Effiks, Morails ‘N Snow

Ok, no blogpost tomorrow so I thought I'd set up a moral/ethical/legal question to keep you interested. This was suggested to me by one of my colleagues (who will get a dedication in my next book – if I remember).

You are called to a young woman, apparently collapsed. As you get there you very quickly realise that she is faking the collapse. Her friends want you to 'save her!'

So far, so normal.

As you deal with the patient, checking for medic-alert bracelets and the like you take out of her pocket a small amount of cocaine.

The patient 'wakes up' and you are now holding a 'Class A restricted drug'.

Do you give it back to the patient, aware that this is bad for her health, and illegal?

Do you 'confiscate' it and dispose of it somewhere, knowing that this counts as stealing from her?

Do you call the police and have them deal with it, even though there is the issue of patient confidentiality and breaches the trust people have with the ambulance service?

If you take it to the police for disposal, what do you tell them? (Yes, I know they are unlikely to care much, but you might get a crusader)?

Or do you do something that I haven't thought of?

It's this sort of real world stuff that sometimes catches us out.


About my foot. I went to see my GP. Oh dear. Not a smile as I went in to the office (and I was the second patient of the shift for him), general disinterest from him. He wasn't going to examine my foot until I took off my shoe. He then examined my foot through my heavy sock. He's prescribed me some anti-inflammatories and rest. Then to return in a week if it's not better.

I've also got a sick note for this week, but I think that'll be the limit of the time I can stay off work – I'll just have to hope it's better by then.

58 thoughts on “Effiks, Morails ‘N Snow”

  1. Without comment on the moral issues, for information the legal position in England and Wales is as follows. Obviously if you are holding a wrap of cocaine then you are in possession of a class A controlled drug. However, section 5(4) of the Misuse of Drugs Act 1971 provides that you are not committing the offence of drugs possession because, knowing or suspecting the article to be a controlled drug, you took possession of it for the purpose of preventing another from committing or continuing to commit an offence in connection with that drug (i.e. possession). It is important to note that you only have this defence if you 'as soon as reasonably possible' take 'all such steps as are reasonably open' to you to either destroy the drug or hand it over to the police.The legal position is therefore quite clear. If you gave the drug back to the person you would be guilty of supplying it to them (since you are giving the person a controlled drug in order to enable them to use it for there own purposes), although a prosecution would be unlikely. Your only legal course of action is therefore to either destroy the drugs immediately (preferably in front of the patient) or to take them to the police. The issue of theft does not come up, since there was no dishonesty in your appropriation of the item in question (theft is not the same as taking without consent).

    This only covers the legal issues, not any practical or moral issues. Obviously if the patient became violent then you would want to leave as soon as possible and deal with the drugs later. When you take it to the police you would be perfectly OK to explain the situation in full and say that you found the drugs on a patient but your confidentiality rules prevent you from giving the police the details.

  2. Or do you keep it, and sell it back to her and/or her friends next time you inevitably get called back there to an O/D or similar to supplement the meagre income aka an ambulance service salary?

  3. I would have said it might depend on her reaction to it being found, but as faked 'collapse' would suggest she is obviously the manipulative and unreasonable type I'd just call -or say I'd call- the police. Then watch them scarper with the very faint hope it might teach them a lesson. If they leave you with the drugs them drop them off with the police to dispose of.Of course, the above idea might go out the window if her friends look dangerous and possibly armed…

  4. I'd take it off of her, and if I knew a cop who could deal with it, I'd hand it over to them for disposal, other wise chuck it yourself. I'd be worried less about the “stealing” from her than have someone else potentially recover it once it was disposed.Getting the cops involved with her or her friends (either calling them straight away or just bringing it to a potential crusader) jeopardizes future care. Patients would be less likely to call for emergency services and might be more hostile to paramedics if they appear to be too aligned with the police.

  5. Down the nearest drain/loo, in sight of the patient if possible so as to ward off any accusation of stealing.Enough of an annoyance to deter them from wasting your time in future, but also reassurance that they can call 999 if they need to without getting nicked.

