He’s Right, Nothing is Absolute

I’ve burned the rulebook/protocols, both physically and metaphorically, probably more times than I can count. There were times when what I did was right, and there were times when what I did was wrong. Either way I learned from the experience, and right or wrong I always owned it and did it knowing there would be repercussions.

Reading the article “Nothing being absolute except death….. and taxes” from The Social Medic brought back some unfortunate memories of when doing the right thing, wasn’t the right thing. His article was sparked by some debate over a story of firefighters that transported a pediatric patient on their fire engine, rather than waiting for the ambulance. I’m not going to come out and say whether or not what they did was “right”. Instead, I’m going to share my own story of “right vs wrong”. I’m pretty sure it will give you a good idea of how I would react if I was in their shoes.

We were dispatched to a doctors office for a younger female that had suffered a pneumothorax as a result of a medical procedure that had gone bad. Her doctor had requested that we transport to a hospital that his group contracts with. At the time, that hospital was on ED closure. I informed him of said closure only to be informed that he had contacted the receiving physician and that he had accepted this patient.

This is something that I have encountered MANY times. Every other time, I would have just transport to the hospital and call them en route to inform them of the situation. NO BIG DEAL…..right?

We loaded the patient without delay and did what me or any other paramedic in our system would have done. We started towards the ER of choice. When I called in report, I was instructed to divert. I called them on a land-line to speak with the charge nurse to inform him of why I was continuing to their facility. He still refused the patient. The accepting physician had already gone home and they were not going to accept this patient.

This was a first for me. I informed the patient of the hospital’s refusal and was immediately met with a demand to stop the ambulance and let her out. She was adamant that she would not receive care at any other hospital and was willing to take her chances with death.

Sure, I had informed her of the risks and she COULD have signed AMA and walked off to die somewhere, but I’m not OK with letting someone go, knowing what’s about to happen. I re-contacted the hospital and explained that the patient was attempting to sign AMA and go home. They didn’t care. Their suggestion was to allow her to do so.

I instructed my partner to divert to another hospital while I attempted to convince our patient to allow another hospital to treat her. We finally had no choice but to pull over before getting to any hospital and call someone to pick her up. I couldn’ legally keep her any more. I called my supervisor for help and he showed up to ultimately receive the same resistance. She was stubborn and she knew her rights. By now her work of breathing had increased and I had to increase her oxygen to maintain a decent Sp02. Not a good time to sign AMA.

Being that transporting was out of the question, we were able to convince her to let her family drive her to the original ER of choice. I told her that we would follow her to make sure she made it OK. She agreed.

My supervisor called the ER one more time to inform them that she was going to be arriving via private vehicle. He asked them to do the right thing and just accept the patient so she didn’t have to resort to such measures. They finally agreed and accepted the patient. We arrived at the ER and the patient was transferred over with no issues.

Later that night – 10 minutes after clearing that hospital, to be exact – the charge nurse filed a formal complaint with our governing EMS agency. I was investigated and found to be in violation of the county’s transport destination policy. I had an infraction placed against my paramedic license and it remains until this day. The EMSA director said obtaining the AMA would have been the right thing to do.

If I had it to do over again, I would do the exact same thing, in the exact same way I did it. I don’t care how stubborn that patient was, it was my responsibility to make sure she received the care she needed.

Sometimes we get confused about what’s right, but I know for sure it’s not always what’s on paper.