Ambulance

What is the name of your state? Utah

I am unsure where I would find an answer on this, so I ask here. Sorry if this is the wrong forum for, not sure where else it would fit.

This is problably a really dumb question, but I am a mothers son, who is uneducated on this, and would like to help in any way I can - besides paying bills =P

In the past few days, there has been conflict between my mother and her husband. As my mother was up all night, she wanted to get some sleep, and took 2 pills of her medication, where as a normal dose consists of a 1/2 pill. With information that was told by my mother's husband (who was away due to the conflict), my mother's friend was concerned that my mother had attempted a second suicide attempt, the first being several months before.
Anyways, ambulance comes, cops come, then after 20 or so minutes of doing whatever they do.. a result was that she was in all normal conditions. Pupils reacted and moved, she was responsive to even light voice command; everything fine, and just very tired.
The main doctor guy calls for some assistance on what to do, and they say to bring her into the hospital. As we know, this causes bills. Big bills. My mother was very responsive and awake at this point, but still a little drowsy.
She refused to go on the above claim. She could walk, talk, and even ask me the time I worked that day.

Point still stands, however, that they MADE her get in the ambulance, which is an additional charge. They would not let her get driven there. They MADE her to go the hosiptal. Even though she was fine.

Is this legal? What could have happened if she refused? Is there anyway to fight this?

Well, this is an interesting question!

If the police made your mother get into the ambulance, I doubt her refusal to do so has any implication. If the EMTs made your mother get in to the ambulance, that may not have been legal. It is common for people refuse to get in an ambulance and go to the ER; they are still responsbile for the ambulance trip to the scene, though.

I don't know what medication your mother took, but chances are that her taking 2 whole pills, which is four times her prescribed dose, was not indicative of a suicide attempt and did not pose a medical emergency.

Perhaps the overzealous friend would like to pay the resulting bills?!

If your mother's marriage is causing her to be suicidal or creating the need for her to escape into a deep sleep for several hours, take her to a divorce attorney and help her put an end to the real problem.

Best wishes,
EC

The first question that needs to be answered is whether the police placed her on a legal hold as a danger to herself (which they would do if they believed she was suicidal, or possibly suicidal and in need of a medical evaluation).

If she was placed on such a hold, they had every right to force her to go to the hospital, and the ambulance was the appropriate means of transport. Even if the examining doctor later determined she was not suicidal, the police were merely acting on the information available to them at the time within the constraints of their training.

If she was on a legal hold, her insurance will be responsible for paying for the ambulance transport; it's not clear to me whether they denied payment or not. If they issued a denial, you should appeal it, and should win.

At the moment that she was told that she needed to go with in the ambulance, there were no cops in the room.
The emts told my mother that she was to go with them, and had no option, otherwise they would talk to the cops and they would force her.

How is it considered that someone is suicidal to themselves?
The pills that she took were a prescription, to her, which were for anxiety.

I mean, you can't just call the cops on someone you don't like and be like - they took 4x the amount of pills they normall should have, I think their suicidal.

My mother was not or is not suicidal as of now. Hell, at this moment she is home, 100% fine, and is in a good mood, aside from the usuall bull-crap. And, I assure you, espescially with previous attempts, if my mother were to commit suicide - she would take more than 2 pills, she would probably take the entire damn bottle.

This entire situation happened earlier today, so unsure on what is going to happen insurance wise etc..

Just at the time, the emt's certainly seemed un-logical, and very forceful.
I got the idea, 'YOU HAVE TO COME WITH US SO WE CAN MAKE MONEY!'.

Slipshanker
I guess if the police were still present, whether in the room or not, then the EMTs were only telling her the options available to her (go willingly or go via the police). If the police had already gone, then the EMTS were out of line.
Insurance should pay; if not, work out a payment plan or apply for assistance with the bill.
EC

Let me offer the Medical/Legal perspective.

A patient who is alert, who is no harm to themselves or others, and who seems to have no medical conditions, is able to refuse transport via ambulance normally, besides two conditions:

1. Police can place the patient in Protective Custody, where they then must be transported via ambulance to the hospital for evaluation. This is usually done in psychological cases, or even the case as you stated. Police do not want to be held responsible should anything happen in the future, so they will place the patient in protective custody, and the patient will be transported via Ambulance.

2. EMTs, as you stated, contacted Online Medical Control. This is a doctor at acting as the medical director for the ambulance service. The doctor is provided with the situation, vitals, and the patients condition. Signs/Symptoms, Pt. History, Medications, and all that good stuff is provided to the doctor via phone or radio. It is then the doctor's decision whether or not the patient is to be transported to the hospital.

A patient does not have to suicidal to be transported to the hospital per Online Medical Control (Doctor's orders). If the doctor believes it is in the patient's best interest to be seen, and does not believe the patient can be safely transported via POV (Privately Owned Vehicle), then the patient then is required to be transported to the hospital.

