Chapter 59. Legal issues
Record-keeping
A Patient Report Form (PRF) should be completed for each patient treated and a copy handed over to the receiving hospital. Written records are the only defence when faced with complaints and legal action.
• Good notes – good defence
• Poor notes – poor defence
• No notes – no defence.
The names of all professionals who have been involved in the care of a patient should be clearly recorded in full. If a patient (or his relatives or friends) is aggressive or uncooperative, this should also be recorded. The form must be viewed as a legal document and stored safely for future recall.
If it was not written down, it was not done
Consent
Patient consent is required before providing any form of treatment
Consent may take one of three forms according to the circumstances of the incident:
1. Express consent is where a patient grants specific permission for a treatment to be carried out
2. Implied consent is where patients, by their actions, present themselves for treatment but without specific verbal or written authorisation
3. Presumed consent can be used, e.g. in the unconscious patient, where the patient is not able to give consent but it could be presumed that if they were able to give consent, they would do so in the given circumstances.
Informed consent implies that the patient has been informed of the foreseeable benefits and possible side-effects of the treatment concerned and understands their right to refuse treatment and the consequences of doing so. Failure to obtain consent is, in legal terms, an assault and such an action brings with it the risk of prosecution.
Capacity
In order to provide consent a patient must have capacity. This means that a patient must be able to make their own decisions by:
• Understanding the information and choices presented
• Weighing up the information to determine what the decision will mean for them
• Then communicating that decision.
Failures of any of these areas mean that the patient may lack capacity. Difficult situations arise with patients who refuse treatment but lack capacity. Clearly, the hypoglycaemic diabetic who is violently resisting treatment needs to be treated anyway.
Refusal of treatment
• Every patient with capacity has the right to refuse treatment
• In this situation, the patient should ideally sign the medical documentation to show that they have had the possible consequences of their actions explained to them
• If they refuse to sign, then the documentation should be signed by another witness, such as another ambulance crew member
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