest guest]

Paramedic lead refusals always fail. There is an urban EMS in North

Texas that provides paramedic lead refusals which have lead to many

deaths and lawsuits, but they are still carried out. Just transport -

it's just easier that way...

-MH

>>> Danny 9/22/2006 8:31 am >>>

Where is it that the Patient refusal forms were the failure?

The medics, just from the news article; appear to have not done a

proper assessment and then gave advice they should have refrained from

giving.

This would be another reason for writing a narrative with the refusal

form, in my opinion.

Here is the problem as I see it:

1) All patients should go to the hospital who wish to.

2) All patients should have a proper assessment every time.

Complacency is where the problem begins.

3) All patients should have the ability to refuse treatment.

4) All EMS personnel should understand that not everyone we see will

tell us everything everytime. Suspect the worst and hope for the best.

5) Supervisors should do just that, SUPERVISE.

My Opinion this morning which is probably not everyones.

Why do we blame the equipment when it appears to be an operator

problem?

" Bledsoe, DO " wrote:

City to pay $100,000 in death

Medics should have advised woman to go to hospital

By Mark Ferenchik

The Columbus Dispatch

Tuesday, September 19, 2006 12:01 AM

More than six years ago, 37-year-old Goldie Beck woke up in the middle

of

the night in her Hilltop home with chest pains and shortness of

breath.

Her husband called Columbus paramedics, who ran tests that proved

inconclusive. She signed a waiver declining to go to the hospital. The

medics told her to eat some bread and take Rolaids, her attorney said.

Beck died of a heart attack less than an hour after medics left. Now

the

city will be paying $100,000 because medics did not follow correct

protocol,

City Attorney C. Pfeiffer said.

The Columbus City Council approved the lawsuit settlement to her

husband,

Beck, yesterday.

After paramedics arrived at 3:52 a.m. on May 27, 2000, they ran an

electrocardiogram, which showed nothing, Columbus Public Safety

Director

J. Brown said.

Beck's attorney, Blue, said paramedics told her she didn't need

to go

to the hospital. Pfeiffer told the council yesterday that Mrs. Beck did

sign

a refusal to transport, but that medics should have advised her to go

to the

hospital.

" That was not done, " Pfeiffer said.

Jack Reall, president of the Columbus firefighters union, said he's

not

familiar with the case. But he said that medics do not refuse

transportation.

" If it doesn't show anything on the EKG, it's very difficult to give

someone

a definitive answer, " Reall said.

" It's up to you. If you want to go to the hospital, we'll take you to

the

hospital of your choice. It's not a position where we want to

strong-arm

anyone. "

[Guest guest]

This is true: Idiots are a protected species, however; what is the options if

refusal forms are eliminated?

Document everything? This sounds good in theory, but generally gaps will

still be left.

Has there been any serious discussion on what a refusal form has to say and

which ones (if any) have been proven in court to be reliable?

Good clinical judgement is the only protection against lawsuits, and even then

that may not be enough.

Perhaps we should just throw up our hands and not do anything.

I DON'T THINK SO.

" Bledsoe, DO " wrote:

She signed a patient refusal form and the city still had to pay

$100,000.00.

She refused treatment it would appear. I have seen, on many occasions,

patients sign refusal forms only to say later they did not understand them,

were coerced into signing them, or similar reasons. In every case, including

one not that long ago in Dallas, the jury or judge sided with the patient.

The US legal system goes to great lengths to protect idiots from signing

away their rights.

_____

From: texasems-l [mailto:texasems-l ] On

Behalf Of Danny

Sent: Friday, September 22, 2006 8:31 AM

To: texasems-l

Subject: Re: Patient Refusal Forms of Little Value

Where is it that the Patient refusal forms were the failure?

The medics, just from the news article; appear to have not done a proper

assessment and then gave advice they should have refrained from giving.

This would be another reason for writing a narrative with the refusal form,

in my opinion.

Here is the problem as I see it:

1) All patients should go to the hospital who wish to.

2) All patients should have a proper assessment every time. Complacency is

where the problem begins.

3) All patients should have the ability to refuse treatment.

4) All EMS personnel should understand that not everyone we see will tell us

everything everytime. Suspect the worst and hope for the best.

5) Supervisors should do just that, SUPERVISE.

My Opinion this morning which is probably not everyones.

Why do we blame the equipment when it appears to be an operator problem?

" Bledsoe, DO " <bbledsoe (AT) earthlink (DOT) <mailto:bbledsoe%40earthlink.net>

net> wrote:

City to pay $100,000 in death

Medics should have advised woman to go to hospital

By Mark Ferenchik

The Columbus Dispatch

Tuesday, September 19, 2006 12:01 AM

More than six years ago, 37-year-old Goldie Beck woke up in the middle of

the night in her Hilltop home with chest pains and shortness of breath.

Her husband called Columbus paramedics, who ran tests that proved

inconclusive. She signed a waiver declining to go to the hospital. The

medics told her to eat some bread and take Rolaids, her attorney said.

Beck died of a heart attack less than an hour after medics left. Now the

city will be paying $100,000 because medics did not follow correct protocol,

City Attorney C. Pfeiffer said.

The Columbus City Council approved the lawsuit settlement to her husband,

Beck, yesterday.

