Man forced into ambulance ride. But was he kidnapped?

EMS1.com is reporting a Florida man who was transported after a loss of consciousness may sue the agency that transported him.

According to the report, the patient suffered a loss of consciousness and was assisted by neighbors to his home and someone other than the patient dialed 911.

After an assessment, according to the patient, the paramedics determined he was “at risk for a stroke” and needed transport.

Kenneth Rothwell, the patient, states he was told, “It was either go, or you’re going to be handcuffed and we’re going to take you.”

Hang on here a minute folks.

The story does not elaborate WHO said anything about the handcuffs, but a deputy and EMT were at the scene.  Now we have reports of 3 rescuers (“Paramedic” “deputy” and “EMT”).  I wonder which one brought up the idea of handcuffs?

 

We have safeguards in place for this kind of situation by way of direct Medical Control.  Whenever I have a high index of suspicion of illness or injury and a patient refuses, I do my best to convince them of what I think is in their best interests.  If that fails I fall back on direct Medical Control to talk to the patient.  If that fails, most times, the MD will instruct me to explain the dangers of staying home to the patient and…wait for it…leave them there.

There is never a threat of “being handcuffed and we’re going to take you.”  That should NEVER be an option.  The urban myth that is patient kidnapping is being supported by poor decision making based on false presumptions.  I can only imagine that the deputy who made the hand cuff comments (unconfirmed) had no intention of placing Mr Rothwell under arrest for passing out.  I’ll have to confirm with Motorcop that is not an arrestable offense.

 

Point is that Mr Rothwell has a very good argument against whoever told him he “had” to go, either willingly or in cuffs.  THAT is the part that bothers me about all this.  That and the fact Mr Rothwell is required to make health care decisions based on out of pocket expenses, but that’s another issue entirely.

 

Comments will surface soon about foolish EMTs or that this is a good reason EMTs and Paramedics should not be making refusal referrals pre-hospital, but this is EXACTLY what Mr Rothwell needed.  BLS before ALS failed Mr Rothwell.  A well trained Paramedic could have offered Mr Rothwell a calm comfortable ride in his first response vehicle, or even to follow him to the local ER if he likes.  Maybe even make an appointment to call or drop by later in the day to check in on him, but we are locked into a 40 year old model that scares our people into transporting every scratch and scrape, tummy and head ache so we don’t get sued.

And this is where it gets us.

At the very least, the agency who mislead Mr Rothwell using intimidation in order to remove him from his home against his will is at risk for setting an industry wide precedent and prove the urban myth a reality.

 

Your training exercise for the day:

Was Mr Rothwell, based on the EMS1.com story facts as reported, kidnapped?

Agree? Disagree? Have something to add? Why not leave a comment or subscribe to the RSS feed to have future articles delivered to your feed reader?

32 thoughts on “Man forced into ambulance ride. But was he kidnapped?”

  1. In the first place, we don’t have the most important facts (i.e., the mental status exam). As Skip Kirkwood has pointed out on the NEMSMA list, to be considered a “kidnapping” requires that someone be re-located against their will for a “nefarious purpose” and taking someone to see a doctor is certainly not a nefarious purpose. So the charge would be battery and perhaps false imprisonment (although I’m certainly not a lawyer). Any refusal must be an informed refusal. In other words, the patient must be able to understand his situation and comprehend the risk he’s taking refusing care. Since we weren’t on the call, this kind of speculation results in the same pointless discussion EMS folks like to go through over and over again, while learning absolutely nothing, and repeating the same old EMS mythology. Is it getting old yet?

    1. What charges, if any, might apply will vary widely from state to state. If the LEO puts the cuffs on, false arrest would be likely and federal civil law issues might kick in.

      Your post is directly on point. Or points actually. From the article, we don’t know what the patient’s condition was, what his competence level was, what the medic may or may not have told him, or what is in the PCR. Is the fire commission backing the fire department because they read the reports and have a good understanding of the legal issues involved? Or are they just circling the wagons? Time will tell.