The decision for the patient to go to the hospital is ultimately the decision of the doctor, and carried out by the EMTs and Medics on scene. Medics acts as a continuation of hospital care, and under doctor's orders. Ultimately the Medical Control doctor is responsible for the decision.

Additionally, EMTs and Paramedics have no personal motive for a patient to be transported to the hospital. They're not paid per patient, and if you knew the amount of paperwork required, in fact most would rather sign the patient off.

Here are the protocols to decide if a patient is suicidal:

• Patient's level of consciousness (Does she know who the president is, the date, and where she is)
• Patient's Medical History - Does she have a history of suicidal ideation or attempts?
• Signs/Symptoms
• Emotional trauma, changes in behavior, drug/alcohol abuse
• Intent - Does the patient have a plan? Can the patient act on that plan?
• Lastly, and most importantly - Contacting Online Medical Control for their opinion

If she refused to get into the ambulance after Medical Control stated she must be transported, she would have been placed in soft restraints and transported to the hospital.

It doesn't matter if the police where there or not, legally it doesn't matter. It is only suggested that the police be there should the patient become violent.

An ambulance is expensive ride for many reasons. Besides costing anywhere from $80,000 - $150,000 each, trained paramedics often sit for hours and hours without calls, just waiting for them to come in. It is expected that they'll be there within four minutes, which means often many crews can sit an entire 24 hour shift and only get a couple calls. Somoene has to pay for the salary, station, ambulance, equipment, gas, and all the other expenses associated with the transport.

I would suggest contacting the person or company who billed you for the transport, and working out a deal. They're used to payment plans and financing options.

I hope that helps.

Great information above, and thanks from me to you.

She could have refused the amulance, however, the police would have handcuffed her, and transported her to the hospital. Having a history of suicide attempts and an overdose of Rx is going to result in her evaluation, next time she gives her friend cause to worry perhaps she should call you for a ride to the hospital first or maybe you should have her stay with you until things are settled? You should be grateful that her friend was there and made the call.

I have to say this before I have to just ignore this thread.

For the purpose of a temporary escape, it is not an uncommon occurrence for women to take a premeditated, risk-evaluated, multiple dose of a sedative, tranquilizer, pain reliever, sleeping pill, etc. The most common complication is increased side-effects and that is the reason women seek medical attention after taking the multiple dose.

This woman took two pills instead of 1/2 pill as prescribed. She had the remainder of her prescription in hand.

Before anyone jumped to the conclusion that the woman was attempting suicide or was suicidal, someone should have verified a pill count.

In South Carolina, situations such as the original poster described led to several successful lawsuits against a particular teaching hospital. There are at least ten law firms in the Spartanburg-Greenville-Columbia SC triangle that advertise specifically for representation in claims of being forced in to ambulance transportation and/or admission to the hospital via the ER.

If it were true that EMTS, paramedics, emergency system contact MDs, have the absolute right make such determinations, restrain and transport a person against his or her will, these lawsuits would not have been successful and these law firms would not have reason to advertise for these services.

EC

Most state have laws providing for the assesment of potential suicides and or psychiatric evaluations. This is not like refusing an ambulance for a minor injury when the paramedics are called. A pill count won't give her serum level, although it may give some clues, some people hord pills. This woman had a previous attempt, that is enough to have caution and while 4x the normal ammount may not be excesive it could be or she may have mixed it, all requiring evaluation at the hospital, there are two ways to get there the ambulance or in the squad car, in handcuffs.

I have seen patients with Rx for #8 at a time to prevent this from happening, if mom is distraught she needs to have someone nearby.

There's a lot of muddy *legal* concepts being tossed around here. The law of Utah is as follows:

(b) Application and certification as described in Subsection (1)(a) authorizes any peace officer to take the individual into the custody of a local mental health authority and transport the individual to that authority's designated facility.
(2) If a duly authorized peace officer observes a person involved in conduct that gives the officer probable cause to believe that the person is mentally ill, as defined in Section 62A-12-202, and because of that apparent mental illness and conduct, there is a substantial likelihood of serious harm to that person or others, pending proceedings for examination and certification under this part, the officer may take that person into protective custody. The peace officer shall transport the person to be transported to the designated facility of the appropriate local mental health authority pursuant to this section, either on the basis of his own observation or on the basis of a mental health officer's observation that has been reported to him by that mental health officer. Immediately thereafter, the officer shall place the person in the custody of the local mental health authority and make application for commitment of that person to the local mental health authority. The application shall be on a prescribed form and shall include the following:

(a) a statement by the officer that he believes, on the basis of personal observation or on the basis of a mental health officer's observation reported to him by the mental health officer, that the person is, as a result of a mental illness, a substantial and immediate danger to himself or others;
(b) the specific nature of the danger;
(c) a summary of the observations upon which the statement of danger is based; and
(d) a statement of facts which called the person to the attention of the officer.