After paramedics arrived at 3:52 a.m. on May 27, 2000, they ran an

electrocardiogram, which showed nothing, Columbus Public Safety Director

J. Brown said.

Beck's attorney, Blue, said paramedics told her she didn't need to go

to the hospital. Pfeiffer told the council yesterday that Mrs. Beck did sign

a refusal to transport, but that medics should have advised her to go to the

hospital.

" That was not done, " Pfeiffer said.

Jack Reall, president of the Columbus firefighters union, said he's not

familiar with the case. But he said that medics do not refuse

transportation.

" If it doesn't show anything on the EKG, it's very difficult to give someone

a definitive answer, " Reall said.

" It's up to you. If you want to go to the hospital, we'll take you to the

hospital of your choice. It's not a position where we want to strong-arm

anyone. "

[Guest guest]

I am not attacking the medics first. I have seen in my career where the problem

usually lies at the top of the food chain.

The leaders don't lead, the troops can't follow. The troops become the ones

to get killed while the leaders are overlooking the battlefield figuring that

maybe that should not have happened.

The problem with lawsuits is that the 3rd party information is usually

corraborated by other facts. Those facts (whether right or wrong) combine for a

powerful offense.

Do the job right. Do the job right every time.

Pray that you do the job right every time.

Pray that you have a better attorney than the other side.

Stay poor. No one wants to sue a poor person.

Hatfield wrote:

Remember that we are getting facts from the media, certainly not the

most

accurate source.

Who is to say that it was the medics fault? Who is to say that they didn't

do a proper assessment, inform her that she should go to the ER and be

checked out? That it was her idea to eat bread and follow up with her PMD?

We'll never know now, all we have is 3rd party information, and a settled

lawsuit so the facts will never be played out in court. She can't testify or

vote now (unless she's democrat..SORRY couldn't resist that!!!), so we will

never know what happened 6 years ago...

As long as there are attorneys who are behind in the car payments...there

will be frivolous lawsuits settled out of court.

Hatfield FF/EMT-P

www.canyonlakefire-ems.org

" Ubi concordia, ibi victoria "

Re: Patient Refusal Forms of Little Value

Where is it that the Patient refusal forms were the failure?

The medics, just from the news article; appear to have not done a proper

assessment and then gave advice they should have refrained from giving.

This would be another reason for writing a narrative with the refusal form,

in my opinion.

Here is the problem as I see it:

1) All patients should go to the hospital who wish to.

2) All patients should have a proper assessment every time. Complacency is

where the problem begins.

3) All patients should have the ability to refuse treatment.

4) All EMS personnel should understand that not everyone we see will tell us

everything everytime. Suspect the worst and hope for the best.

5) Supervisors should do just that, SUPERVISE.

My Opinion this morning which is probably not everyones.

Why do we blame the equipment when it appears to be an operator problem?

" Bledsoe, DO " <bbledsoe (AT) earthlink (DOT) <mailto:bbledsoe%40earthlink.net>

net> wrote:

City to pay $100,000 in death

Medics should have advised woman to go to hospital

By Mark Ferenchik

The Columbus Dispatch

Tuesday, September 19, 2006 12:01 AM

More than six years ago, 37-year-old Goldie Beck woke up in the middle of

the night in her Hilltop home with chest pains and shortness of breath.

Her husband called Columbus paramedics, who ran tests that proved

inconclusive. She signed a waiver declining to go to the hospital. The

medics told her to eat some bread and take Rolaids, her attorney said.

Beck died of a heart attack less than an hour after medics left. Now the

city will be paying $100,000 because medics did not follow correct protocol,

City Attorney C. Pfeiffer said.

The Columbus City Council approved the lawsuit settlement to her husband,

Beck, yesterday.

After paramedics arrived at 3:52 a.m. on May 27, 2000, they ran an

electrocardiogram, which showed nothing, Columbus Public Safety Director

J. Brown said.

Beck's attorney, Blue, said paramedics told her she didn't need to go

to the hospital. Pfeiffer told the council yesterday that Mrs. Beck did sign

a refusal to transport, but that medics should have advised her to go to the

hospital.

" That was not done, " Pfeiffer said.

Jack Reall, president of the Columbus firefighters union, said he's not

familiar with the case. But he said that medics do not refuse

transportation.

" If it doesn't show anything on the EKG, it's very difficult to give someone

a definitive answer, " Reall said.

" It's up to you. If you want to go to the hospital, we'll take you to the

hospital of your choice. It's not a position where we want to strong-arm

anyone. "

[Guest guest]

I disagree. It is IMPROPERLY TRAINED medics doing medic lead refusals that

fail.

We need to stop lowering our standards to allow the slowest one in, and

insure that either the slowest one can catch up, or thin the herd.

The time of " there was this medic/service " , followed by " that's why we don't

do it anymore " , needs to be out the door right behind " because we've always

done it that way " .

Mike

Hatfield FF/EMT-P

www.canyonlakefire-ems.org

" Ubi concordia, ibi victoria "

Re: Patient Refusal Forms of Little Value

Paramedic lead refusals always fail. There is an urban EMS in North

Texas that provides paramedic lead refusals which have lead to many

deaths and lawsuits, but they are still carried out. Just transport -

it's just easier that way...

-MH

>>> Danny <petsardlj@sbcglobal <mailto:petsardlj%40sbcglobal.net>

..net> 9/22/2006 8:31 am >>>

Where is it that the Patient refusal forms were the failure?

The medics, just from the news article; appear to have not done a

proper assessment and then gave advice they should have refrained from

giving.

