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How to refuse Ambulance trips to ER?

I've had several seizures over the past few years where I regain consciousness soon enough that a paramedic hasn't yet arrived but before I am not fully coherent until after I reach the hospital. My insurance has a high deductable for going to the emergency room, so I really don't want to go.

Each time that I've had a seizure, I have tried to refuse to let the paramedics take me to the hospital. After having a seizure, I just want to stay where I am and rest until I can get up and go on with lift. But they insist on doing it as a precaution. The paramedics standard procedure is to ask me a battery of questions over and over again. At first, I can hear them and understand them and can picture who the president is but I can't speak. Eventually I get to a point where I can barely speak but can remember his name (so the best that I can answer is something like "big ears, black") and can't remember whether they've asked me this question already. Eventually I am coherent enough (by the time that we reach the hospital) that I can say "I don't want to go, I don't need to go" but they take me in anyway

How do I stop them? At what point are they no longer allowed to insist on taking me?

Comments

Re: How to refuse Ambulance trips to ER?

I cannot include URL's here but I found this paper on pateint refusals. It can be found at: www(dot)emsmdc(dot)com(slash)pdf(slash)patient(underscore)refusals(underscore)cumulative1(dot)pdf

What it boils down to is that a competent adult with the capacity to understandcan legally refuse. Competency is decided by the court and an incompetent person is usually assigned a guardian. Capacity refers to:  "At the outset, a patient must be eighteen years of age or older, and be alert, oriented to person, place and
time, and have a glascow coma scale score of fifteen in order to refuse care. The mere fact that a patient
appears intoxicated, has received a head injury, or suffers from a mentally debilitating disease such as
dementia or Alzheimer's does not mean that a patient who is A& Ox3 and has a GCS of 15 lacks the
capacity to refuse care."

The tricky thing is that paramedics risk lawsuits if someone refuses and later changes their mind.

You may want to consider some sort of legal pre-reufsal. By that I mean get documentation from a Dr. about your E and how you respond to seizures (like just needing to rest, that whereas you may not recall the president at the moment it is just an effect of coming out)  if your Dr is on board. Also perhaps speak to an attourney if you can (the Dr's note would help) to draft some kind of release "I am aware that I have E, I understand the risks of not being transported to an ER after a seizure, I may not be able to answer your questions, however as a competent adult I am refusing medical advocacy for now and in the future when I have had a seizure with no injury." You colud also try to write this document yourself but it will not hold as much water.

I don't know the legalities of all of this it may not even be an option, but perhaps something to look into. 

When the paramedics come and you cannot answer their questions about the president, it may lead them to think you are incompetent at the moment to refuse care. Maybe documentation would help clarify that. I don't really know for sure.

Re: How to refuse Ambulance trips to ER?

When I am post-ictal and have trouble answering questions the paramedics are checking vital signs and in my area they will repeat things 3 times. I have signed the paper work several times declining to go.

I had 2 seizures together .  It was a benefit for me.  I have medication to stop seizures and my family gives it to me and the EMTs will let them give it to me and that has stopped me from going to the ER's.

One time I had a questionable medication reaction/TIA?  The next thing I woke up in the ER.  I was going into Status.

I have been pulled out of pools, out of streets and dangerous locations and went on there wishes.  I was groggy and could not speak, but the hospital staff knew me and for my safety checked me and called my husband to say I was all right and that I could be picked up.  After they did labs and a CT.

It seems like a hassle, but at times when you cannot quiet get out of it.  It is better to be safe then sorry.  I have had status epilepticus attacks and didn't know it.

Each individual is different my medic alert bracelet is a life saver for me. 

Re: How to refuse Ambulance trips to ER?

My daughter has uncontrolled epilepsy and the only time we'll take her to the hospital is when she is in status (unrelenting seizures).  She has seizures several times a week so we just make sure that she's in a safe place when she has her seizures.  There is no post care that is needed other than some rest.

Since it appears that you know what your needs are  after you have a seizure (having to lay down, rest, etc), why not inform the person that has been calling 911 that you don't need this emergency service unless the seizure is prolonged? 

You might also talk to your doctor about having a routine established when you do have a seizure and/or to have instruction ready if a call to 911 is in order.

Karen

Re: How to refuse Ambulance trips to ER?

Hi GF70,

Here in California, there is the notorious "being 5150-ed" for anything (supposedly limited to dangerous non-physical Mental States, but, in practice, not so limited at all).   The official form notes that "... epilepsy....[does] not, by [itself], constitute a mental disorder", but in Catch-22 land with epilepsy, authorities will hide behind ignorance to obtain total immunity from legal justice.  The quick view form is at:

https://docs.google.com/viewer?a=v&q=cache:PwZloVa-BYAJ:www.dmh.ca.gov/News/Publications/Forms/docs/MH302.pdf+california+5150+form+epilepsy&hl=en&gl=us&pid=bl&srcid=ADGEESi2Xg4MH0-S06mKzKUVhZ4IWbtzeH6Hjx8gMJAW3b6Gkr6o8AzlQHoSRmWm_bnJVQy3WNnuU4fZ-boDe4_-EDnyJUcCI-oD4ZwjSKVCuxPfPMdK8ZA79hwwch1OwhJSWW4KBy3p&sig=AHIEtbQnivcmMSQ-bsMuq-cY-g3AOA0zrw

Wikipedia notes its application to individuals who appear not "sober":  

http://en.wikipedia.org/wiki/5150_(Involuntary_psychiatric_hold)

I've had many trips to ERs due to epileptic seizures.  With ones in public, in many situations, people will "look the other way" for simple avoidance, while some situations will result in overly protective/assertive individuals (a few seemingly to the proxy of Munchausen levels)  making mountains out of the situation.  Having epilepsy ID and/or instructions is basically irrelevant to the results.

