Fox in the Henhouse: When the Accused is a Caregiver

EMS Reruns is an advice column designed to address dilemmas you may have experienced in EMS that you did not know how to handle. But it offers you a luxury you don’t have on scene: plenty of time to think. If you think of an example like the one that follows, send it to us. If we choose to publish your dilemma, we’ll pay you $50. We don’t know everything, but we do know a lot of smart people. If we need to, we’ll contact just the right experts and share their advice with you. Send ideas c/o emseditor@aol.com.

Mary Keegan is a 70-year-old brittle diabetic who has trouble controlling her insulin. You find yourself kneeling in front of her, seated alone on the couch in her little trailer. She’s unresponsive to all but painful stimuli. You gently move her to the floor and insert an NPA and an IV. Her blood sugar reads 11. That’s no surprise, and you administer the Os and Ds. As usual, it takes her a few minutes to get with the program.

It’s obvious that Mary doesn’t have a good system for managing her meds. Her neighbor, who called 9-1-1, tries to keep an eye on her, but the neighbor is not always around. You find a Naprosyn bottle containing three different kinds of pills, and Mary can’t tell you what they are. From your past encounters with her, you know she doesn’t seem to have any family contacts. She doesn’t want to go to the hospital today, but you prevail on her to come with you—mostly to see if you can get her some kind of support.

On the way to the hospital, she thanks you for your kindness. Then she looks deep into your eyes and says there’s a paramedic in your service who took more than $200 from her purse last time she went to the hospital. She says the paramedic warned her not to say anything or she would be “real sorry.” Then she gives you a clear description of the one person it could be.

Brandon is a paramedic on another shift. He has kind of a funny personality, like maybe he’s from a big city or something. He comes across like he’s always too busy to listen to people. You’ve never personally worked with him, but based on your interactions at shift changes, you don’t want to. And you’re not the only one who feels that way. The first responders don’t like him either, although they never complain about his medicine.

Q. This is serious stuff. What can you do to protect this lady?

A. Whoa, be careful. It’s serious, all right, but if you and your agency don’t handle this properly, you can all do a lot of damage. On one hand, you can destroy the life of someone who spends his life helping people, based on the testimony of someone who only a few minutes prior to her testimony was unresponsive. A rough affect is not a caregiver’s best tool, but it certainly is not evidence of a crime. On the other hand, you might fail to protect one of the most vulnerable people in your service area from a criminal in a position of great trust.

Q. But Mary seemed so sure, and her description of Brandon was perfect. She’s the defenseless one. Shouldn’t you give her the benefit of the doubt?

A. Imagine she had been describing you to another crew—maybe even to Brandon. Maybe you’re not his favorite person either. Or maybe he has no idea that he comes across the way people perceive him. You’ve never even worked with the guy. That means you’re relying on other people to decide that you don’t like him. And like him or not, you would be depending on him for fairness on your behalf. How would you expect him to proceed? Remember, as important as it is for you to protect Mary, she can’t keep track of her medicines. There’s at least a chance she’s mistaken about that money, too.

Q. So, what can you do that’s fair for Brandon and still good for this patient?

A. That should be spelled out in your agency’s policies and procedures manual. If it is, following the protocol to the letter is the best thing you can do to support an objective investigation, regardless of Brandon’s innocence or guilt. Chances are, that will involve an immediate call to a supervisor and the completion of an incident report. Remember, how you proceed may justify or jeopardize your whole agency. This lady could still trigger an investigation by the hospital as well—in which case, inaction on your part could eventually make you and a lot of other good people look pretty bad.

Q. What about notifying Brandon himself that something’s up? After all, he is a colleague.

A. Sounds reasonable, doesn’t it? That’s what you would expect under the same circumstances. But in this case, the patient is also alleging a verbal threat. If her account is accurate, that might be the worst thing you could do.

Finally, it may not seem so, but chances are your superiors handle these kinds of situations all the time. You may not hear about most of them because their discretion is often essential. In this particular case, so is yours. You can do incredible damage to innocent people by talking too much about unresolved accusations.

This is a true story, and the dispatch records reflected that the paramedic who matched this lady’s description had never encountered her as a patient.