This would be another reason for writing a narrative with the refusal

form, in my opinion.

Here is the problem as I see it:

1) All patients should go to the hospital who wish to.

2) All patients should have a proper assessment every time.

Complacency is where the problem begins.

3) All patients should have the ability to refuse treatment.

4) All EMS personnel should understand that not everyone we see will

tell us everything everytime. Suspect the worst and hope for the best.

5) Supervisors should do just that, SUPERVISE.

My Opinion this morning which is probably not everyones.

Why do we blame the equipment when it appears to be an operator

problem?

" Bledsoe, DO " <bbledsoe (AT) earthlink (DOT) <mailto:bbledsoe%40earthlink.net>

net> wrote:

City to pay $100,000 in death

Medics should have advised woman to go to hospital

By Mark Ferenchik

The Columbus Dispatch

Tuesday, September 19, 2006 12:01 AM

More than six years ago, 37-year-old Goldie Beck woke up in the middle

of

the night in her Hilltop home with chest pains and shortness of

breath.

Her husband called Columbus paramedics, who ran tests that proved

inconclusive. She signed a waiver declining to go to the hospital. The

medics told her to eat some bread and take Rolaids, her attorney said.

Beck died of a heart attack less than an hour after medics left. Now

the

city will be paying $100,000 because medics did not follow correct

protocol,

City Attorney C. Pfeiffer said.

The Columbus City Council approved the lawsuit settlement to her

husband,

Beck, yesterday.

After paramedics arrived at 3:52 a.m. on May 27, 2000, they ran an

electrocardiogram, which showed nothing, Columbus Public Safety

Director

J. Brown said.

Beck's attorney, Blue, said paramedics told her she didn't need

to go

to the hospital. Pfeiffer told the council yesterday that Mrs. Beck did

sign

a refusal to transport, but that medics should have advised her to go

to the

hospital.

" That was not done, " Pfeiffer said.

Jack Reall, president of the Columbus firefighters union, said he's

not

familiar with the case. But he said that medics do not refuse

transportation.

" If it doesn't show anything on the EKG, it's very difficult to give

someone

a definitive answer, " Reall said.

" It's up to you. If you want to go to the hospital, we'll take you to

the

hospital of your choice. It's not a position where we want to

strong-arm

anyone. "

[Guest guest]

I agree.transport is much easier. At Eagles 2005, I think it was

Ossman, from Georgia, who noted once the box arrives on scene, you have

spent 80% of the cost to make the run and transport the patient. There

isn't a cost savings to not transporting and if the stats are correct

about refusals being 50% of patient centered EMS lawsuits, it just makes

sense to transport them.

Re: Patient Refusal Forms of Little Value

Paramedic lead refusals always fail. There is an urban EMS in North

Texas that provides paramedic lead refusals which have lead to many

deaths and lawsuits, but they are still carried out. Just transport -

it's just easier that way...

-MH

>>> Danny <petsardlj@sbcglobal

<mailto:petsardlj%40sbcglobal.net> .net> 9/22/2006 8:31 am >>>

Where is it that the Patient refusal forms were the failure?

The medics, just from the news article; appear to have not done a

proper assessment and then gave advice they should have refrained from

giving.

This would be another reason for writing a narrative with the refusal

form, in my opinion.

Here is the problem as I see it:

1) All patients should go to the hospital who wish to.

2) All patients should have a proper assessment every time.

Complacency is where the problem begins.

3) All patients should have the ability to refuse treatment.

4) All EMS personnel should understand that not everyone we see will

tell us everything everytime. Suspect the worst and hope for the best.

5) Supervisors should do just that, SUPERVISE.

My Opinion this morning which is probably not everyones.

Why do we blame the equipment when it appears to be an operator

problem?

" Bledsoe, DO " <bbledsoe (AT) earthlink (DOT)

<mailto:bbledsoe%40earthlink.net> net> wrote:

City to pay $100,000 in death

Medics should have advised woman to go to hospital

By Mark Ferenchik

The Columbus Dispatch

Tuesday, September 19, 2006 12:01 AM

More than six years ago, 37-year-old Goldie Beck woke up in the middle

of

the night in her Hilltop home with chest pains and shortness of

breath.

Her husband called Columbus paramedics, who ran tests that proved

inconclusive. She signed a waiver declining to go to the hospital. The

medics told her to eat some bread and take Rolaids, her attorney said.

Beck died of a heart attack less than an hour after medics left. Now

the

city will be paying $100,000 because medics did not follow correct

protocol,

City Attorney C. Pfeiffer said.

The Columbus City Council approved the lawsuit settlement to her

husband,

Beck, yesterday.

After paramedics arrived at 3:52 a.m. on May 27, 2000, they ran an

electrocardiogram, which showed nothing, Columbus Public Safety

Director

J. Brown said.

Beck's attorney, Blue, said paramedics told her she didn't need

to go

to the hospital. Pfeiffer told the council yesterday that Mrs. Beck did

sign

a refusal to transport, but that medics should have advised her to go

to the

hospital.

" That was not done, " Pfeiffer said.

Jack Reall, president of the Columbus firefighters union, said he's

not

familiar with the case. But he said that medics do not refuse

transportation.

" If it doesn't show anything on the EKG, it's very difficult to give

someone

a definitive answer, " Reall said.

