Here’s a law firm’s press release worth reading.   Why?  Because it actually provides an appellate law citation.  In this case, it’s from the New York Court of Appeals, which makes the decision binding case law in New York.

The case determined that, in the state of New York, emergency department physicians have no legal duty to detain an intoxicated patient and prevent them from leaving the emergency department.

I’d note that this case only applies to New York and the facts of the case only apply to the legal duties and obligations relating to an emergency department physician.  But this is a case that applies regularly to EMS, assuming we deal with intoxicated patients.   The laws applying to EMS are likely different than the physician patient relationship and will definitely differ in other states.  It’s a case that’s eventually going to happen to EMS and this appellate case potentially might give us some clues as to how courts, at least in New York, might view the issue.

But the legalities of dealing with an intoxicated person are much more relevant to EMS legal issues than constant crowing about the supposed illegality of EMS providers making a diagnosis, whether EMS stickers on your car create a duty to act, or any of the other legal nonsense that EMS legal discussions regularly devolve into.

I’m fortunate enough to practice both law and paramedicine regularly.  As a result, I see a lot of ignorance where lawyers don’t understand medicine.  Namely, that lawyers continue to mislead the lay public that a bad outcome equals malpractice.

But I find healthcare types regularly blaming lawyers for so-called “defensive medicine.”  The latest one of these came from the respected (well, as respected as a blog can be) physician blog KevinMD.  The blog posted an opinion piece about a Boston jury awarding over $4 million in a malpractice verdict for an emergency department physician misdiagnosing a patient who later died of viral myocarditis.

Let me tell you again (because I’ve blogged about this before) what a jury verdict or a settlement should mean to the average healthcare provider, whether a CNA, paramedic, or attending physician at a world renowned medical school — NOTHING. Zero. Zip. Nada. Zilch. Nil.  You get the message.  A jury verdict, settlement, or even a plaintiffs’ firm’s press release have no binding legal authority.   They are meaningless except, perhaps, maybe to the specific case at hand.

So, then, what law should a healthcare provider pay attention to?  Quite simply — federal and state statutes in your jurisdiction, including the administrative regulations adopted by your jurisdiction’s licensing/regulatory authorities.  Also, you should pay attention to reported case law from appellate courts in your federal and state jurisdictions.  These are the laws and interpretations of law that you’re under.   Nothing else. Not even on odd-numbered Thursdays.

So, in short, to my fellow healthcare providers — learn the law.  Learn to recognize the phobias of law.  Learn to recognize and avoid panic and hysteria over any jury verdict you hear in the news. And learn when to call BS.  And just like you get mad when someone consults Uncle Ernie instead of a doctor, learn to consult someone schooled in the law when you have a legal question.

Obligatory final caveats and disclaimers.  This isn’t legal advice.  I’m not your lawyer.  I don’t want to be your lawyer.  This is just my personal opinion expressed through my blog.  My opinions are my own and don’t reflect the opinion of any employer, past, present, or future.  Objects in mirror may be closer than they appear.  Press hard, three copies.

AND FOR CRYING OUT LOUD — QUIT READING MEDICAL BLOGS AND WEBSITES FOR LEGAL GUIDANCE!

Earlier this week, I spoke with a colleague who works for a smaller private transfer provider in Houston who is looking at changing jobs.  On a side note, there are over 200 private EMS providers in the Houston area.  These aren’t 911 services, but rather private transfer operations.

My friend told me about the constant pressure from the current employer to chart things “just so” to make it possible for Medicare, Medicaid, or private insurance to reimburse for the transport.  The new company that they interviewed with removed 12-lead EKG cables from their ambulances because “they were tired of them getting lost.”  Additionally, this private service says they don’t do a lot of 12-lead EKGs on “routine” transports.  Additionally, this employer pays medics who have all of their charts completed correctly early.  Medics who don’t have all of their charts in and/or submitted correctly get paid on the “regular” payday instead.

I’ve got two observations from hearing and seeing some of these antics with some (not all, mind you) of the “mom and pop” services out there.   The first is that I could have a very nice standard of living suing several of these companies on billing fraud and violations of employment law, particularly the Fair Labor Standards Act.

