SSV EMS MICN Course Module 4 EMS Legal

S-SV EMS MICN Course Module 4 EMS Legal Aspects S-SV EMS Agency MICN Training (Updated 12 -2019) 1

EMS Legal Aspects • Definitions Overview § Criminal Law § Do Not Resuscitate (DNR) § Civil Law § Physician Order For Life Sustaining Treatment (POLST) § Good Samaritan Law § Advance Directive § Living Will § Durable Power of Attorney for Healthcare S-SV EMS Agency MICN Training (Updated 12 -2019) 2

EMS Legal Aspects • Criminal Law § Crime and punishment § State vs. offending person § “Beyond a reasonable doubt” S-SV EMS Agency MICN Training (Updated 12 -2019) 3

EMS Legal Aspects • Civil Law § Contracts and domestic relations § Conflicts between two or more parties § One individual against another o Malpractice suit § “Preponderance of evidence” o Unanimous jury not required S-SV EMS Agency MICN Training (Updated 12 -2019) 4

EMS Legal Aspects • Good Samaritan Law 1 § Individual is protected from liability if they: o Acted in good faith o Acted within scope of practice/training (if applicable) Ø Off duty EMS personnel may provide BLS care only – ALS care requires medical authority within an organized EMS system o Did not act negligently o Did not accept money for the assistance provided 1 CA H&S Code, Div. 2. 5, § 1799. 102 S-SV EMS Agency MICN Training (Updated 12 -2019) 5

EMS Legal Aspects • Advance Directive § Written statement of a person’s wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor S-SV EMS Agency MICN Training (Updated 12 -2019) 6

EMS Legal Aspects • Living Will § Written document stating whether an individual does or does not want artificial life support if: o They become terminally ill and will die shortly without life support; or o They fall into an irreversible coma or persistent vegetative state S-SV EMS Agency MICN Training (Updated 12 -2019) 7

EMS Legal Aspects • Durable Power of Attorney For Healthcare § Allows an individual to empower another with decisions regarding his or healthcare and medical treatment § Becomes active when a person is unable to make decisions or consciously communicate intentions regarding treatments § Person with a durable power of attorney for healthcare cannot contradict the terms of a living will S-SV EMS Agency MICN Training (Updated 12 -2019) 8

EMS Legal Aspects • Do Not Resuscitate (DNR) § No chest compressions or defibrillation § No assisted ventilation or advanced airway § No cardiotonic medications § Patients still receive palliative treatment for pain, dyspnea, major hemorrhage, or other medical conditions S-SV EMS Agency MICN Training (Updated 12 -2019) 9

EMS Legal Aspects • DNR (cont. ) § Types of EMS approved DNR orders o Written DNR order dated and signed by a physician (POLST, EMSA form, patient’s chart – including electronic medical record, or physicians verbal order sheet signed by an RN) o Medic Alert DNR wrist or neck medallion o Patient’s physician verbal order (physician must be on scene) o California Durable Power of Attorney for Healthcare (agent or attorney-in-fact must be present and provide ID) S-SV EMS Agency MICN Training (Updated 12 -2019) 10

EMS Legal Aspects • Physicians Orders For Life. Sustaining Treatment (POLST) § Intended to express a patient’s wishes in end-of-life decisions, backed by physician’s orders § CA law mandates recognition by healthcare workers and provides immunity for those who comply in good faith S-SV EMS Agency MICN Training (Updated 12 -2019) 11

EMS Legal Aspects • POLST (cont. ) § Alternative to DNR § Use is voluntary, does not replace an Advance Directive § Any incomplete section implies full treatment for that section § Must be signed by physician and patient/guardian/ decision maker to be legal/valid – full treatment required if signatures are missing S-SV EMS Agency MICN Training (Updated 12 -2019) 12

EMS Legal Aspects • DNR/POLST Notes § If more than one version/type of form is present, use the form with the most current date § When in doubt, prehospital personnel shall begin resuscitation and contact the base hospital immediately for direction/consultation § DNR/POLST documentation should be taken with the patient to the receiving hospital if transported § Prehospital personnel are required to include a copy of the DNR/POLST in their documentation if possible S-SV EMS Agency MICN Training (Updated 12 -2019) 13