  6. While I haven't dabbled in charlie myself, I know a lot of people who have and still do, when suspecting an 'illegal substance abuse' with a conscious casualty, I always do the same thing – sit down next and give them the old “Go on, you've had a little (insert suspected drug here), haven't you? It's ok, I'm not a copper, I can't do anything to you if you have, but the more Iknow, the more I can help.” I'm always friendly and understanding (something I've found some of my collegues don't have the patience for) – it's their body, and I would be a hypocrit (not to mention, a liar) to get them in trouble for it (unless they were violent of course). And while i dont dance with the monkey myself, I do drink (sometimes quite a bit), both alcohol, caffeine and sugary fizzy drinks – all of these things have affects to behavioural and metabolic systems, and can adversely affect health when moderation goes out the window.I would not acknowledge the baggy. My hand would close over it and I'd check her vitals before saying she should see her GP if symptoms persist, and then I'd leave. If she asks for it back, I'd get police involved, but otherwise deliver it back to the police at the end of the shift, explaining that it was from an anonymous casualty, or cite the patient confidentiality – either way, they can take the drugs. If the girls try to take back the baggy, that would be assault (it usually is when cocaine is involved) and then the police should rightly be involved. More than likely, if they notice you holding the drugs, they'll either run for it, try to explain it away, or do the old “How did that get there?”

    Either that, or (and this is more likely) I would “Accidentally” drop it down a storm drain in front of them. They can't hurt themselves, you have no evidence to give police (thus breaking patient conf), and they don't go to prison for an extremely long time. Everybody wins. Plus, they're less likely to do stupid 999 calls again.

  7. You cannot give it back as technically you could be charged with supply!I would make sure my crew mate saw it and was aware of the situation as if you just closed your hand over the bag there is always the chance of someone being very vigilant and seeing you try to hide it. They then could assume that you were hiding it with the intention of keeping it.

    I would not wait until the end of the shift to give it to the police! What happens if it falls from your pocket or someone accidently finds it on you during the rest of your shift? I would get the Police involved straight away. They have made the decision to use illegal drugs and should accept the consequences of that decision.

  8. I would probably say, “Oh, dear. Shall I just get rid of this for you?”. I'd expect the ambulance service to be regarded as part of “the authorities” to the extent that they'd let you take it rather than risk you calling the police if they said no. Then dispose of as quickly as possible, preferably in front of a crewmate if one available.

  9. Whatever you decide, do not keep it,a police friend of my mum did just that,

    and when he went back to the station to get rid of it,

    he ended up losing his job!

    (This was a few years ago)

    What a dilema.

    Personally I think I might accidentally drop it, and maybe stand on it – woops!

    Best of luck.

    Sarah

    xx

  10. Technically, as soon as you handle it, you are breaking the law. Only the police (that I am aware) have the authority to do this. They are generally very good, however, at turning a blind eye to people who have a legitimate reason for it (ie. this example, doormen at a nightclub etc.), as long as it is immediately passed on to them. To be honest, however, I would agree with the person who suggested dropping it down a drain – they're hardly likely to accuse you of stealing anyway – that would involve admitting to the police that they were in possession of class A drugs!Sounds like the doctor gave you the usual “wait and see” treatment, as per the GP protocol!

    Hope it fixes itself in time

  11. I would leave it with her, but then inform the Police so *hopefully* she didn't have time to take it before the police come round. Obviously an anomous tip-off.

  12. Take it dispose of it in front of them. Whilst it would technically be stealing they are not likely going to report you for the theft of an illigal drug. That and it might teach them a little lesson.Hope your foot gets better soon mate 🙂

  13. Legally the first part of the quandry should be clear. You would have to return the powder (as I'm assuming it didn't come with a label and so you'd only be guessing what it was) in the same way you would with anything else you discovered on the patients person.Ethically you would be breaching patient confidentiality by reporting it to the police, if you asked yourself why you were doing it the answer would probably be “spite” and that's far from a reasonable motive.

    Morality clearly contradicts both of the last two answers, however morality bears no relavence to your professional behaviour, that is governed by medical ethics and the law. Morality, oddly enough is something we seem to impose on others far more freely than we expect it of ourselves.

    At the end of the day 'Cleaning up the streets' is best left to Batman!

    DSO

  14. You have no right to take it off her – it's theft, you have no right to call the police – it's a breach of patient confidentiality. You have no choice but to give it back to her, and maybe point out the side effects.

  15. At one time I would have thought to do something moral, but you know… I would just give it back to her and get out of there. I don't need her BF (who is also a drug addict) to knife me in the alley cause of something like that.That sounds awful… but i've found that trouble finds me when i do my best to keep my nose out of it…. let alone when I go looking for it.

    Thoughts?

    PS. I'm a new reader… I LOVE your blog… I hope you get over your winter blues soon! (and hope your foot is better soon too!)

