When does a drunk become a patient?

In a previous post, I discussed the criteria for refusal competency. We covered the reasons why a paramedic would transport a person who has impaired faculties to the hospital. The question we will explore today is another tricky one: When does a person who is impaired by alcohol or other intoxicants become a patient?

This was brought on by a call I ran recently that put my opinion at odds with the opinion of another medic. In this incident, we had been sent to the scene of a home where the caller had dialed 911 because a man was unconscious in his yard, and then woke up and stole a bicycle. When we arrived, a cop was already there. I asked the cop what the guy's problem was, and got the answer: "He's an idiot."

The subject (note that I did NOT say patient) was standing there talking to various bystanders, and only spoke Spanish (not an uncommon occurrence) but the caller/homeowner was translating. The subject also reeked of booze, denied having ID, and was from Mexico (all pretty common conditions in these parts). He denied having been unconscious, and claimed he was just sleeping. He also said that he did not want to go to the hospital. The translating bystander said that his Spanish seemed normal and unslurred.

A brief huddle ensued, and the following decisions were reached:

- The cop didn't want to arrest him for petty theft, saying the jail wouldn't take him since he was drunk, until he had been to the ER for evaluation. He also didn't want to take him to the ER, because it would be hours before the prisoner would be released from the ER to go to the jail, and the cop had better things to do with is time.

- The medics decided that he was not a 'refusal' because in order to be a refusal, people who are drunk cannot refuse. Besides, in order to refuse, you must first be a patient.

- An hour later, another crew found him passed out drunk in the gutter, and transported him. This medic was pissed and wanted to know why we didn't transport him against his will, seeing as how he was drunk.

So what makes a patient? When does a person with whom you have made contact become a patient?

I claim that a person who either has a medical complaint, or a visible medical problem is a patient.

The other medic states that since alcohol intoxication has a diagnosis code, that all intoxicated people are patients and must be transported, even if they have no other complaint or injury. The medic says that drunk people can possibly step out in front of cars, and he doesn't want the liability.

I responded by pointing out that male pattern baldness also has a diagnosis code, and unless the intoxicated person is drunk to the point where he cannot stand, is passing out, or has some other problem, he is not a patient. I also point out that people have rights, and I am not going to infringe upon them by forcing a person to the hospital simply because they are drunk.

What say ye? At what point does a person who is drunk become a patient? When do you begin the chain of events that forces a person to go to the hospital against his will?