Parent of patient is altered

[theseeker4]

So here is a bit of a twist on the standard legal question of whether you can force an altered patient to stay. What does the law and precedent say about keeping a minor patient and not allowing the legal guardians to take patient out of the hospital if the guardian is visibally altered? Had a patient with a minor complaint, but is a child, and the mother was visibly high on something. She was slurring words, dozing off while talking, confused, etc. She states she drove here and will be driving home. So we asked her to find a ride, and she was unable to do so. Verbally agreed to take a cab, but staff was not comfortable with putting them on a cab due to concern for liability.

Now the guardian fell asleep and slept it off in the ED, but before that happened we were considering holding the patient, calling CPS, calling the police, etc. What is everyone's opinion on holding a child in the ED and preventing the guardian from leaving with him or her, vs. letting them leave but calling police/CPS/etc.?

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[BAM!]

So here is a bit of a twist on the standard legal question of whether you can force an altered patient to stay. What does the law and precedent say about keeping a minor patient and not allowing the legal guardians to take patient out of the hospital if the guardian is visibally altered? Had a patient with a minor complaint, but is a child, and the mother was visibly high on something. She was slurring words, dozing off while talking, confused, etc. She states she drove here and will be driving home. So we asked her to find a ride, and she was unable to do so. Verbally agreed to take a cab, but staff was not comfortable with putting them on a cab due to concern for liability.

Now the guardian fell asleep and slept it off in the ED, but before that happened we were considering holding the patient, calling CPS, calling the police, etc. What is everyone's opinion on holding a child in the ED and preventing the guardian from leaving with him or her, vs. letting them leave but calling police/CPS/etc.?

I agree with letting the guardian sleep it off in the ED.

Is there another parent around? Perhaps they could provide some collateral info. Is this just a one time drinking episode? More routine / addiction problems?

Bottome line: we are mandated as providers to report to CPS if there are suspicions for child abuse or neglect. Certainly this raises suspicion. If you don't report and something happens to the kid, then you will be legally liable. Depending on circumstances, you could be charged in a criminal or civil suit. You have zero repercussions for calling CPS.

I would stall and try to expedite CPS. I would tell them they can't leave if they try. If they barge past, I'm not tackling them. I'm not placing them on any holds or administering chemical sedatives or restraints. If they do barge past and leave or elope without looking, I'm having the charge nurse call CPS and the police.

The parent is not a patient, so I don't think HIPAA applies and you can call the police as a concerned citizen, rather than their doctor.

 

[Zebra Hunter]

Treat them the same way I'd treat a drunk patient. Don't let them leave until a reliable individual shows up to pick them up or they become clinically sober. If the individual threatens violence or states they are going to leave regardless of what we say, allow them to leave without the child and call CPS. If they refuse to leave without the child and forcibly attempt to leave with the child, call security then call CPS.

But like I said, if they are just happily drunk or stoned and are agreeable to waiting for sobriety or for a more reliable individual to show up and drive them home, I won't get CPS or the police involved.

 

[shoal007]

Treat them the same way I'd treat a drunk patient. Don't let them leave until a reliable individual shows up to pick them up or they become clinically sober. If the individual threatens violence or states they are going to leave regardless of what we say, allow them to leave without the child and call CPS. If they refuse to leave without the child and forcibly attempt to leave with the child, call security then call CPS.

But like I said, if they are just happily drunk or stoned and are agreeable to waiting for sobriety or for a more reliable individual to show up and drive them home, I won't get CPS or the police involved.

i strongly disagree. the guardian made a poor choice driving their kid to the ED intoxicated. Id call CPS.

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[Zebra Hunter]

i strongly disagree. the guardian made a poor choice driving their kid to the ED intoxicated. Id call CPS.

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I agree, it's a very poor choice, and I think it's reasonable to call. Nevertheless, if the parent is otherwise pleasant, this does not appear to be a frequent occurrence, the child appears to be an excellent health without any evidence of neglect or emotional or physical abuse, I also think it's reasonable to not get CPS involved.

There are times when parents panic regarding their child's health and will make rash decisions like driving while still intoxicated. So if it appears this parent has the child's best interest at heart, I'd prefer not to make their lives a living hell by getting CPS involved.