" It's up to you. If you want to go to the hospital, we'll take you to

the

hospital of your choice. It's not a position where we want to

strong-arm

anyone. "

[Guest guest]

The service I work for operates on a " You call, we haul " principal. If

a patient calls for an ambulance, we ask, " What hospital do you wish

to go to? " Instead of " Do you want to go to the hospital? " We get

fewer refusals as a result and avoid this type of litigation when

possible. Better to haul and not be necessary than to obtain a refusal

when a trip to the hospital would be better.

[Guest guest]

If a patient calls 911 and then " refuses " transport I am VERY suspect. What

that implies to me is that something happened after the call to change their

mind. Most likely what happened is communication of some sort from the EMS

system reassured them that they did NOT need transport. (i.e. medic

practicing medicine or using devices like EKG and BP cuff that gives the

person the impression they have been evaluated and " everything looks good. " )

Now, this is a different situation than when someone ELSE has called 911.

For example, at an MVC, many well meaning people may observe and call 911

who then finds a person with minial injuries or none and does not want

transport.

Ask yourself, however, if the PATIENT called 911, why woudl they THEN

refuse transport.

This is a hot topic for me as I have personally talked to medics who have

them sign the pt refusal form when in fact the medic refused transport. It

is common and it lacks integrity.

If the medic feels like it is a stubbed toe and not worthy of transport

that should be well documented and they should sign off on that. In some

systems that is NOT what happens.

I personally feel that patient " refusal " is a high risk situation that

should require online medical control involvement.

I have seen or heard so many stories of " refusal " that I would firmly be

biased in favor of the patient. The system needs fixing.

Kirk D. Mahon, MD, ABEM

6106 Keller Springs Rd

Dallas, TX 75248

[Guest guest]

I can't agree with you enough. However, don't judge all systems by one or a few.

I may be wrong but I feel that it falls in the category of lack of supervision

of the medics. Older tenure medics that understand what EMS is really about and

not just being a Para God should instill in the younger ones that we are indeed

here for the patients and not our own egos. The system they work for should make

it very clear that if a patient calls they should be offered the opportunity of

a transport. I am not saying lets capture that dollar. I am saying offer it with

impact if you feel the patient really needs it and out of courtesy even if you

feel they don't. Sometimes folks call out of anxiety for something really really

minor. At this point after you have assessed the patient explain to them that

their condition seems to be fine but if they would like that you would be happy

to transport them. Here we even offer to follow them to the E.R. Its all about

attitude. Actually its about to much attitude. We have all been their and with

time and a little guidance the fire eaters will outgrow it if they stay in the

business. Until then we just need to keep an eye on them and offer that

guidance.

Henry

RE: Patient Refusal Forms of Little Value

If a patient calls 911 and then " refuses " transport I am VERY suspect. What

that implies to me is that something happened after the call to change their

mind. Most likely what happened is communication of some sort from the EMS

system reassured them that they did NOT need transport. (i.e. medic

practicing medicine or using devices like EKG and BP cuff that gives the

person the impression they have been evaluated and " everything looks good. " )

Now, this is a different situation than when someone ELSE has called 911.

For example, at an MVC, many well meaning people may observe and call 911

who then finds a person with minial injuries or none and does not want

transport.

Ask yourself, however, if the PATIENT called 911, why woudl they THEN

refuse transport.

This is a hot topic for me as I have personally talked to medics who have

them sign the pt refusal form when in fact the medic refused transport. It

is common and it lacks integrity.

If the medic feels like it is a stubbed toe and not worthy of transport

that should be well documented and they should sign off on that. In some

systems that is NOT what happens.

I personally feel that patient " refusal " is a high risk situation that

should require online medical control involvement.

I have seen or heard so many stories of " refusal " that I would firmly be

biased in favor of the patient. The system needs fixing.

Kirk D. Mahon, MD, ABEM

6106 Keller Springs Rd

Dallas, TX 75248

[Guest guest]

I could not agree more with Dr. Mahon. Medic initiated refusals are an

invitation for a lawsuit. If you don't believe me, just do a Freedom of

Information request to any big city-run EMS where they allow medic refusals.

I taught a course on this very thing yesterday. My advice: " You call--we

haul. " It's easier and cheaper in the long run.

If you MUST decline to transport, be sure that your refusal form shows

present mental capacity and informed refusal. I have seen very few refusals

that

meet the requirements; thus, most of them are not worth the paper they're

printed on because they're conclusionary rather than factual.

Gene G.

>

> If a patient calls 911 and then " refuses " transport I am VERY suspect. What

> that implies to me is that something happened after the call to change their

> mind. Most likely what happened is communication of some sort from the EMS

> system reassured them that they did NOT need transport. (i.e. medic

> practicing medicine or using devices like EKG and BP cuff that gives the

> person the impression they have been evaluated and " everything looks good. " )

>

> Now, this is a different situation than when someone ELSE has called 911.

> For example, at an MVC, many well meaning people may observe and call 911

> who then finds a person with minial injuries or none and does not want

> transport.

>

> Ask yourself, however, if the PATIENT called 911, why woudl they THEN

> refuse transport.

>

> This is a hot topic for me as I have personally talked to medics who have

> them sign the pt refusal form when in fact the medic refused transport. It

> is common and it lacks integrity.

>

> If the medic feels like it is a stubbed toe and not worthy of transport

> that should be well documented and they should sign off on that. In some

> systems that is NOT what happens.

>

> I personally feel that patient " refusal " is a high risk situation that

> should require online medical control involvement.

