Med Control, Consent, and Implied Consent

Today’s burning question comes from a friend who is a nurse and is studying for her paramedic license. She took issue with an exam question, which is paraphrased here as follows:

You are called to the residence of a 77 year old woman, whose private physician believes she has had a stroke and needs to be transported to the ER. When you arrive, she is looking around the house for her cat and will not engage in conversation about transport. Her family insists that she be transported. Who has the authority to order transport without her consent?

  • a.      Her son
  • b.      Her physician
  • c.      Medical Control
  • d.      Her sister in law

My friend chose answer (a) her son, and was marked wrong. The “correct” answer was (c) Medical Control. The instructor said that since EMS is all delegated practice, Medical Control is “God” and can order anything.

 

Answer: I believe (c) is the least incorrect answer… which I suppose then makes it the most correct answer – but having said that I am not convinced that (c) is correct. In fact if the question was a true or false question to the effect:  Medical Control can order the treatment and transport of a patient without their consent, or even Medical Control’s permission is required to treat and transport the patient in this scenario based on the circumstances described, the correct answer would probably be false (I’ll leave myself some wiggle room in case there is some strange law in some state that does in fact elevate Medical Control to a God-like status).

Neither the son, nor the doctor of the patient, nor Medical Control can order the treatment or transport of a competent adult patient. Only the patient can consent.

Upon assessing the patient, if the patient is found to lack the capacity to consent, and an EMS provider concludes the patient needs treatment and transportation – then the provider has implied consent to treat and transport her. The EMS provider does not need Medical Control to have that authority.

Of course if there is an advanced directive such a living will or durable power of attorney for health care decisions that delegates medical decision-making to a certain family member, that would also come into play.

In summary, Medical Control has no more right to authorize you to transport than you already have via implied consent. Admittedly medical control may help you determine whether the patient lacks capacity and/or needs medical attention – so may the son (“she is not acting like she normally does”) and so may her doctor (“I think she has had a stroke”). But at the end of the day, if you determine the patient lacks capacity and needs transport – you have implied consent… all by your lonesome…. without med control.

Others with thoughts …. Please chime in!!!!!!!!!!!!!!!!!!!!!!!!

About Curt Varone

Curt Varone has over 40 years of fire service experience and 30 as a practicing attorney licensed in both Rhode Island and Maine. His background includes 29 years as a career firefighter in Providence (retiring as a Deputy Assistant Chief), as well as volunteer and paid on call experience. He is the author of two books: Legal Considerations for Fire and Emergency Services, (2006, 2nd ed. 2011, 3rd ed. 2014) and Fire Officer's Legal Handbook (2007), and is a contributing editor for Firehouse Magazine writing the Fire Law column.
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