 

[gro2001]

As I am not a lawyer, I have no idea what the law actually is on this. I realize that common sense and the law are not always the same thing, but these are my thoughts:

1) Letting the intoxicated parent drive the kid home? No. Not if I wouldn't let a patient in my care, with that level of intoxication, drive themselves home.

2) Letting the intoxicated parent take the kid home in a cab? Well... how intoxicated? And how young is the kid? Is the parent intoxicated to the point that I am concerned about leaving a kid alone with them? It's not like parents are never allowed to drink or all alcoholics automatically lose their parental rights.

 

[UKEMdoc]

In the past we've called the police and had parents locked up for drunk driving. I'd be keeping the kid in the department until social work(CFS) show up, you've got a powerful duty of care to the kid and none to the parent.

I suspect even if you sober the parents up then they'll probably neck half a bottle of vodka/get high the second you let them back in the car

 

[n2b8me]

I think we should have a very low bar for calling CPS. We are mandated reporters... that's it. All we do is make a report. We don't have to hold anybody in the ER or "wait for CPS to come" lol. The report could be a voicemail. I used to be very nervous about making this report and wondering if it is necessary. Now I've been exposed to the psychology/counselling spectrum and they call CPS for anything... they even call "CPS consults" to see if it should be reported. It's for the same stuff we see, being intoxicated around children and not being a "good parent". Even if the adult was on their prescription meds and came in looking this way, if you suspect something it is just a report. Done and done.

 

[gro2001]

I think we should have a very low bar for calling CPS. We are mandated reporters... that's it. All we do is make a report. We don't have to hold anybody in the ER or "wait for CPS to come" lol. The report could be a voicemail. I used to be very nervous about making this report and wondering if it is necessary. Now I've been exposed to the psychology/counselling spectrum and they call CPS for anything... they even call "CPS consults" to see if it should be reported. It's for the same stuff we see, being intoxicated around children and not being a "good parent". Even if the adult was on their prescription meds and came in looking this way, if you suspect something it is just a report. Done and done.

While I agree with the general premise of having a low threshold to call CPS and agree with the solemn responsibility we have for our pediatric patient, I would urge some caution with being overly trigger happy with CPS. I know a couple of physician parents who have had CPS called on them for BS reasons and it causes a lot of grief and anxiety for the parents, even when the only thing that happens is a one time visit from CPS. It's an extremely invasive process and it sounds pretty similar to being questioned by the cops, in the sense that there is a shadow of guilt over you just for the fact of being questioned.

 

[theseeker4]

Just an update, the parent in question didn't press the issue of leaving, and slept in the room overnight. The parent was clinically sober in the morning and allowed to leave with the patient. None of the attending physicians involved wanted to involve CPS as long as the parent didn't try to leave with the child before we decided it was safe.

 

[deleted109597]

Is the parent intoxicated to the point that I am concerned about leaving a kid alone with them?

I'm not sure what you mean by this. I bet some parents are asleep while their kids are awake right this minute. Are you calling CPS on them?

I agree to encourage her not to leave. Although I wonder how many of you don't let drunks leave on their own (which, btw, we are protected from by case law).

You might want to consider what you're saying, which is effectively criminalizing alcohol use in the presence of a child. http://www.npr.org/sections/13.7/20...for-putting-kids-at-perceived-but-unreal-risk

 

[RustedFox]

I'm not sure what you mean by this. I bet some parents are asleep while their kids are awake right this minute. Are you calling CPS on them?

I agree to encourage her not to leave. Although I wonder how many of you don't let drunks leave on their own (which, btw, we are protected from by case law).

You might want to consider what you're saying, which is effectively criminalizing alcohol use in the presence of a child. http://www.npr.org/sections/13.7/20...for-putting-kids-at-perceived-but-unreal-risk

Elaborate more on this case law, please

 

[deleted109597]

Elaborate more on this case law, please

http://www.wilsonelser.com/news_and...ew_yorks_highest_court_finds_er_physician_and
It's been discussed on here (that's how I searched for it)

 

[evilbooyaa]

http://www.wilsonelser.com/news_and...ew_yorks_highest_court_finds_er_physician_and
It's been discussed on here (that's how I searched for it)

I think the important part of that is that the patient came voluntarily into the ED. I don't think you can let drunks who come in as MVAs or DUIs or whatever just walk out.