    2. while taking someone to see a doctor, or to a hospital, may not be a nefarious undertaking, there are some extenuating circumstances that need to be considered. if i am ever involved in an accident or suffer an illness necessitating transportation to the hospital by emergency medical ambulance, i will ALWAYS refuse as long as i am conscious. this is due to the fact that i am very, extremely, severely claustrophobic and cannot tolerate restraint of any kind. i cannot even buckle the seatbelts in my personal vehicle, and carry an exemption to the mandatory seatbelt law in my state. i have talked at length with the local E.M.S. leaders in my state and they have all assured me that in no way,shape, form, or circumstances would i ever be transported in one of their ambulances unless i was securely strapped to the gurney as per state law. any attempt to restrain me causes severe anxiety and panic attacks resulting in increased heart rate and blood pressre, extreme sweating and trembling, and pounding headache, and all out nuclear war erupts between me and the providers trying to restrain me. when this occurs i am no longer in control of myself. this is a no holds barred fight to the finish, and will continue until victory is won. the stakes are way too great to take the chance of losing. if restraint were ever successful my extreme fear will cause a stroke or fatal heart attack, as i will not quit fighting until i die. please do not suggest i see a psycholigist for treatment. i have been there and done that. all i want and need is assurances from any E.M.S. providers that happen upon me that they will under no circumstances make any attempt at restraint, even buckling the straps on the gurney, and if that is not possible, to leave the scene and let me. anything else and it will not be help that you will be rendering. please, has any E.M.S. provider ever transported a patient in their ambulance completely free of reatraints?

  2. Assuming the pt was within guidelines to refuse all it takes is a call to medical control like you said, they can make the decision. If the pt refuses then you document that you called medical control and spoke with Nurse Betty and/or Dr Spock, document the tape and log number, and put in your report that pt was informed of all risks of refusing treatment up to and including the possibility of death, and was instructed to call back if at anytime s/he wants or needs to go to the hospital.

    1. Here’s my problem with the punt to medical control option. Are you willing to, essentially, detain the patient if online medical control says he has to go? Are you sure that, in your conversation to medical control, you aren’t subconsciously leaving out details since you’re biased towards transport? The online control physician only has the picture you paint to go by, which may or may not be as accurate as you’d like it to be.

    2. It no doubt varies by state or even system, but a doctor can not authorize or negate a refusal by a patient who is not mentally incapable of making an informed decision. Just because WE think he’s making the wrong decision does not mean that we can over ride that decision and substitute our judgment for the patient’s.

      Patients have the right to refuse, even if we think it’s the wrong decision. The key is the mental capability of the patient, the detail of explanation given, and documentation.

  3. It would depend on the pt’s current mental status. Where I live, the police can ‘force’ a patient to go to the hospital by putting them on papers requiring them to get a mental health evaluation, if they feel they are making decisions that are putting themselves at risk. I had a call where the police forced a patient to get evaluated after an MVA due to the mechanism of injury (same deal, they told the pt either he go willingly or they would put him on ‘papers’)… pt denied injury, wouldn’t allow me to get baseline vitals, but I had to transport him (not allowed to question pd here). The pt walked out of the ER w/out evaluation, and then later refused to pay the ambulance bill. My company decided not to force the issue and not go after him for the ambulance charges.

    1. Why are you not allowed to question PD? What is the PD’s medical training? Tell the officer that he can make medical decisions for you when you can make use of force decisions for him.

      1. Yeah, but he can make the use of handcuffs decision on me for ‘interfering with an officer’ or some other BS complaint if they’re a real badge-heavy cop. In my not so humble opinion, it’s best to defer to the person with the gun until you get back to the station, and then have your captain call their sargent.

  4. Not only was he kidnapped, he was assaulted as well. If the EMT/Paramedic who does not have power to arrest, made the statement that he would cause physical contact to occur outside of the patient’s wishes, the patient was assulted. If he had followed through and actually performed the act, that would have been battery.

