How do I avoid ambulance fees while unconscious?
November 23, 2005 7:31 PM   Subscribe

Somewhat hypothetically: How might one prevent undesired emergency medical treatment while unconscious?

I've known several people who ended up owing thousands of dollars for ambulance and ER treatment which took place while they were out of it, and to which they didn't explicity consent (often when the treatment wasn't really necessary); I suppose in such a situation there is some sort of assumption of consent. But I'm wondering if it's possible to pre-emptively refuse this sort of treatment — what would happen if I carried a card in my wallet stating that I refuse treatment unless otherwise specified in writing?

I'm interested in both the legal issues (would such a document be binding? would it release the bearer from liability if the EMTs ignored it? is there any case law?) and the practical issues — how would EMTs/hospital admissions react to this? Would they honor it? Is there a more effective way to prevent treatment? How do religious groups which object to certain kinds of medical treatment handle this?
posted by IshmaelGraves to Health & Fitness (26 answers total)
Magic-Marker, Big Letters, you choose the body part.
posted by blue_beetle at 7:43 PM on November 23, 2005

This probably isn't exactly right, but it seems like you're looking to wrap yourself in a sort of EULA. "By removing my clothes, you agree that I will not have to pay for any subsequent surgery or other medical treatment."

But seriously, is this worth the risk? Are you willing to die to avoid a few thousand bucks of debt?

Maybe I'm not understanding. Could you say more about the unnecessary and costly medical treatments that your acquaintences received?
posted by alms at 7:45 PM on November 23, 2005

The old tattoo across the chest or forearm comes to mind. Alternatively an ID bracelet. Paramedics are trained to look for those.

I remember reading somewhere that in the old days in NYC people used to tattoo "Take me to Mount Sinai" or similar to avoid being transported to one of the "bad" hospitals in New York. Not sure if this still happens.
posted by Dag Maggot at 7:46 PM on November 23, 2005

Could you say more about the unnecessary and costly medical treatments that your acquaintences received?

One friend hit a car riding his bike and got knocked out. I think he sprained his wrist — certainly something that should be treated, but something that didn't really need an ambulance or immediate ER attention. (Yes, I realize he could have had other internal injuries which might not have been apparent at the scene). I'd like to avoid a situation where I'm paying $800 for the equivalent of a $10 cab ride.
posted by IshmaelGraves at 7:54 PM on November 23, 2005

Dude, be careful what you wish for. As alms says, is this worth the risk? You can't know what kind of injuries you've sustained, but if you're passed out, they're probably not good. Do you really want the paramedics to stop trying to help you before they know what's wrong with you? Also, if you've been knocked out, isn't there always the risk that you've sustained a serious head injury?
posted by Dasein at 8:06 PM on November 23, 2005

So, in your example, doesn't the "I realize he could have had other internal injuries" part kinda... you know, outweigh the chance that you might pay?

There's no way to know whether your friend had spinal injuries, or a concussion, or something even more serious. The ambulance and hospital visit are the only reasonable things to do in cases where there's any kind of question. And, if you're unconscious - there's definitely a question.
posted by odinsdream at 8:10 PM on November 23, 2005

Has it occured to anyone else that this could simply be a question leading directly up to a suicide attempt?

While I hope that's not the case, it comes to mind as one of the only "reasonable" explanations to not be resuscitated. Besides fees; most people still value their life over a few bills.
posted by disillusioned at 8:12 PM on November 23, 2005

What are they supposed to do with you if they find you in the middle of the road unconscious and you have some kind of DNR equivalent? Leave you there? Put you in someone's garden? Call you a cab?

I am not a doctor, but if I were in a situation where I had to provide basic first aid to an unconscious person, and I found some tag or tattoo on them that said not to, I still would. I don't know about professionals though.
posted by crabintheocean at 8:18 PM on November 23, 2005

I have a Addison's Disease, which is an adrenal glad dysfunction (as in: doesn't work). I might just pass out - flat - and be perfectly OK after an hour. If someone called an ambulance and they took me to ER, it'd cost me and probably be unnecessary, but shit, why woudn't they? I'd be face-down and unresponsive, but ultimately OK, but how would they know? I consider it the price to pay for posibilities that could be worse.
posted by tristeza at 8:28 PM on November 23, 2005

I'm not asking whether this is a good idea. I'm quite competent to choose my own priorities and risk tolerance (and I have no plans to carry any such card in the forseeable future). I'm asking about the practical issues involved. Pretend this is the 'How do I dispose of a dead body?' thread.
posted by IshmaelGraves at 8:31 PM on November 23, 2005

So you want to be taken to the hospital if you have internal injuries but not if you're just unconscious but your spleen is okay and the paramedics or whoever finds you and cares for you have to make this diagnosis on the scene with enough certainty that they can feel comfortable just leaving you untreated. Yeah, that seems pretty impractical.