Idk if I'm talking out of my ass, but I thought that was an important distinction.

 

[deleted109597]

I think the important part of that is that the patient came voluntarily into the ED. I don't think you can let drunks who come in as MVAs or DUIs or whatever just walk out.

Idk if I'm talking out of my ass, but I thought that was an important distinction.

I see no distinction in that article, and the MVA/DUI people are also there not in custody. The laws don't change until they are. If the cops have them in cuffs then they're responsible. If they don't, the patient is responsible.

 

[TooMuchResearch]

I think the important part of that is that the patient came voluntarily into the ED. I don't think you can let drunks who come in as MVAs or DUIs or whatever just walk out.

Idk if I'm talking out of my ass, but I thought that was an important distinction.

I don't see why a motor vehicle crash or DWI changes it.

 

[DrDrummer]

http://www.wilsonelser.com/news_and...ew_yorks_highest_court_finds_er_physician_and
It's been discussed on here (that's how I searched for it)

I asked this in another thread where this case law was cited, but never heard a satisfying answer-- does this generalize to physicians practicing outside NY state? Are there other relevant cases out there, or counter-examples?

 

[deleted109597]

I asked this in another thread where this case law was cited, but never heard a satisfying answer-- does this generalize to physicians practicing outside NY state? Are there other relevant cases out there, or counter-examples?

It's better than nothing. I haven't seen any other state say the opposite.

 

[Perrotfish]

I'm not sure what you mean by this. I bet some parents are asleep while their kids are awake right this minute. Are you calling CPS on them?

I agree to encourage her not to leave. Although I wonder how many of you don't let drunks leave on their own (which, btw, we are protected from by case law).

You might want to consider what you're saying, which is effectively criminalizing alcohol use in the presence of a child. http://www.npr.org/sections/13.7/20...for-putting-kids-at-perceived-but-unreal-risk

The age of the patient is important here, and was not mentioned in the original post. An intoxicated parent is effectively not present. They are not competent to make appropriate decisions on behalf of their child. From my read if you send a minor home with an intoxicated parent you are saying that it was appropriate for the minor to have been home alone and it is appropriate to send them back to their home alone. A parent who left an infant at home for 12 hours while they went to work would easily meet the standard of negligence, and they are equally negligent if they spent the last 12 hours in an alcohol induced stupor. You have to drop your kid off at daycare, rather than leaving them in the crib. Leaving a 12 year old alone for 12 hours would obviously be 100% appropriate. A 5 year old who could 'probably' call 911 in an emergency... that's difficult. I'm not sure if it is worth CPS (I would probably call) but its definitely worth at least having the parent sober up first.

.

 

[Vandalia]

I asked this in another thread where this case law was cited, but never heard a satisfying answer-- does this generalize to physicians practicing outside NY state? Are there other relevant cases out there, or counter-examples?

It technically only applies in New York. However, if the issue comes up in another state it is a good precedent. The other states don't have to follow it, but it is a pretty strong argument to have on your side.

 

[Birdstrike]

So here is a bit of a twist on the standard legal question of whether you can force an altered patient to stay. What does the law and precedent say about keeping a minor patient and not allowing the legal guardians to take patient out of the hospital if the guardian is visibally altered? Had a patient with a minor complaint, but is a child, and the mother was visibly high on something. She was slurring words, dozing off while talking, confused, etc. She states she drove here and will be driving home. So we asked her to find a ride, and she was unable to do so. Verbally agreed to take a cab, but staff was not comfortable with putting them on a cab due to concern for liability.

Now the guardian fell asleep and slept it off in the ED, but before that happened we were considering holding the patient, calling CPS, calling the police, etc. What is everyone's opinion on holding a child in the ED and preventing the guardian from leaving with him or her, vs. letting them leave but calling police/CPS/etc.?