>

> I have seen or heard so many stories of " refusal " that I would firmly be

> biased in favor of the patient. The system needs fixing.

>

> Kirk D. Mahon, MD, ABEM

>

> 6106 Keller Springs Rd

> Dallas, TX 75248

>

> _

[Guest guest]

I can't remember where it was done, probably Mr. Bledson knows, but there has

been a study done that attempted to measure the abilities of pre-hospital

caregivers to determine which patients would be admitted to the hospital. The

results were abysmal.

Bledsoe, I think it was, or another astute physician, once told me that the

scariest thing about being an ER doctor is making the decision who to admit and

who to discharge. And this is from someone who has the education and

training, all the toys, bells, and whistles, to diagnose.

I like Henry's approach. Let's take that " anxious " patient. I want to

know WHY the patient is anxious. Lots of times patients are anxious because

they think they're about to die, and lots of the time they're right. It's

extremely embarrassing to have left a patient, thinking that all they need is to

take an aspirin and call their family doctor in the morning, only to be called

back one hour later for a code.

Ruins one's day.

Gene G.

[Guest guest]

I'll answer this with an example from my personal life...

>

> If a patient calls 911 and then " refuses " transport I am VERY suspect. What

> that implies to me is that something happened after the call to change their

> mind. Most likely what happened is communication of some sort from the EMS

> system reassured them that they did NOT need transport. (i.e. medic

> practicing medicine or using devices like EKG and BP cuff that gives the

> person the impression they have been evaluated and " everything looks good. " )

> Ask yourself, however, if the PATIENT called 911, why woudl they THEN

> refuse transport.

Case in point. My daughter, at the age of 4, was visiting her mother

at mom's apartment. I was at work on the ambulance. My daughter was

running through the house, tripped and fell and landed face first,

striking her forehead on the baseboard. She lacerated her forehead

above her left eye and proceeded to bleed profusely. She also got up,

ran to mommy, crying the whole time - but from a " diagnostic "

perspective had no loss of consciousness, was aware of strking her

head, had good motor control to get up while injured, go to mommy,

recognize mommy, etc. A fellow medic (different unit, same service)

responded to mom's panicked 911 call. He arrived, evaluated my

daughter, checked the laceration, checked my daughter's status, etc.

He advised her that he could take them to the hospital, or that they

could go on their own, and that there would be no difference in

treatment either way, and that not being in an ambulance would likely

be less traumatic to my daughter, and that there was nothing he was

going to do other than provide transport (the lac was already

bandaged, and obviously needed wound care). Mom refused and took her

instead. Mom, the 911 caller, provided the refusal. She called 911

because she panicked at the sight of the blood, especially on her

daughter, but was calmed by the arrival of trained medical personnel

who checked her bandaging, checked the wound, verified that she'd done

everything right, verified that my daughter appeared okay, and

counseled her on her transport options and treatment choices.

In her case, she refused because the arriving of the medics, and the

application of their knowledge, was the care that was really needed -

not the transport of my daughter. I consider this both an appropriate

refusal, and appropriate guidance from the attending medic(s) - but I

also realize that this is a personal story and " anecdotal. "

> This is a hot topic for me as I have personally talked to medics who have

> them sign the pt refusal form when in fact the medic refused transport. It

> is common and it lacks integrity.

> If the medic feels like it is a stubbed toe and not worthy of transport

> that should be well documented and they should sign off on that. In some

> systems that is NOT what happens.

Absolutely. Paramedics shouldn't cut corners and have patients sign

refusals that didn't in fact refuse AMA, but at the paramedic's

suggestion or inclination - that borders on false documentation at the

worst, laziness (not being willing to document at the level required

for a paramedic-counseled, non-AMA refusal. Some systems, however,

won't allow the stubbed toe to be counseled to refuse, so the

paramedic is stuck between making a transport that he knows isn't in

the best interest of the patient or in the best interest of the

community served by the now-out-of-service EMS unit. I can understand

the reasons, in that case, for the paramedic getting the patient to

sign a refusal. Not that I agree with it, but I think that points

more at the problems with " absolutely " restrictive protocols, policies

and procedures.

> I personally feel that patient " refusal " is a high risk situation that

> should require online medical control involvement.

As much as I hate to do it (almost as a source of pride), I have to

say that the current science supports your opinion. That *really*

grates on me as I'd like to think that paramedicine (had) can

progress(ed) to the point that medics could help qualify the need for

emergent treatment, but there's nothing that currently says that's the

case. So, for now, you're right...

Mike

[Guest guest]

Henry,

I totally agree with you. And I should have said, " I know one system that

needs fixing. " I have had experience with several that do NOT have the

issues discussed.

Would anybody condone the following scenario:

90 year old lady has syncope and family calls 911. She comes to and is

asymptomatic on EMS arrival. An ekg is done and since it is normal she

doesn;'t come to the ER. What do you think just happened there?

The official llights and sirens and badges would assure anybody that they

are dealing with a proper authority to make that decision. However, syncope

(especially in an older person) is a problem that needs a lot of detailed

history, exam, labs, and monitoring. They need a physician evaluation. An

ecg is not enough and it is a disservice to use it at the scene if your are

then going to let people assume that the " machine that goes beep " says

everything is ok and use that information to not transport....this is

similar to the case mentioned in the article.

