LEGAL ASPECTS OF PRE-HOSPITAL CARE

Presented by:

Steven Jones, NREMT-PClear Lake Emergency Medical Corps

andElizabeth Bradley, EMT-P StudentCollege of the Mainland

Definitions

• Abandonment– failure to provide care for the patient once it has been

initiated

• Assault – an action that places a person in immediate fear of bodily

harm

• Battery– touching another person without their consent

• Civil (tort) law– deals with noncriminal matters such as contract disputes,

medical malpractice, and conflicts between two parties. The parties sue each other

Definitions

• Confidentiality– privacy of all patient related information

• Consent– granting permission to treat

• Criminal law – deals with crime and punishment. The state sues an

individual who is accused of committing a crime

• Emancipated Minor– a minor (under 18 years) that is responsible for his/her own

maintenance and support

Definitions

• Expert Witness– a witness that has special or extensive knowledge regarding

the subject about which they are called to testify

• Expressed Consent – when a competent, adult patient gives permission to be

treated

• Implied Consent– when a patient is unable to give expressed consent the law

assumes that they would desire to have life-saving treatments rendered

• Lawsuit – a legal action initiated by one party against another

Definitions

• Libel– injuring a person’s character or reputation by false or

malicious writings

• Negligence– failure to administer the same degree of care that a

reasonable person would exercise under the same circumstances

• Rights– liberties, allowed for under the law, for which each person is

entitled

Definitions

• Slander– injuring a person’s character or reputation by false or

malicious words

• Standard of Care– what a reasonable and prudent person would do under

similar circumstance

Scope of Practice

• Scope of Practice– outlines the care EMT’s are able to provide

to the patient

• IN TEXAS . . . . . . – There is no “defined” scope of practice

Scope of Practice

• Established by Medical Director– Medical Practice Act

• Allows Physicians to delegate procedures to EMS personnel

– Protocol– On-Line

Standard of Care

• Local Custom– Similar Training & Experience– Protocol– Other factors

• Location • Hazards• Crowds

Standard of Care

– “- - - how a reasonably prudent person with similar training & experience would act under similar circumstances, with similar equipment, and in the same place.”

Standard of Care

• Law– Constitutional– Legislative– Executive– Judicial

Standard of Care

• Professional Standards– American Heart Association (AHA)– American Ambulance Association (AAA)– National Association of Emergency Medical

Technicians (NAEMT)– Texas Department of Health (TDH)– Department of Transpiration

Standard of Care

• Institutional Standards– Service

• Agency Specific Protocol

– Regional Systems• Regional Trauma Systems / Guidelines

Negligence

• Simple (Ordinary) Negligence

• Gross Negligence• Proving Negligence (4 Pillars of Negligence)

– Duty to Act– Breach of Duty– Damages– Causation

Abandonment

• Failure to Continue Treatment:– Termination of care without Pt’s consent– Termination of care without provision for

continued care

• Failure to transport

Abandonment

• Handing Over Care– EMT > EMT– EMT > EMT-I– EMT > EMT-P– EMT > LVN– EMT > RN– EMT > Physician

Adult Consent

• Adult - Any person over 18 years of age who is not under a court-ordered disability

• Actual Consent (Informed, Expressed)• Implied Consent

– Pt. is unconscious or unable to communicate and is suffering from what appears to be a life-threatening injury or illness

Adult Consent

• Involuntary Consent– An adult may be treated against his will

only if:• Treatment is ordered by a magistrate• Treatment is ordered by a peace officer or

corrections officer who has the patient under arrest or in custody

Adult Consent

• Consent of the Mentally Incompetent As Deemed by EMS– Suicidal Ideations or Suicide Attempt

• Encourage patient to transport voluntarily

• Involve Law Enforcement– Force Transport – have patient placed in custody

Adult Consent

• Right of Refusal of Treatment/Transport– Mentally competent adults have the right to

refuse care– the person must be informed of risks,

benefits, treatments, & alternatives– Obtain signature & witness

Minor Consent

• Minor - any person under 18 years of age who has never been married and who has not had his/her minority status changed by the court– Pregnant Minor– Emancipated Minor– Minor Living Alone and Responsible for

50% of Personal Living Expenses

Minor Consent

• Actual Consent (Informed, Expressed)– Parents– Guardian– Others Closely Related of Majority Age

