Wednesday, January 9, 2008

Parental refusals

Alot is being made about this story. I cannot speak for the police side of things, but I can give some insight into how paramedics do business, especially in my neck of the woods.

Patient consent seems like a pretty easy subject when we are in school as a parafetus. In fact, many programs gloss over the subject, but in my experience no single issue gets medics in trouble as often as the subject of consent and refusals. What complicates things further is when a patient is forced to go to the hospital against his will, or a child has to go over the objections of a parent.

In order to explain how this happens, a little explanation about consent and mental capacity is in order. In order for patient care to happen, the patient must consent to this care. The law allows a medic to care for a person who for some reason is incapable of making an informed decision for themselves. Examples include unconscious or intoxicated adults, and children in the absence of their parent or guardian. This is called "implied consent."

In the case of a child with a parent in attendance, this can get even stickier. Even though the parent has the right to refuse, the paramedic is still obligated to report the injury to the authorities if he feels that the life or welfare of the child is in danger. In this case, according to the article, the medic had plenty of clues to lead him down that path:

1 The mechanism of injury: The child was drug by a moving car
2 Facial trauma, "a black eye and visible bruising," facial edema, and a dilated pupil
3 The only way to rule out a brain injury is to do a head CT. This cannot be done in the field, so referring him for more treatment was appropriate.

The social workers saw the same thing, and offered to pay for the treatment. The father refused, and when they told him they could get a court order, he replied that they would need to "bring an army." So, the workers reported their findings to the Judge.

The judge, believing that the probable cause was there, issued a warrant and court order. The deputies attempted to enforce the order, and the father again refused. So, the Deputies enforced the warrant.

The child was evaluated, treated, and released.

The entire thing was properly done, in my opinion. The paramedics reported possible child neglect to child services. Child services attempted to handle it. Warrant obtained, after a judge found probable cause. Father resisted, warrant served. What did the father think would happen? The cops would just go away and discard the warrant, while saying "Oh well, we tried."

What would people be saying had the medics and social workers NOT done what they did, and the child had died? This happens all the time, and when it does, the DCF workers and medics get into hot water for it. Damned if you do, and damned if you don't. At least if I act, I don't have a dead child on my conscience.

and until you have held a dead child in your arms, you can't possibly tell me what that is like.

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