By Dave Kearney
Paramedic Michal McMahon, who was charged with assault and other crimes while in the course of defending himself from an attack by a patient suffering an altered mental state consistent with severe hypoglycemia, is a unique case that is worth additional review and discussion. The facts in this case raise important questions for EMS leaders and managers.
Review of the incident
On the day in question, EMS responded and found a delusional patient that was insisting on going outside into a snow storm where she would face the possibility of exposure, hypothermia or even trauma. The patient became violent and assaulted one of the EMTs.
She then turned her wrath on McMahon who repeatedly attempted to calm her down. She struck McMahon in the head and lunged at him in an attempt to strike him again. McMahon, now trapped in a confined space, and having a split second to respond to the escalating situation blocked the patient’s blow, inadvertently striking her face and temple area. He then restrained the 300-pound woman until she calmed down and proceeded to render aid to bring her blood sugar to an appropriate level.
After treating the patient, McMahon and his team explained her treatment options. After meeting all the refusal guidelines, she refused further treatment and transport. The paramedic prepared a patient care report that included that there was an altercation.
Later the same day, EMS was dispatched to the patient’s residence for a second time due to a change in her mental status. At the hospital the patient was diagnosed with a subdural hematoma.
The paramedic’s employer, Malvern Fire Company, requested that McMahon write a detailed incident report, which he did consistent with the aforementioned facts. Importantly, at the time no accusations were levied against McMahon regarding alleged deviations from the protocols or professional misconduct by the employer, their medical director or the Chester County EMS Field Services Division.
Investigation, arrest and trial
Three days after the incident, after working back-to-back 12-hour shifts, McMahon was asked to meet with local police without being notified of his Miranda rights. He told the detectives, without the benefit of counsel, what happened; that she was out of control and he was defending himself. McMahon’s voluntary statements would later appear as the primary piece of evidence in his subsequent arrest and trial. McMahon and the other responders were also accused by the prosecutor of engineering a cover-up of the event.
5 questions for leaders and providers
The facts of this case raise important questions and concerns for EMS providers and their employers:
1. Is McMahon’s arrest and prosecution in a criminal court a first in what will become a trend? Issues regarding injury of patients are normally addressed in the civil courts.
2. Because of this case will EMS providers be less apt to take what is seen as inherent risks in providing care? Must EMS providers balance the fear of prosecution with that of allegations of patient abandonment?
3. Will the lack of impartial eyewitnesses in this case lead departments to require providers to wear body-mounted video cameras? If so, what is the impact of video recording on patient privacy?
4. What harm has this arrest and prosecution done to the relationship between law enforcement and other first responders in this community?
5. When an incident like this happens, should providers refuse to speak to police without legal counsel?
EMS training programs do a great job teaching us when we shouldn’t go into a scene without it being secured. We are taught how to approach scenes where we are dispatched for shootings, stabbings and other violent acts.
What is not taught in EMS classes is what to do when a non-violent call suddenly and unexpectedly becomes violent because of a medical condition. Does your service have a procedure or policy on what to do in a case like this?
In Pennsylvania, where this incident occurred, regulations require EMS agencies to have a “policy regarding management of providers’ safety.” In the course of this trial, no policy was ever entered into evidence. EMS managers should ensure that they have a policy and that it includes direction on how to react when the unexpected happens.
About the Author
Dave Kearney has served as an firefighter, EMT, Paramedic and supervisor for 29 years in Philadelphia and it’s surrounding counties. Kearney was formerly the Recording Secretary of IAFF Local 22 (Philadelphia) and has served as a member of the Philadelphia Regional EMS Council and the Pennsylvania Emergency Health Services Council. He lives in Philadelphia with his wife and four children. He can be reached at firemandave@me.com. Attorney James Funt contributed to this commentary. www.gpeff.com