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Tue Apr 22 21:44:34 BST 2008

Exactly  either this patient was awake, alert, oriented and competent to
understand the risks and benefits of an unpleasant medical procedure and
therefore able to refuse ,  OR he was a disoriented, combative,
inappropriate, violent, head-injured trauma patient who needed to be
sedated to complete an appropriate work-up — or something in between.
I don't know which he was — and may not have known even if I was at
the event. I do know that I'm more likely to believe that the docs were
trying to do the right thing than the lawyer is telling the truth —
and so did the jury who knows a lot more about the event then we do.

A question for the group. You have a patient who is alert and oriented
after being struck in the head and being knocked out for 5 or so
minutes. He refuses a cat scan, becomes belligerent although still
oriented and tries to leave AMA. What do you do?

Bill

William J. Bromberg, MD, FACS
Chair, EAST Practice Management Guidelines Committee
Savannah Surgical Group
912 350-7412

>>> "Moore, Rick" <Rick.Moore at TriadHospitals.com> 4/22/2008 4:06 PM
>>>
Once again someone taking incomplete and possibly incorrect
information
and making judgments. You weren't there, don't know the extent of the
patients injuries or the reasoning of the physician for insisting. If
we
accept a refusal we are sued for not convincing them refusal is a bad
thing, if we don't accept a refusal we are criticized, sued or
arrested
for assault. 

-----Original Message-----
From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org] On Behalf Of
bowwow49 at bellsouth.net 
Sent: Tuesday, April 22, 2008 2:39 PM
To: Trauma &amp; Critical Care mailing list
Subject: Re: Rectal Exam Lawsuit DENIED

And in the same frame as when a women says no, it means NO, not maybe,
correct ! What is the difference when a man says no, and it makes no
difference in this world what the Dr's opinion was, if this man did
indeed say not only no, but begged for this not to be done, this is
still , at least as of right now ,The United States of America people
and it is his right and any one on this list that feels there MD
overrules the free choice of a adult that is Awake Alert and oriented
,
should not only be found liable, but further more there should have
been
charges filed against this doctor, not the pt that was being assaulted
just because this ER doctor was pissed because someone lacking the
proper information of why this might have needed to be done had the
ignorance to refuse his judgment ! This kind of situation is just as
responsible for lawsuits as the BS crap that comes up ! Come on folks
!
Bowser
-------------- Original message from "Charlene M Morris"
<cvmmorris at gmail.com>: -------------- 

> Apart from the ramifications of an exam the clinician feels is 
> necessary, I am STILL of the mind that patients have rights and 
> responsibilities. In this instance, I would have documented in bold 
> letters: "PATIENT DECLINES [OR REFUSES] RECTAL EXAM DESPITE STATING 
> ITS IMPORTANCE IN HIS CASE FOR DETECTING NEUROLOGICAL DEFICIT". 
> Whether that holds up in a COURT OF LAW is yet another issue.
> 
> I once worked with a Dr. who wanted to do a breast exam on ALL women.

> His nurse defended his committment to detecting breast cancer, but to

> my mind-- if a woman (PATIENT) says no, she should NOT be subjected
to
what the Dr.
> *felt* necessary.. 
> 
> JMO--
> 
> Charlene Morris
> 
> 
> On 4/22/08, Jeffery Hammond wrote: 
> > 
> > I guess it's time to agree to disagree. :)
> > 
> > JSH
> > 
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org [mailto: 
> > trauma-list-bounces at trauma.org] 
> > On Behalf Of Moore, Rick
> > Sent: Tuesday, April 22, 2008 1:30 PM
> > To: Trauma & Critical Care mailing list
> > Subject: RE: [ccm-l] RE: Rectal Exam Lawsuit DENIED
> > 
> > 
> > Gee, I didn't hear any indignation about "passing judgment in a 
> > situation where we have very limited information" directed towards

> > the other comments that were uniformly condemning lawyers and 
> > praising the "good guys."
> > 
> > That's because until your comments nobody had been indignant
calling

> > the procedure unwarranted, unnecessary and hogwash, again based on

> > only one limited side of the story. All conclusions that no one 
> > other than those close to the case with all the information should
make.
> > 
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org 
> > [mailto:trauma-list-bounces at trauma.org] On Behalf Of Jeffery
Hammond
> > Sent: Tuesday, April 22, 2008 12:01 PM
> > To: 'Trauma & Critical Care mailing list' 
> > Cc: 'CCML' 
> > Subject: RE: [ccm-l] RE: Rectal Exam Lawsuit DENIED
> > 
> > Replies below to Dr Myers comments... 
> > 
> > -----Original Message-----
> > From: Jeff Myers, D.O., Ed.M. [mailto:myersj at alum.rpi.edu] 
> > Sent: Tuesday, April 22, 2008 12:38 PM
> > To: Jeffery Hammond
> > Cc: 'Trauma & Critical Care mailing list'; 'CCML' 
> > Subject: Re: [ccm-l] RE: Rectal Exam Lawsuit DENIED
> > 
> > Remember all, we are getting the lay press' report of the events
and

> > armchair quarterbacking the incident.
> > 
> > -->>Agreed
> > 
> > All I glen was that this patient was struck in the head at a 
> > construction site. Was the treating team concerned about a head
and
c-spine injury?
> > 
> > -->> You don't need a rectal exam for an injury limited to the
head
> > in a patient moving all 4 extremities. 
> > 
> > Were they concerned the patient was combative / ? altered from the

> > head injury?
> > 
> > -->> He was apparently talking to them. He didn't become
> > combative
> > until they tried to bugger him. 
> > 
> > The patient was not only sedated but intubated (according to the
> > description) - doesn't this scenario occur across the country when

> > we are taking care of altered trauma patients so we can obtain 
> > timely imaging and intervene rapidly?
> > 
> > -->> Yes, in heavily intoxicated patients or those with major
> > TBI. 
> > But, in this case (agreeing that we have only part of the data) I 
> > would counsel any trauma team member who intubated a patient just
to

> > do a rectal exam.
> > 
> > I just ask you all to reflect on situations where you may have done

> > the same thing as reported because you were doing the right thing 
> > for the patient before passing judgment in a situation where we
have

> > very limited information.
> > 
> > -->> Gee, I didn't hear any indignation about "passing judgment
> > in a situation where we have very limited information" directed 
> > towards the other comments that were uniformly condeming lawyers
and

> > praising the "good guys."
> > 
> > Jeffrey Hammond MD, MNPH
> > New Brunswick, NJ
> > 
> > 
> > 
> > 
> > 
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Rectal Exam Lawsuit DENIED