Bad News for Paramedics and Ambulance Companies!!!

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DitchDoc73

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http://www.orlandosentinel.com/news/local/volusia/os-ambulance-verdict-20100519,0,2751496.story

Check this out. This is ridiculous, the jury awarded a $10 million award against an ambulance company and Paramedic for accepting an interfacility transport and saving the Pt's life!!!

A little background for those of you who don't want to read the article. A woman went in to a rural hospital in premature labor (~6 months along). This hospital does not have OB or L&D services, so the ER physician arranges emergent interfacility transport to the closest appropriate facility (Arnold Palmer Hospital in Orlando with a level 3 NICU). During the transport the woman delivers a non breathing neonate. The Paramedic successfully revives the neonate and completes the transfer. The parents turned around and sued the ambulance company and Paramedic for $10 million and won, because the jury believes the Paramedic should have assessed the Pt and REFUSED the transport that had been ordered by the ER physician and accepted by the recieving physician!

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I realize that lawsuits don't take things like the consequences of their decisions into account, but good luck to the unfortunate mom who needs an interfacility transport for premature labor ever again in the state of Florida.

And good luck to the paramedic who refuses an ER attending (especially one who I'm guessing was sh**ing himself over this patient being in his ER) based on his assessment of what's a necessary transport.

Ideally, a neonatal transport team would have taken this transfer, but we rarely deal with ideal situations. This medic likely felt it wasn't his job to determine the appropriateness of transports, made the best of what was a terrible situation... I mean, delivery of an apneic 25-weeker, in the back of a rig? Talk about your high pucker factor.

I somehow doubt the outcome would have been better in any circumstance, and I'm especially angry that a medic who did his job well gets crucified over this.

Tort reform, anyone?
 
I don't see how the medic and his company can be held responsible for following medical direction and the ER Doctors orders. Could you keep us posted if there are any other developments in the case? That's crazy!!!
 
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I don't see how the medic and his company can be held responsible for following medical direction and the ER Doctors orders. Could you keep us posted if there are any other developments in the case? That's crazy!!!

Yeah...I will do my best to keep up on the case, especially since it potentially has major implications...I do know that the ambulance company has already filed an appeal to the ruling.
 
I realize that lawsuits don't take things like the consequences of their decisions into account, but good luck to the unfortunate mom who needs an interfacility transport for premature labor ever again in the state of Florida.

Refusing transports wont help -- you will get sued either way. Either you get sued for "failing to provide the necessary level of care at a higher acuity hospital" or you get sued based on the ridiculous grounds of this lawsuit.

Either way, the lawyers win. Unfreakinbelievable.

All the doctors involved in this pt's care should drop them and let that scumbag family fend for themselves. Refuse all care except in the ER where its mandated by law. Screw this greedy family.
 
Guys, keep in mind that these lawsuits ALWAYS have an "expert" witness. This wasnt just the lawyer spouting off, he found a hired gun "EMS expert" who testified that the EMS crew screwed up by not refusing the transfer.

We need to find out who this "EMS expert" is, and crucify him. Take away his license, take away his ability to ever work in the medical field again. I'm sure he got a nice cut of 500k for his "expert" testimony against this paramedic company.

Its time to cut off these hired gun "experts" who are nothing more than lawyer ******. They get paid many hundreds of thousands of dollars for bogus testimony. Time to cut them off at the knees and make sure they never work in the healthcare field again.

Also, I'm curious as to what the paramedic was "supposed" to do in this situation. Assess the pt, decide she was too far along or too premature, and then block the transfer? I dont think so. Paramedics dont get the right to question transfer orders -- they just do it.
 
Also, I'm curious as to what the paramedic was "supposed" to do in this situation. Assess the pt, decide she was too far along or too premature, and then block the transfer? I dont think so. Paramedics dont get the right to question transfer orders -- they just do it.

That's exactly what they argued the Paramedic should have done. But of course they don't mention anything about the mom not getting any prenantal care, and then going to a hospital with no L&D or OB services...
 
