The Dreaded Medical-Legal Lecture

Everyone who’s been through EMT or Paramedic classes vaguely remembers their medical-legal class.  You know, the one that the instructor stumbled though.  He or she probably just basically read the PowerPoint slides verbatim and maybe told some old wives’ tales.  (No offense to old wives.  They’re welcome to read my blog too.)  And the material in the textbook?  Equally vague and nebulous.  This is where you end up with falsehoods like “If I have an EMS sticker on my personal car, I have to stop at any car wreck.” My personal favorite myth is the one about being able to report child/elder abuse to the nurse or social worker in the emergency room. (By the way, that myth may cost you your certification in some states!)

In almost any other part of an EMS education program, we’d never tolerate a lecture to be taught by someone whose only education on the subject came from their initial EMS education.   Can you imagine cardiology taught by someone who’d only sat through the cardiology lecture and never had touched a cardiac patient or even had an ACLS card?  The program would likely be considered a joke at best.  And good luck getting the state or CoAEMSP to accept the program.  (More on accreditation in a future post, by the way.)

Yet, we continue to accept allowing the (dreaded) medical-legal lecture to be taught by virtually anyone with an EMS certification.  Whether for better or worse, we continue to cling to the falsity that EMS legal issues are the same from state-to-state.

A few suggestions to improve EMS legal education:

1) Actually invite attorneys to guest lecture.  Difficult/technical topics beyond an instructor’s skill set should be taught by experts.  (Conflict warning:  I actually give a fun medical legal guest lecture.)

2) Remove specific legal issues from the educational standards.  State laws on negligence, abuse reporting, and Good Samaritan issues vary from state to state.  Teaching the general rule is a disservice to students.  That also means not testing on these issues on the Registry.  Many states require a separate medical-legal exam on state regulations for physicians.  Maybe that should be considered for EMS as well.

3) EMS students should be regularly quizzed/challenged on their documentation.  Documentation practices should be taught as a means of avoiding legal liability rather than the emphasis that employers may have on billing.

4) And, as an absolute must, each EMS student needs to be taught, at the very least, how to find their state’s EMS statutes and regulations.  In the ideal world, state EMS regulators should provide an introduction to the legal issues and regulatory framework in their state.

As the old maxim goes, ignorance of the law is no defense.  Sadly, in EMS, we have so many instructors educating students who now have no defense.

Comments

  1. The separate legal exam for each province an EMS practitioner wants to be licensed in is something that we’ve actually got north of the border. (Also, we’re also mostly licensed here as opposed to certified.) It’s a mild nuisance at times, but I must say that paramedics who transfer their licenses into a province here often seem to have a better grasp on the provincial laws than practitioners who were initially trained in a province and stay there.

    • Out of curiosity, what does your license allow you to do that my certification doesn’t allow me to do? Can you practice without a medical director, set your own protocols, decide where or if you’ll transport without any guidelines?

      • Honestly, from the perspective of an individual provider there isn’t any appreciable difference at best, and at worst it just means they get you for *way* more money. (My annual licensing fees are more than $500 in one province.)

        There are differences from a broader perspective in that provinces where we’re licensed the legal apparatus treats us in a manner not that different from the way it would handle a physician or an RRT. That has both positive and negative implications, of course.

        It’s not really anything to do with licensing vs. certification, but in Canada we are seeing some jurisdictions moving away from strict protocol-driven care and towards “treatment guidelines,” or at least talking about it, with the implication being much more clinical freedom for the individual practitioner.

  2. Michael Ulrich says

    I’ve been a private entity critical care paramedic and an Instructor/Coordinator for close to 14 years now, and just passed my 19th year in the field. Taught many initial paramedic and EMT courses over the years, and attended quite a few med-legal CE classes as well. Next to cardiology and pathophysiology, med-legal is one of my favorite classes to teach. My breadth of knowledge on med-legal may not be as great as yours, but I recognized the vital importance of the topic when I was going through my own paramedic course. My own med-legal class (the one that I taught), rather than being a standard two-hour canned lecture like many I’ve seen over the years, usually lasted a full four hours, getting as in-depth as I could and trying to impress upon my students of it’s importance and to their well-being in the field. Even though I am not an official “Field Training Officer” at my current company as I was at my previous company, I still do my best to mentor my partners in the Art of EMS.

    I find it mildly amusing and quite ironic that my company’s latest quarterly training included that very example: “Documentation practices should be taught as a means of avoiding legal liability rather than the emphasis that employers may have on billing.” Operations explained the very need that “two signatures” were required on every report. “Yours and the patient’s”. No mention whatsoever of the most important signature: the RN/Doctor’s signature. The one that will keep the legal liability where it belongs: away from me.

    I find the ignorance overwhelming within my own company. All the way to the top. From the most experienced to those right out of school. I keep trying to chip away, leading by example and explaining why I do what I do to anyone that is willing to listen and learn. Unfortunately, I am not in a position anymore to be able to do any instructing at my current company as I did at my previous company. So I do what I can with what I have. Maybe they’ll “get it” when it receives notice of “that” lawsuit, and lose. And pay. Until then, they’re playing with fire. And then, if there is still a company to manage, there will be the “mandatory” training. Always reactionary, never prophylactically.

    Great article!

    • Btw, thanks Michael for that note about how a lacking RN signature is a liability issue. I know many medics who forgot to do that post-call & they treated it like purely a QA or billing issue & not thinking in terms of their own vulnerability.

  3. I appreciate articles like this. I often search for articles that help me write with an eye to the negligence charge & frankly I haven’t found much. After 5 years as a medic, the collected answers run along the lines of “write down everything,” “always be honest,” or “justify everything.” Well, thanks, but that’s not that helpful as I make specific decisions or decide on certain report habits knowing I am creating my stand against possible unjustified legal charges. Where is the provider’s coach who is looking out for the provider’s back end?

    I would love to read an article that helps me think like a prosecuting lawyer who finds weak spots & creates the arguments establishing duty, breach, causation & damages & then explains how to create a a stronger bulwark.

    I just want to create honest, tenable reports & not be washed away when someone else screws up & tries to blame me.