Consesnt vs. Responsibility follow-up;

[Krin135 at aol.com]

In a message dated 11/6/2006 2:33:56 AM Central Standard Time,  
tangentcarrot at hotmail.com writes:


One point to be cleared- it did not happen in the US, but in  Israel.

About law enforcment officers- none were at the scene, since  the weren't 
activated. The night club owner probably did not want "any  trouble", and the 
EMS were not acknowledged that it was the consequence of  a fight.
You wrote-
>"since when does a 3rd party (employer or not)  get to make ANY decisions "

Since he's the head of security of the  night club. Arguing too much with him 
wouldn't have fallen right with the  principle of "safety first" we embrace 
in pre-hospital acute treatment  :)
And being serious- I'm sure that it wouldn't have been at the best  intrest 
of the pateint to start arguing with the boss, since i'd be kicked  out and 
the pateint left alone with out a professional.

About the  possibility of intoxicication- it is very unlikely. The guy works 
at the  club and gets his drinks from a bar tender he knows and works with.  
Moreover, they do everything they can so the club stays drug free, and as  a 
veteran commer to the club, i've never encountered drugs there.   According 
to freinds, he had one drink all night long, which makes him  even competent 
to drive.

And a thought- if the pateint does not  know what happen to him, becuase of 
the amnesia, how deeply does it imapct  his ability to refuse? He does not 
fully understand his condition, does  he?




Item the first: I'm not sure about Israel, but here in the US, the Head of  
Security in a situation like that should have been the first one urging the 
chap  with the problem to go to the hospital, as the *Club* could be held liable 
if  the chap really did have a serious problem. This is even more true if the  
patient was an employee of the club. It would have looked even worse for the  
head of security and the club if they had kicked you out for trying to help 
the  patient and the patient had later died...such things can result in 
negligent  manslaughter charges being filed here in the states.
 
Also, in many areas of the US, a call for a possible altercation  
automatically results in a police response, for crowd control if nothing  else.
 
As far as the amnesia causing problems with his refusal, again, it depends.  
The main problem remains that the patient is still 'walking, talking and potty 
 trained,' and capable of forcibly resisting physical attempts to bring him 
to  the ED. Lacking training in safe take down techniques (usually provided by 
the  law enforcement folks), I'm not sure that I'd want my medics trying to 
bring him  in, especially if the Club management is resisting the situation.
 
Documentation of good faith efforts on the part of the responding EMS  folks, 
as well as coordination with on line medical control (and hopefully,  
documentation on the part of the doc at the other end of the radio) will go a  long 
way to providing recourse if the situation does go south....but there is  
little that I can see to be done for the patient in the situation you are  
describing.
 
ck
Charles S. Krin, DO FAAFP