Hypothetical Situation: Doctor's Office

[Dionysusigma]

Well, I've been working as a business manager at a new local neighborhood doctor's office for a few months now. Today for lunch, we all sat down for a meeting and, as the morning receptionist came in she said, "Well! I just had one of the rudest people I've ever seen demand an appointment this very moment! I told him that he could be scheduled this afternoon for 2:00, but he just stormed out..."

Now, she's a tough, sweet, 70-something-year-old southern great grandma, so she wasn't worried--but still, it got me thinking.

Say the day is going how it usually is. People coming and going, when all of a sudden somebody rushes in demanding to see the doctor. They've been shot, or have someone with them who's been perforated. Or both. Anyway, when told they should go to the ER instead of here (which is our policy--emergencies must go to Emergency Rooms), they produce a gun and threaten whomever is working the desk.

I'm (I will be, anyway) the only one with both a CHL and weapon (Makarov). Calling the police is a given. The question is, would shooting a person in self-defense be justifiable if they've already been shot?

Now, regardless of who was doing the actual reception work at the time is irrelevant, as it would be either the aforementioned Southern Grammaw, my older brother, the nurse, the doctor (aka Dad), or me. They're either family or they're really close; close enough to be on the list of "People Whom I Would Defend, Unquestionably, by Using Deadly Force." Anyone working in the back of the building can hear what's going on out front, and can call the police without exposing themselves or being heard.

Any advice or suggestions?

 

[Mulliga]

Hmm. While the pragmatist in me would tell you that the individual in question is fair game and you should shoot without hesitation, the back of my mind wonders...

What if you were the one who was shot? Or if it was your family member who was shot? If you or a loved one are bleeding to death, you might be just a little bit stressed by a person who says you should "go to the emergency room" because of "policy." Perhaps trying to talk them down would be a better solution than starting another gunfight.

 

[runswithscissors]

Do as they say

In this situation, I would not shoot. I would tell him that I will get him doctors right away and proceed to do so. The person does NOT INTEND to shoot anyone. They are simply desperate to get medical attention. The best thing to do is to find a doctor and get them treatment ASAP. 99% of the time this situation will play out as the person getting treated and no one getting hurt. Even if the person makes threats to shoot someone, I would still not fire. I would definently slowly pop my thumbstrap and be prepared for anything. In a courtroom, the family of the person you shot would be very convincing in front of a jury. They would cry and claim that their loved one was desperate to get medical aid and that if medical aid had been given, the situation would have ended peacefully. I don't think there is any cop who would shoot this person. Cops only shoot as a last result. That is why they negotiate with hostage takers instead of just making a new whole in the terrorists head.
Now, consider this situation instead. A person barges in with a gun, pointing it at everyone and demanding drugs. The person does not have any visible wounds and appears to be in withdrawal. When asked what drugs this person requires and they say any and all, then it sounds like a robbery to me. I might consider shooting then, but only if the person begins to become severly unstable and appears that they WILL shoot. Otherwise, give him the drugs and let them leave.

 

[Tim Burke]

If you or a loved one are bleeding to death, you might be just a little bit stressed by a person who says you should "go to the emergency room" because of "policy."

The reason for that policy is because definitive care is available at the ER, and you are wasting time at the office.

 

[gezzer]

I would think first aid then a call for an ambulance would fit the situation better.

Aren't Doctors supposed to help?

 

[DSRUPTV]

I think that the doctor should help and call for an ambulance and police immediatly. I also think it would be good to tell the person with the gun to put it down on the condition that aid will be rendered. If they really want help and see that it will be given when they put the gun down I think they will.

 

[peacefuljeffrey]

Runs said

In this situation, I would not shoot. I would tell him that I will get him doctors right away and proceed to do so. The person does NOT INTEND to shoot anyone. They are simply desperate to get medical attention. The best thing to do is to find a doctor and get them treatment ASAP. 99% of the time this situation will play out as the person getting treated and no one getting hurt.

I don't know why, given this scenario, you feel justified in stating unequivocally "the person does NOT INTEND to shoot anyone."

