It’s 1:30 a.m. You and your paramedic partner respond to an incident that police determined isn’t a criminal matter but is a mental health issue. Your patient resists all EMS interventions. Medical control wants the patient transported. Suddenly, the patient runs away down a dark alley.
Forty-five minutes later, you respond to the scene of a sexual assault. Your patient from earlier is in custody, identified as the perpetrator by the victim. You had him. Did you and your partner, in the absence of an involuntary committal form, do everything that’s in your power to paint a picture to medical control that your patient was refusing treatment? Did you document on a taped phone line when you gave your report to the hospital? Where is the liability?
Legal authority?
According to the ESO EMS Index, from June 1, 2017–May 31, 2018, the most recent period of time for which data are available, EMS providers from at least 1,000 agencies responded to about 360,000 psychiatric or behavioral emergencies. One could assume that any of these responses required the use of an involuntary committal form.
The exact process for implementing an involuntary committal form varies from state to state. However, according to OpenCounseling.com, which is a resource for mental health facilities, therapists and affordable counseling, “All 50 states and the District of Columbia have laws in place that allow police and, in many cases, private citizens to initiate a process of civil commitment so that these individuals can be placed in a treatment facility, held and treated until they are no longer dangerous.”
The process of involuntarily committing a patient isn’t cut and dried. Surely, there are checks and balances, flow charts and policies that lead an EMS provider to the appropriate solution. That said, often, EMS is forced to assess a patient’s mental status based on very little or no behavioral health training. Herein lies the trick bag: Online medical control wants your patient transported, but the on-scene police presence is taking a “hands-off” approach.
The question that begs to be answered: Do EMS providers, acting in good faith and under guidance of a medical director, have legal authority to commit a person to the process of civil commitment without police or a mental health expert on scene?
“I know of no instances that EMS can commit somebody,” says Jerry Marzullo, who is a partner with the law firm of Puchalski Goodloe Marzullo and a deputy chief with the Berwyn, IL, Fire Department. “I do not believe that would be in our authority.”
Dual models
Who is responsible for bearing witness or initiating the involuntary committal form? In Illinois, for example, a sworn police officer or family member is asked to sign on the dotted line. Yet, nine times out of 10, police defer to EMS on scene for guidance.
Odds are, this “understanding” could go away. Illinois recently passed a bill that, among other things, restricts the use of force except in instances that protect human life.
“What I think we’re going to see is two-fold,” Marzullo tells Firehouse Magazine. “First, you are going to see a drawback of police services. No longer are officers on the street willing to go hands on as before. On the EMS side, our medics on the scene are going to have to have the ability to articulate to medical control what they are seeing and why those actions aren’t going to be taken.”
“My philosophy is business as usual,” says Kane County, IL, Sheriff Ron Hain in regard to the new law and the relationship between police and EMS. “The Sheriff’s office is already doing 90 percent of what’s listed on the justice reform bill. Our deputies will never stop responding to support our first responders.”
Still, rumblings among some police departments suggest otherwise where patient restraint might be required. If police stop assisting on psychiatric calls, scene safety isn’t ensured. In situations in which a patient must be physically restrained, EMS might not be trained properly or might be forced to make a risky decision.
A lack of clear and defined guidance opens the door to litigation, civil rights violations and legal red tape. Is there an alternate solution or supplementation to the involuntary committal form? Perhaps a nationwide dual EMS mental health model?
Hain hired two social workers to pair streetside with four sworn officers. Hain says the social workers are on call 24/7 and assist on calls that involve juveniles, domestic incidents and seniors, among others.
The EMS/mental health model is showing success in some states. If scene safety is the priority on EMS responses, this might reduce the danger to those on scene and cut the red tape and confusion about involuntary committals.