EMS Legal Aspects • End of Life Option Act § California Law that became effective June 1, 2016 § Authorizes an adult (≥ 18) meeting certain qualifications and suffering from a terminal disease to request/utilize an aid-in-dying drug § Individual is required to complete a ‘Final Attestation’ document which should be available in close proximity S-SV EMS Agency MICN Training (Updated 12 -2019) 14

EMS Legal Aspects • Other EMS Legal Matters § EMS Liability Protections § EMS Medical Authority § Standard of Care § Negligence § Consent § Suspected Child or Elder/ Dependent Adult Abuse Reporting § Patient Initiated Refusal of EMS Services § Misc. EMS Legal Issues § Prehospital Documentation § EMS Personnel Licensure/ Certification Enforcement S-SV EMS Agency MICN Training (Updated 12 -2019) 15

EMS Legal Aspects • EMS Liability Protections § CA Health & Safety Code, Division 2. 5, § 1799. 102 o No person who in good faith, and not for compensation, renders emergency medical or nonmedical care at the scene of an emergency shall be liable for any civil damages resulting from any act or omission. The scene of an emergency shall not include emergency departments and other places where medical care is usually offered. This subdivision applies only to the medical, law enforcement, and emergency personnel specified in this chapter. S-SV EMS Agency MICN Training (Updated 12 -2019) 16

EMS Legal Aspects • EMS Liability Protections (cont. ) § CA Health & Safety Code, Division 2. 5, § 1799. 104 o (a) No physician or nurse, who in good faith gives emergency instructions to an EMT-II or mobile intensive care paramedic at the scene of an emergency, shall be liable for any civil damages as a result of issuing the instructions. o (b) No EMT-II or mobile intensive care paramedic rendering care within the scope of his duties who, in good faith and in a non-negligent manner, follows the instructions of a physician or nurse shall be liable for any civil damages as a result of following such instructions. S-SV EMS Agency MICN Training (Updated 12 -2019) 17

EMS Legal Aspects • EMS Liability Protections (cont. ) § CA Health & Safety Code, Division 2. 5, § 1799. 106 o …. a firefighter, police officer or other law enforcement officer, EMT-II, EMT-P, or registered nurse who renders emergency medical services at the scene of an emergency or during an emergency air or ground ambulance transport shall only be liable in civil damages for acts or omissions performed in a grossly negligent manner or acts or omissions not performed in good faith. S-SV EMS Agency MICN Training (Updated 12 -2019) 18

EMS Legal Aspects • EMS Medical Authority § EMS personnel function under the authority of a physician o ‘Offline Medical Control’ – Following established S-SV EMS policies/protocols (as written) Ø Function under the authority of the S-SV EMS Medical Director o ‘Online Medical Control’ – Following a base hospital physician order deviation from established S-SV EMS policies/protocols, but still within applicable scope of practice Ø Function under the authority of the base hospital physician who provided the specific order Ø Base hospital physician consultation/approval is required for any deviation from established S-SV EMS policies/protocol S-SV EMS Agency MICN Training (Updated 12 -2019) 19

EMS Legal Aspects • Standard of Care § State statutes/regulations establishes scope of practice § S-SV EMS establishes medical control policies/protocols o California Health and Safety Code: “Every local EMS Agency shall have a full or part time physician functioning as the Medical Director to ensure medical accountability” § Can also be derived from the peer standard o What a reasonable and prudent similarly trained/certified/ licensed provider would do in the same or similar circumstance S-SV EMS Agency MICN Training (Updated 12 -2019) 20

EMS Legal Aspects • Standard of Care (cont. ) § The following may also be used to establish a standard of care in a legal proceeding: o EMS course curriculum o EMS textbooks o Employer policies o Expert testimony § Deviation from the standard of care can lead to allegations of negligence S-SV EMS Agency MICN Training (Updated 12 -2019) 21

EMS Legal Aspects • Negligence § The following four (4) requirements must be met in order for negligence to be proven o Duty to act o Breech of duty o Damages occurred o The breech of duty was the proximate cause of injury/harm S-SV EMS Agency MICN Training (Updated 12 -2019) 22