However, minions, you’ve probably already figured that out.   Here’s my heretical thought.   Believe it or not, this is a case where bigger is better.  Namely, the large EMS companies (AMR, Acadian, Rural Metro, Paramedics Plus, etc.) can’t get away with some of these shenanigans.  These companies are simply too large, too visible, and too easy of a target to commit blatant violations of law relating to EMS standards, employment law, and billing integrity/compliance.   The potential loss of licenses and/or financial implications would be too large to comprehend.  That’s why these companies have at least some form of a QA/QI program, a (presumably) competent human resources department, a compliance program, and perhaps even in-house counsel.

So, the next time your large employer institutes some seemingly inane policy, there might actually be a reason to their rhyme. The policy might even protect both you and your employer. Even if not, I’ve never heard of an Acadian paycheck bouncing.   That’s more than I can say for more than one of the small transfer services that pop up like pimples on the face of our healthcare system.

Well, as we all know, so many people in the healthcare field think they’re attorneys when they aren’t driving ambulances, inserting a Foley catheter, or writing an order.  Couple that with the pack of lemmings that comprise so many of us online and you’ve got a recipe for a massive EMS legal f–k up.  (I’m only censoring myself for those of my two or three minions who access this from work.  Remember to sign up for minion status.  The Dark Side offers milk, cookies, and Halliburton stock.)

So, today, EMSers on Facebook have been blowing up Facebook over a three year old news report buried on the JEMS website.  See the following panic inducing link:  “Florida Verdict Could Change Way Paramedics React to Calls.”

But other than alarming the EMS world, what does it really mean?  Fortunately, minions, you have a paramedic who’s admitted to the Texas Bar to help you understand what this story means to you.  In short – ZILCH.  Nada.  Nothing.  Don’t change anything you’re doing based on reading this article.  Definitely don’t change anything you’re doing based on Facebook reactions to this article.  (For those of you who haven’t read the Facebook posts, they either say “OMG!  Zombie trial lawyer apocalypse!” or “What was the jury smoking?”)

What does this story teach us?  First of all, as I’ve said when teaching, you never want your patient care judged by twelve people who couldn’t figure out how to get out of jury duty.  (Think Casey Anthony or O.J. Simpson.)   Second, there was almost definitely some ego involved on behalf of the EMS system.  They could’ve settled and avoided a trial, but for some reason, they decided to go to trial even after the hospital and doctor(s) settled.  Too many EMS systems start to believe their PR and think that they are as great as their PR says.

Next, let’s talk about the applicability of the law in this case.  It’s a principle of law, regardless of the jurisdiction in the United States, that trial court decisions (a.k.a. the jury verdict) are not binding decisions on other courts.  Only appellate court decisions are binding on the lower courts under their jurisdiction.  In other words, a Florida trial court decision shouldn’t have any impact on a California EMT or a Massachusetts paramedic.  Only a United States Supreme Court decision truly represents the “law of the land” that applies to all of us.   Even if a Florida appellate court upheld this decision, it would be based on Florida tort law and only apply in Florida.  So, in other words, no big deal really.  Most states’ tort (a.k.a. “personal injury”) law is state-specific.

I haven’t seen any followup articles about any appeals of this case.  Appellate courts base their decisions on how the law should be applied and the decisions are made by judges rather than juries.  In most cases, judges are less likely than juries to be swayed by a sympathetic response to a tragedy.  In other words, the argument that someone is to blame (and has to pay) for a child having cerebral palsy is much more likely to be successful with the twelve people who couldn’t get out of jury duty than a panel of experienced judges who are law school graduates.

I would take home a couple of lessons from this case, though.  First, you never know what a jury will do.  Second, there’s a strong argument for carrying your own personal liability insurance.  In a trial where every defendant is pointing blame at the other, having insurance is a good idea.  Insurance provides a way to pay for a verdict in case you are found liable.  More importantly, liability insurance comes with a “duty to defend.” In brief, that means your insurance carrier will supply you with a lawyer to defend the lawsuit. And finally, there’s something to be said for covering your a– when you’re faced with a sticky situation.  I don’t know all the facts in this case, but if I was a medic and given such an unstable transfer, I’d have at least contacted a supervisor and tried to punt the issue up the food chain.

And on a final note, shame on the local newspaper and JEMS for such a headline.  The headline is inflammatory and completely misrepresents the legal principles involved.  And to the armchair lawyers who think they know the law based on some continuing education class or some war story from a grizzled older paramedic or nurse, law school applications are down.  You might have a chance of getting into law school these days.