Legal Concepts for the MCC Paramedic
Peter Bonadonna, EMT-P, MICP
 Dan Labowitz, JD, EMT-P

Abandonment: A health care provider who terminates the relationship (or care) of their patient prior to safely finding similar or better care. Temporarily leaving the patient to get needed equipment or to use the phone would generally not constitute abandonment.
Assault: Deliberate intimidation in any way to cause a feeling of doubt or insecurity. To threaten harm.  Assault, while usually done face to face, could even occur during a phone conversation. However in criminal application there must be an identifiable injury.
Axelrod’s Criteria: (Historic Local Use). Named after a NYS State Commissioner of Health whose guidelines ensured that patients called dead are really so. Criteria includes decapitation, rigor mortis, dependent lividity, exposed brain matter etc.
Battery: Unwanted physical touching. Used in Civil Law.
Breach: A violation or infraction, as of a law, a legal obligation, or a promise. Your legal obligation is to give good care. When you fail to use reasonable judgment, care or skill, you have breached your obligation to the patient.
    There are two types of breach:
    Commission (committed) -  giving improper care. (Action)
    Omission (omitted)           -  failing to complete a needed treatment or
                                                  procedure. (Non-Action)
Certification: An acknowledgement usually signified by card or diploma, given by any entity who wishes to set standards and directions. Usually given by government or large organizations / institutions. Today in a legal sense,  is viewed much like licensesure .
Chain of Custody: The legal supervision, tracking and documentation of items (such as blood samples) by paramedics, physicians, nurses, and law enforcement personnel which will stand up to scrutiny in a court of law. (Accountability)
Civil Law: Also called Tort law. Involves disputes regarding contracts, money,  personal behavior and all other issues that are not “criminal law”.
Court Order: Usually the highest level of authority in Medical Care issues. Courts can order medical professionals to deliver care to a competent adult patient, even if they are refusing care. Courts can order children into the hospital even if the parents refuse.  In such cases, law enforcement will call you and be present during the event as emotions run high and this is a potentially dangerous call.
Criminal Law: Government-run legal system that administers law to protect the community.
Defendant: The party against which a court action is brought.
Doctor:  Latin for "Teacher". One who has completed 8-10 years of organized education in a particular area of specialty. Examples include: JD, MD, PhD, DVM, DO, DDS, DMD. In the list above, only MD and DO are physicians.
DNR: Do Not Resuscitate. A legal order allowing you to honor the patient’s wishes not to receive resuscitation at the time of their death. The date on a DNR or its recommended renewal date is of no concern to the EMT or Paramedic.
Duly: In a proper manner.
Duty: Legal responsibilities and legal obligations.
Dying Declaration: Legal premise that words taken from a dying patient can stand as direct testimony rather than hearsay. Paramedics and law enforcement personnel must be properly trained in how to take and document a Dying Declaration.
Emancipated minor: Any minor who has been declared an adult by the courts or by law. The courts have ruled that a minor female who is pregnant or caring for her child/children has the rights of an adult (she is emancipated). Paramedics can allow “Temporary Emancipation” in minors who claim physical or sexual abuse from a primary care giver and who are immediate danger if you don’t take them to the hospital. The police should be notified as soon as possible. Do not sit at the scene.
False Imprisonment: Now termed Unlawful imprisonment. See Unlawful imprisonment below.
Good Samaritan Law: A protection (from a negligence charge) provided by some states that offers legal protection to medically trained individuals if they stop and assist at an emergency. They must not be paid at the time and not expect or demand financial compensation while giving care. It does not protect them from a charge of Gross Negligence.

Health Care Proxy: A useful legal tool when interpreting an incompetent patient’s desires about medical care and end of life issues. Esp. in the absence of family or friends or when there is disagreement between family members.
Hearsay: Comments from one person recalling what another person said. Usually hearsay is inadmissible in a court of law due to errors in recall or purposeful manipulations of the truth (lying).
Held to a Higher Standard: Individuals or groups with formal training or knowledge have documented awareness and therefore have increased responsibility in their practice and everyday life. EMTs and Paramedics can not give a friend an aspirin without making sure that the headache is not a cerebral hemorrhage. The lay public would not be held to this kind of scrutiny if they error.
Intervener Physician: A physician who happens by an emergency scene and wishes to help but has no relationship with the patient or the EMS system. Most EMS systems do not allow an Intervener Physician to take charge!  
JD: Juris Doctorate.  A lawyer.
Kidnapping: To restrain or restrict a person’s movements (especially a child) intentionally and unlawfully in such manner as to interfere substantially with his liberty by moving him from one place to another, or by confining him/her either in the place where the restriction commences or in a place to which he has been moved with out consent and with knowledge that the restriction is unlawful. Similar to Unlawful imprisonment but this has the connotation that the victim is hidden away from view for the purposes of abuse or other crime. In normal practice, paramedics would never be charged with kidnapping.
Libel: Written defamation of character based on a falsehood, with the intent to harm in some way.
Licensure: Similar to certification but is almost always administered and regulated by the State Education Department of a state.
Litigation: To engage in legal proceedings.
Malfeasance: Misconduct or wrongdoing, especially by a public official.
Malpractice: Improper or unethical conduct by the holder of a professional or official position.
Misfeasance: Improper and unlawful execution of an act that in itself is lawful and proper.