EMS Legal Aspects • Patient Autonomy § A patient has the right to direct their own care § EMS providers must respect and honor the patients rights, including: o Consent for treatment o Refusal of EMS care S-SV EMS Agency MICN Training (Updated 12 -2019) 23

EMS Legal Aspects • Patient Autonomy (cont. ) § Types of consent: o Informed Consent – Risks and benefits explained o Expressed Consent – Verbal/nonverbal permission granted o Implied Consent – Patient is unable to provide expressed consent so implied consent is assumed Ø Unconscious/unresponsive Ø Altered mental status Ø Unemancipated minor o Involuntary Consent – Court order, 5150, etc. S-SV EMS Agency MICN Training (Updated 12 -2019) 24

EMS Legal Aspects • Patient Autonomy (cont. ) § Withdrawal of consent may be done by any competent adult (responsible for their own healthcare) at any time o Withdrawal of consent must be informed o Not applicable to involuntary consent (court order, 5150, etc. ) S-SV EMS Agency MICN Training (Updated 12 -2019) 25

EMS Legal Aspects • Suspected Child or Elder/Dependent Adult Abuse Reporting § Child: Any person under age 18 § Elder: Any person over age 65 § Dependent adult: Any person between the age of 18 – 64 who is unable to care for themselves and/or is admitted to an inpatient 24 hour healthcare facility S-SV EMS Agency MICN Training (Updated 12 -2019) 26

EMS Legal Aspects • Suspected Child or Elder/Dependent Adult Abuse Reporting (cont. ) § EMS personnel are mandated reporters o Required by law to report knowledge or observation of abuse (law enforcement, APS, CPS, etc. ) o Immune from criminal or civil liability for reporting as required S-SV EMS Agency MICN Training (Updated 12 -2019) 27

EMS Legal Aspects • Refusal of EMS Care § Litigation risk o A large percentage of EMS related litigation involves patients who are NOT transported after contact with EMS S-SV EMS Agency MICN Training (Updated 12 -2019) 28

EMS Legal Aspects • Refusal of EMS Care (cont. ) § Person (not considered to be a patient) o An individual who does not have a complaint suggestive of an illness/ injury, does not request evaluation of an illness/injury and/or in the judgement of EMS personnel, does not demonstrate a known or suspected illness/injury that requires EMS care § Patient: o An individual who has a complaint suggestive of an illness/injury, requests evaluation of an illness/injury and/or in the judgement of EMS personnel, demonstrates a known or suspected illness/ injury that requires EMS care S-SV EMS Agency MICN Training (Updated 12 -2019) 29

EMS Legal Aspects • Refusal of EMS Care (cont. ) § Patient Representative o An individual legally responsible for healthcare decisions involving a patient (parent, legal guardian, conservator, agency/attorney-in-fact) Ø A law enforcement officer may also legally represent a patient who is in their custody if the circumstances warrant S-SV EMS Agency MICN Training (Updated 12 -2019) 30

EMS Legal Aspects • Refusal of EMS Care (cont. ) § Competent person/patient o An individual who has the capacity to understand the circumstances for which EMS care is indicated and the risks associated with refusing all or part of such care o They are alert and their judgement is not impaired by alcohol, drugs/ medications, illness, injury, or grave disability S-SV EMS Agency MICN Training (Updated 12 -2019) 31

EMS Legal Aspects • Refusal of EMS Care (cont. ) § Individuals determined by EMS personnel to meet the definition of a person do not require EMS care § Patient assessment and refusal of care procedures shall be performed by ALS personnel whenever possible Ø BLS personnel may only complete the refusal of EMS care procedures if ALS personnel are not on scene/not available S-SV EMS Agency MICN Training (Updated 12 -2019) 32

EMS Legal Aspects • Refusal of EMS Care (cont. ) § A patient/patient representative may decline all or part of EMS care if the following actions have taken place o EMS personnel have provided enough information so there is informed consent o The patient/representative is competent and understands the risks and options concerning their decision o EMS personnel have involved law enforcement and/or the base hospital as required by S-SV EMS policy S-SV EMS Agency MICN Training (Updated 12 -2019) 33

