Hi! I'm a RN in a rural community in Colorado. One of the dotors offices here takes advantage of "Rule 800" of the Board of Medical Examiners specifications on deligation of medical acts in a private physicians office. Has anyone heard of this? Basicly it says that a physician can have an EMT-B with only 6 weeks of "medical training" (or anyone else who dose'nt have there own licenses) do anything the physician tells him to. I pulled the rule out myself and read it. It says that the physician can delegate any task they deem reasonable. It says that the physican should ensure the EMTs competance but there is no way provided to monitor these providers.
The reason I am bringing this up is that I have seen EMT - B in this office give 10 times the dose of MS that was ordered because she didn't know the difference between mg and ml. I have seen another basic give an overdose of the same drug becasue the doctor handed her a full one cc syringe of MS 15mg/1 cc with the order to give 2 mg and so the EMT pushed the syringe down to the number 2. That same EMT tried to hang a "valium drip" but I caught that one before she did it.
This doctor has his EMT-Bs read his x-rays over the phone to him and then tells them what to do to the patient. Now I am pretty sure they don't teach EMT-Bs how to read x-rays in a 6 week EMT class. They also do sutures when he is not there and who knows what else. The kicker is that this doctor has been turned in to the board and they didn't do anything but give him a copy of Rule 800.
I have never thought of myself as an activist but I am very concerned about this practice and this rule. I contacted the Board of Medical Examiners and they said that there has to be enough evidence to stand up in court or they can't do anything which I guess makes sense. Unfortunatly, it is easy to control your documentation when you have non-professionals working in your office. This particular doctor for example documented that the correct doses of medications were given and that he in fact gave them. I was there. I know it isn't true but I can't prove it.
I'm writting this is to see if anyone else has an issue with this "rule 800". I am sure this doctors office is not the only one that abuses this power. It seems to me that this rule should be far more limiting and specific as to the acts EMTs or other non-professional can do. Pluse shouldn't there be a method to monitor the situation to protect the public from unethical physicians like the one I told you about? He specificly doesn't allow his Employees to identify themselves as EMT's unless the patient specificly asks.
I'm attaching this URL - I hope it works so if your interested your can read it yourself. If it does'nt work let me know and I'll tell you how to find it.
Ya I guess each state is different with its rules about EMt's and the way they refer to them. I am an EMT as well except I did things backwards. I've been a nurse for 17 years and started working on the ambulance 2 years ago. I went through the EMT class just last year. I was humbled!! A lot of the information I already knew but I was supprised at how much I didn't know or better yet didn't know how to apply it in the immediate emergency, pre-hospital setting. I was a great class. I sit in on some of the "I" class for the review. I would like to take that as well but I have too much going on right now.
As for the EMS dirctor - He knows what is going on. He has turned people in too but the BME doesn't do anything. He has tried talking to the EMT's and they say that the good doctor says what they do is legal - and according to this rule 800- most of what they do its. It seems someone has to really be hurt or be killed before the "good-'ole-boys" (meaning physicians) stop protecting each other. Personally I think Doctors have far to much power. Maybe the answer is public education.
I am in Tennessee, and an office I know of has an EMT and trained her(if you want to call it training), they have one LPN , and the other girl is just someone they trained without any medical background. I was very afraid when I was there, they would come and get me to give childrens injections and got upset when I wouldn't give the injection they had drawn up. I love nursing and it scares me to think that the law will allow anyone to give medictions, preform procedures, and inform patients about what they need to do as far as health care. It falls back on the MD, if they are good then usually they will adequately train their staff regardless of licensure.
As for EMT's working in a physician's office, there is nothing illegal about it; the physician assumes the responsibility for their acts, and the onus is on the md if there is a grave error. Insofar as med errors, I am always amazed at the number of RN's in the ED who still cannot calculate drips, mix drips, or even know the difference between Humulin N and Regular Insulin...errors are made all the time, but it is easier to place blame on the lowest ranking in the medical hierchy. As far as training goes, EMT's must do 1 semester at a local college; to become a Paramedic, it is an additional 3 semesters...essentially, 2 years of training culminating with a AS degree in Emergency Medical Services. Experienced Paramedics can and do work in what I call "Doc in a Box", as First Assist in surgical/dental procedures in offices, monitoring vital signs, and intervening prn should there be a problem such as the patient going into anaphalaxis, or worse, coding. The bottom line is, there are outstanding practitioners of pre-hospital medicine, as there are RN's...and unfortunately, there will always be the slugs, who somehow gained the license/certification, title, but do nothing to improve the image of the profession.
Is there documentation of the wasting/administration of controlled substances? I know you wrote that the MD charted the correct amount of medication was adminstered, but is there a separate narcotic sheet that might have the discrepancies listed? That documentation and your testimony regarding witnessing these events might be enough to at least start an investigation...unfortunately, otherwise it may require patient injury or fatality before the BOM steps in.
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Ya I guess each state is different with its rules about EMt's and the way they refer to them. I am an EMT as well except I did things backwards. I've been a nurse for 17 years and started working on the ambulance 2 years ago. I went through the EMT class just last year. I was humbled!! A lot of the information I already knew but I was supprised at how much I didn't know or better yet didn't know how to apply it in the immediate emergency, pre-hospital setting. I was a great class. I sit in on some of the "I" class for the review. I would like to take that as well but I have too much going on right now.
As for the EMS dirctor - He knows what is going on. He has turned people in too but the BME doesn't do anything. He has tried talking to the EMT's and they say that the good doctor says what they do is legal - and according to this rule 800- most of what they do its. It seems someone has to really be hurt or be killed before the "good-'ole-boys" (meaning physicians) stop protecting each other. Personally I think Doctors have far to much power. Maybe the answer is public education.