If you are worried enough to do an ecg then you had damn well better

transport. I am a huge believer in autonomy (not paternalism) but you need

to make sure that the patient gets in the box. The real truth is, if they

don't, there is a very good chance it is due to your communication about

your assessment and the ecg that weighed in. That is dangerous.

Kirk D. Mahon, MD, ABEM

6106 Keller Springs Rd

Dallas, TX 75248

[Guest guest]

Dear Humble,

You're right if the world were perfect. And you're probably right that SOME

medics can make those distinctions.

I have no problem with discussing alternatives with the patient with an

isolated minor finger laceration, a stubbed toe, and so forth, but in all cases

it

is preferable for the patient to make the decision for treat and transport vs.

no treat and transport.

The abusers are a problem all their own. What they really need is social

services to help them with the underlying problems that cause them to abuse.

But all in all, if a patient really wants to go, I'm going to take them. I

don't ever want to have it come back on me that I refused someone who actually

needed treatment.

I remember one night with a large city FD EMS where we made three calls to

the same place for a 3 year old child with an earache. Each time the mother

was told that this wasn't an emergency and that she should drive to the ER

with the child herself. She pleaded that she did not have transportation, et

cetera. I could hardly keep my mouth shut, but since I was a guest, I did.

However, on the third call, one of the medics made the astute observation that

we might as well go ahead and transport because we were going to get called

all night if we didn't. So on the third time we transported.

Of course, if that service had ANY sort of effective supervision at that

time, that wouldn't have happened. The kid was sick. I'm told that things

have

changed. I certainly hope so.

GG

>

> There are actually a number of studies out there that talk about Paramedic

> initiated refusals.

>

> In some instances it is a liability looking for a place to happen, however,

> there are instances that Paramedic initiated refusals are appropriate. Now

> before we get a rope and look for a tall tree..let me explain. In instances

> where a definitive cause of a sign or symptom cannot be found, then the

> patient should in fact be transported, or be encouraged to be transported,

> syncope in the elderly, as explained by Mike , is generally caused by a

> cardiac event of some kind, and should never be ignored or played down,

> treated with a high index of suspicion and cared for accordingly. Abdominal

> pain is another catch all for transport, etc. etc.

>

> There area small number of abusers of the system. Those that require a

> ride, and nothing more. Do they need a ride? Yep. Do they need a ride in an

> ambulance? Nope. Can we arrange for alternative transportation? That's the

> question. Then it comes down to, which patients qualify for alternative

> transport.

>

> I do believe that with the right training, the right oversight and good QI,

> that there are a number of patients that can be refused transport.

>

> Are there medics who are not astute enough to learn it? Are there some that

> will get refusals because they are too lazy to transport? Yes on both

> counts, and they need to find another career field, we cannot slow this

> field down for the slowest person, we need to continue to move forward and

> thin the herd as necessary.

>

> Just my humble opinion...being the humble person that I am.:-)

>

> Mike

>

> Hatfield FF/EMT-P

>

> www.canyonlakefire- www.ca

>

> " Ubi concordia, ibi victoria "

>

> Re: Patient Refusal Forms of Little Value

>

> I can't remember where it was done, probably Mr. Bledson knows, but there

> has

> been a study done that attempted to measure the abilities of pre-hospital

> caregivers to determine which patients would be admitted to the hospital.

> The

> results were abysmal.

>

> Bledsoe, I think it was, or another astute physician, once told me that the

> scariest thing about being an ER doctor is making the decision who to admit

> and

> who to discharge. And this is from someone who has the education and

> training, all the toys, bells, and whistles, to diagnose.

>

> I like Henry's approach. Let's take that " anxious " patient. I want to

> know WHY the patient is anxious. Lots of times patients are anxious because

> they think they're about to die, and lots of the time they're right. It's

> extremely embarrassing to have left a patient, thinking that all they need

> is to

> take an aspirin and call their family doctor in the morning, only to be

> called

> back one hour later for a code.

>

> Ruins one's day.

>

> Gene G.

>

>

[Guest guest]

Ditto Dudley. And have we forgotten that we're supposed to be patient

advocates? Why are we there? For the wellbeing of the company, or for the

wellbeing of our patients?

GG

[Guest guest]

> Would anybody condone the following scenario:

> 90 year old lady has syncope and family calls 911. She comes to and is

> asymptomatic on EMS arrival. An ekg is done and since it is normal she

> doesn;'t come to the ER. What do you think just happened there?

Uhh, " something above my pay grade? " Seriously, I remember from a

recent geriatric class that about 2/3rds of all falls in geriatric

patients are syncope-related, and the majority of those are

cardiac-related. As to what happened here, I could make any number of

wild guesses, but I'm trained to suspect cardiac problems such

as an unseen run of vtach, or a brief episode of bradycardia, or

tachycardia resolved by fainting (SVT)... either way, I can't tell

what happened - but more importantly, I can't tell what DIDN'T happen,

either. More follows...

> The official llights and sirens and badges would assure anybody that they

> are dealing with a proper authority to make that decision. However, syncope

> (especially in an older person) is a problem that needs a lot of detailed

> history, exam, labs, and monitoring. They need a physician evaluation. An

> ecg is not enough and it is a disservice to use it at the scene if your are

> then going to let people assume that the " machine that goes beep " says

> everything is ok and use that information to not transport....this is

> similar to the case mentioned in the article.

