? for all Medics and Docs out there

91W · Post by **91W** » September 9th, 2006, 9:38 pm

How long do you push for consent to treat a child?

The scenerio:

6 year old boy bicycle accident. Helmet broken acting lethargic, pupils equal but sluggish. Responding to verbal stimuli. Abdomen tender becoming rigid with gaurding. Vitals and general apperance showing compensated shock. Mom refusing to allow to treat due to no insurance. Sheriff Deputy willing to place into protective custody for treatment.

I ended up with a scene time of 21 min with about 16 of those getting consent. All she would allow to that point was vitals and a quick focused exam.

How long would you try to get mom to let you treat before using law enforcement. Granted it is alot less messy if you can get the consent but every min is putting your patient that closer to crashing. The outcome was good in the end but just wondering what the thought of more seasoned medics might be. Also wondering what Docs think on this.

SkyShark · Post by **SkyShark** » September 11th, 2006, 4:40 pm

I guess money is more important than ones child. I just don't get it. I am a parent. I don't care what financial situation I am in. My kid is hurt, he is going to be treated the best possible. Fucking people never cease to amaze me.

Doc Roberts · Post by **Doc Roberts** » September 12th, 2006, 5:42 am

Would have waited just long enough for her to show just how truly stupid she is. Fuck her. Your health and especially that of your loved ones comes before an check book issues.

Thursday · Post by **Thursday** » September 12th, 2006, 6:43 am

I would get the police involved as soon as the mother said she didn't want treatment for her child. I would explain that it doesn't matter if they have insurance or not, he needs to be treated in a hospital. In my mind, if she still is refusing treatment for her child, then that is a sign of abuse (neglect) and would have the child put into protective custody by the police, or would have the mother arrested for something or another to go about getting treatment for the child.

Phulano · Post by **Phulano** » September 12th, 2006, 8:08 pm

Thursday wrote:I would get the police involved as soon as the mother said she didn't want treatment for her child. I would explain that it doesn't matter if they have insurance or not, he needs to be treated in a hospital. In my mind, if she still is refusing treatment for her child, then that is a sign of abuse (neglect) and would have the child put into protective custody by the police, or would have the mother arrested for something or another to go about getting treatment for the child.

I'm pretty new to EMS so take this for what its worth, but I was under the impression a parent has the right to refuse medical treatment for their child.

I'm not weighing in with my personal opinion. I agree 100% and would consider it neglect.

P

Thursday · Post by **Thursday** » September 13th, 2006, 1:30 am

It is true GB Phulano, but, in a situation where I felt that the child had a serious injury and needed definate medical attention, then I would respond the way that I said above.

If I get called to a scene where there isn't a serious problem, trauma or not, then I'm not worried about letting a parent refuse for their child. But if it is an MVC and the car is pretty banged up and the kid is looks as though he will need to be seen in the ER, then yes, I will do everything in my power to get that child the proper care he/she needs.

Phulano · Post by **Phulano** » September 13th, 2006, 8:22 am

Thursday wrote:It is true GB Phulano, but, in a situation where I felt that the child had a serious injury and needed definate medical attention, then I would respond the way that I said above.

If I get called to a scene where there isn't a serious problem, trauma or not, then I'm not worried about letting a parent refuse for their child. But if it is an MVC and the car is pretty banged up and the kid is looks as though he will need to be seen in the ER, then yes, I will do everything in my power to get that child the proper care he/she needs.

Whats GB?

I'm learning the ropes. I'm working in a hospital right now, and will be doing my first EMS rotation next week. Ive heard people talking about different tricks to get abused or neglected children to the ED when they need to be seen or even just need to be pulled from the house, but I havent encountered it myself yet. Gotta do what ya gotta do for the kids.. I'll learn as I go I suppose.

Doc Roberts · Post by **Doc Roberts** » September 13th, 2006, 11:26 am

Phulano, in Georgia if the LE can show that the injuries are life threatening or of serious concern they can take the child into protective custody to get treatment for the child. AT that point I would also contact DFCS (family child services) and initiate an investigation into the incident against the mother. Also, the reason for non-treatment is insurance, not religious which allows the LE to take for treatment as well.

91W · Post by **91W** » September 13th, 2006, 11:27 am

Thanks for your suggestions. I got an answer from the DA that i talked to. If a child is in immediate threat in the state of Indiana a medic has implied consent wether or not the legal gaurdian gives consent. If the mother says no and you have good reason to believe that the child may lose life, a limb, or eyesight you have the consent to treat and tell the parents where the child will be.