  16. I would 'accidentally' drop it down the drain or spill it or something. 'Oh damn sorry, so clumsy, didn't mean to do that, you didn't need it did you??' Calling the Police as standard would stop people who have od'd calling you in case you get the police involved. I'm a PCSO and I've always found that when I find someone who's od'd (quite often…) they will only get in the ambulance if they know I'm not getting involved (if they're concious that is). I think the ambulance service need to be neutral in this kind of situation in order to make sure people feel safe calling for help – even if it is their fault they're in that situation.That's my penny's worth anyway, for what it's worth!

  17. This is a really tricky one. As a hospital pharmacist, I have been in a similar situation in the past, albeit on a ward, which possibly made it a bit easier.If you do give it back, then technically this could count as dealing. On the other hand, you cannot legally destroy a controlled drug, so if you flush it down the loo/drain, tempting as it may be, you could get disciplined for that. I think on balance I would probably get your partner to witness you taking custody of the drug, and take it to the nearest police station as soon as the call was over, and get them to sign to say that they received the drug from you, to safeguard yourself from any accusation of theft. As it was only a small amount, presumably for personal use, I would not break patient confidentiality, & would decline to give her details to the police. If, on the other hand, it was a large enough amount for you to suspect her of dealing, then I would give her details to the police.

    Hope the foot gets better soon, Tom.

  18. Actually, it may not count as dealing, since you don't know CONCLUSIVELY that it is cocaine. Sure, it may LOOK like coke, but until a field lab or regular lab ID's it, it is just suspicion of cocaine. In this instance, I'd actually give it back, just because it places me in that difficult situation of either disposing of it, or giving it off to a cop, who would then arrest her little rear end. Either way, even with giving it back, there is paperwork to deal with regarding it. Out of curiousity, have any of you found drugs in your rig while cleaning it out? This happened to me years ago. We just found the nearest cop and turned it over. What's your protocol for this?

  19. If she was going to be staying put, I would drop it on the floor next to her and make sure she saw me do it. That way, I'm not holding it, I'm not handing it back to her, and she's not going to kick off and get violent at me for taking her stuff away (legality is all very well when the nearest copper is not, in fact, near. Given a choice between not getting beaten up, or, getting beaten up, and then dragging through the courts, I know what I choose).If she was being transported to hospital, though, then I would hang on to it and take it with me to give to the hospital staff so they can find out what exactly she's had. This would also be a bargaining point if she tried to insist on being taken in unnecessarily (“well, I could take you in, but I'd have to give them this because otherwise they can't treat you properly”).I can't honestly imagine that the police would get at all excited by one drug user with one baggie. Nor can I imagine the drug addict whose addiction will be broken by having one baggie confiscated.

  20. No bony tenderness, so I'm not crying out for an x-ray. If anything I'm pondering ligament strain from some forgotten manuever that I've done in the past or (much more unlikely) tarsal tunnel syndrome, and if it is I can't feel any masses.(Neither could the doctor through the sock…)

    Wait and see for another week seems reasonable to me.

  21. I'd give it back. I don't like cocaine or what it does to people at all (something I've had a great deal of experience of- I've lived with a cokehead), but it's none of my business if people choose to take it.(I'll admit I'd be sorely tempted to “accidentally” spill it everywhere, but I wouldn't do it)

    I would however draw attention to the fact that I knew what it was, and ask the patient how much they had taken, and if they'd taken anything else as well.

  22. As soon as you take the powder out of her pocket, you are in possession of a Class A drug.You do not have lawful authority to possess the drug, therefore you are committing the offence of possession of a Class A drug.

    There are defences in law to possession. In this case, you have a defence if you intend to pass the drug to the police as soon as possible or dispose of the drug as soon as possible. This does not mean hanging on to it till the end of the shift. It means quickly!

    If, having taken possession of the Class A drug, you give it to someone who cannot lawfully possess the drug, then you are guilty of supplying a Class A drug. It is possible to be found guilty of supplying someone with their own drugs. There are stated cases – trust me.

    You have only two choices – you dispose of it immediately or you get your control room to get the police to join you. Anything else would leave you open to all sorts of nastiness.

    Patient confidentiality is not an issue.

  23. I kind of agree with you. But…Legally, I'm not sure that you would be stealing, that or you could get done for supplying.

    Ethically, unless the cocaine is part of the cause for her collapse would I be breaking confidentiallity? If she confessed to murder would medical confidentiallity come into it?

    (But in real life, I'd be doing what you suggest – path of least trouble if nothing else…)

  24. Good point on the coppers not being nearby – also a good point on not getting beaten up by anyone.Not getting beaten up by anyone is normally an indicator of a good shift.

