Guest guest Posted March 13, 2011 Report Share Posted March 13, 2011 In Texas you have to determine if the patient has " Present Mental Capacity " . A general practice that is used to determine present mental capacity is determining all of the following: Language - Name 3 items and have them repeat it back to you - ask them to remember those items and that you will be asking them to recall them again Calculation - Have them tell you how many dimes are in a dollars or count backwards from 100 by 5's. A&O X 4 (Person, Place, Time, and Event) GCS-15 Recall - Have them repeat those 3 items back to you. If they can answer those questions, then they should have adequate present mental capacity to make their own transport decision (regardless if it is a bad decision). Once your determine present mental capacity is present, then you simply make sure that it is an informed refusal - they are advised of the risk of refusing and why it is in there best interest to be seen by a MD. Have them verbalize an understanding of the risk and your good to go. JT Email: jtmedic@... PRIVILEGED AND CONFIDENTIAL: The information contained in this electronic message and any attachments are confidential property and intended only for the use of the addressee. Any interception, copying, accessing, or disclosure or distribution of this message is prohibited, and sender takes no responsibility for any unauthorized reliance on this message. If you have received this message in error, please notify the sender immediately and purge the message you received. > Ok so I have my opinions on this but am curious what others believe and practice, would also like the legal gurus input. So the scenario is MVA sat. Night pt. Is obviously under the influence (ETOH smell, slurred speech, belligerent etc.) all TBI is ruled out (as best can be done in field). BGL is fine and they give you the typical 2 beer response. Pt. A&Ox4 (sorry Gene that's for short hand purposes only lol) They adamantly refuse further treatment and transport, and LE. Is not much help cause they can't place the driver behind the wheel. Pt may need sutures and has a possible fractured wrist so transport would be best to CYA. So what now?!?! Pt says " touch him again and he'll sue your ass, because he knows his rights and dad is an Attoroney. " . Should you transport or get a refusal? My opinion and this may be way off base but, I transport full c-spine precautions. I would rather error on the side of the pt. Than not. I have been told if they cannot sign for a loan at a bank (because they are drunk) then they cannot make appropriately informed decisions about their medical care. I would rather defend my patch because I did too much rather than not enough. Your thoughts? > > P.s. I know, I know; document, document, document, but that's not the response I'm looking for what do you all actually practice, SOP's, protocols, etc..... > > -Chris > > Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2011 Report Share Posted March 13, 2011 In Texas you have to determine if the patient has " Present Mental Capacity " . A general practice that is used to determine present mental capacity is determining all of the following: Language - Name 3 items and have them repeat it back to you - ask them to remember those items and that you will be asking them to recall them again Calculation - Have them tell you how many dimes are in a dollars or count backwards from 100 by 5's. A&O X 4 (Person, Place, Time, and Event) GCS-15 Recall - Have them repeat those 3 items back to you. If they can answer those questions, then they should have adequate present mental capacity to make their own transport decision (regardless if it is a bad decision). Once your determine present mental capacity is present, then you simply make sure that it is an informed refusal - they are advised of the risk of refusing and why it is in there best interest to be seen by a MD. Have them verbalize an understanding of the risk and your good to go. JT Email: jtmedic@... PRIVILEGED AND CONFIDENTIAL: The information contained in this electronic message and any attachments are confidential property and intended only for the use of the addressee. Any interception, copying, accessing, or disclosure or distribution of this message is prohibited, and sender takes no responsibility for any unauthorized reliance on this message. If you have received this message in error, please notify the sender immediately and purge the message you received. > Ok so I have my opinions on this but am curious what others believe and practice, would also like the legal gurus input. So the scenario is MVA sat. Night pt. Is obviously under the influence (ETOH smell, slurred speech, belligerent etc.) all TBI is ruled out (as best can be done in field). BGL is fine and they give you the typical 2 beer response. Pt. A&Ox4 (sorry Gene that's for short hand purposes only lol) They adamantly refuse further treatment and transport, and LE. Is not much help cause they can't place the driver behind the wheel. Pt may need sutures and has a possible fractured wrist so transport would be best to CYA. So what now?!?! Pt says " touch him again and he'll sue your ass, because he knows his rights