If you object to certain procedures in all circumstances then you can have a document or a bracelet or something to convey that, but if you just want save money by not getting reasonable care when you're unconscious you'll probably die or something.
posted by thirteenkiller at 8:34 PM on November 23, 2005

Well, the easy answer, then, is... you don't. You don't avoid the ambulance fees when unconscious, because someone is going to call an ambulance, and they're going to take you, even if you're wearing an "i hate ambulances" shirt.
posted by odinsdream at 8:34 PM on November 23, 2005

Oh right sorry, you weren't asking if it was a good idea. Forget what I said then.
posted by thirteenkiller at 8:34 PM on November 23, 2005

I think it's impossible.

Health care professionals are used to DNRs and stuff for people who are already "enmeshed" in the health care system, but what you're talking about is so far out of the mainstream that I'm sure whatever you came up with would be ignored.

Patients often enough insist on nutty stuff verbally that health care professionals routinely ignore, I can't see how writing something crazy down will make them pay any more attention to it.

They'd rather be sued for saving you than letting you die. It's what they do.
posted by popechunk at 8:46 PM on November 23, 2005

Just finished a geriatrics rotation, so I have a basic level of understanding of this stuff. For folks found down at home, I'm told paramedics (at least in California) will look in two or three common places for a DNR order: on the back of the front door, near the bed, and in the refridgerator. You can wear a DNR bracelet, but paramedics are not going to leaf through some lengthy document and find your particular predicament and then figure out if they're supposed to bring you in or not. It probably wouldn't hold up in court, anyway. (Interestingly, many times even if you have a DNR but your Durable Power of Attorney of Health Care wants to keep you alive, doctors' hands are tied to honor your wishes; a dead person can't sue, but a dead person's family sure can for wrongful death.) You may find this helpful.
posted by gramcracker at 9:03 PM on November 23, 2005

They'd rather be sued for saving you than letting you die.

Compared to either of these scenarios, your skipping your bill is a very survivable event for them.

I'd worry about wearing a "don't treat me" bracelet, myself.
posted by scarabic at 9:10 PM on November 23, 2005

I was an EMT in a former lifetime, and we didn't respect DNR orders... that was up to a physician. In some situations, when people refused treatment, we would wait until they'd bled out enough to lose consciousness, then act on implied consent. This is my experience only, but the casualnesss of the procedure made me think it was common.
posted by kamikazegopher at 9:30 PM on November 23, 2005

I've thought this over (long ago, as it happens) and I decided that there's nothing I could be shown or told that would prevent me from treating an unconscious adult person's emergency, at least to the point of stabilizing their vital functions. This is because all information is typically not available at the time of emergency. If in the final analysis, all data being gathered, failure to treat turns out to have been the wrong decision, it is irreversible.

Treatment can also be irreversible, but anyone who's really broken up about it can go buy a gun and shoot themselves in the head later, in a time and place where preservation of their lives is not my legal and ethical responsibility.

Consider this situation: the wishes of ALL family members are not considered; instead, a lying family member who happens to be present (and who, for example, stands to inherit a large amount of money) prevents the resuscitation of a patient. Can you say "wrongful death suit"? Doctors can go to jail for this kind of thing; beyond that, a great harm has been committed. During an emergency there is almost never leisure to discover whether this kind of thing might be happening.

I have been prevented from transfusing packed red cells into children of adult Jehovah's Witnesses. Some of these children died preventable deaths. This disturbs me greatly and I sometimes think of these beautiful young children, rattling out their last breaths, in the middle of the night. I feel their blood is on my hands.
posted by ikkyu2 at 9:49 PM on November 23, 2005

If you have a bike accident (or pretty much any kind of physical accident) that involves a blow to the head, you will get strapped to a backboard, loaded into an ambulance, and checked out by a doctor.