    Regardless of who said what, this was just bad judgement and unprofessional. We, the medical professionals, are to advocate for our patients and give them the knowledge to make an informed decision and then follow through with wishes.

    Somebody crossed the line….waaaaaaaay over the line!

  5. You’re blaming this on BLS before ALS? BLS here advises people on a regular basis that they don’t need to go to the hospital. In fact some BLS departments only offer transport if they think the patient needs it.

  6. Like tbouthillet said, we don’t have the necessary information or context to determine if the medic acted appropriately. If the patient was altered, forcibly removing the patient in restraints would have fallen under Implied Consent, the implication being that under sound mind the patient would have wanted medical treatment. The deputy on scene would then place the patient on a 5150 hold.

    Furthermore, when negotiating with altered patients that possibly pose a danger to themselves, the use of scare tactics such as the empty threat of incarceration are not only effective, they are preferred to the use of force.

    I’ve decided to give the medic the benefit of doubt. Let’s not jump to conclusions without all the information.

      1. As I have already stated, we don’t know what the patient’s mental status was. My statement was prefaced with an “if.” IF the patient was altered AND presenting with stroke-like symptoms AND refusing care, then they most certainly qualify for a 5150 as a danger to themselves.

        1. He absolutely would not qualify for a 5150 for these circumstances. Implied consent? Maybe. 5150? Absolutely not. Legal holds under section 5150 of the California Welfare and Institutions Code are specifically for mental health disorders only, not strokes, not seizures, not traumas. The section 5150 multiple times discusses mental health facilities and mental health providers and never discusses things like neurologists or neurosurgery (in fact, while not codified under 5150, the right to refuse neurosurgical procedures are retained by people with psychiatric disorders being held under section 5150).

          Please read section 5150 and respond with a quote where a 5150 hold can be issued for non-mental health related issues. This patient needs a neurologist, not a psychiatrist, and that alone disqualifies him for a 5150 hold.

          I should also note that a 5150 hold comes with some very specific restrictions on one’s rights, such as the right to bear fire arms. Should a person who was placed under a 5150 for proper reasons be restricted? Sure. Someone placed under it because they might be having a stroke and wants to exercise their right as an individual to direct their own medical care? Absolutely not.

          1. I’ll also note, that Section 5150 is specifically for California, while this happened in Florida. As such, it would be a “Baker act” detainment, and I’m not exactly sure what the criteria for Florida is as I’ve worked in California and have never worked in Florida. Assuming this case happened in California, though (as you can’t have a “5150” in Florida), the preceding argument about this not being a mental health disorder still applies.

    1. Pt is not a threat to himself or others as far as we know and making “empty threats” is the same as lying. I will not lie to them when it comes to their options.
      I’m not assigning blame, just looking for opinions as to the initial facts.

      1. With all due respect, Justin, all we have to work with is assumptions. I’m assuming the medic was competent to determine the patient’s lack of competence. The patient had a syncopal episode followed by stroke-like symptoms. Unless we are made aware of the patient’s GCS, we have to assume the medic determined it to be < 15. An altered patient falls under implied consent.

        1. Hamid, thanks for reading and commenting. I partially agree with you, but a person who recalls being threatened with handcuffs if not agreeing to a transport is likely a 13 or greater on that useless scale. Keep in mind a dead person scores a 3.
          We are assuming too much here, I’m just asking if, on the basis of what we know now from the article, if there was a basis for the urban myth (in my opinion) of patient kidnapping and, if so, who was the initiating agency.
          I’m fairly certain the threats of incarceration were not made by EMS, but again, as has been as stated by many, we do not have the facts.
          But we never will have the facts, so let’s keep the lines of communication open before this kind of thing happens again.
          Thanks for reading.

  7. This is one side of the story from someone threatening to sue. We don’t know if he is exaggerating or making things up. We don’t know what his mental status was, his condition, etc. It does say neighbors assisted him home and called 911. Perhaps they were still on the scene and stating the he was not behaving normally. Either way, not enough info in the story to make the call.

