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Sun Nov 5 23:01:59 GMT 2006

In a message dated 11/5/2006 4:28:53 PM Central Standard Time,  
rgross at harthosp.org writes:

I  know what you are saying  - but then again, we are NOT shrinks.   That
gives us the advantage of being fairly sane, which gives us the  ability
to use our best judgement.  And THAT gives us the ability to  see that a
patient with this history cannot, under any stretch of the  imagination,
be considered capable of mentating to the point of compentency  for the
purpose of deciding what is in his best interest at this  time.  Short
story - transport regardless of what the patient says,  and worry about
the consequenses later.  Rest assured that if he died  'cause he
herniated, your butt would be there for all to chew on.  So,  as I see
it, I would be happy to have some dumb-ass lawyer try to accuse me  of
kidnapping or assault. At least I could look at myself in the  mirror
each morning and know that I did the right  thing.

Ron:

While I do agree with you, the practical problem is in restraining this  
patient if he is refusing to go. Not only would there be a substantial risk of  
increasing the bleeding during the struggle, but most of our field medics are  
NOT properly trained in forcible take downs of resisting patients, and most  of 
the peace/law enforcement officers I know would NOT want to get  involved in 
this kind of situation if there is no indication that the patient is  
currently having problems. "Sweet Reason" is actually the best and safest method  of 
managing transport in these cases.

In Tennessee and Louisiana (where I have practical experience in), a  
physician who has personally examined a patient can make a decision to  require the 
assistance of law enforcement in forcibly restraining a person that  the 
physician has reason to believe is unable to care for themselves for what  ever 
reason. There is also an Order for Protective Custody in Louisiana, that  the 
Coroner may issue 'upon sworn statements of witnesses', requiring the  Sheriff's 
Office or PD to bring an affected person into a medical treatment  facility for 
medical/psych evaluation. Here in Missouri, the case is a bit  more complex, 
as a judge must sign a formal order for restraint, something that  is only 
done 'upon application by affidavit.' In all three of these states, if  the 
appropriate format is followed in good faith, the physician (and  the LEO) is held 
immune from civil or criminal actions.

I've had more than a few situations over the years where I've been stuck  
with a patient who, while clinically intoxicated or otherwise impaired, did not  
meet the legal requirements for forceable restraint and who refused further 
care  while demonstrating that they had enough control of language to make it 
plain  that they did understand what was going on (often in unprintable 
terms)....while  we did occasionally involve law enforcement in some cases (such as 
the  patient threatening to drive himself home), often the best we could do was  
to insure that the patient did not go home alone and did not drive  
themselves.

ck
Charles S. Krin DO FAAFP

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