RN here...I refused three IF transports in my time working a nurse ambo...

one due to weather (stable ICU pt, 2130, being downgraded to a SNF; sleet and hail, 50 mile transport in high country, wanted to wait until daylight/sunshine);

And the other two due to safety concerns (direct admit, stable toddler in a non peds ED, no inpt ped beds, needing routine transport to a kid's hospital for pneumonia , and NO CAR SEAT...silly ER doc tells mom "he can ride on your lap...WRONG!!!!!!!!!)

other for a 79% sat (on 15l NRB), AWAKE 38 y/o female, 10 mile trip to a cath lab, for an active MI...
NOT BY MYSELF dude...get her tubed and I'll take her (I was alone in the back of this RN ambo and didn't feel like tubing alone (mind you, I am an RN, NOT a medic))



one question is, did he know he could have refused transport???

(I think this might be a problem; most pre hospital guys that I have talked to do not get that point...they think that if they are told to transfer, then they must do it, period...WRONG!!!!)

And as a previous hired nurse expert, juries frown upon experts that always align to one side only (pimp)...
 
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When I was a medic I never outright refused a transfer but on several occasions I asked the sending facility to take some action which they had not to stabilize the pt a bit before the transfer...like how about some antiarrythmic for this guy having runs of vtach that you want me to transfer over 50 miles....on a few occasions I asked for an extra person to come along in case a very unstable pt decided to code enroute....ever run a code by yourself? not a whole lot of fun....
 
We really do not know what was going on with the patient; however, a paramedic does have the right to question. Clearly, this case also agrees with this notion. I know my employer has preggo guidelines and if patients fall outside of these guidelines, we do not fly the patient.

However, without any details it's pretty difficult to Monday morning quarterback...

However, much of this may have been prevented by mom going to the right hospital. EMTALA is a real PIA. I remember working places with a four bed ER and dealing with preggos. It would have been so nice to tell them, "we can't do anything for you here keep driving." Of course, it is likely mom would have sued the receiving facility. As you guys well know, lawsuits are not always related to poor care...
 
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When I was a medic I never outright refused a transfer but on several occasions I asked the sending facility to take some action which they had not to stabilize the pt a bit before the transfer...like how about some antiarrythmic for this guy having runs of vtach that you want me to transfer over 50 miles....on a few occasions I asked for an extra person to come along in case a very unstable pt decided to code enroute....ever run a code by yourself? not a whole lot of fun....

I agree completely...I have personally required another person to ride along (EMT, Medic, or Nurse) in some situations (critical, certain medications, multiple medications, etc), but I have never outright refused a transport in 12+ years.

RN here...I refused three IF transports in my time working a nurse ambo...

one due to weather (stable ICU pt, 2130, being downgraded to a SNF; sleet and hail, 50 mile transport in high country, wanted to wait until daylight/sunshine);

And the other two due to safety concerns (direct admit, stable toddler in a non peds ED, no inpt ped beds, needing routine transport to a kid's hospital for pneumonia , and NO CAR SEAT...silly ER doc tells mom "he can ride on your lap...WRONG!!!!!!!!!)

other for a 79% sat (on 15l NRB), AWAKE 38 y/o female, 10 mile trip to a cath lab, for an active MI...
NOT BY MYSELF dude...get her tubed and I'll take her (I was alone in the back of this RN ambo and didn't feel like tubing alone (mind you, I am an RN, NOT a medic))



one question is, did he know he could have refused transport???

(I think this might be a problem; most pre hospital guys that I have talked to do not get that point...they think that if they are told to transfer, then they must do it, period...WRONG!!!!)

Mainly for stable Pts, and I understand the justification behind why you did (and it makes sense). However with a physician telling you that she will not deliver until after you make it to the other hospital, a Paramedic would be hard pressed to refuse the transport. Most Paramedics know that they have the right to refuse an interfacility transfer, but when a physician says that a Pt is stable enough for transport, I don't see where the Paramedic would have a leg to stand on. In the region that I am in, if you refused to transfer a Pt (against Dr's orders), you better start looking for another job...Whether this is right or wrong is not for me to decide, just stating how it is. It is accepted that the Physician's medical expertise and education vastly trumps that of a Paramedic. I am very curious to see how this is going to affect interfacility transfers in the near future...
 
my buddy was fired for refusing a ground RN transport (stable pt) in bad weather...

how about a not so stable pt?

chopper pilots do it all the time...
 