The majority people who fall off their bikes will end up with just a few cuts and bruises. But a significant minority will end up with (possibly non-obvious) spinal injuries. Until you have been checked out by a doctor, there's no way to know which category you are in. If you're in the latter category, the backboard treatment could easily save your live. That's why no medical professional will do anything other than put you on that backboard.

(This is based on my own Red Cross first response and search and rescue training, and talking to EMTs and other emergency medical professionals.)
posted by mbrubeck at 10:07 PM on November 23, 2005

ikkyu2 - It is hard to participate in any part of a chain of events that ends in a death and not feel responsible unless you've hung from the ceiling to fight the specter of it tooth and nail. I would simply remind you that this sense of personal responsibility is what would lead you to do the right thing if it were your child and your decision, in contrast to someone who offloads same to an imaginary being and willingly lets it happen - worse: helps it happen. You should feel good about the fact that you feel bad, in other words. It's an admirable relfex, though ultimately we can never consider ourselves entirely responsible in matters of life and death where we don't have ultimate control over them. Doctors wear angel slippers on occasion but they're not gods. I hope that these events come to trouble you less.
posted by scarabic at 10:21 PM on November 23, 2005

I feel their blood is on my hands.
Absolutely not. It is on the hands of their parents and their sick and debased religion. You do not bear one jot of responsibility for those deaths.
posted by PinkStainlessTail at 10:22 PM on November 23, 2005

The upside of you getting treated even though you don't want to be left with the bill is that inability to pay doesn't = no emergency treatment.

If things were set up so that you could say (non verbally, since you'd be unconscious) "hang-on, I don't think I can pay for this, I'll take my chances", what would be there to stop the rescuing party doing likewise?
posted by crabintheocean at 10:44 PM on November 23, 2005

Wouldn't it be easier and more foolproof to avoid bills by carriying fake identification or otherwise committing some kind of fraud?
posted by glibhamdreck at 10:47 PM on November 23, 2005

I was raised Jehovah's Witness and carried a No Blood card for as long as I can remember. It was signed by my dad and an elder from our Kingdom Hall and gave "alternatives" to blood (I believe some sort of saline solution was allowed) as well as some stuff about legal action being taken if blood was given. It kind of terrifies me now that all the time I was carrying that card (more than a decade) something could have happened and my parents would have let me die rather than let me have blood. I can't even imagine what it must be like for the doctors who have to deal with those situations.
posted by speranza at 3:39 AM on November 24, 2005

I was a nurse at a childrens hospital and we had many Jehovah Witness families who didn't want their children to have blood. We routinely got a court order which took the decision out of the parents hands. This was OK with the church teachings and got the parents "off the hook".
On the topic of the question, you should know that licensed health professionals have a DUTY to assist aid when needed. If I passed by a car accident and didn't offer assistance I could lose my license. ( It would have to be proven and is almost never followed up on, but them's the rules)
Besides, almost any hospital has programs for folks who can't pay. They have to offer some free's tied to the money they get from goverment sources. And NOT getting treatment when you need it is bound to cost a hell of a lot more down the road.
posted by what-i-found at 1:18 PM on November 24, 2005

Has it occured to anyone else that this could simply be a question leading directly up to a suicide attempt?

DNR orders are not, to my knowledge, respected in cases where the injury is suspected to be the result of a suicide attempt. In the psych ward where I work, everybody has a full code status absent very specific legal paperwork (which requires that they show they had the desire before they were put in a psych hospital).

Also, people actually looking to commit suicide don't care about stopping the paramedics from resuscitating them through legal means: the attempt itself will be such that it will prevent paramedics from resuscitating them.

As for the ambulance bills: any loss of consciousness associated with a head injury is a medical emergency, and you really need to go to the ER, immediately. Assuming that you wouldn't refuse essential medical treatment, then the question is silly. An EMT is not going to find you unconscious, notice that you seem to be fine except for a swollen wrist and maybe a bump on the head, and say, "Well, this card says we can only treat life-threatening conditions," and leave. Head injuries associated with loss of consciousness ARE potentially life-threatening.

The best way to keep them from giving you that $200 band-aid for a scrape that you don't really need is to just not carry around a health insurance card. If they think you're uninsured, they're probably not going to throw much unneccessary care at you.

Also, call your congressperson or senator and tell them you're in support of universal health care. Better yet, get lots of people to do it.
posted by dsword at 6:48 PM on November 24, 2005

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