and dad is an Attoroney. " . Should you transport or get a refusal? My opinion and this may be way off base but, I transport full c-spine precautions. I would rather error on the side of the pt. Than not. I have been told if they cannot sign for a loan at a bank (because they are drunk) then they cannot make appropriately informed decisions about their medical care. I would rather defend my patch because I did too much rather than not enough. Your thoughts? > > P.s. I know, I know; document, document, document, but that's not the response I'm looking for what do you all actually practice, SOP's, protocols, etc..... > > -Chris > > Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2011 Report Share Posted March 13, 2011 Understood, now let me throw this wrench in there. What if they fail field sobriety test does that make a difference? They obviously don't have the mental capacity to perform simply motor function and cognitive thinking, but they DO have the mental capacity to tell you to piss off?!?! -Chris Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > > In Texas you have to determine if the patient has " Present Mental Capacity " . A general practice that is used to determine present mental capacity is determining all of the following: > > Language - Name 3 items and have them repeat it back to you - ask them to remember those items and that you will be asking them to recall them again > Calculation - Have them tell you how many dimes are in a dollars or count backwards from 100 by 5's. > A&O X 4 (Person, Place, Time, and Event) > GCS-15 > Recall - Have them repeat those 3 items back to you. > > If they can answer those questions, then they should have adequate present mental capacity to make their own transport decision (regardless if it is a bad decision). Once your determine present mental capacity is present, then you simply make sure that it is an informed refusal - they are advised of the risk of refusing and why it is in there best interest to be seen by a MD. Have them verbalize an understanding of the risk and your good to go. > > JT > > > Email: jtmedic@... > > PRIVILEGED AND CONFIDENTIAL: The information contained in this electronic message and any attachments are confidential property and intended only for the use of the addressee. Any interception, copying, accessing, or disclosure or distribution of this message is prohibited, and sender takes no responsibility for any unauthorized reliance on this message. If you have received this message in error, please notify the sender immediately and purge the message you received. > > > > > >> Ok so I have my opinions on this but am curious what others believe and practice, would also like the legal gurus input. So the scenario is MVA sat. Night pt. Is obviously under the influence (ETOH smell, slurred speech, belligerent etc.) all TBI is ruled out (as best can be done in field). BGL is fine and they give you the typical 2 beer response. Pt. A&Ox4 (sorry Gene that's for short hand purposes only lol) They adamantly refuse further treatment and transport, and LE. Is not much help cause they can't place the driver behind the wheel. Pt may need sutures and has a possible fractured wrist so transport would be best to CYA. So what now?!?! Pt says " touch him again and he'll sue your ass, because he knows his rights and dad is an Attoroney. " . Should you transport or get a refusal? My opinion and this may be way off base but, I transport full c-spine precautions. I would rather error on the side of the pt. Than not. I have been told if they cannot sign for a loan at a bank > (because they are drunk) then they cannot make appropriately informed decisions about their medical care. I would rather defend my patch because I did too much rather than not enough. Your thoughts? >> >> P.s. I know, I know; document, document, document, but that's not the response I'm looking for what do you all actually practice, SOP's, protocols, etc..... >> >> -Chris >> >> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone >> >> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2011 Report Share Posted March 13, 2011 Understood, now let me throw this wrench in there. What if they fail field sobriety test does that make a difference? They obviously don't have the mental capacity to perform simply motor function and cognitive thinking, but they DO have the mental capacity to tell you to piss off?!?! -Chris Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > > In Texas you have to determine if the patient has " Present Mental Capacity " . A general practice that is used to determine present mental capacity is determining all of the following: > > Language - Name 3 items and have them repeat it back to you - ask them to remember those items and that you will be asking them to recall them again > Calculation - Have them tell you how many dimes are in a dollars or count backwards from 100 by 5's. > A&O X 4 (Person, Place, Time, and Event) > GCS-15 > Recall - Have them repeat those 3 items back to you. > > If they can answer those questions, then they should have adequate present mental capacity to make their own transport decision (regardless if it is a bad decision). Once your determine present