Big difference between ground based EMS and HEMS. The Pilot (PIC) has the ultimate authority to refuse the mission. The FAA produces FAR's that pilots must follow. This includes weather considerations. The PIC's decision should not even take patient condition into consideration. If you are a purist, you could even say that the PIC should not even know the patient condition beforehand.

The sending or receiving physicians are in no way involved with the PIC's decision and the PIC flies under their own license and answers to a completely different agency. So, I think a profound difference exists between a pilot and a medical provider.
 
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Big difference between ground based EMS and HEMS. The Pilot (PIC) has the ultimate authority to refuse the mission. The FAA produces FAR's that pilots must follow. This includes weather considerations. The PIC's decision should not even take patient condition into consideration. If you are a purist, you could even say that the PIC should not even know the patient condition beforehand.

The sending or receiving physicians are in no way involved with the PIC's decision and the PIC flies under their own license and answers to a completely different agency. So, I think a profound difference exists between a pilot and a medical provider.

I know of several HEMS organizations where everyone on the team has the authority to refuse / cancel a mission, not just the pilot...
 
I know of several HEMS organizations where everyone on the team has the authority to refuse / cancel a mission, not just the pilot...

Right, the "three to go one to stay" rule as they call it. However, my point was that the PIC can cancel the mission regardless of the patients condition and that the sending or receiving physician has absolutely no say in the matter.
 
Refusing transports wont help -- you will get sued either way. Either you get sued for "failing to provide the necessary level of care at a higher acuity hospital" or you get sued based on the ridiculous grounds of this lawsuit.

My point was that I could see EMS agencies making it policy that they don't do prenatal transfers, period, thanks to this ruling. I'm not sure how a company could be sued for refusing a transfer if they say "we don't have the staff/specialized training for that." Although you're right, somehow there's probably a way to lose in that case as well.

Another salient point is that the article seems to imply that the plantiffs' argument seems to depend on the lack of a documented examination by the medic prior to his/her leaving the hospital with the patient. That, along with pictures of the poor kid with CP, make for a bad day in court.
 
My point was that I could see EMS agencies making it policy that they don't do prenatal transfers, period, thanks to this ruling. I'm not sure how a company could be sued for refusing a transfer if they say "we don't have the staff/specialized training for that." Although you're right, somehow there's probably a way to lose in that case as well.

Another salient point is that the article seems to imply that the plantiffs' argument seems to depend on the lack of a documented examination by the medic prior to his/her leaving the hospital with the patient. That, along with pictures of the poor kid with CP, make for a bad day in court.

It very well could stem from a lacking in proper documentation...If that is the case, then it is a costly lesson to document properly...But as we said before, we don't know ALL of the details.
 
Big difference between ground based EMS and HEMS. The Pilot (PIC) has the ultimate authority to refuse the mission. The FAA produces FAR's that pilots must follow. This includes weather considerations. The PIC's decision should not even take patient condition into consideration. If you are a purist, you could even say that the PIC should not even know the patient condition beforehand.

The sending or receiving physicians are in no way involved with the PIC's decision and the PIC flies under their own license and answers to a completely different agency. So, I think a profound difference exists between a pilot and a medical provider.

That's how it is in this region. The pilots are told nothing about the case itself other than location.
 
Um, I don't know where you folks are from but around here a licensed paramedic has the right to refuse a patient transport even if the ed attending "orders" us to. Our clinical specialist (read: patient care supervisor/ QI guru) will hold us accountable for transporting patients from facility to facility without the proper manpower, equipment, or if the patient is too unstable in our own judgement forthe type of transfer ordered. That doesn't mean I won't take the unstable MI to the cath lab at the academic Mecca over the hill, because I understand the need. But it's a good bet my medical director would pull my clinical privliges if I took a women in labor with a high risk pregnancy all by myself..If he Ed staff really wanted to make a transfer like that happen around here they would have to let us borrow a nurse or physician to ride with us.

I have refused to transfer a few times as well for insurance type calls where he pt is going from private hospital ED to Kaiser ED due to their insurance. One particular case I remember was a pt with a large plueral effusion. ED doc tellig me to transfer out of her ED(a level II facility with) to a community kaiser hospital. Pt was in extremis when I went to assess her, very tachypneic win satsuma in the low 80s. Severe shortness of breath. Doc was really pushing me to take her, I declined. Far be it for me to be a contributor to a potential EMTALA violation and civil lawsuit. They ended up draining over a lieter and a half of fluid and we came back later, with the doc apologizing and telling me I made the right call.