I was trained in my " basic " paramedic school that the ECG is at best

30 minutes behind the precipitating event. So a negative ECG doesn't

rule out cardiac problems, it just doesn't rule IN anything I can (or

should) treat. Much like " head pain " in the ER - the CT won't rule

out a head bleed, only rule it in - the LP is the diagnostic test.

Same goes for ECG in the field. Certainly not someone I'd comfortably

obtain a refusal from.

> If you are worried enough to do an ecg then you had damn well better

> transport. I am a huge believer in autonomy (not paternalism) but you need

> to make sure that the patient gets in the box. The real truth is, if they

> don't, there is a very good chance it is due to your communication about

> your assessment and the ecg that weighed in. That is dangerous.

I can agree with this... that's probably a good way to pass on that

nugget (if you're worried enough...) - one of the " quotables " of this

list this year.

Mike

[Guest guest]

The main reason I don't refuse patients who I'm tempted to think don't have

anything serious wrong with them is NOT what I know, but what I know that I

DON'T know.

For example, here are some of the causes of abdominal pain:

parietal peritoneal inflammation due to infection (appendix, PID)

parietal peritoneal inflammation due to chemical irritation (perforated

gastric or peptic ulcer; pancreatitis, Mittelschmerz, ruptured ectopic

pregnancy)

inflammation of bowel wall

Crohn's disease,

ulcerative colitis,

microscopic colitis

diverticulitis

gastroenteritis

lactose intolerance

celiac sprue

sarcoidosis

vasculitis

mechanical obstruction of hollow viscera

gallstones

vascular disturbances

embolism

thrombosis

vascular rupture

torsional occlusion (volvulus)

sickle cell anemia

renal vein entrapment

superior mesenteric artery syndrome (nutcracker syndrome)

mesenteric traction

muscle trauma

muscular infection

distention of visceral surfaces such as hepatic or renal capsule

referred pain from the thorax (MI, pneumonia), spine, genitals (testicular

torsion)

metabolic disturbance (lead poisoning, black widow spider bite, uremia, DKA,

porphyria, C1-esterase inhibitor deficiency, adrenal insufficiency)

tabes dorsalis

herpes zoster

Lyme disease

Irritable Bowel Syndrome

torsion of the ovary, endometriosis

diarrhea

meningitis

cholecystitis

pyelonephritis

hepatitis

mesenteric adenitis

subdiaphragmatic abscess

cancer of the ovary, bowel, stomach, liver, kidney, etc

ascites

And there are surely others

Any medic who feels comfortable telling someone with vague abdominal pain

that it's just an upset stomach is playing with fire, and will soon see the

judge

and jury. And that's the kindest thing I can say about such a person.

If I were a board certified general surgeon or gastroenterologist in the

ambulance, I still wouldn't street such a patient. Yet paramedics do it every

day.

It boggles the mind.

Gene G.

[Guest guest]

There are actually a number of studies out there that talk about Paramedic

initiated refusals.

In some instances it is a liability looking for a place to happen, however,

there are instances that Paramedic initiated refusals are appropriate. Now

before we get a rope and look for a tall tree..let me explain. In instances

where a definitive cause of a sign or symptom cannot be found, then the

patient should in fact be transported, or be encouraged to be transported,

syncope in the elderly, as explained by Mike , is generally caused by a

cardiac event of some kind, and should never be ignored or played down,

treated with a high index of suspicion and cared for accordingly. Abdominal

pain is another catch all for transport, etc. etc.

There area small number of abusers of the system. Those that require a

ride, and nothing more. Do they need a ride? Yep. Do they need a ride in an

ambulance? Nope. Can we arrange for alternative transportation? That's the

question. Then it comes down to, which patients qualify for alternative

transport.

I do believe that with the right training, the right oversight and good QI,

that there are a number of patients that can be refused transport.

Are there medics who are not astute enough to learn it? Are there some that

will get refusals because they are too lazy to transport? Yes on both

counts, and they need to find another career field, we cannot slow this

field down for the slowest person, we need to continue to move forward and

thin the herd as necessary.

Just my humble opinion...being the humble person that I am.:-)

Mike

Hatfield FF/EMT-P

www.canyonlakefire-ems.org

" Ubi concordia, ibi victoria "

Re: Patient Refusal Forms of Little Value

I can't remember where it was done, probably Mr. Bledson knows, but there

has

been a study done that attempted to measure the abilities of pre-hospital

caregivers to determine which patients would be admitted to the hospital.

The

results were abysmal.

Bledsoe, I think it was, or another astute physician, once told me that the

scariest thing about being an ER doctor is making the decision who to admit

and

who to discharge. And this is from someone who has the education and

training, all the toys, bells, and whistles, to diagnose.

I like Henry's approach. Let's take that " anxious " patient. I want to

know WHY the patient is anxious. Lots of times patients are anxious because

they think they're about to die, and lots of the time they're right. It's

extremely embarrassing to have left a patient, thinking that all they need

is to

take an aspirin and call their family doctor in the morning, only to be

called

back one hour later for a code.

Ruins one's day.

Gene G.

[Guest guest]

Mike,

That is a great example...BUT...since we are talking anecdotal...lets say on

your wife's way to the ED, your daughter began acting funny and within in

minutes was either decreasing consciousness or was seizing...

Would this still be an appropriate decision by a medical professional or would

this be a discussion of why paramedics shouldn't be so prideful and acting like

they are physicians?