mental capacity is present, then you simply make sure that it is an informed refusal - they are advised of the risk of refusing and why it is in there best interest to be seen by a MD. Have them verbalize an understanding of the risk and your good to go. > > JT > > > Email: jtmedic@... > > PRIVILEGED AND CONFIDENTIAL: The information contained in this electronic message and any attachments are confidential property and intended only for the use of the addressee. Any interception, copying, accessing, or disclosure or distribution of this message is prohibited, and sender takes no responsibility for any unauthorized reliance on this message. If you have received this message in error, please notify the sender immediately and purge the message you received. > > > > > >> Ok so I have my opinions on this but am curious what others believe and practice, would also like the legal gurus input. So the scenario is MVA sat. Night pt. Is obviously under the influence (ETOH smell, slurred speech, belligerent etc.) all TBI is ruled out (as best can be done in field). BGL is fine and they give you the typical 2 beer response. Pt. A&Ox4 (sorry Gene that's for short hand purposes only lol) They adamantly refuse further treatment and transport, and LE. Is not much help cause they can't place the driver behind the wheel. Pt may need sutures and has a possible fractured wrist so transport would be best to CYA. So what now?!?! Pt says " touch him again and he'll sue your ass, because he knows his rights and dad is an Attoroney. " . Should you transport or get a refusal? My opinion and this may be way off base but, I transport full c-spine precautions. I would rather error on the side of the pt. Than not. I have been told if they cannot sign for a loan at a bank > (because they are drunk) then they cannot make appropriately informed decisions about their medical care. I would rather defend my patch because I did too much rather than not enough. Your thoughts? >> >> P.s. I know, I know; document, document, document, but that's not the response I'm looking for what do you all actually practice, SOP's, protocols, etc..... >> >> -Chris >> >> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone >> >> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2011 Report Share Posted March 13, 2011 I would give the medical director and daddy the lawyer a jingle. Sent from my Verizon Wireless BlackBerry Intoxication? Ok so I have my opinions on this but am curious what others believe and practice, would also like the legal gurus input. So the scenario is MVA sat. Night pt. Is obviously under the influence (ETOH smell, slurred speech, belligerent etc.) all TBI is ruled out (as best can be done in field). BGL is fine and they give you the typical 2 beer response. Pt. A&Ox4 (sorry Gene that's for short hand purposes only lol) They adamantly refuse further treatment and transport, and LE. Is not much help cause they can't place the driver behind the wheel. Pt may need sutures and has a possible fractured wrist so transport would be best to CYA. So what now?!?! Pt says " touch him again and he'll sue your ass, because he knows his rights and dad is an Attoroney. " . Should you transport or get a refusal? My opinion and this may be way off base but, I transport full c-spine precautions. I would rather error on the side of the pt. Than not. I have been told if they cannot sign for a loan at a bank (because they are drunk) then they cannot make appropriately informed decisions about their medical care. I would rather defend my patch because I did too much rather than not enough. Your thoughts? P.s. I know, I know; document, document, document, but that's not the response I'm looking for what do you all actually practice, SOP's, protocols, etc..... -Chris Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2011 Report Share Posted March 13, 2011 The key is in assessment of present mental capacity. A number of conclusions have been stated (A&Ox4, " obviously under the influence " " drunk " ) that must be backed up by factual observations (ETOH smell [of limited usefulness], slurred speech, belligerent attitude), and documentation of the following: 1. That the patient either did or did not possess the present mental capacity to understand the nature and quality of his condition and to make a rational judgment either to accept or refuse treatment. Failure to cooperate in " testing " is an objective finding, although he has no legal obligation to cooperate. It's all about what's " reasonable " under the circumstances. 2. That if he did NOT possess the present mental capacity to understand the nature and quality of his condition, the objective findings supporting that conclusion are documented. 3. That if he DID possess the present mental capacity to understand the nature and quality of his condition, that he was provided with the requisite information about his probable condition and the possible reasonably foreseeable consequences of refusal. 4. That the information given about consequences is thoroughly documented. 