  25. Yep, twice.First one I showed it to a copper guarding a patient in the A&E, he advised me to flush it, so I did in front of him.

    Copper obviously not bothered by such a small amount.

    Second time the patient was in front of me and asked for it back. So I gave it to him (it was the world's tiniest bag of pot).

  26. Oh, and of course it's coke – I do the whole 'Miami Vice' rubbing it in my gums thing…*DISCLAIMER – I'm joking, to do this in real life is really rather stupid and dangerous*

  27. I agree with the commenter who suggested dropping the baggie by the patient where they could see it but you wouldn't be giving it back to them. Calling the police for anything less than an amount used for dealing shows you are allied with them and may mean that people who have OD'ed or are in real trouble will not call the ambulance service. Dropping it down the drain is taking the moral high ground and is only likely to aggravate people who might already be feeling somewhat aggressive and may aggravate the situation. Whatever you do though you shouldn't carry it on you – it can only lead to trouble.

  28. I would be worried, she is faking and knowing she is in posession of a class A drug which you will find. Am I suspicious, or just cynical to think she is trying to set up the innocent (you) to see them get into trouble by having to deal with the drug..Me, if I found something like this situation, I would defnitely get control to alert the police so it is recorded as an incident on the call; that way you at least have some documented evidence of handling it as correctly as you see fit.

    Interesting post though, and the posts on here both by you and your other readers are a fasicnating insight into humanity.

    Good luck with the foot Tom, don't think much of your doctor and I would definitely get a second opinion or visit a sports physio who probably sees injuries like this most days.

    Sage

  29. Here in New Zealand our drug law covers exactly this type of situation, and I would guess that your law would have something very similar to this:(3) In any proceedings for an offence against this section in respect of the

    possession of a controlled drug, in which it is proved that the defendant had a

    controlled drug in his possession, it shall be a defence for him to prove—

    (a) that, knowing or suspecting it to be a controlled drug, he took

    possession of it for the purpose of preventing another from committing or

    continuing to commit an offence in connection with that drug and that as soon

    as possible after taking possession of it he took all reasonable steps to

    destroy the drug or to deliver it into the possession of a person lawfully

    entitled to have possession of it;

  30. Just my humble opinion:1. You don't know that is cocaine, you just suspect it;

    2. However if you suspect it you aren't entitled to handle it;

    3. As soon as you are aware of this (and the onlookers as well) a few scenarios open:

    3.1 Nobody actually realizes what's happening and the young lady herself doesn't remember about the powder;

    3.2 The young lady or one of her friends get immediately very angry at you;

    3.3 The [insert name of a tabloid here] undercover journalist who wants to do some cheap sensationalism start taking pictures;

    3.4 The [insert name of the badge carrier here] undercover who wants to increase his/her quota flashes the abovementioned badge;

    3.5 After sometime someone remembers about the bag and start wondering-worrying….

    4. Given this I would cover my back and ask for Police support.

    Reason: Even if not entitled to decide-suspect-prosecute about the powder, I'd have to cover my back. What if I left the powder in the pocket and the person snorts the content afterwards and collapses for God? (pun intended).

    As stated before: JMHO.

    Andrea (MD, formerly EMT)

  31. Pick it up, put it down and pretend you never saw it. It might be a totally harmless substance and it's really none of my business. I want them to know they can call again. We call an OD-team to do the follow-up if the patient wants us to. I know; I work in a small town in a small country where we still have the time and energy to be nice to people. We are very lucky.

  32. I agree.Plus if it's her pet's probiotic powder she's going to sprinkle on their food (seriously, I used to carry some in a baggie years ago) – or glucoee powder she carries for some reason, and you get her booked & searched/questioned by the police…. not a good scene.

  33. “2. However if you suspect it you aren't entitled to handle it; “Doormen at nightclubs often have to handle suspect powders (or more usually pills) – short of calling the police everytime they find a pill, it's the only option.

    And that pill could be a birth control pill that worked its way through the foil in a handbag, or a paracetamol tablet…. the police would NOT be best thrilled I guess if they got called to every pill found at every nightclub, and had to take the person in & analyse it!

  34. “Legally, I'm not sure that you would be stealing…”More to the point, if she actually goes to the police to tell them you stole her cocaine, then she's is not only faking illness and a druggie, but dimmer than a 2 watt bulb.