That has not been established. We don't even know who the person is, why he was shot, and whether he is inclined to shoot more people. Maybe he was a carjacker shot by a would-be victim! Maybe he was a mass murderer who ran into a CCW holder while killing several other people. YOU can't state that he "does not intend to shoot anyone." What did you use as a basis for claiming to know that?

Wasn't there an episode of E.R. that had some gangbanger demanding help for his buddy who was hurt during the commission of a crime? This could be a situation like that, only with one person instead of a victim and his cohort.

You say, "99% of the time this situation will play out as the person getting treated and no one getting hurt," as though this is a situation that you've seen or heard of happening so many times?!

What kind of unfounded statement/proclamation is that??
Could you cite a few similar incidents that played out along the lines described here (injured/shot person comes into doctor's office with gun demanding treatment at gunpoint) so we can understand why you feel justified in saying that these things "play out" just fine "99% of the time"?


-Jeffrey

 

[Hardware]

I don't know about this situation. There are too many environmental variables. First, the most dangerous creature is a wounded animal. Check, got one of those. This isn't like a home invasion situation. It's a doctor's office on any day in the USA. There are patients, visitors waiting for or with patients, staff people, etc. Now, do you want the police showing up for an armed confrontation in a confined area with such a high potential for hostage taking or stray shots hitting bystanders? The reason why he didn't go to the ER is probably because he knows the ER will call the police and report a gunshot wound.

I would get the intruder into a treatment room and start treating his wound. You've just taken control of the situation by getting him out of a random environment and into a smaller, contained environment. He's probably going to be more relaxed because his immediate concerns are being dealt with. Now, while he's on the treatment table start treating him for shock, lay the table down and elevate his feet. Stop the bleeding and prepare a nice, big intravenous injection of valium to knock his ass out. Tell him it is a tetanus shot. Tell him there is no sense treating his wound if he is going to die in ten days from lockjaw. Lie your ass off to get the drugs into him and then sit there and tend to his GSW while they take hold and he rides the short bus to Lala land.

I'm basing this off of ten years experience working with the mentally retarded and mentally ill in a clinical environment. There are times when giving them what you want to get what you want is the best course. In this case you want bystanders out of the line of fire. Presumably while you are taking care of the intruder the other office staff is evacuating the office and alerting the authorities. The sad thing is that a prosecutor is going to ask why you didn't give him what he wanted. Plus, gunplay in a doctor's office might go against the "do no harm" ethic. On the other hand, if the intruder escalates the situation while receiving treatment you have to be prepared to use deadly force. In that situation at least you can say you tried using the least amount of force necessary. That will go a long way with prosecutors and a jury if it comes to it.

Now, having asked this question, might it not be a good idea to plan ahead with the other staff and the doctor so everyone else has an idea of what to do? Forwarned is forearmed.

 

[pete f]

In our state, A good samaritan law is in effect, which means you can not get sued if you work in good faith to help someone who needs it. Entwined in that legislation is that IF you are a trained professional and YOU do not provide help, you can be sued. In other words, If you are a Dr. and Life threatening situation is presented to you. You must provide help and assistance. So in our state, you must provide assistance, you may want them to go to a trauma center/ER but if they show up you have no choice. Now your second step after gettting your Dr. out to help these people, is to call 911 and tell them the situation, You need an ambulance, you need the cops. and you need them aware of why. This can be done from another position so that the aggitated party is not within ear shot, it also may be smart to grab another person and have them make the call and you stay near DR with your weapon discreetly available but out of sight.

If possible, once assistance is being rendered to the injured party, if it was another party who was screaming help him or i will kill you, go to that person, talk calmly to them and tell them look the ambulance is on the way, the cops will be here too, you need to put the gun away so the cops do not see it. etc etc. or here You can ride in the ambulance, I will hold your gun till you get back, be nice, soothing, they will probably be in such shock as to just hand it to you.

if it was the injured party screaming hte threats, once the Dr is working bring the Dr some Versed. He will know what to do.

 

[runswithscissors]

Why wouldn't I?

