Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Mentally Ill Patient Escapes EMS and Sues for Injuries

 

A Bronx woman is suing police and emergency medical services providers for injuries that occurred when she escaped custody and ended up leaping from a third story window.[1]

 

What is our liability for the behavior of patients with behavioral problems?

What is our authority to control the behavior of patients with behavioral problems?

 

She has filed suit against the city, the ambulance service, and the police officers for not properly supervising and restraining her. She argues that she was clearly mentally ill and should have been immobilized for her own protection.[2]

 

While the police and EMS probably could not have predicted that she would jump from the third floor of the building if she escaped, that does make a pretty good case for her being off her rocker not being responsible for her actions. On the other hand, the LD50 for jumping from a building is 4 floors, so she did not jump from high enough to expect to die.
 

It’s unclear whether the officers called for an ambulance because Rodriguez suffered injuries from damaging the car or because they recognized that she might be mentally ill.[2]

 

We, and the police, are called to protect everyone else from patient like this, but we are also called to protect the patients from themselves.

Kelly Grayson just posted on Facebook about the difference between a couple of behavioral problem patients.
 

What’s more stressful than dealing with the violent, hulking behemoth with a tenuous cheese-cracker interface?

Dealing with the *potentially* violent, hulking behemoth with a tenuous cheese-cracker interface, that’s what.[3]

 


Image credit.
 

If they all looked like this, it would be easy to treat aggressively and avoid problems, but that is not the way many will present – especially after being restrained by police.

The article does not provide many details, but that is the essence of the problem Kelly is describing – these patients are unpredictable unknowns. Many will sit calmly and cooperate at all times. Others are just waiting for the opportunity to do something creative, which is not good for us.

These patients are the known unknowns, but their future behaviors are the unknown unknown.[4] Often, they do not even know what they are going to do.
 

I started out by asking –

What is our liability for the behavior of patients with behavioral problems?

That may be up to a jury. We also have to live with the adverse outcomes we could have prevented.
 

The responders erred in “not restraining or immobilizing [Rodriguez] to ensure that she was not capable of hurting herself” and were negligent in “allowing her to leave the ambulance without fully assessing her mental state,” the complaint states. It cites a line in Article 9 of the New York Mental Hygiene laws, which notes the “Powers of Certain Peace Officers and Police Officers to take into custody any persons who appears to be mentally ill and is conducting himself or herself in a manner which is likely to result in serious harm to the person or others.”[2]

 

Interesting assertions, but we do not have anywhere near enough information to know if they are true. In Pennsylvania, I do not have the authority to involuntarily commit patients.

My preference is to sedate patients. Safer for everyone involved, including the techs, nurses, PAs, and doctors at the hospital.

What is our authority to control the behavior of patients with behavioral problems?

That is often up to the medical director – state, county, service – and the ability of the medical director to understand how unstable these patients can be.
 

I think this is a cautionary tale for all of us. We need to be aware of what our patients are doing once we have them in our care and should not leave them unattended in the back of an ambulance especially when perhaps they are mentally disturbed. I want to make it clear that I’m not second guessing these EMTs.[1]

 

There is a lot to discuss.

Footnotes:

[1] Mentally Ill Patient Escapes EMS and Sues for Injuries
By podmedic
August 2, 2013
MedicCast
Article

Social Media, EMS and Public Health on Episode 344
By podmedic
July 29, 2013
MedicCast
Article with link to podcast.

[2] Woman Sues EMTs, Police for Letting Her Leave Ambulance and Jump Out Apartment Window
By Albert Samaha
Tue., Jul. 16 2013 at 10:30 AM
The Village Voice Blogs
Article

[3] What’s more stressful than dealing with the violent, hulking behemoth with a tenuous cheese-cracker interface?
Facebook
Kelly Grayson
Post

[4] Secretary Rumsfeld Press Conference at NATO Headquarters, Brussels, Belgium
Secretary of Defense Donald H. Rumsfeld
June 06, 2002
Transcript

Q: Regarding terrorism and weapons of mass destruction, you said something to the effect that the real situation is worse than the facts show. I wonder if you could tell us what is worse than is generally understood.

Rumsfeld: Sure. All of us in this business read intelligence information. And we read it daily and we think about it and it becomes, in our minds, essentially what exists. And that’s wrong. It is not what exists.

Now what is the message there? The message is that there are no “knowns.” There are things we know that we know. There are known unknowns. That is to say there are things that we now know we don’t know. But there are also unknown unknowns. There are things we do not know we don’t know. So when we do the best we can and we pull all this information together, and we then say well that’s basically what we see as the situation, that is really only the known knowns and the known unknowns. And each year, we discover a few more of those unknown unknowns.

It sounds like a riddle. It isn’t a riddle. It is a very serious, important matter.

There’s another way to phrase that and that is that the absence of evidence is not evidence of absence. It is basically saying the same thing in a different way. Simply because you do not have evidence that something exists does not mean that you have evidence that it doesn’t exist. And yet almost always, when we make our threat assessments, when we look at the world, we end up basing it on the first two pieces of that puzzle, rather than all three.

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