(3) A person committed under this section may be held for a maximum of 24 hours, excluding Saturdays, Sundays, and legal holidays. At the expiration of that time period, the person shall be released unless application for involuntary commitment has been commenced pursuant to Section 62A-12-234. If that application has been made, an order of detention may be entered under Subsection 62A-12-234(3). If no order of detention is issued, the patient shall be released unless he has made voluntary application for admission.
(4) Transportation of mentally ill persons pursuant to Subsections (1) and (2) shall be conducted by the appropriate municipal, or city or town, law enforcement authority or, under the appropriate law enforcement's authority, by ambulance to the extent that Subsection (5) applies. However, if the designated facility is outside of that authority's jurisdiction, the appropriate county sheriff shall transport the person or cause the person to be transported by ambulance to the extent that Subsection (5) applies.
(5) Notwithstanding Subsections (2) and (4), a peace officer shall cause a person to be transported by ambulance if the person meets any of the criteria in Section 26-8a-305. In addition, if the person requires physical medical attention, the peace officer shall direct that transportation be to an appropriate medical facility for treatment.
Amended by Chapter 141, 1999 General Session


Thus, the answer to your question is that yes, the police officers can force a transport against her will and yes, that transport must be by ambulance.

If the police officers did not follow the required course of action for assessment and detention, then you have a basis for a complaint, otherwise you may be out of luck. Some cases are successful, but I doubt that's the majority. Here's a list of some of the successful ones:

http://www.centerforpublicrep.org/page/74280;cat_id=768

There are a lot of 'muddy legal issues' being tossed around and I have some additional comments. I couldn't let this go (imagine that!), so I made some phone calls, one of which was to a SC attorney whose ad shows a speeding ambulance with lasso in the air, chasing a fleeing man. The cases in SC were not suicide related issues; however, forced transportation of a suicidal or reported suicidal person is, according to the attorney, "a twisted mess".

Next, I called a friend, an RN, director of a level one trauma center in a major hospital in a major city and this is what she said regarding a 911 call for a reported suicide attempt or suicidal person, "it's a weird mess that you don't want to get involved with". She went on to state that the EMTs are duty bound to transport the person and can not leave without the person UNLESS the police have verified that it was a prank call reporting the suicidal person and "everyone" has been notified of such and the ambulance call has been "withdrawn". Otherwise, the person has to be transported against his or her will BUT the EMTs (or paramedics) can not use force to restrain the person or subdue the person. The use of force has to be made by the police and can include using pepper spray to subdue a completely oriented, alert, nonsuicidal person who has been reported as suicidal. Then, the EMTs can apply restraints and transport the person to the ER. HOWEVER, the patient and, or the patient's insurance CAN NOT BE BILLED for the ambulance service or the ER visit or the subsequent admission to the hospital IF THE PERSON REFUSED EMT SERVICES, AMBULANCE TRANSPORTATION, AND/OR ADMISSION TO THE HOSPITAL.

Therefore, my initial response is correct:

If the police made your mother get into the ambulance, I doubt her refusal to do so has any implication. If the EMTs made your mother get in to the ambulance, that may not have been legal.

Click to expand...

and, the answer to the original poster's question, "Is there anyway to fight this?", is, "yes"; the ambulance service and the hospital can not bill the patient (his mother) for services that were forced upon her by the legal aspects of healthcare.

I said upfront that it was an interesting question and it has surely proved to be just that, "interesting", and quite an opportunity to learn more about such situations.

EC

Ellen,
The opinon of an RN in an UNNAMED city does not constitute the applicible section of UTAH law where OP's mother resides, which Censored cited, they can transport her in the ambulance, against her will.

Fine.
I'm not naming her or the hospital or the city.
I believe you will find that her information is correct.
It is always good to remember that laws, state codes, etc. are only as good as the case law that interprets the law.

I don't think we are in disagreement; obviously, you think we are.

EC

Editing note or a PS : I was so sure that the teaching hospital in SC had been sued in a suicide-related, forced admission, lawsuit, that I had to make one more phone call...it did happen. A woman came to the ER with GI and GU complaints and after giving her recent medical history, which included increasing some of her medications without contacting her MD, the MD on duty and with his group of residents in tow, loudly proclaimed she was suicidal, and with the assistance of security, had the woman restrained and began aggressive overdose management protocols. The woman's husband was running around screaming for help and an RN handed him a telephone and a telephone book and walked away. The husband took the hint and called an attorney. On the advice of the attorney, the woman cooperated, restraints were removed about 30 minutes after the attorney and the husband spoke via telephone, the woman was admitted for overnight observation, and when discharged went straight to the attorney's office. I do not know the rest of the story, but I may have to stop by the courthouse the next time I am in that area and see if I can find out what type of action was filed and what the plaintiff was able to recover.