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Sun Nov 5 23:27:19 GMT 2006

Hey Charlie,
I am not real keen about hand to hand combat in the field with
patients, so I too would discourage takedowns by medics. ;-)

On the other hand, you did mention the ever so popular "sweet reason". 
I will suggest that this could be augmented with that "sweet persuasion"
that our law officers are often able to gently provide to assist the
medic.  Personally I would be in favor of this if I felt, in my best
professional opinion, that the patient was a danger to him/herself
and/or to others, and regardless of what that patient said - and
regardless of the colorful language it was expressed with - I would do
my best to bring the patient to the hospital for evaluation.

Just my opinion - that and a token will get ya mugged on the subway!!

Take care,
Ron
>>> <Krin135 at aol.com> 11/5/2006 6:01 PM >>>

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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