The guardian sleeping it off in the ED is the best case scenario. It looks like you lucked out there. But in the worst case scenario, I think you have to view from the stand point of, "Is there real or potential child abuse/endangerment?" and if so, you proceed in that fashion. Your path at that point is pretty straight forward if you can show that the parent is a danger to the child, if not directly, then potentially by endangerment or neglect. You then call CPS, police, hold the patient and do what you suggested. If a parent is clearly intoxicated and ready to get behind the wheel with a child, not only due you have the option to prevent that from happening, you have not only an ethical and professional duty to do so, but a legal one, in the sense that as a medical professional, you're required by law to report child abuse, endangerment or neglect. Certainly as a physician, you're equipped to assess and document signs of intoxication, as much if not more so, than a law enforcement officer. I think your instincts here, were the correct ones.

 

[gro2001]

I'm not sure what you mean by this. I bet some parents are asleep while their kids are awake right this minute. Are you calling CPS on them?

I agree to encourage her not to leave. Although I wonder how many of you don't let drunks leave on their own (which, btw, we are protected from by case law).

You might want to consider what you're saying, which is effectively criminalizing alcohol use in the presence of a child. http://www.npr.org/sections/13.7/20...for-putting-kids-at-perceived-but-unreal-risk

I am not sure if I was being unclear or if you just read half of my post before replying, but I was actually saying the opposite. The very next sentence after the one you quoted says:

It's not like parents are never allowed to drink or all alcoholics automatically lose their parental rights.

To be clear, I think that just being intoxicated (even to the point of being passed out) would not by itself cause me to pull the trigger on calling CPS.

However, if the parent is so smashed that they are, for example, falling over and can't keep themselves upright let alone be trusted not to drop/smother/otherwise harm their 2 month old, then maybe that is something I'd consider.

 

[shoal007]

I am not sure if I was being unclear or if you just read half of my post before replying, but I was actually saying the opposite. The very next sentence after the one you quoted says:



To be clear, I think that just being intoxicated (even to the point of being passed out) would not by itself cause me to pull the trigger on calling CPS.

However, if the parent is so smashed that they are, for example, falling over and can't keep themselves upright let alone be trusted not to drop/smother/otherwise harm their 2 month old, then maybe that is something I'd consider.

im not sure we're the best to make such judgements and I feel much better with getting CPS involved to make the judgement. its their job. Id rather call on 10 than miss 1. I do understand the horrible nature of the invasiveness of the process but as a parent if your child is safe and well cared for -- there really is nothing to worry about.

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[WilcoWorld]

I would add that, from a consequentialist perspective, we're equally obligated to call 911 on any intoxicated patient that is about to get behind the wheel. Even if that drunk person isn't chauffeuring a toddler, he or she will be sharing the road with chauffeured toddlers.

Point being that adding in the driving part makes the question a little too easy to answer. Of course we shouldn't let someone who is obviously wasted drive.

A much harder question to answer is what to do if a parent got high, then their kid got sick, and then they called 911 to come to the ED?

 

[shoal007]

I would add that, from a consequentialist perspective, we're equally obligated to call 911 on any intoxicated patient that is about to get behind the wheel. Even if that drunk person isn't chauffeuring a toddler, he or she will be sharing the road with chauffeured toddlers.

Point being that adding in the driving part makes the question a little too easy to answer. Of course we shouldn't let someone who is obviously wasted drive.

A much harder question to answer is what to do if a parent got high, then their kid got sick, and then they called 911 to come to the ED?

tough one. im not so sure what id do.

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[Apollyon]

I know a couple of physician parents who have had CPS called on them for BS reasons and it causes a lot of grief and anxiety for the parents, even when the only thing that happens is a one time visit from CPS. It's an extremely invasive process and it sounds pretty similar to being questioned by the cops, in the sense that there is a shadow of guilt over you just for the fact of being questioned.

I had to do child abuse CME for license renewal, and I was reiterated in what constitutes a CPS referral. It seems pretty clear. If this two physician couple was doing something that weird, then that's what it is. The onus is NOT on us to be the cop/investigator, but, the standards do reflect what is outside the pale. I don't know what they were doing, but being doctors does not excuse one from being an even pseudo-normal parent. Or, in other words, I am not going to not call, because it will inconvenience someone. If someone isn't guilty, they should welcome it (or, at least, have a clear conscience).

 

[Birdstrike]

I know a couple of physician parents who have had CPS called on them for BS reasons and it causes a lot of grief and anxiety for the parents, even when the only thing that happens is a one time visit from CPS.

What happened? There's a story to tell here.