David Givot, an EMS1 columnist and editorial advisor, occasionally receives questions from EMS providers who find themselves in the kinds of situations about which he writes. The following is a question Givot received from a reader and is happy to answer.
Question: My partner is a terrible writer. When it’s his turn to write the narrative for the ePCR every sentence has multiple grammar errors and misspellings. Important details about assessment and care are often left out. I’ve tried to make corrections, but he always wants me to just “sign the dam report” so we can clear the hospital for quarters or the next call. He’s also the crew chief so it’s not easy for me to call out his poor writing skills. As a co-signer am I liable for his mistakes? How can I make sure we have more accurate and more professional narratives without turning him against me?
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Answer: Wow. The worst part about your question is that it is so common in EMS. What you are experiencing is happening everywhere – despite my best efforts to the contrary.
The short answer to your long question is: yes, you may be considered liable for the mistakes contained in the patient care report if you are cosigning as to its accuracy.
The longer answer is far more troubling.
Since our parents’ and grandparents’ time, grammar, spelling, table etiquette, work ethic, and the like were ingrained into us and reinforced daily. Dangling participles and elbows on the dinner table were often met with the same response. Lazy work was not tolerated.
Over the years, though, we have grown lazy and complacent. Everyone gets a trophy, and nobody fails in school, so we simply don’t care as much about once-important notions like spelling, grammar and etiquette. Work ethic seems to have gone the way of the dodo. It stands to reason that complacent EMS providers and grammatical and spelling errors are all too common in patient care reports.
EMS partners are a team
The more sinister issue you point out; the much, much bigger problem that will directly affect you is the reality that “…[i]mportant details about assessment and care are often left out…” of his reports. My experience has been that omissions in documentation equate to omissions in care and that is what will bring you both down. It does not have to be true, it only needs to appear true.
The law views EMS partners as a team; each provider is responsible for the [known] conduct of the other. For example, if you are both paramedics and you see your partner about to commit a treatment error and you don’t intervene, it is as if you made the error.
Likewise, if you know or should know that your partner is documenting improperly or incompletely or, worst of all, fraudulently, and you do not intervene, it is as if you committed fraud. You will both be sanctioned equally. Any documentation you sign off on, whether you wrote it or not, whether you read it or not, you own everything in it and everything that is missing.
Partners solve problems together
How you fix this problem without straining the relationship is delicate work until it is not.
Partners are supposed to have each other’s backs. Partners are supposed to look out for one another. Partners are supposed to protect each other, even when doing so may be uncomfortable. The partner who drives you to be better is the partner you know you can trust. The partner who expects you to lie for him or her is the one you know you cannot trust; that is the one who will burn you before he burns with you.
Your crew chief partner is not acting like a crew chief, much less a partner. I don’t know him or his personality, so I cannot tell you definitively how to handle it. I can give you a couple of options:
Talk to him, partner to partner.
“Hey, I understand wanting to go available faster. The problem is that our duty to the patient we just transported is not satisfied until we have provided the kind of accurate, complete, and thorough documentation that affords the patient and the hospital the best opportunity to provide continuity of care.”
(That is a lot of words. Convey the message in your own words).
Maybe your attention to quality will be contagious; problem solved. Maybe not.
Maybe the conversation needs to be a little more direct.
“Incomplete documentation is bad for the patient, makes us both look bad, and can come back to haunt both of us. Making sure that the ePCR is as good as it can be is not a ding against you; it’s me being a good partner and us doing right by the patient.”
If the diplomatic route fails, stand your ground. A wise person once told me that doing the right thing is not always easy, but it is always the right thing. You may need to get tough, go over his head; you may need to drive the culture of your agency to a better place; a higher standard.
You will hit resistance. My feeling about providers who resist improvement is that they don’t belong in EMS.
The conflict you are facing with your crew chief is the same conflict that countless EMS providers face every single day. Hopefully, your question and this answer will help you and them, too.
What are your thoughts on how to solve this problem? If you are a weak writer, what feedback from your partner would be most helpful to you?
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Do you have an EMS legal question for me? Email me David@thelegalguardian.com and I will consider it for an upcoming EMS1 column. Note: I am only licensed to practice law in California. Any response to hypothetical questions is intended for educational purposes only and is not intended to be nor should it be considered legal advice.