  8. We all have had the situation where the person who was been drinking alcohol or smoking pot and they want to sign AMA. This person is able to answer question appropriately and GCS 15, but they are technically under the influance. How would you handle the situation?

    1. A/Ox4 and GCS does not determine capacity. Nor does 1 drink of alcohol or 1 joint remove it. Does the patient understand the decision he is making, and the consequences thereof? Only after having a conversation with the patient, during which the decision over capacity can be made, could you begin to determine if you can treat and transport under implied consent or not.

      1. Guy staggers out of bar, falls and hits his head on the parking lot. Wife calls 911. EMS arrives and finds 55 y/o male A/OX4 standing, no loss of consciousness per wife, and angry as hell. Patient states “screw you guys, I didn’t ask for you, I ain’t paying for no ambulance, go away. Don’t touch me, or I’ll sue your a$$.” Wife states he is normally “a friendly drunk” and has had 6 beers in the last hour. You explain the risks of refusal, he rants and raves and refuses to listen or sign refusal. Wife begs him to go, he pushes her away, and staggers back into the bar.

        Do you want to be the medic justifying your actions in this case? He may show up in court in a suit and sober, claiming you kidnapped him and cost him thousands of dollars in an effort to justify your salary amid budget cuts. Or will he be in a wheelchair with his sympathetic wife who will cry and say that she told you he was sick and you were too lazy to do your job?

        Personally, I would rather be sued for kidnapping in this case than abandonment.

        1. Neither kidnapping nor abandonment fit the case you described. we are not the police and we are not trained in subduing persons. The fact that this man is usually a “friendly drunk” means nothing other than he apparently is usually intoxicated.
          According to your abbreviated description he is fit to sign a refusal in my system, or I will quote him clearly in my report, which I’ll write in the parking lot, and if he heads for his car I’m calling MC and his buddies.
          We can only do as much as our patients will let us. And since this man did not call and was physically able to remove himself from our presence, he isn’t even a patient.

          On the same note. You and I are playing cards in the garage, garage door open, in your home, when you tip back too far and fall and hit your head. You’re bleeding and we’ve had a few drinks, but you say you’re fine. The neighbor across the street calls 911 and an ambulance has arrived and is trying to assess you. Do you allow them? If you were the responding crew, is this even a patient contact?

          Only recently did my service even file a definition of the word patient.

          Thanks for reading.

          1. Disagree as to SF system ‘standards’ – presence of any intoxicants renders a patient unable to make transport decisions, that is, they can’t make their own choices. The work-day reality is much different from the printed word, as we all know.

          2. “presence of any intoxicants renders a patient unable to make transport decisions,” Not true. The technical check box states “Patient does not appear to be under the influence…” quite different from simple presence or ingestion. heck, half the population is medicated to some degree and by your above listed standard unable to make decisions for themselves. New Mexico has (had) a great law called the EMS Transport Statute which allowed Paramedics to transport persons against their will in certain circumstances. I used it often and folks agreed, knowing the law. So few patients understand their “rights” when we arrive.

          3. So you’re intoxicated after a glass of wine? What about people on opioid pain killers? Would a lack of sleep (which can be just as bad as being legally drunk) also remove a person’s right to self determination of medical care?

          4. Joe,

            Not just the examples you list, but cough medicine often contains alcohol.

            Many medications may contain alcohol in quantities that may not even show up on a breath test, but if we are going to lower the standard for actions that automatically result in removal of my civil rights to presence of any intoxicants would have to include these medications.

            What about the use of an alcohol wipe on a cut?

            What about pouring some alcohol from a half liter bottle of isopropyl alcohol on a cut?

            Where does presence of any intoxicants end?

            Is there any medication that a patient can take that does not have the potential for intoxication?

            Please provide an example.

            Intoxicants include everything.