However he told me that if I do that it had better be documented correctly and i had better get a lawyer for the civil suit that is inevitable.

So it works the same as if no gaurdian was around. Consent is implied when acting in the best interest of your patient. I hope that I do not run into this again, I had a hard enough time not knocking the mom out and treating under implied consent.

Creeping Death · September 13th, 2006, 11:46 am

That's pretty much the way it is in my AO as well. Luckily, due to local demographics and protocols, the paramedics are usually there by the time I am finished with my initial assesment, and they take command of the scene.

But in any event, anyone in that position in my AO can act under implied consent and duty to act to save the life of a minor, and document the living shit out of the call in prep for the ensuing complaints and legal action. If injuries are non-life threatening, the parents can refuse care. If it is obvious neglect in a non-life threatening situation, then get the LEOs involved to facilitate proper care for the kid. But here again, documentation is PARAMOUNT.

Bottom line is I ain't gonna watch a kid die and do nothing about it, consequenses be damned.

91W · Post by **91W** » September 14th, 2006, 6:31 am

Creeping Death wrote: Bottom line is I ain't gonna watch a kid die and do nothing about it, consequenses be damned.

Amen Ranger, I was ready to kill mom to make it happen the other night. Like I said I hope that the situation does not present itself again but we beat LE by 10 min. The accident was four blocks from EMS quarters so we had a 45sec response time and it was way out in BFE. It is nice to know that when encountering a "To stupid to parent" type we can take matters in our own hands. Next time I will fly them out and simplify the whole process. I had not ran into the situation in 10 years but have always worked in a rural enviroment where family comes first to everyone. I just regret not getting CPS involved when I wrote the chart. Next time i will be ready if it presents itself. I love the job for this reason, everyday you learn something new and no call is the same, ever.

On a side note my partner and I had to answer the other day as to why we did not fly from the scene. The Doc was a little pissed at us. I should have reshearched the scenario before it presented itself and would have made better decisions. That is part of the job and now I know, and can pass that info on.

DJB · Post by **DJB** » September 16th, 2006, 8:57 am

yeah 30 sec sounds about right

Sleepy Doc · Post by **Sleepy Doc** » September 19th, 2006, 8:21 am

This is an excellent question/scenario for anyone because it really varies from state to state, and even locality. Having a lot of varied experience throughout the country (military and civilian) I can offer these insights;

1-You were correct to ask a DA what, if any criminal liability you may incur. Ultimately they would be the ones to kidnapping charges, if any.

2- Get your online medical control involved (time permitting). In most areas, if you call the hospital directly and get clearance from a doctor your actions will be further justified.

3-This is definitely a case where proper and thorough documentatin will save your ass. Include everything you can think of, no matter how trivial. IE-Moms emotional state, any direct quotes from her, the temperature outside, whatever. Use extra sheets if needed. Also, have your partner write an incident report.

4-If LE is on scene, have them deal with mom while you take care of/transport your patient. They will be your best friend and ally in this situation. Again, make sure you document that you took the child into protectivve custody with the authority of the LE. DO NOT document that you think it is abuse or neglect, only the conditions leading you to think the child was in immediate danger.

5-If you are a BLS provider this is a case where you should not delay transport. Have the Paramedics intercept with you enroute.

I've run into situations similar to this and can tell you that I don't envy you. Yes, the parents have the right to refuse all care for any reason, but you have to balance that with being an advocate for your patient. In a non life threatening situation I sat on scene for a hour before I convinced a patient to go to the hospital. They also didn't have medical insurance. Remind them that even even if they owe a million dollars to the hospital they will be seen and given treatment. If they say "I don't wantto get a bill" tell them, "Fine, don't pay it." Let the parent know in no uncertain terms that their child could die right there if they don't get treatment. Be blunt, unapologetic, and clear in what you say. Have witnesses, document what you said and again her reaction.

It sucks that we as medical providers have to deal with dumb-asses like this. (god, I miss being in the regiment..) I like my local guidelines for maximum on scene time; 10 min for trauma, 20 min for medical. For serious patients less than that and treat enroute, but I am no more than 30 minutes at the most from a level one trauma center. Remember, sometimes the best treatment is diesel-injection. Just make sure that you document the shit out of this one.

Silverback · Post by **Silverback** » September 19th, 2006, 8:23 am

Sleepy Doc,
Post an introduction in the appropriate area prior to posting anything else.