Have you ever had am intoxicated patients enter your ED after a car crash? Often times they’re not too happy. In fact, I’ve had some intoxicated patients say some very mean things about me, my mother, my family and my genetic upbringing. He didn’t even know my mom. Not very fun.

What can you do about drunk patients?

Belligerent, intoxicated patients can often fight you when you’re attempting to provide treatment. When an intoxicated patient says, “I’m taking this collar off and you can’t stop me,” what exactly is the right thing to do? Can the patient provide consent?

Sound mind and patient consent

Justice Benjamin Cardozo said we have the right to consent to our own healthcare, but there were some caveats. You have to be of adult years and… what?

Of sound mind.

If you are not of sound mind you cannot make decisions about your healthcare.

Back to the patient

So when it comes to the intoxicated patient shouting that you cannot make him keep his collar on… yes, yes you can. You can immobilize physically or chemically and even intubate the patient as deemed necessary to prevent the patient from causing harm to his or herself.

I heard about a belligerent drunk who was trying to fight the board ED doctor, so the doctor sutured the patient’s earlobes to the backboard. Ultimately this doctor was acting accordingly. Why?

Because the doctor felt it was in the patients best interest.

I read about a patient who insistently refused treatment. He took his collar off and stormed out and due to his C-Spine fracture and became a quadriplegic.

When a quadriplegic comes into court and the jury sees this permanently disabled patient – the last thing they’ll want to hear is, “we couldn’t control him because he was drunk.” The jury’s going to say that the provider should have controlled him, that’s the provider’s job.

Ultimately, you have the right and responsibility to control intoxicated patients. It’s for their (and your) own good.

Now, what about the person that had only two beers? Two glasses of wine? Are they of sound mind? It absolutely depends on how your note tells the story. If they are clear in speech, making sense, walking without ataxia and not going to drive, I will deem them of sound mind. I will use that exact verbiage in my chart, “patient is of sound mind because…” Also, make sure the nurse’s note is saying the same thing as well.

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John Bielinski, Jr., MS PAC is a practicing emergency medicine clinician, and has been lecturing nationally for more than ten years, teaching the tactics that have proven invaluable in his career as a medical professional.
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