LEGAL ASPECTS OF PRE-HOSPITAL CARE Presented by: Steven Jones, NREMT-P Clear Lake Emergency Medical Corps and Elizabeth Bradley, EMT-P Student College 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 –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