  35. They tend to have a drugs box, of the type that things can be put in, but only removed with the correct tool. They put it in there, then contact the police to tell them its there. At that point, it becomes the responsibility of the police to collect it. Perhaps a similar system should be available to you guys on the ambulances.

  36. We had something similar a few weeks ago.Called to an opiate OD, patient had a GCS of 3, resps of approx 2-4pm, pinpoint pupils, half a syringe of brown liquid on the floor, belt around the upper arm. It was fairly obvious what was going on.I assisted resps, OP airway and BVM whilst my mate drew up Narcan. The Narcan did its job but just as we were about to leave after the patient was back in the land of the living and refusing to go to hospital, he asked us “where's me pin?” I'd squirted it down the khazi and dropped it into the sharps bin.I told him it had gotten trodden on and snapped and the needle was now disposed of. He was OK with it.Was that wrong to dispose of it? Chances are as he was asking for the syringe as soon as he came round we'd have been back there 10mins later when he did it again.

  37. As sad as it is, (and its really leaving a bad taste in my mouth to type this). Our jobs are to treat the patient, we deal with whats wrong with them, we allow them their 'rights' and when they damage themselves again (which most do because 90% of the public are morons) its our job to deal with that too. There should be some strict rules in place for this, probably arrived at by some overpaid ethics council. Until then we just have to try and close our eyes to it, and do our jobs.

  38. Hee hee – I get my (prescription) ibuprofen in these great big tubs that are really a bit large for a suitcase, never mind a small ladies handbag. There's also no 'subtle' or 'discreet' way of opening those childproof tubs, and I don't like going “Hey, look at me, taking a tablet!” I mean you might as well have a badge saying “ask me about my medical history”. So I used to wrap a couple in tinfoil to carry around with me.It took a couple of little incidents before my addled brain realised how dodgy it looks to unaware observers in a pub, cafe or restaurant ,when a twentysomething woman is fiddling with her bag under the table… withdraws a bit of foil… takes a dayglo pink tablet out… palms it and furtively swallows it.

  39. That's exactly why I like my days-of-the-week pillbox. It's so obviously medicine when taken from one of those and no one bats an eye. Something illegal users could also consider. (I'm only saying this so they get fashionable like stash tins did, and I get more choice of colours than pink or beige…)

  40. Matt is absolutely correct. I had a similar discussion with a Police drugs squad officer recently and that is the advice I was given.–Phil, SRPara

  41. In all honesty, I'd just give it back to them. Never come across a pt with more than cannabis on them, and that went straight back into the patient's wallet in front of my crew mate, the responder and the uni para student all on the back of the truck.As far as I'm aware, as mentioned above we have no powers to confiscate it, but more importantly, we have no obligation to do anything about it.

    Wrong attitude to take? Maybe, but take it off them and not only risk dodgy legal grounds, but let's face it, they'll just buy some more.

  42. Just ignore it and let her take the lot – hopefully putting herself out of everyone else's misery.No sympathy, I'm afraid.

  43. Like carpal tunnel syndrome (carpals are the bones in your wrist) only in your tarsals (the bones in your ankle)I thought you were a paramedic (by your name 'paramedic'!!)

  44. My current one (from Boots) is seven separate holders that easily fit in a pocket, each divided into four sections with sliding dividers (so if, say, the morning section needs to be bigger than the bedtime section it can be). Each holder is made of translucent blue plastic, and there's a solid dark-blue wallet about the size of a pencil case to hold them all together if I'm away from home.But I do envy the friend of mine who found this.

  45. I would have had the police arrest her butt! I too have no sympathy for drug takers. Especially when they leave needles all over the local park where the kids play *rant over*Liz & Josh (20w 1d)

  46. “Disgusting creatures”To an addict, their next fix FEELS like food to a starving person – I've read that the part of our brains that deals with basic survival needs also encourages them to be highly motivated to find their next fix.

    (Otherwise, people could just kick addictions with ease.)

    So to an addict, doing that is no more disgusting than a starving person eating spilled food off the floor.

    A sense of perspective and understanding when dealing with addiction & substance abuse is essential IMO, otherwise you never get past first base trying to help anyone break free from it.

  47. down the loo for me.not because it's “bad for her health, and illegal”, I couldn't give 2 hoots, but because I'd be annoyed at her wasting my time by faking it!

  48. you mean that the protocol driven AS hasn't written a protocol to cover this kind of situation?? Your big bosses best get their pens out!

  49. no no my name is paramedic TO BE!! I really really want to be a aramedic but i am not. Not yet anyway. I live in hope! Cheers though

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