Thanks for the response. It was interesting to see two polar opposite views on self determination (which, by the way, I do agree that patient's choice trumps all within reason) from lawyers in the span of a month.
I'll throw a curve ball to the board.
You have a patient who has been put under a psychiatric hold (i.e. Baker Act, 5150, Section 12, etc depending on location). The patient is requesting a different hospital than the one that the authority that is placing the hold. For the sake of argument, both facilities have inpatient psych facilities, both hospitals are within a reasonable distance, and the patient is being cooperative. How far, if at all, do you pursue changing destinations?
I don't question your legal knowledge but I do question the ability of a service to self-determine how it will transport patients. In my particular instance (and I am not the chief, just a humble college educated paramedic) there is a common sense factor that supercedes the legal precedents of patient autonomy. Let me explain:
I would never question the right of any human being to consent to medical treatment, make informed medical decisions, etc. That is unarguably a part of United States law and is not in question. What I think could be argued is the ability of the system to meet the patient's demands to be transported to a particular destination.
If an ALS Fire engine shows up on scene and deems the patient is not ALS but BLS, they do not have an obligation to transport the patient. They can call for a BLS transport unit (often a private ambulance company). In a very real sense they are declining to transport the patient. Now what if the patient insists to go with the Fire department transport rather than waiting the BLS transport unit? Are you somehow violating the patient's right of self determination by not allowing them to be transported by WHO they wished to be transported by?
In our service which is small and rural, admittedly we run 9,000 calls per year split between four trucks. This amounts to a very busy ALS service. We have determined in our protocols that the patient will go to the nearest appropriate facility for the simple reason that we do not have the manpower to send trucks out of service to far off and exotic destinations although we do make every effort to transport the patient to their destination of choice we will not accomodate an unreasonable request. It's a matter of logistics; when you take an ambulance out of service to make a needlessly long transport you are potentially hurting someone in the county who will now get a delayed response time because you have taken a unit out of service.
Is it right? No, we should have more ambulances available in a perfect world. Is it the model we run? Yes. Are we constantly tied up with lawsuits? I have never heard of a single one.