For the initial parts of the event that gave me the moniker "3 Hours To Live", when I demanded to be taken to an ER, emergency response medics tried to convince me that I was just having a harmless seizure result that I should just wait out at home, without wasting any more emergency ambulance/ER resources (when I finally arrived at ER and got a CTscan, ER had me rushed to a distant neurosurgeon for emergency surgery).  

My catergorically needy financial situation might be a large factor, as when the situation gives no clues about poor finances, full emergency response is much more likely.  At any ER without a history, soon discovered Medicaid status inspires prejudice to assume drugs are involved, with otherwise forced tests for illegal drugs, before any claims of epilepsy will be entertained.

In a previous post, I noted:  My local doctor and my more distant Emergency Room had started referring me to each other. I think it was more because they both had already met their respective Medicaid quotas, and neither wanted me as a low paying, high cost, patient. My neurosurgeon had previously told me to seek ER emergency treatment with any possibility of an impending secondarily generalized tonic-clonic (TC), but the ER reported that my typical warning seizures in a cluster generally before a TC, were simply migraines, and issued instructions directing me to my local doctor.

Weeks later,when I met my scheduled appointment with my local doctor, I was having a painless migraine with "prodromal aura of migraine" where fragrances would aggravate my migraine (and typically, within hours, result in great headache pain, but definitely not leading to, other than mere chance of possible coincidence, epileptic seizures). I've had epilepsy for about 58 years now, and both painless and painful migraines for about 30 years, and my aura of migraine is sufficiently different from my aura of epilepsy, that I can quickly recognize the differences, with only mere random coincidences that an epileptic seizure strikes during an otherwise non-epileptic migraine.

Well, I told my local doctor that I was having the initial stages of a migraine in front of her (being aggravated from the perfume in the room), and she said no, she judged it that I was having dangerous epileptic seizures, and she called an ambulance, then told me about her summoning the ambulance. It is a long and expensive trip back from the ER, and I didn't want the inconvenience, risks, and expense, while my walk back home from the local doctor was less than a mile, so I refused the ambulance service (and I just wanted to distance myself from the perfume smell). Then the doctor refused to let me leave her clinic room until I signed a form relieving her from all legal responsibility for her actions, and she told me that she was refusing me as a future patient because of my failure to follow her ER recommendations. (Her office later filed an Adult Protective Services notice claiming that I was a danger to my own health, while, with the denial of future services, I filed an ADA discrimination complaint against the doctor and medical clinic).

Still, even without the concerns of profitable payments for medical providers, doctors are not able to distinguish between migraine phenomena and much of epilepsy phenomena. Most doctors just follow standardized "decision trees" (which are at times promoted as nearly being a 100% accurate and valid, but in truth, just a bit better than deciding by flipping a coin). The decison trees usually match with instances of my migraines versus instances of my seizures, but Medicaid consequences really bend the trees more than my actual impairments do.

Tadzio

Re: How to refuse Ambulance trips to ER?

i have only had the chance to refuse help one time,  i was with my mother and we were on our way out of town i had a seizure, my mom paniced and called 911, but it took them long enough to get to me that i was coherent by the time they arrived i remember joking with one of the EMTs that i hadn't paid off my last bill yet and i didn't want to make it any bigger than it was.  But here lately i've been having my seizures at work, that's a different story the ladies in HR told me that since i blackout 911 has to be called every single time. i do not agree with that at all my husband works with me and he knows how to take care of me, and im stuck with the bill when they call.

Re: How to refuse Ambulance trips to ER?

Who is calling 911? If this keeps happening at the same place (work, for example), then you want to explain the situation to them, that an ambulance is more harm than help.

Get a medical ID bracelet. Mine lists my name, "epilepsy", "lamictal", and my husband's name and phone number. I haven't put the theory to the test, but would hope that whoever is vigilant enough to call 911 will notice I have a bracelet and call that number first.

Paramedics are in the middle here, unfortunately...they are accepting liability by not taking you to the hospital, especially if you are not fully recovered. You could try printing the following on a sheet of paper, have it handy at all times and pull it out for those moments:

 My name is ______________
I have epilepsy, and experience _______________ seizures (type - complex partial, grand mal, absence, however you describe them to people)
I am currently recovering from a seizure, and DO NOT require a trip to the emergency room. I will be back to normal within _____ minutes (15? 30?)
Feel free to call my ____________ (husband, daughter, friend, neighbor) at ________________ and they can verify that ER treatment is unnecessary.

An experienced paramedic should understand. Giving a time frame and a key contact might just be the key, that way they won't feel like they're just leaving you alone.

Good luck! It is so frustrating when people are geniuinely trying to help.
If only the general public had a better understanding of seizures...