Legal Considerations

She had been down this road before and was ready for me.

"Do you know where you are?" I asked.

"Right here at home, 572 Fedora Street, Providence, Rhode Island, USA 02908."

"What day is it?"

"Thursday, May 26, 0737 hrs, SIR!" she snapped off a crisp salute.

"Who is the president?"

"President Barack Obama, sir!"

3-3. Not good. Time for Plan B.

"Lucy, the gentleman behind me is worried about you. he says you are not well."

"Too bad, I'm good as gold, better when you all get the hell out of my house."

"I'd like to take you to the VA to get checked out."

"Why?"

"Because you appear to be in the manic part of your bi-polar disorder."

"Prove it."

Prove it. She had me. Called my bluff, answered all of the questions and left me standing there with nothing. When a patient suffers with bi-polar disorder, and presents in a manic phase, they are disarmingly brilliant, articulate and clever. I knew she was heading for trouble, and needed to be taken to the ER for a psych evaluation. I did not know how to get her there without stepping on her rights, or overstepping mine. The police were on scene and had decided that this was a "medical," and stood by in case we needed to restrain the patient. I knew that if I touched her, or tried to force her to cooperate, a struggle would ensue and she would fight until exhausted. The end result would be her tied or handcuffed to the stretcher.

The last person to know that they are mentally compromised is usually the person who is compromised. They will fight, and struggle and do everything in their power to hold on to their freedom.

"Lucy" is a twenty year honorably discharged Air Force Veteran. According to her case worker from the VA she had been up for three days, hallucinating and calling friends in the middle of the night. All of the window shades in her apartment were drawn, so the people outside couldn't see in, she explained. The place was in disarray, but her cat had food and clean water, and there was no safety issues in plain sight.

I knew she needed help. So did I. Legal help. Problem is, I don't have a lawyer in my med bag.

Check out Fire Law for some answers!

http://firelawblog.com/

I had the pleasure of working with fellow author and blogger Chief Curt Varone for the first fifteen years of my career. I'm pretty sure he was a chief when I was sworn in in 1991. By all accounts, he was a good firefighter. I know he was a good chief. Anybody who has read his books and blog knows he is a good lawyer and writer. (Anybody reading this who is not in the fire service, "good" is the best compliment you can get.)

Chief Varone and I have decided to share our experience and his law expertise. By linking between the blogs, we hope you get a better understanding of how the law affects our decisions in the street.

*Every story on Rescuing Providence is hypothetical, based on hundreds of different scenarios pieced together for clarity

http://firelawblog.com/2011/05/diminished-capacity-protective-custody-and-refusing-aid/

6 Comments

  • John says:

    Mike,
    In 20 years of doing this, I've learned more about handling these issues from you, Curt, and Justin Schorr than from any class I've taken. Keep up the good work, many of us are struggling with these issues every day and the discussion and advice really help.

  • I think one of the huge problems with dealing with psychatric disorders is the drastic lack of education regarding the different disorders. Proove it? Ok, have you asked about other common mania symptoms? Does she admit to staying up all night? Did you ask about racing thoughts or recent purchases? Does she admit to hallucinations? What was her speech pattern like? Would her response have been different if you were able to respond with, "Well, I think you're in a manic phase because insomnia, racing thoughts, rapid pressured speech, and hallucinations are all trademark signs of mania"?
    Is she under the care of a PMD or psychiatrist, and if so, did you suggest that she goes on her own to see one ASAP? Partnering with the patient is going to work better than trying to force the patient into only one destination decision.

  • Michael Morse says:

    I actually have extensive experience with mental illness. The question is how best t o get a person who needs emergency psychiatric care that care without impeding their rights, not just from a legal viewpoint, but a human one as well. Who are we to enter a person's home, and decide for them that their mental status is unacceptable, especially considering our lack of history or clinical knowledge of the patient. Maybe their base is racing thoughts and irrational purchases, and staying up all night. Suggesting a patient seek medical and psychiatric help in lieu of transport help ease my consience a little when I leave somebody I have the gut feeling needs help, and soon, but I'm not too sure it does much good.

    • Sorry if the glib about education was taken personally, as it wasn't meant that way. I was, however, surprised with the "got me there" comment as leading questions like that should have an answer planned out.
      Who are we to do that? We're medical professionals. If it's not the EMS provider's job on a prehospital call, then whose call is it? We should be the best source at determining capacity due to medical problems on a 911 call than, say, the police. Maybe their base is racing thoughts and irrational purchases (is it a pathological base, though, like the COPD patient who's baseline SpO2 is 89%?), but at the same time the patient's recent actions call into question whether something has changed. However, has that also changed their insights into her medical care?
      2 quick questions. Would you feel different if it was, say, a patient with chronic a-fib who was refusing to take their antiarrhythmics? Also, have you ever had the chance to read The Man who Mistook his Wife for a Hat by Dr. Oliver Sacks (ISBN: 0684853949). One of the stories from that that sticks out (and, albeit not exactly the same since Tourettes doesn't change mental capacity) was a man with Tourettes who ended up working out a treatment plan where he took his medications during the week so he could hold a job, but went off of them over the weekend so he could play drums in a jazz band. Could she be non-compliant with her meds because of side effects? Sure, it's not the paramedic's job necessarilly to ask, but if no one asks, then she's just going to fall through the cracks.

  • …and thank you very much for the link!

  • michael says:

    No worries, Joe. It has been my experience that it matters little to the patient presenting with signs of manic behavior what my opinions, questions of diagnoses are, they are desperately trying to maintain their independance and no matter what I say or do will maintain their assertion that all is well with them, even though we suspect different. When a person has "lost it" completely, things get much easier, it's yhe gray areas where they are still coherent enough to give proper answers to obvious questions, and then rationalize my counter questions.
    I know they need to go get help, but at which point do we take controll.

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