By law: Theft, burglary and stolen property
Why administration of normal saline off-duty constitutes possession and delivery of a controlled substance
File this under: things you can’t do anymore. Four Iowa EMS providers were cited by the state Department of Public Health after one allegedly gave another IV fluids to treat intoxication while off duty.
If we are being honest with each other, we know this happens and has happened for generations. We know that there’s nothing like 1,000 cc of normal saline (and 50 of D50) to get you right again after a little too much to drink – heck, it is big business for Las Vegas hotels.
Please understand, I am not saying that it is OK for providers to do what these folks did; I am saying that it happens, and it is absolutely illegal.
In this case, three paramedics and an EMT received citations and warnings for "professional incompetency" stemming from an incident at the EMT's home, where, according to officials, she became intoxicated and then asked one of the paramedics to start an IV for her. The who and why behind the incident being reported to authorities is a matter for a different column. I want to take this opportunity to tackle the much bigger issues.
First, as an EMS defense lawyer, and with no more information than what was provided in the news story, it seems that just citations and warnings were fair and appropriately lenient. It could have been a whole lot worse – if there is a next time, I am sure it will be.
Second, and far more importantly, are the bullets that were dodged.
Legal standards for controlled substances
Under Iowa Code §124.401(5), possession of a controlled substance is a “serious misdemeanor” punishable by a fine between $250 and $1,500 and up to one year in jail.
Under Iowa law, substances are recognized as drugs based on the official United States Pharmacopoeia, official Homeopathic Pharmacopoeia of the United States or National Formulary, or any supplement to any of them. They include substances intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease in humans or animals and are intended to affect the structure or any function of the human body or animals. Even normal saline, when prepared for IV administration, can be considered a controlled substance. Merely having it away from the job can be a crime.
Moreover, under Iowa Code §124.401(1), it is unlawful for any person to deliver, or possess with the intent to deliver, a controlled substance or to act with, enter into a common scheme or design with, or conspire with one or more other persons to deliver, or possess with the intent to deliver a controlled substance. Having the IV solution, transporting the IV solution, administering the IV solution are all potentially criminal acts. If more than one person was involved in facilitating the possession, transportation, and/or administration of the IV solution, there was a conspiracy to do those things and every member is equally liable.
If you are reading this from someplace other than Iowa, I can assure you, there is a very similar set of laws wherever you are.
In addition to possession, transportation and distribution of a controlled substance, there are all of the collateral (potentially) criminal acts as well. If you have IV solution, you will need the tools and equipment with which to administer it – aka, paraphernalia. If you are not authorized to possess, transport or use drug administration paraphernalia off-duty, you could find yourself facing even more criminal charges.
Then of course, there’s practicing medicine without a license. Under Iowa Code §148.6(3), any person engaged in the “practice of medicine” without a license may be charged with a Class D felony. Once again, there are similar laws in every state and the District of Columbia.
Yes, there’s more.
In every state, taking the IV solution and/or paraphernalia from a station, hospital, ambulance or restocking cabinet is theft.
Entering a structure, cabinet or vehicle intending to take the IV solution – or anything else that doesn’t belong to you – is burglary.
Accepting such items constitutes receiving stolen property.
The same is true for everything from band-aids, to alcohol prep pads, to the needles and syringes perfect for injecting sauces into whole grilling chickens.
The bottom line is that EMS professionals are expected to be professional. One day, maybe paramedic licensure will evolve to a place where providers are not as limited as they are now; perhaps the day will come when paramedics enjoy the kind of autonomy that allows for administering IV solution to family members and friends, but such is not the case now and, believe me when I say, the law is watching you.
When your friend has had too much to drink, there are plenty of remedies available over the counter. If you decide, however, that 1,000 cc of normal saline and 50 of D50 are the way to go, then plan to be evaluating your career options when you are released from jail.
Listen for more
On this episode of Inside EMS, our host, Chris Cebollero, is joined by EMS1 Columnist and Editorial Advisory Board Member, Rob Lawrence, to discuss the Iowa EMTs that were cited by the state for starting an IV off duty to an intoxicated EMT.
4 Iowa EMS providers cited after medic allegedly gave intoxicated medic IV fluids
Two of the providers were cited for allegedly witnessing the incident and not preventing or reporting it