Cocaine Binge

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i have been racking this situation through my head and needed some outside input. so, the other day a police officer presented to the er with a 30ish male. pd stated that he pulled over the pt for failure to stop at a stop sign. when he approached the vehicle the pt was shoving bags of cocaine in his mouth. since he had done such a good job and got it all the officer couldn't charge him with posession and brought him to the er as a voluntary pt. when he arrived his bp was about 210/110 and p 150. the pt was cooperating until pd left. he then decided that he wanted to sign out ama. i was not in charge of this pt but was helping with his care. the md in charge is historically non-agressive with pt treatment. instead of doing a 1013 (which we call it in ga, the form to make treatment mandatory), he allowed the pt to leave. his nurse and i did everything we could to convince him to stay for treatment. finally, the other nurse took off his bp cuff and said that she would see him later and allowed him to leave. of course, he came in 1 hour later as a code and didn't last long. i just don't understand why a 1013 wasn't imposed (if anything to cover the mds butt). i just needed to get it off my chest and see if you guys had any relateable experiences. i hope no hippaa violations :specs:

thanks :nurse:

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Specializes in ER.

Despite his bad decisions, if the patient was Awake and Alert, oriented and answering questions appropriately, the patient has every right to refuse treatment...Unfortunately stupidy doesn't qualify as failure to care for oneself...Where the MD butt covering comes in to play here, is the documentation that pt was explained risks of leaving and verbalized understanding despite continuous staff encouragement to stay...document...document...document...

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I agree w/ the OP w/ the question of why more was not done. In most states, if a pt is in immediate danger to self or others, or neglecting basic needs so it may become life threatening, psych can become involved and tx forced, at least on a short term basis.

In this case, pt was obviously in immediate danger to self - even holding for a psych consult would have kept him in the ER for tx when he "passed out" from the drug. (I use that term loosely.)

Yes, the pt was coherent and yes, refused tx... but an intentional overdose of any substance requires tx and if the pt refuses...

I think the dr followed the letter of the law, but not the spirit. jmho.

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Specializes in PeriOp, ICU, PICU, NICU.

Not a nurse, but seems to me that he made his own death bed. In this situation your are da*n if you do and da*n if you don't. It is such a terrible outcome but if he was wide awake and the dangers were explained to him, then obviously he don't care about his own life :stone

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The stickiest part here is, if he had that much cocaine on board he couldn't have truly been competent. He could have been held for a psych consult and tox screen, minimum.

That's what we do with our patients, even when they may seem reasonable at first. If there's a chance or any sign they're under the influence they get screened.

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We hold them for 72 hours with or without their permission. In Louisiana, we use what is called PEC ( Physician executed commitment or something like that)

if they come in overdose whether accidental or deliberate. This way, our butts are covered and the patients are taken care of whether they like it or not.

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who says there isn't justice is in this world

i have been racking this situation through my head and needed some outside input. so, the other day a police officer presented to the er with a 30ish male. pd stated that he pulled over the pt for failure to stop at a stop sign. when he approached the vehicle the pt was shoving bags of cocaine in his mouth. since he had done such a good job and got it all the officer couldn't charge him with posession and brought him to the er as a voluntary pt. when he arrived his bp was about 210/110 and p 150. the pt was cooperating until pd left. he then decided that he wanted to sign out ama. i was not in charge of this pt but was helping with his care. the md in charge is historically non-agressive with pt treatment. instead of doing a 1013 (which we call it in ga, the form to make treatment mandatory), he allowed the pt to leave. his nurse and i did everything we could to convince him to stay for treatment. finally, the other nurse took off his bp cuff and said that she would see him later and allowed him to leave. of course, he came in 1 hour later as a code and didn't last long. i just don't understand why a 1013 wasn't imposed (if anything to cover the mds butt). i just needed to get it off my chest and see if you guys had any relateable experiences. i hope no hippaa violations :specs:

thanks :nurse:

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who says there isn't justice is in this world

You did everything you could you could not have restrained him or anything, so you did your best. Must be hard in a&e

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Specializes in Emergency & Trauma/Adult ICU.

ER newbie here ... I can sense your frustration with the outcome on that one.:stone

I'm inclined to think that that situation depended heavily on the laws of your particular state regarding voluntary/involuntary commitments, the willingness of the police officer to follow through, and the MD's approach. Did the pt.'s vital signs remain stable (not normal, but stable) while he was in the ER? What did the blood/urine tox screens show? Could the police and/or the MD have initiated an involuntary commitment?

People seal their own fate outside the confines of the ER, and you can't "fix" that. I'm still learning to deal w/that too.

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Specializes in ER.
I agree w/ the OP w/ the question of why more was not done. In most states, if a pt is in immediate danger to self or others, or neglecting basic needs so it may become life threatening, psych can become involved and tx forced, at least on a short term basis.

In this case, pt was obviously in immediate danger to self - even holding for a psych consult would have kept him in the ER for tx when he "passed out" from the drug. (I use that term loosely.)

Yes, the pt was coherent and yes, refused tx... but an intentional overdose of any substance requires tx and if the pt refuses...

I think the dr followed the letter of the law, but not the spirit. jmho.

Intentional overdose, this was not..he did not take the drugs to intentionally harm himself..he did it so he wouldn't get caught or arrested by the police officers...He had no signs from what you describe of being psychiatrically incompetent...so a psych commitment would have never held up in this case...Pts refuse all the time...for instance a pt having an MI that needs to go to the cath lab that refuses to go despite needing to have a stent placed, potentially is in "immediate danger" however, the patient because they refuse to have the procedure done despite the risks of death by not having it done isn't necessarily incompetent just because they are refusing it...People that are at risk sign out AMA all the time...just because the person is under the influence of cocaine or a chemical substance doesn't mean they are incompetant to make decisions...I'm sure you may even meet people every day that you have no idea they are under the influence of some sort of drug, because they have done it so much they have learned to live a "normal" life and seem no different than you and me..I'm not saying they don't need some intervention, but you can't force people to do things because it is what you think is right, simply because it is self destructive behavior.

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Specializes in ER.

definately sounds like a darwin award finalist.

just because the person is under the influence of cocaine or a chemical substance doesn't mean they are incompetant to make decisions

i dont know about where you work, but around here, if the cops bring someone in after seeing them ingest the remains of a bag of cocaine and their BP is 210/110 with a HR of 150, they arent going anywhere. period and end of argument. the person would be under the influence of a controlled substance and be deemed incompetent to make decisions like leaving AMA.

i dont know the laws there, but around here, someone would get hung out to dry on that case.

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Specializes in ICU, CCU, Trauma, neuro, Geriatrics.

Self neglect is not illegal, just frowned on.

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