See, I agree with Dr. Mahon...if someone calls 911 (first party caller) wanting

an ambulance, and when we arrive they no longer want to go...something has

happened. Is it like your case where time has passed and things are calmer, is

it a stubborn male who has had an additional 6 to 8 minutes to get deeper in

denial, is it the embarrassment from 2 or 3 emergency vehicles in front of their

house and the " Uh-Oh Squad " on their front lawn...

Then, we walk in and, unless we are very well trained and prepared, we, as

responders take on the attitude of the patient we are there to see. They say

its no big deal...so it must not be a big deal....

I truly feel that WAY too often we get suckered into the mindset of our patients

and/or their family and that leads us to making poor decisions...

In addition to you and Dr. M's assertion of calling Medical Control, when the

party is a 1st or 2nd party caller...the question " do you want to go to the

hospital " should not be asked...instead ask " which hospital do you want to go to

today? "

IF the patient or caller is truly calmer and in a clearer head...and there is

not perceivable need for ambulance transport...when they answer with " I have to

go to the hospital??? " you can then reply like you showed in your example...but

if not, then they are merely answering a question when they say " Main Street

Hospital " ...instead of a possibly embarrassed or denying patient " overruling "

the paramedic who may be giving some impression of not needing/wanting to take

them to the hospital.

Each time we " take " a refusal, it is a crap shoot, roll of the roulette wheel,

or asking for another card when you are holding 18...

Your argument about poor use of ambulance resource is only a valid argument up

until someone who should have been transported isn't....and that decision is

ALWAYS made in hindsight...no one has ever been sued for taking someone to the

hospital by ambulance...

My thoughts,

Dudley

Re: Patient Refusal Forms of Little Value

I'll answer this with an example from my personal life...

>

> If a patient calls 911 and then " refuses " transport I am VERY suspect. What

> that implies to me is that something happened after the call to change their

> mind. Most likely what happened is communication of some sort from the EMS

> system reassured them that they did NOT need transport. (i.e. medic

> practicing medicine or using devices like EKG and BP cuff that gives the

> person the impression they have been evaluated and " everything looks good. " )

> Ask yourself, however, if the PATIENT called 911, why woudl they THEN

> refuse transport.

Case in point. My daughter, at the age of 4, was visiting her mother

at mom's apartment. I was at work on the ambulance. My daughter was

running through the house, tripped and fell and landed face first,

striking her forehead on the baseboard. She lacerated her forehead

above her left eye and proceeded to bleed profusely. She also got up,

ran to mommy, crying the whole time - but from a " diagnostic "

perspective had no loss of consciousness, was aware of strking her

head, had good motor control to get up while injured, go to mommy,

recognize mommy, etc. A fellow medic (different unit, same service)

responded to mom's panicked 911 call. He arrived, evaluated my

daughter, checked the laceration, checked my daughter's status, etc.

He advised her that he could take them to the hospital, or that they

could go on their own, and that there would be no difference in

treatment either way, and that not being in an ambulance would likely

be less traumatic to my daughter, and that there was nothing he was

going to do other than provide transport (the lac was already

bandaged, and obviously needed wound care). Mom refused and took her

instead. Mom, the 911 caller, provided the refusal. She called 911

because she panicked at the sight of the blood, especially on her

daughter, but was calmed by the arrival of trained medical personnel

who checked her bandaging, checked the wound, verified that she'd done

everything right, verified that my daughter appeared okay, and

counseled her on her transport options and treatment choices.

In her case, she refused because the arriving of the medics, and the

application of their knowledge, was the care that was really needed -

not the transport of my daughter. I consider this both an appropriate

refusal, and appropriate guidance from the attending medic(s) - but I

also realize that this is a personal story and " anecdotal. "

> This is a hot topic for me as I have personally talked to medics who have

> them sign the pt refusal form when in fact the medic refused transport. It

> is common and it lacks integrity.

> If the medic feels like it is a stubbed toe and not worthy of transport

> that should be well documented and they should sign off on that. In some

> systems that is NOT what happens.

Absolutely. Paramedics shouldn't cut corners and have patients sign

refusals that didn't in fact refuse AMA, but at the paramedic's

suggestion or inclination - that borders on false documentation at the

worst, laziness (not being willing to document at the level required

for a paramedic-counseled, non-AMA refusal. Some systems, however,

won't allow the stubbed toe to be counseled to refuse, so the

paramedic is stuck between making a transport that he knows isn't in

the best interest of the patient or in the best interest of the

community served by the now-out-of-service EMS unit. I can understand

the reasons, in that case, for the paramedic getting the patient to

sign a refusal. Not that I agree with it, but I think that points

more at the problems with " absolutely " restrictive protocols, policies

and procedures.

> I personally feel that patient " refusal " is a high risk situation that

> should require online medical control involvement.

As much as I hate to do it (almost as a source of pride), I have to

say that the current science supports your opinion. That *really*

grates on me as I'd like to think that paramedicine (had) can

progress(ed) to the point that medics could help qualify the need for

emergent treatment, but there's nothing that currently says that's the

case. So, for now, you're right...

Mike

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[Guest guest]

>

> Are there medics who are not astute enough to learn it? Are there some that

> will get refusals because they are too lazy to transport? Yes on both

> counts, and they need to find another career field, we cannot slow this

> field down for the slowest person, we need to continue to move forward and

> thin the herd as necessary.

Think like a gazelle - don't fret if you're not the fastest... just

don't be the slowest. That's the one the lions eat...