            Death by water intoxication.
            Gardner JW.
            Mil Med. 2002 May;167(5):432-4.
            PMID: 12053855 [PubMed - indexed for MEDLINE]
            http://www.ncbi.nlm.nih.gov/pubmed/12053855

            Should we consider the presence of water to be the presence of any intoxicant?

            We are made of water.

  9. Here are what look to me to be the most relevent parts of the law in Florida.

    It depends on the patient’s capacity to consent.

    401.445 Emergency examination and treatment of incapacitated persons.– (1) No recovery shall be allowed in any court in this state against any emergency medical technician, paramedic, or physician as defined in this chapter, any advanced registered nurse practitioner certified under s. 464.012, or any physician assistant licensed under s. 458.347 or s. 459.022, or any person acting under the direct medical supervision of a physician, in an action brought for examining or treating a patient without his or her informed consent if: (a) The patient at the time of examination or treatment is intoxicated, under the influence of drugs, or otherwise incapable of providing informed consent as provided in s. 766.103; (b) The patient at the time of examination or treatment is experiencing an emergency medical condition; and (c) The patient would reasonably, under all the surrounding circumstances, undergo such examination, treatment, or procedure if he or she were advised by the emergency medical technician, paramedic, physician, advanced registered nurse practitioner, or physician assistant in accordance with s. 766.103(3). Examination and treatment provided under this subsection shall be limited to reasonable examination of the patient to determine the medical condition of the patient and treatment reasonably necessary to alleviate the emergency medical condition or to stabilize the patient. (2) In examining and treating a person who is apparently intoxicated, under the influence of drugs, or otherwise incapable of providing informed consent, the emergency medical technician, paramedic, physician, advanced registered nurse practitioner, or physician assistant, or any person acting under the direct medical supervision of a physician, shall proceed wherever possible with the consent of the person. If the person reasonably appears to be incapacitated and refuses his or her consent, the person may be examined, treated, or taken to a hospital or other appropriate treatment resource if he or she is in need of emergency attention, without his or her consent, but unreasonable force shall not be used. (3) This section does not limit medical treatment provided pursuant to court order or treatment provided in accordance with chapter 394 or chapter 397. History.–s. 17, ch. 89-275; s. 15, ch. 89-283; s. 3, ch. 89-336; s. 1, ch. 90-192; s. 25, ch. 92-78; s. 3, ch. 93-12; s. 25, ch. 93-39; s. 802, ch. 95-148; s. 1, ch. 2007-176.

  10. I have found that the best method is to have the patient’s best interest at heart, to generally care about you patient, & to be able to effectively convey that to your patient through your choice of words, body language, etc. More often than not, I can talk virtually anyone into going to the hospital. If they don’t, there is the option of “punting” to medical control, but as was mentioned earlier, they only get the picture we paint for them, which may or may not be 100% accurate. Some of my most detailed reports are my refusals. I do this because I have about 15-20 criteria that should be met in order for a refusal. I’m not going to kidnap a patient, however, the situation does arise on rare occasions where a patient cannot be left alone. I make every effort to convince these people to allow us to transport them. As I’ve gained knowledge and experience, I’ve gotten more & more willing to let the drunk found sleeping at the bus stop go home… provided there is a responsible party there. Most of the time, the police are with us and they courtesy transport them. Recently I did the same when I ran one of my agency’s captain’s 20-something daughter who was drunkenly fell into the bushes not more than 500 yards from her apartment. I made sure I documented who I left her with, what instructions I gave that person, and that I told them to call back if she deteriorated or did not improve. But a smile, kind words, and generally giving a ____ work better than posturing, screaming, & threatening. As far as kidnapping, false imprisonment, etc., I feel that those provider are not guilty of any crimes. However, the guilt/blame falls on the current EMS system, the legal system, and our overly litigious society. The sad part is that we could do everything by the book, document a refusal, & still find ourselves in court for years for respecting a patient’s wishes. I feel that our roles, responsibilities, & liability should be clearly spelled out for situations such as these & that the liability should be limited to cases of gross negligence and/or malfeasance.

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