Jeff,
An obviously injured person walks into a doctors office with a gun and demands medical attention. Why would he demand medical attention only to shoot those qualified to help him. I like to think that I am a good judge of a persons demeanor as well as their intentions. The person did not ask for drugs, money, or a hostage. They are in an obvious life threatening situation and their primary concern is to get treatment. If it appeared that the person was mentally disturbed I would do my best not to escalate the situation and be prepared to draw and fire.
As I am not a law enforcement officer, I do not feel the need to protect another individuals life at the expense/risk of my own. That is of course not to say that if I saw someone in need of help, I would not be willing to do what I felt I could or what was necessary to help this person.
Unless someone is pointing a gun at me, or a loved one, and threatening to shoot them, I would not draw and fire on that person. If I believe that the persons actions are leading to violence, I will be the first to fire in an attempt to save my life as well as those around me.

As far as the research of individuals who have used a weapon to gain medical treatment and then have injured one of the medical staff or patients, I could not find it. Not of course to say that it doesn't exist, but I could not find it.

Maybe this person is a criminal who was shot by a citizen or a cop. Don't they still deserve treatment? Or maybe it is a cop who was just involved in a shootout with a criminal and knows that the extent of his injuries demand medical attention NOW. Maybe in his haste and panic to recieve treatment he demands attention by drawing his service pistol. Or maybe his partner is hit, they are 45 minutes from the nearest hospital, it is rush hour traffic, and his partner is dying. When told that the office will not treat his partner becuase of "policy" the cop makes a decision(perhaps a poor one) to convince the staff to treat his dying partner. After all, his partner was just shot stopping a serial killer from nailing his 12th victim.
Either way, the person first asks for medical treatment, when they are refused treatment and basically told "sorry your dying but, policy says.." they become desperate for their life. Instead of trying to reason or argue with the staff, they decide to pull a weapon and demand treatment.

Of course, then again, the person could be faking the injury only to have more staff come to his aid so that he could shoot more people.

I can say what I would like to do in this situation, but maybe I would pee my pants and start crying like a small child, or maybe I would kung fu the persons gun away, and give expert medical treatment, thereby saving the persons life. Who knows. All I know is that I would not draw and fire unless a gun was pointed directly at me or a loved one and a specific threat was made to kill them. Then the BG should surely hope he not turn his attention away from me, becuase I WILL NOT hesistate to fire on ANYONE who threatens me or my loved ones with harm and/or death. No questions asked.

You made a great point though Jeff, one that all of us should hope to never have to make. Wait out a situation and hope everything goes well, or shoot and possibly prevent a terrible event. Either way, I think that it depends on each individuals skills and knowledge to assess the situation and act or react accordingly. I train drawing and firing my weapon so should a time come when I need to fire, I will hopefully have trained well enough to perform.

 

[MikeIsaj]

"I don't know why, given this scenario, you feel justified in stating unequivocally "the person does NOT INTEND to shoot anyone."

It's really simple, he stated what his desire was. That is based on 15yrs experience and all the training I have received in crisis management, hostage negotiation and hostage survival. I don't watch ER so I can't talk about their policy. The fact is most people using a gun to back up a demand, don't want to shoot, they want what they are demanding. Armored car drivers are trained to give up the bag when confronted with a gun. Why? Because they know when the demand is met the assault almost always stops. This isn't an absolute, there are no absolutes. When playing the odds, you play the odds in your favor. No sane person wants to get into a gunfight so, you try everything you can to avoid it.

On the origional post, I'd reconsider the "no treatment" policy. If I was gunshot victim I would be sueing your Doctor for everything his grandkids were going to have for failing to render aid. And I would win!

It is not worth risking or taking a life over a policy. Especially when it has been made abundantly clear that they want treatment, not violence.

 

[Dionysusigma]

Wow... never thought of it like that before. Interesting how the original question went unanswered but the resulting replies made me think in a whole new way.

I've gotta say--y'all make (a) pretty good point(s). However, a couple more questions:

1) What if they burst in, but are demanding drugs (or money)? Not that we have a huge supply of anything a narcer would want--a lot of sinus medication, and huge Ibuprofen horse-tablets, but that's about it... no codiene, hydrocodone, morphine, nitrous oxide, or anything like that.

