Court Case Illustrates Importance of Following Patient Refusal Guidelines

A federal appeals court ruled that an EMS agency whose personnel allegedly failed to follow the wishes of a competent patient could be liable under the Americans With Disabilities Act (ADA) as well as under state tort law for transporting the patient against his will.

In Green v. City of New York (read the entire court case by CLICKING HERE) the patient, who was suffering from advanced amyotrophic lateral sclerosis (ALS) - or Lou Gehrig's Disease - was unable to speak, but communicated by a system of eye blinking and through a laptop computer that spoke for him.  After experiencing an episode of respiratory distress due to a failure of his mechanical ventilator, his family called EMS to assist in ventilating the patient.  When he was successfully resuscitated, he regained consciousness and was allegedly determined to be alert and oriented on the scene (his residence).  By blinking his pre-arranged code for "no" and by typing into his laptop that he didn't want to go to the hospital, the patient indicated his desire not be transported.  Nevertheless, allegedly without performing an assessment of the patient's mental status, the paramedic in charge ordered that the patient be transported. 

The federal appeals court ruled that failing to adhere to a competent patient's wishes - where the patient could communicate but could not speak due to a physical disability - could constitute a violation of the ADA as well as civil assault and battery under state tort law.

Download PWW's sample patient refusal form and policy by visiting our Sample Forms and Policies page.

Read much more about this case in the November 2006 issue of the EMS Insider.