August 4, 2017 • By Dennis Beaver
Body boarding–also known as Boogie Boarding–is a popular, ocean water-sport similar to riding a surfboard. While injuries are low in comparison to football, fractures and catastrophic spinal cord injuries occur when waves smash riders into the sea floor. As San Diego reader, “Eric” explained:
“While our 15-year-old son ‘Terry’ was Boogie Boarding, a wave ‘broke’ near the shore and he went down, shoulder first and complained to lifeguards of shoulder pain. They called 911, paramedics showed up and transported him to a nearby ER.
“Neither the paramedics at the scene, ambulance crew or the ER called me or my wife to obtain our consent for transportation or treatment. We were both home and live 15 minutes from the beach. Final ER diagnosis was a collarbone fracture.
“The ambulance bill came to $2,177.31. I am an ER physician, my wife is an RN and we would have told the paramedics NOT to transport him to the ER for a shoulder injury.
“I could have taken him to a nearby urgent care. The ER bills are pending. They did CAT scans, x-rays, blood tests and I anticipate hospital/ER bills of approximately $10,000. Our Blue Cross insurance is for catastrophic coverage with very high deductibles. I called Blue Cross and they said the facility is out of network and insurance will not be of much help for the ambulance transport.
“What are consumers like us to do? I called the ambulance company to try to work something out and they are not budging. Their position is that they already did the transport and I owe them for their services. They said if I don’t pay it, they will send me to collection.
Is there a legal basis in California to dispute the charge for transporting a minor for a non-life threatening condition without parental permission? When children are brought into a hospital ER, in non-life threatening situations, every effort to contact a responsible adult is attempted before doing anything. Any guidance or suggestions is appreciated.”
Lack of consent is a defense to the bill
In speaking with Terry, we learned that a friend with him tried to get someone at the scene to call the parents, but was told to stay away. Terry “felt really pressured to say nothing, and no one asked me about contacting mom or dad. If they had, I would have agreed, of course.”
We ran these facts by Albuquerque, New Mexico, based attorney Winnie Maggiore. Herself a licensed paramedic for 35 years, she routinely conducts training seminars for EMT’s and hospital workers on these types of situations.
“Who can give consent to provide ambulance transportation and ER care in cases of this type is one of the most confounding and frustrating issues facing Emergency Medical Services providers. EMTS in the field are presented with difficult choices and are generally not thinking ‘What is this going to cost?’ It’s just not in the equation when evaluating consent,” she points out.
“Every situation is different. In this case, a 15 year old is very different from a 10 year old. Age, severity of the injury, mechanism of injury, ability to contact parent or guardian are all factors. Here, someone there at the scene–lifeguards or 911 responders – absolutely should have tried to contact Terry’s parents.” Maggiore strongly maintains.
What did it look like to those paramedics at the scene?
“Dennis, it’s important to understand that patient care is the first responsibility of those people on scene where it is possible to evaluate an injury as more serious than it turns out to be. While after the fact we know that it was a fractured clavicle, there was no way of knowing then if Terry had fractured a rib or punctured a lung.
“When we are out there, we don’t have x-rays or labs. Half the time there’s a lot that we just don’t know, and must go with the information that we have and readily obtain on scene. We don’t know what it looked like to those paramedics at the scene, where Terry could have been perceived as more severely injured than he was.”
“Don’t transport – I’ll be right there!”
What if you have a medic who feels the patient really does need to be transported now, and a parent who says, “No, I do not want to pay that kind of an ambulance bill? I’m on my way and will be there shortly.”
“This is very confounding situation for paramedics,” she replied, adding, “And I have been there. Especially when dealing with children, our greatest enemy is time. If we make a mistake, it should be on the side of caution,” she concluded.
Dennis Beaver practices law in Bakersfield and enjoys hearing from his readers. Contact Dennis Beaver.