I read this and was, quite frankly disturbed at the precedent that would be set if there are criminal charges filed against the Paramedic involved. Not that I don't disagree that they were way out of line and probably should not be in EMS. What are your thoughts on this?
There is some line where gross negligence crosses the line and could become "criminally negligent homicide." I don't think it's been worked out in any case involving EMS. There have been several fire officers prosecuted in the US when reported negligence in managing fire operations or training has resulted in death. Some were convicted and sent to jail.
I read recently that several UK fire officers were questioned (after being advised of their rights, much like the US Miranda warning) by police, about an incident where death of firefighters occurred.
The DC and Pittsburgh EMS cases in the current news are actions of omission. Does that make a difference in either criminal or civil law? I'd think that a failure to take an action that may or may not have prevented a death are held to a lesser standard than actions that cause a death, or in the WA case, where the conviction was due to lying to investigators in a case that would probably have never resulted in a conviction on the more serious charges, and in fact did not result in such a conviction.
Medic-initiated patient refusals are the 800 lb. gorilla in the EMS room, and are typically performed by only a handful of medics within each service. When questioned, almost everyone "knows" who leads the pack in obtaining refusals within each service. Some actually pride themselves on performing the fewest transports.
All EMS administrators should maintain statistics on patient refusals for each medic using comparable operational metrics (excluding MVA's and "no patient contact".) By doing so, the culprets quickly surface. I've seen a refusal rate as high as 38% of all patient contacts, compared to <5% for other medics with the same 911 assignments in the same district over a one-year period.
People call EMS with the expectation of being transported to a hospital, not to be evaluated and qualified for transport by an individual who sees himself as an itinerant medical practitioner, who happens to arrive in an ambulance, and who possesses neither the clinical knowledge, nor diagnostic and treatment capabilities that can be obtained at a hospital. Until this expectation changes, it's intuitive that these types of events will continue - if not escalate.
We had a case here, where a crew attended a patient who had arrested whilst on the phone to dispatchers, the line was still open, and negative comments about the patient and their living conditions were recorded on the 999 call. The dispatch manager passed the incident directly to the police before any internal disciplinary proceedings. This is very unusual and in inner circles here, it sounded like the service was looking for an excuse to get rid of the medics in question and used the incident as the reason to do so. The crew was charged with "neglecting duties of public office and a position of trust"
Negligent homicide is a criminal charge brought against people who, through criminal negligence, allow others to die. This definition at least suggests that an act of omission would be sufficient. However, each state's criminal code is free to include its own definition, and then the courts "refine" that, so state-by-state legal research is required to get a specific answer for a specific case.
Negligent Homicide is a lesser included offense to first and second degree murder, in the sense that someone guilty of this offense can expect a more lenient sentence, often with imprisonment time comparable to manslaughter. U.S. states all define negligent homicide by statute. In some, the offense includes the killing of another while driving under the influence of drugs or alcohol. Examples of such cases include the crash of Aeroperu Flight 603 near Lima, Peru. The engineer who put the tape while cleaning the ill-fated Boeing 757 was convicted of negligent homicide after he forgot to take the masking tape (which was normally unused while cleaning airplanes) off.
"Criminal negligence" is one of the three general classes of mens rea (Latin for "guilty mind") element required to constitute a conventional as opposed to strict liability offense. It is defined as careless, inattentive, neglectful, willfully blind, or in the case of gross negligence what would have been reckless in any other defendant.
There seems to be a continuum that on one end is "intentional" and at the othe end "accidental", with a transition from criminal to civil happening somewhere in the vicinity of "gross negligence" and up.
Could be very interesting....