When treating patients under the influence of alcohol or drugs, emergency physicians must think about both the medical and legal implications of their actions. Issues of patient mental capacity are common, and overlooking this aspect of treatment is extremely risky.

“Often, we go in as physicians or advanced care practitioners thinking, ‘OK, I can just apply my medical knowledge on what medical issues are here,’ but [capacity] brings up a lot of other issues, and it’s something that we’ll face multiple times every shift for different reasons,” said Christopher B. Colwell, MD, FACEP, chief of emergency medicine at Denver Health.

These patients could be impaired by alcohol, drugs, head trauma, or psychological disorders, among other reasons, all of which Dr. Colwell will discuss in his presentation, “The Combative, Uncooperative, Arrested, and Threatening Trauma Patient: A Legal, Ethical, and Medical Minefield!”

Because of his hospital’s location, Dr. Colwell has years of experience with capacity encounters. He says it is common at his large, urban emergency department for evening-shift physicians to encounter 10 to 15 incapacitated patients a night, while weekend physicians could see up to 40.

For these patients, physicians must weigh the legal implications of treating patients despite their wishes, which could lead to a violation of their civil rights, versus agreeing to their demands for early discharge, which could lead to further injury or death.

Because physicians frequently do not have training in the complicated state and federal laws regarding patient capacity, increased awareness of capacity issues, as well as advice from lawyers, is necessary to avoid lawsuits. Dr. Colwell will present several examples of capacity-related lawsuits during his talk.

“You could argue that most of what we take care of in the emergency department is a result of bad decisions, and we have to acknowledge the freedom that we all have to make bad decisions as long as we have the capacity to understand the implications of that decision,” said Dr. Colwell.

Dr. Colwell
The Combative, Uncooperative, Arrested, and Threatening Trauma Patient: A Legal, Ethical, and Medical Minefield!
Monday, Oct. 27
4:30–5:30 p.m.
Skyline Ballroom, Room W375B