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Ken Lavelle, MD, NREMT-P
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Cell: 215-776-0584

-----Original Message-----
From: "Ken Lavelle, MD, NREMT-P" <[log in to unmask]>

Date: Wed, 19 Aug 2009 16:10:36 
To: Julia Whitefield<[log in to unmask]>
Subject: Re: On Line Medical Directorship and Treatment Relationships


I was a former medic and now am in Philly at a hospital that does med command.

How we teach:

When a base command call comes in for a refusal, we get the info from the provider and their impression. Sometimes the case is minor and the refusal is reasonable.

We try to talk to the patient (or parent) when possible, just to get them on tape.  Will this help legally/liability? Dunno, but can't hurt.

If we feel the patient is not competent to refuse, then we discuss with EMS. If they agree, they will see if the police will support forcing them to go. (Surprisingly sometimes they won't get involved.) If not, EMS will usually not get physical on they own. We all document for bear and hope it ends up ok.

For a child, if we really feel it is unsafe for them not to come, we can usually either convince them (let them know our plan when they get here - based on what we know - usually is good enough) or PD will get involved.

Overall liability? I guess it is there, might be administrative/general liability based on oversight of EMS rather than med-mal. Only cases I have seen were medical command diverting to another hospital via radio.  As long as you recommend transport, you've done what you can. Rest is up to EMS and PD.
Ken Lavelle, MD, NREMT-P
[log in to unmask]
Cell: 215-776-0584

-----Original Message-----
From: Julia Whitefield <[log in to unmask]>

Date:         Tue, 18 Aug 2009 17:48:23 
To: <[log in to unmask]>
Subject: On Line Medical Directorship and Treatment Relationships


Dear All: a question was posed to me today as I was giving a lecture on malpractice and legal issues. 

When an ambulance calls and wants advice from any of us as on line medical directors and the patient/patient's guardian refuses being taken to the hospital, do you

1. Take it upon yourself to tell the EMTs to restrain the patient and bring them to you? (This is after trying to sweet talk them into being transferred and they feel strongly the patient needs to be seen.

2. Do you let them walk? You don't really have a relationship with the patient (yet)

3. If it is a parent and you feel strongly their child needs to be transported to the hospital do you have them call the police? Take custody of the child?

 

What are your opinions regarding having a treating relationship with the patient - you really don't yet. Or you have given some orders and you do have an indirect treating relationship with the patient?

 

What are the legal implications?

Food for thought!

Thank you!

Julia Whitefield MD, Ph.D.

Pediatric Emergency Medicine

UNM

ABQ, NM

 

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For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html