EMS Legal Aspects • Refusal of EMS Care (cont. ) § EMS personnel refusal of EMS care procedures: o Perform an adequate assessment and advise the patient/representative of the known/suspected medical condition and risks of refusing EMS care o Involve law enforcement for any of the following: Ø Attempted suicide, verbalized suicidal/homicidal ideations Ø Clearly irrational decision in presence of a life threatening condition Ø Concern for patient neglect of endangerment S-SV EMS Agency MICN Training (Updated 12 -2019) 34

EMS Legal Aspects • Refusal of EMS Care (cont. ) § The following patients refusing EMS care require base hospital consultation by prehospital personnel: o New altered LOC o Potentially life threatening condition, including but not limited to, pts. meeting STEMI, stroke, or trauma triage criteria o Unstable vital signs o Disagreement between law enforcement and EMS about whether or not the patient requires EMS care S-SV EMS Agency MICN Training (Updated 12 -2019) 35

EMS Legal Aspects • Refusal of EMS Care (cont. ) o A patient not legally responsible for their own healthcare being released to self or another individual on scene who is not their legally designated healthcare decision maker o Any other circumstance where EMS personnel believe that the involvement of the base hospital would be beneficial § Patient refusal consultation can be completed by an MICN, but may require physician consultation if there are concerns for the patient’s safety S-SV EMS Agency MICN Training (Updated 12 -2019) 36

EMS Legal Aspects • Refusal of EMS Care (cont. ) § Prior to releasing patients who are not legally responsible for their own healthcare decision making, EMS personnel shall attempt to contact the legally designated healthcare decision maker if they are not on scene § A patient/representative refusing EMS care must sign a Refusal of EMS Care Form S-SV EMS Agency MICN Training (Updated 12 -2019) 37

EMS Legal Aspects • Miscellaneous EMS Legal Issues § Patient Abandonment o A form of medical malpractice that occurs when the provider-patient relationship is terminated without reasonable notice or a reasonable excuse, and the patient is not provided with an opportunity to find a qualified replacement care provider § False Imprisonment o Restraint of a person in a bounded area without justification or consent S-SV EMS Agency MICN Training (Updated 12 -2019) 38

EMS Legal Aspects • Miscellaneous EMS Legal Issues (cont. ) § Assault o A violent physical or verbal attack o A threat or attempt to inflict offensive physical contact or bodily harm on a person that puts the person in immediate danger of or in apprehension of such harm or contact § A patient threatened with the possibility of a painful procedure in order to gain compliance with EMS personnel may claim assault if they had reasonable anticipation of bodily harm S-SV EMS Agency MICN Training (Updated 12 -2019) 39

EMS Legal Aspects • Miscellaneous EMS Legal Issues (cont. ) § Battery o An offensive touching or use of force on a person without the person’s consent S-SV EMS Agency MICN Training (Updated 12 -2019) 40

EMS Legal Aspects • Miscellaneous EMS Legal Issues (cont. ) § Libel o Injuring an individual’s character by writing § Slander o Injuring an individual’s character by spoke words S-SV EMS Agency MICN Training (Updated 12 -2019) 41

EMS Legal Aspects • Miscellaneous EMS Legal Issues (cont. ) § Other laws o Crimes against persons o Domestic violence reporting o Motor vehicle laws – operation of emergency vehicles, response and transport codes S-SV EMS Agency MICN Training (Updated 12 -2019) 42

EMS Legal Aspects • Prehospital Documentation § Required for all responses where EMS personnel arrived at scene § Legal medical record, must be complete and accurate § Includes the following: o Interim patient care report – minimum documentation that must be left at the receiving facility o Electronic patient care report (e. PCR) – must be provided to the receiving facility within 24 hours S-SV EMS Agency MICN Training (Updated 12 -2019) 43

EMS Legal Aspects • Prehospital Personnel Licensure/Certification Enforcement – reportable incidents o Sentinel events o Breach of the standard of care o Medication and/or treatment errors o Care beyond the appropriate scope of practice o Failure to follow S-SV EMS policies/protocols o Suspected violations of § 1798. 200 of the H&S code o Any alleged or known injury to a patient by EMS personnel S-SV EMS Agency MICN Training (Updated 12 -2019) 44