Today, among my numerous calls, I made great friends with a local assisted living facility. (I hope you detect some sarcasm there.) The call: a fall. The patient: a 90-something year old. The issue: she fell; facility says she has to go to the hospital, patient says she doesn’t want to.
The story and assessment: my patient was walking through an area of the facility when she tripped over her own feet (goodness, I do it at my 20-something age…can’t imagine how bad I’ll be in 70 years!) and knocked her noggin on a table. The patient is conscious, alert and oriented (and happily eating breakfast when we arrived). She knows who she is, where she is, when it is, what is going on and can tell me everything that happened during her elegant fall. She has no complaints at all. Upon inspection of her head (where they say she hit), there is no bleeding, no deformity, no swelling or other issues that would indicate that there was an issue. Patient denies any other complaints: no headache, no dizziness, no problems with her vision, no neck or back pain, no chest pain, no difficulty breathing, no nausea — nothing. The patient’s vital signs all check out perfectly.
The fun part: we ask the patient what hospital we can take her to. She asks if she has to go. We explain to her that there is a chance something else is going on that we don’t know about and that it would be good to get checked out. She strongly expresses her wishes to stay where she is and not be transported. We go through a gamut of questions, answers and explanations about what could happen if she doesn’t go and all of that fun legal stuff (though, as medical professionals, we know it to be true…not just there for legal reasons). She still insists on not going.
Enter the staff: when they notice we are getting the patient to sign our fancy-dancy refusal form, they approach us to see if the patient is going to be transported, to which we responded “no.” They begin talking to the patient: “Oh, but ‘Ethel’ (not her real name), you have to go! You can’t stay here. You must go to the hospital and get checked out.” To this, I kindly explain to the staff member sharing this opinion that it is the patient’s right to stay where she is and refuse treatment. She is of sound mind and is clearly oriented to her surroundings and what has happened. She can answer every question appropriately. She is able to refuse anything that she wants. You, by law, cannot make her go. They begin to get feisty and try to explain that it is their policy that if a resident hits their head, they must be transported to the hospital (while I don’t disagree with the idea behind the policy, it is not something they can force). As I begin to talk with the staff member again, she (quite rudely) cuts me off saying that this conversation is between her and the patient and that I have nothing to do with it (wrong). As she was with another resident at the time, she walked off. My patient signed our refusal form and returned to her breakfast.
The trouble: we get outside to our rig, with our gear put back inside and are sitting in the truck getting ready to pull out when another staff member comes outside to the rig and says that we have to take the patient to the hospital. We, again, explain the law and how it works. She says that she will just call 911 again when we leave (to which we laugh and say to ourselves that we’ll be the ones who get it…so good luck).
Enter a supervisor: as things were beginning to get a bit out of control, I called our supervisor and asked him to join us. As he is on the way, we are informed by the staff that the patient has “changed her mind” and wants to be transported now. The patient has been escorted to the front lobby to wait for us. We load her up and transport her to the ER. My supervisor joins us at the ER to discuss the call and what went on. He agreed with us that we were in the right and that the facility was not.
Here’s how it works: no matter what someone else says (even if they have Healthcare Power of Attorney [HPOA]), if a patient is conscious, alert and oriented to person, place, time and event, and if they have not made a declaration that they want to hurt themselves or someone else, NO ONE CAN MAKE THEM GO TO THE HOSPITAL. Now, you can always try to convince and (the better term) coerce them into being seen. But you cannot mandate that they be transported. If I took them (assuming the above), that would be kidnapping. I can’t do that. That is illegal. Even if it is a policy that your facility has, you cannot mandate something that takes away the individual freedom of the patient to make decisions for themselves.
(Also, do not tell me what I will and will not do. Not many people can get away with that [and not many = one, sometimes]. Ask me nicely and perhaps I will help you out. Demand it, and we will have some serious issues.)