5. That the patient demonstrated objectively that he understood the possible consequences by repeated them back to you and explaining what he understood the risks to be. 6. That after all the above he refused treatment and transport and executed the refusal. LE can be of great help. They do not have to place him behind the wheel to arrest him for public intoxication. So he gets his choice: jail for PI or a nice trip to the nice hospital in the nice ambulance with the nice medics. So there can be no rigid SOPs or protocols. All is dependent upon the unique fact situation of the case. GG Intoxication? Ok so I have my opinions on this but am curious what others believe and practice, would also like the legal gurus input. So the scenario is MVA sat. Night pt. Is obviously under the influence (ETOH smell, slurred speech, belligerent etc.) all TBI is ruled out (as best can be done in field). BGL is fine and they give you the typical 2 beer response. Pt. A&Ox4 (sorry Gene that's for short hand purposes only lol) They adamantly refuse further treatment and transport, and LE. Is not much help cause they can't place the driver behind the wheel. Pt may need sutures and has a possible fractured wrist so transport would be best to CYA. So what now?!?! Pt says " touch him again and he'll sue your ass, because he knows his rights and dad is an Attoroney. " . Should you transport or get a refusal? My opinion and this may be way off base but, I transport full c-spine precautions. I would rather error on the side of the pt. Than not. I have been told if they cannot sign for a loan at a bank (because they are drunk) then they cannot make appropriately informed decisions about their medical care. I would rather defend my patch because I did too much rather than not enough. Your thoughts? P.s. I know, I know; document, document, document, but that's not the response I'm looking for what do you all actually practice, SOP's, protocols, etc..... -Chris Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2011 Report Share Posted March 13, 2011 The key is in assessment of present mental capacity. A number of conclusions have been stated (A&Ox4, " obviously under the influence " " drunk " ) that must be backed up by factual observations (ETOH smell [of limited usefulness], slurred speech, belligerent attitude), and documentation of the following: 1. That the patient either did or did not possess the present mental capacity to understand the nature and quality of his condition and to make a rational judgment either to accept or refuse treatment. Failure to cooperate in " testing " is an objective finding, although he has no legal obligation to cooperate. It's all about what's " reasonable " under the circumstances. 2. That if he did NOT possess the present mental capacity to understand the nature and quality of his condition, the objective findings supporting that conclusion are documented. 3. That if he DID possess the present mental capacity to understand the nature and quality of his condition, that he was provided with the requisite information about his probable condition and the possible reasonably foreseeable consequences of refusal. 4. That the information given about consequences is thoroughly documented. 5. That the patient demonstrated objectively that he understood the possible consequences by repeated them back to you and explaining what he understood the risks to be. 6. That after all the above he refused treatment and transport and executed the refusal. LE can be of great help. They do not have to place him behind the wheel to arrest him for public intoxication. So he gets his choice: jail for PI or a nice trip to the nice hospital in the nice ambulance with the nice medics. So there can be no rigid SOPs or protocols. All is dependent upon the unique fact situation of the case. GG Intoxication? Ok so I have my opinions on this but am curious what others believe and practice, would also like the legal gurus input. So the scenario is MVA sat. Night pt. Is obviously under the influence (ETOH smell, slurred speech, belligerent etc.) all TBI is ruled out (as best can be done in field). BGL is fine and they give you the typical 2 beer response. Pt. A&Ox4 (sorry Gene that's for short hand purposes only lol) They adamantly refuse further treatment and transport, and LE. Is not much help cause they can't place the driver behind the wheel. Pt may need sutures and has a possible fractured wrist so transport would be best to CYA. So what now?!?! Pt says " touch him again and he'll sue your ass, because he knows his rights and dad is an Attoroney. " . Should you transport or get a refusal? My opinion and this may be way off base but, I transport full c-spine precautions. I would rather error on the side of the pt. Than not. I have been told if they cannot sign for a loan at a bank (because they are drunk) then they cannot make appropriately informed decisions about their medical care. I would rather defend my patch because I did too much rather than not enough. Your thoughts? P.s. I know, I know; document, document, document, but that's not the response I'm looking for what do you all actually practice, SOP's, protocols, etc..... -Chris Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone Quote Link to comment Share on other sites More sharing options...
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