Alcoholic with head injury

[canigetawhatwhat]

"So if you went out drinking, found passed out at the bar, EMS took you to my ER, you have a BAC of 300, then I have the right to keep you until you are sober? Are you really going be happy that someone is going to tie you down and shoot you up with Haldol?"

If Im a violent dingus, yes.

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[scummie]

This is something that I'm struggling with as a new attending (wow!). Had a patient the other day who was AAOx3, arguing with staff saying they didn't want to be there but had a bump on their forehead. Said they had been drinking and were in an MVC just PTA. By this thread, it makes me feel like I should have chemically restrained them or intubated them if it came to it. They were able to walk without help, were asking for water and was able to say, "Oh yes, I understand that I could have a major head injury and could die blah blah blah." I tried bargaining, redirection but couldn't get them to stay and they eventually walked out. I mean, they wouldn't even let me use my stethoscope on them. Should I have made them sign AMA? I know that doesn't provide a ton of legal protection, but that the honey pot is in the documentation. While yes, they had been drinking, I didn't think I had enough to pull the trigger on getting a medical detention order. Thoughts?

 

[BoardingDoc]

This is something that I'm struggling with as a new attending (wow!). Had a patient the other day who was AAOx3, arguing with staff saying they didn't want to be there but had a bump on their forehead. Said they had been drinking and were in an MVC just PTA. By this thread, it makes me feel like I should have chemically restrained them or intubated them if it came to it. They were able to walk without help, were asking for water and was able to say, "Oh yes, I understand that I could have a major head injury and could die blah blah blah." I tried bargaining, redirection but couldn't get them to stay and they eventually walked out. I mean, they wouldn't even let me use my stethoscope on them. Should I have made them sign AMA? I know that doesn't provide a ton of legal protection, but that the honey pot is in the documentation. While yes, they had been drinking, I didn't think I had enough to pull the trigger on getting a medical detention order. Thoughts?

You are describing a patient who is clinically sober. Treat them like any other sober person. AMA them if you feel it appropriate. They can elope if they want to. Document clinical sobriety, capacity to make own decisions, understanding of why you want to do whatever test you want. They can do whatever they want after that.

If I restrain a patient like this and a case is brought against me, it may well be a CRIMINAL case. Unlawful detention, assault, what have you. Assuming I lose that case my life and career are essentially over. Jail time, will never have a medical license again, etc.

I will be rather surprised if you can cite any case like this which resulted in criminal prosecution of the physician in question.

 

[turkeyjerky]

You are describing a patient who is clinically sober. Treat them like any other sober person. AMA them if you feel it appropriate. They can elope if they want to. Document clinical sobriety, capacity to make own decisions, understanding of why you want to do whatever test you want. They can do whatever they want after that.


I will be rather surprised if you can cite any case like this which resulted in criminal prosecution of the physician in question.

Agreed, it's really a moral qualm rather than a legal one in deciding to sedate/restrain a patient against their will. I mean, the documentation will certainly justify restraint.