Negligence: Failure to exercise the degree of care and caution considered reasonable under the circumstances, resulting in an unintended injury or death to another party.
To prove negligence in court the plaintiff has to prove four points:
*        That a DUTY existed.
*        That you BREACHED that duty.
*        That the person suffered INJURY or DAMAGES.
*        That there was PROXIMAL CAUSE the linkage or “cause and effect” between
                  breach and injury.
OGA: Obstructing Governmental Administration. (NYS Penal Law 195.05) Charge used to arrest anyone*1 (including the arrest of a physician) who interferes with the duties of a Police officer, Paramedic or Fire Fighter who is dutifully carrying out their responsibilities. This interference must be of a magnitude that it endangers the safety of the patient, Police Officer, Paramedic, FF, or bystanders and no other option is available.
 *1  an EMSer can not ask a Police officer to OGA another public servant.
Penal Law: or Penal Code. Set of laws that guide the criminal legal system. They define inappropriate behavior and list various levels of penalties for each. See your instructor for the location of the NYS Penal Law books. NY also has Criminal Procedure Law for how cases should be handled.
Plaintiff: The party that institutes (starts) a suit in a court.
PMD: Personal or Private Medical Doctor. One who has a professional relationship to the patient.
Preponderance: Superiority in weight, force, importance, or influence. Greater that 50%
Previous detrimental history: Previously known or discoverable facts that can later degrade your credibility. Examples “the medic always admitted that he was fearful of delivering a baby”. If you are being tried for a drug dose error that killed a patient, and your Paramedic final math scores are subpoenaed, do you want 98% or 60% to be announced in court.
Privileged animals: i.e. Guide Dog, Police Dog, Assist Monkey, Police Horse. Animals whose service is recognized as extremely valuable and where sometimes, extraordinary efforts are used to care for, protect, and grant these animals extra privileges or rights.
Proximal cause: The "linkage" between Breech and Injury. The proof that your omission or commission caused the damages.
Rape: A person is guilty of rape when he or she engages in sexual intercourse with another person to whom the actor is not married, who is non-consenting or who is incapable of consent by reason of some factor other than being less than seventeen years old, or who is less than seventeen years old.
Reasonable man theory: In “gray areas” of practice or in areas of constantly changing medical opinion - affords some additional legal protection if you act in a similar way to others who have similar training and experiences. If they would have done what you did in a similar situation, this can be protective.
Reciprocity: Certification or Licensure granted automatically based on agreements between States.
Res Ipsa Loquitur: "The thing speaks for itself". Situations where the harm is so obviously the fault of the medic that the medic must now prove they’re innocent. Shifts the burden of proof to the defendant.
Respondeat Superior: If your employer or boss makes policies that are in error, they are also responsible. Basically your employer shares in the responsibility for your actions unless the company can show you were functioning alone and not to company directives.
Slander: Spoken or recorded defamation of character with the intent to harm a reputation.
To be Sworn: Legal premise that you are telling the truth. -in court, -in to duty. MCC Paramedics, like police officers, are Sworn into service at the graduation.  In law enforcement has even more specialized meaning.
Tort Law: See Civil Law.
Treating animals: Yes you can. But only under a strict set of rules and circumstances.  Paramedics and EMTs can administer emergency medical care to animals and have the ability to greatly influence the outcome for the animal. Typical examples are caring for an animal pulled from a smoke filled house (giving oxygen), assisting a police officer when his K-9 partner is injured (controlling bleeding, splinting, even an IV of Saline), being called to the local zoo surgical center to defibrillate a tiger.  All of these examples are appropriate so long as you do not deny human patients care, do not transport red lights and siren, don’t bill or have expectation of financial renumerations, and use reasonable care.  Paramedics or their dispatchers should have the phone numbers of 24 hour Animal Hospitals and Veterinarians that would be willing to respond to the scene. Specific policies and protocols should be developed by Ambulance Operations in conjunction with Medical Control and local Veterinarians.
Unlawful Imprisonment: To restrain or restrict a person’s movements intentionally and unlawfully in such manner as to interfere substantially with his liberty by moving him from one place to another, or by confining him either in the place where the restriction commences or in a place to which he has been moved with out consent and with knowledge that the restriction is unlawful. Because paramedics may on occasion, restrain people (in a lawful way), it is highly unlikely that a paramedic would be charged with (or conviced of) Unlawful Imprisonment. This is because the intent to hold a patient is for the patient’s or public’s safety and he/she would not hold the patient for more than 1 hour. The paramedic would hold a person in "public view" only until a police officer can be summoned to evaluate the person for mental hygine/criminal behavior. Another important feature of this is that the medics intent is to help and not harm the person. Many states use 6 hours as a minimum required to press charges.


Updated: February 13, 2004