Edit: I am not making judgments about this case since I don not know what went down. My post above was dealing with hypothetical high risk pregnant patien in labor where I knew that before hand and would be alone during transport. Pardon my spelling I'm on my iPhone at work.
 
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Did this deviate substantially from the standard of care by pre-hospital providers? Did his treatment deviate from the standard of care?

If so, then the expert witnesses should be sued. There is a growing movement to hold "pay-for-hire" expert witnesses accountable for their testimony. Most expert witnesses are practicing physicians, but their malpractice insurance doesn't cover expert testimony. So let them pay for the defense costs to defend their cases, and hopefully let them pay for any awards the paramedics and physicians might get against them. Maybe that will cause expert witnesses around the nation to think twice before signing off on something that doesn't clearly deviate from standard of care (or gross negligence, if your state adopted it as the standard for malpractice).
 
I've had to refuse interfacility transports a few times. Most times, the issue was a "sending" physician asking me to perform or maintain treatment during transport what was outside my scope of practice. It is a sad truth that many physicians are unaware of what a paramedic can or cannot do, and it is often up to the paramedic to make that physician aware if there is a problem.

Case in point, a few weeks ago a cardiac ICU physician (resident?) tried to get me to transport an unstable heart transplant patient (on several heavy duty pump meds with which I was not familiar) two and a half hours to a different hospital. I declined. We discussed it together and found a solution where ICU nursing staff would ride along for the trip.

I don't know whether it was relevant or not in this particular court case, but I think it is part of the professional responsibility of a paramedic to be honest about what he/she can or cannot handle when accepting responsibility for a patient. Simply "doing whatever the doctor says" is not good enough.
 
I've had to refuse interfacility transports a few times. Most times, the issue was a "sending" physician asking me to perform or maintain treatment during transport what was outside my scope of practice. It is a sad truth that many physicians are unaware of what a paramedic can or cannot do, and it is often up to the paramedic to make that physician aware if there is a problem.

Case in point, a few weeks ago a cardiac ICU physician (resident?) tried to get me to transport an unstable heart transplant patient (on several heavy duty pump meds with which I was not familiar) two and a half hours to a different hospital. I declined. We discussed it together and found a solution where ICU nursing staff would ride along for the trip.

I don't know whether it was relevant or not in this particular court case, but I think it is part of the professional responsibility of a paramedic to be honest about what he/she can or cannot handle when accepting responsibility for a patient. Simply "doing whatever the doctor says" is not good enough.

I agree completly...Everyone needs to know their limitations and abilities, especially when it comes to scope of practice issues. Unfortunately we just do not know enough of the details to know exactly what everyone was thinking in this situation. I am guessing that the Paramedic believed the Pt was stable enough for transport, which I would guess has a good deal to do with the ER Physician's assurances that the Pt was stable enough."
 
This is a no-win situation all around. Delivery is a BLS skill, even at this early in the pregnancy. What would the ER doc have done differently? He would have delivered (no ER doc is going to section a living mother) and resusitated the baby, just like the paramedic did. Nothing special or magical would have happened in the sending facility. It was just a matter of who was going to be sued. From the available info, this woman needed a c-section. If the sending doc had held the mother in the ER to deliver, the outcome would have been the same and he would have been sued for not sending the mother in a timely fashion to a facility that could appropriately manage the mother and baby. If the paramedics had refused to transport the pt, the kid would have been delivered in the ER with the same outcome. The paramedics would still have been sued for the delay in transfer to a higher level of care. It was a bad situation for all involved. Add to the fact that you now have a kid with CP and you might as well just take out the checkbook.
 
If the sending doc had held the mother in the ER to deliver, the outcome would have been the same and he would have been sued for not sending the mother in a timely fashion to a facility that could appropriately manage the mother and baby.

Based off of this fiasco, what I'm about to say may come off as fairly harsh, but so be it. You have to understand the view of the EMS providers in much of this country. That's fine, as long as the EMS agency doesn't get sued. Limiting liability is more important, apparently, than patient care.
 
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