What do we owe our patients?

DWK Fraser, CD, BA, PCP @DWKF
Views are my own, and do not represent my employers in any way.

No, not like that, although we’ve all encountered patients or other members of society with a, shall we say, heightened sense of entitlement.  But what is our duty of care as prehospital professionals?  When can we leave a patient and when must we stay with them to definitive care?

Duty to Act

There isn’t a huge amount of information available in Canadian law that applies to this subject with regards to Paramedics and other prehospital providers, but there are some basic principles at play and some guidance from some EMS authors, the BC EMA Licensing Board and the Royal College of Physicians and Surgeons of Canada. The Royal College outlines four fundamental obligations of a physician to their patient:

  • The obligation to obtain informed consent.
  • The obligation to provide prudent and diligent care.
  • The obligation not to abandon the patient.
  • The obligation to preserve confidentiality.

While Paramedics and other prehospital providers are not bound by regulations of the Royal College, it seems prudent and reasonable to look to our physician’s guiding documents, and note that there is absolute overlap between the duties of physicians and the duties of paramedics in the other three areas mentioned. The Emergency Licensing Board of British Columbia Schedule 3 Code of Ethics writes, in part:

(a) consider, above all, the well-being of the patient in the exercise of their duties and responsibilities;

(c) protect and maintain the patient’s safety and dignity, regardless of the patient’s race, colour, ancestry, place of origin, religion, marital status, family status, physical or mental disability, sex or sexual orientation;

(d) preserve the confidence of patient information consistent with the duty to act at all times for the patient’s well-being;

(g) carry out professional responsibilities with integrity and in accordance with the highest standards of professional competence;

One key question that must be answered if any fault is to be found is “Did the Paramedic have a duty to act?”  In the prehospital setting, it is reasonable to say that a Paramedic or other public safety member who is responding in a professional capacity to a call for service, whether this comes from a flag-down on the street or a 911 call, has an established duty to act in the best interests of the calling party (if they and the patient are the same individual), or, with consent, any person found in medical distress at the location.

What is abandonment?

Nancy Caroline, the author of Emergency Care in the Streets very succinctly wrote “Abandonment can occur anytime Paramedics turn over their patients inappropriately or to a level of care lesser than themselves or if they leave a patient without ensuring the patient had the mental capacity to refuse treatment or transport.”

If you have established a relationship with a patient, by assessing, treating, or otherwise offering aid to a person in distress, and then you leave them without handing them off to a person capable of providing care to an equal or higher level you have abandoned your patient. You have breached your duty of care to that person, and can be held liable.

In the EMALB code of ethics, (c) protect and maintain the patient’s safety, would imply that Paramedics must protect the patient against reasonably foreseeable complications and risks.  While untested, this could include occult injuries at a MVC scene or the resuscitated narcotic overdose patient refusing care.

“In other words, after care of any kind is administered, the physician must “provide the medical follow-up required by the patient’s condition” unless the physician has ensured that a colleague or another competent professional will do so.36 Where a physician wishes to refer the patient to a colleague, he/she remains responsible for the patient until the new physician takes up the patient’s care.37″

You can read more in this article from EMS 1

 

I’m not a lawyer, and this shouldn’t be taken to construe legal advice.  I didn’t even stay at a Holiday Inn last night.  Comments? You can find me on Twitter @DWKF