Mandated Reporting

The following is related to information I got third-hand. I can’t account for how accurate it is, and I’m not going to use names because of the nature of the incident involved. But it is worth talking about simply because it is a reality that I and others like me see almost every day. And I’m going to do my best to be accurate with what I know, at least as far as I can be.

I had a conversation not too long ago with a friend of mine who works for another EMS provider. It was regarding a situation that nobody in our line of work ever likes to see or deal with. And he wanted some advice as to how to follow up on whether or not the situation in question was handled the way it needed to be.

In our job, as in many jobs that are related to the health, welfare, and safety of the public, we’re obligated to be Mandated Reporters. In a nutshell, a Mandated Reporter is someone who is required by law to report a finding of abuse or neglect of a child, a senior citizen, or someone who is unable to do so for themselves due to incapacity, to the proper authorities. Whether it’s the police, the DSS (in Massachusetts) or DCYF (in New Hampshire) in the case of children, or the Bureau of Elder Affairs in the case of an elderly adult, we have to take that action to ensure that the person at risk is taken out of a bad situation.

The situation my friend had to deal with involved a 77 year-old male that he found to be living in abysmal conditions, made all the worse by a child who added to what was happening by making it incredibly difficult for this man to get prescription medications or even groceries. All because his daughter and son-in-law somehow got control of his finances.

The ambulance crew was called to this particular residence for an individual complaining of general weakness. When they arrived at the home – by all appearances it was well-kept on the outside – they found that they had a difficult time getting in because of the overwhelming amount of stuff that was piled in front of the kitchen door. They found a similar problem with the front door, and it was so bad that they had to request assistance from both Police and Fire.

Once they were able to get inside they found their patient. He was living in one room of this house, two stories, a total mess from top to bottom. A downstairs bedroom, also incredibly cluttered, a commode next to the bed that was full of urine. Empty food cans – mostly soup or stew or other similar things – were on a desk that was near the bed as were empty plates or bowls that looked, from what the crew told me, as though they’d been there for quite some time. The patient himself looked to be a mess: he was unshaven, he needed a bath, and he had bedsores. Apparently he’d been sick off and on for quite some time and his family either was unaware or they were unwilling to do anything about it. Considering that one of his children had control of his checkbook, I’m inclined to think that the latter was the case.

His chief complaint was that he’d been dizzy and nauseous for going on five days. My understanding was that he was rather seriously dehydrated, and based on that finding in their assessment they requested help. If I were in his shoes I’d be inclined to do the same thing. So ALS was summoned and Paramedics arrived to find them extricating the patient from his house, apparently also covered in feces in addition to the bedsores that were present. His mental status was also rather tenuous: conscious but not fully comprehending what was going on. Was this due to sickness or some other cause? To be honest, I couldn’t say since I wasn’t there.

At about the same time, his daughter – the one who’s handling his finances – arrived on scene and, from what I was told, got in everyone’s faces complaining loudly that she should have been notified immediately on the crew’s arrival at the house (apparently she also has Durable Power of Attorney or is this man’s health care proxy). The crews, as well as the cops, did their best to explain what had happened, but she didn’t want to hear it. Nor did she want him transported to the hospital for evaluation and treatment.

It was at that point that one of the medics on the ALS truck intervened and told the daughter about the conditions that he was found in and that they had a responsibility to not only ensure that he got proper treatment but that he be removed from what appeared to be an unsafe and completely unmanageable situation. I’m told he was as tactful as he could be, given the circumstances, but considering the way it was described to me I’m surprised he didn’t rip the daughter in half. I’m also a little surprised the police didn’t have a little bit more to say to the daughter. Even if they were to do that I’m not convinced it was either the place or the time to do so.

Because of the conditions they found their patient in, the EMS crews had to report it. So they transported the patient to the hospital then did what they had to do to report what they found. If things were done “by the numbers” once the report was filed the family would have been contacted by an investigator as would the crew responsible for the reporting. But I don’t know if these things happened the way they were supposed to; backlog being what it is, I wouldn’t be surprised if as of this writing it hadn’t gone that far.

I say that because, unfortunately, it happens way too often.