Minor Consent

• Implied Consent – Life or Limb Threatening– No Parental Refusal

Minor Consent

• Right of Refusal of Treatment/Transport– Mentally competent adults

(Parent/Guardian) have the right to refuse care for their children

– the person (Parent/Guardian) must be informed of risks, benefits, treatments, & alternatives

– Obtain signature of Parent/Guardian & witness

Assault & Battery

• Assault– Unlawfully placing a person in fear of

immediate bodily harm without consent

• Battery– Unlawfully touching a person

Immunity

• Governmental (Sovereign) Immunity

• “Good Samaritan” laws– Do not prevent lawsuits– Offer a defense for those who act in “Good

Faith” and meet the Standard of Care”– Do not protect against Gross Negligence

Do Not Resuscitate

• What Is A OOHDNR?– Out Of Hospital Do Not Resuscitate

• An order that allows patients to direct health care professionals in the out-of-hospital setting to withhold or withdraw specific life-sustaining treatments in the event of respiratory or cardiac arrest.

Do Not Resuscitate

• “Living Will”/ “Advance Directives” must be Presented upon Patient Contact

• Determine validity– May Not be Witnessed by Anyone Who

would Benefit from the Death of the Patient

Do Not Resuscitate

• Texas Law Allows:– OOHDNR – Original Document– OOHDNR – Copies of Original Document– Medallions (DNR Device)

• Medical ID Bracelets / Necklaces• Laminated Wallet Cards

Do Not Resuscitate

• Can Include (Any or All)– Cardiopulmonary resuscitation (CPR)– Transcutaneous Cardiac– Defibrillation– Advanced Airway Management– Artificial Ventilation

Do Not Resuscitate

• Determine Specificity as to Levels of Care to Render– Usually Comfort Measures Only– Pain Management is SPECIFICALLY

Allowed

• If Transporting the Patient– A copy of the OOHDNR or DNR Device

must accompany the patient

Do Not Resuscitate

• Once Treatment Begins:– If a Valid OOHDNR is Discovered / Presented

• Cease using CPR, transcutaneous cardiac pacing, defibrillation, advanced airway management and artificial ventilation on the patient

• Provided supportive care as necessary SPECIFICALLY comfort care

– Pain Management

Do Not Resuscitate

• Conditions To Dishonor a OOHDNR– The patient is pregnant – There are unnatural or suspicious circumstances

surrounding the death– The form is not signed twice by all who need to

sign it or is filled out incorrectly and no DNR device is present

– An IMMEDIATE family member is protesting the DNR on scene

Do Not Resuscitate

• A DNR can be revoked at any time by the patient or the person who acted on behalf of the agent. Revocation can be in the form of communication to responding health care professionals, destruction of the form, or removal of devices

• Consider Family Reaction

Do Not Resuscitate

IN DOUBT ??

TREAT!!

Records & Reports

• Complete & Accurate

• Legible & Neat– An untidy or incomplete report is evidence

of incomplete or inexpert care.

• Legal Document– If it wasn’t written down, it didn’t happen!

Patient Confidentiality

• Patient Confidentiality must be Kept:– To Ensure the Patient’s Right to Privacy– To Maintain the EMT’s Reputation of

Professionalism– To Maintain the Service’s Reputation of

Professionalism– It is No One else’s Business!

Patient Confidentiality

• Patient Information May Only be Released:– It is necessary to ensure continuity of care– It is requested by Law Enforcement– It is required for billing purposes– It is Subpoenaed– When the Patient Signs an Information

Release Form

Special Reporting Requirements

• Childbirth

• Child Abuse– Report to:

• Law Enforcement• Physician - Emergency Department• Child Protective Services (CPS)

– Don’t Accuse - Report Observations Only– Immunity - Good Faith

Special Reporting Requirements

• Elder Abuse

• Injury During the Commission of a Felony

• Drug Related Injuries

Special Reporting Requirements

• Crime Scene– Scene Survey– Document– Preserve– Report to Law Enforcement

Special Reporting Requirements

• Sexual Assault– Report to Law Enforcement

• MUST OBTAIN PATIENT’S PERMISSION)

– Retain Evidence

Special Reporting Requirements

• Dead on Scene– Document Absence of Vital sign– Contact Law Enforcement– Do Not Disturb or Move Body– Additional Documentation

• All EMS Personnel Present• Where EMS Stepped• What EMS Touched• General Scene Appearance