2) Would it be a good idea to try to coax the person to put the gun away (after we begin seeing to them/their companion), or would this result in me getting shot?

 

[Sean Smith]

Someone qualified to help someone in a genuine medical emergency (i.e. potential loss of life, limb, etc.), who doesn't do so, probalby deserves be shot themselves for being an all-around scumbag.

Your policy is unethical, frankly. You need to render first aid, THEN hand them off to the ER, not just tell somebody bleeding on your carpet to pound sand.

That said, all bets are off once the person starts threatening people with a gun.

 

[Zach S]

Someone qualified to help someone in a genuine medical emergency (i.e. potential loss of life, limb, etc.), who doesn't do so, probalby deserves be shot themselves for being an all-around scumbag.

Your policy is unethical, frankly. You need to render first aid, THEN hand them off to the ER, not just tell somebody bleeding on your carpet to pound sand.

That said, all bets are off once the person starts threatening people with a gun.

I agree. Its understandable when someone comes into your office demanding treatment for a broken arm or a cut that just needs a few stitches or anything else not life threatening, but if someone comes into your office with more holes than they were born with, telling them to go to ER becasue of a policy is beyond cold IMO.

Treat the wound as best as you can, even if its just applying pressure, call an ambulance, and the gun probably doesn't come into play. It would probably be real helpful to the operator to have someone with some medical training and experiance on the phone.

 

[Dionysusigma]

Hey! Relax!

I brought up this matter (more or less... gave him a similar situation) with the doc just now, and he said the following:

"Yeah--I'd treat them as fast and as best I could, but then send them on, with a priority referral, to St. Anthony's (a local hospital) where they're MUCH better equipped. As for the 'Emergencies go to the ER' policy, that's like if someone fell off their roof or a heart attack or something like that--don't come to us, go to the ER! But if someone was seriously injured in a car wreck not far from here, I'd be there doing my best until the paramedics arrive."

Me, in my first post: Anyway, when told they should go to the ER instead of here (which is our policy--emergencies must go to Emergency Rooms), they produce a gun and threaten whomever is working the desk.

I apologize for being misdirecting in my original post. It's the fruit of not thinking and not knowing. :banghead:

 

[Sean Smith]

That's nice to hear, too many people just slavishly follow retarded policies "because they are the policy."

It is nice to hear I was too cynical for once.

 

[Vitamin G]

I'm not sure I could live with myself if someone died as a result of my inaction.

This applies to both the gunshot victim, or whomever GOT shot by the crazy guy demanding medical attention for his family member.



My response : Shoot the gunman, call 911, render 1st aid to both.

 

[Khaotic]

Ok, how bout if you DO go to the emergency room with an injury, or complication from an injury/treatment thereof - and THEN they refuse you treatment and have a large state trooper MAKE you leave, even though said injury is infected, blindingly painful, and debilitating.

Would it not be beyond consideration to use violence or threat thereof to get that treatment ?

That's not a theoretical, that actually happened - and it happened to me.
Had I the ability to issue a believeable threat of violence in any way, shape or form, I would have done so, and matters might have turned out a little differently than they did.. if the difference was between saving a limb, and eventual amputation, would you not make threats if you were able to deliver them believably ?

The treatment and amputation that *did* save my life, came as a direct result of physical force threat, against an HMO doctor who flatly refused a referral to a surgeon because it would cost his company too much to actually provide the medical care they promised.

Under violent threat of force, this doctor issued a referral, which was recieved, followed up on, and resulted in removing the mangled limb before infection and the like killed me, and overall, it was still a damned near thing.

You can check with Revdisk if you disbelieve, he's seen the paperwork firsthand... the 'system' is notorious for stalling off the medical care of poor, underinsured/uninsured people in hopes that they will simply die and save them the trouble.

So most of the time, someone in such a situation is very desperate, *especially* if they feel that they're unlikely to survive without treatment, and yes, they are quite capable of shooting folk, although that's not what their intent is - but it comes to it, YES, they will indeed shoot you.

Hardware gave the best strategy for dealing with such individuals, overall, at least in my opinion as having *been* one of those individuals, by necessity, twice.

-K

 

[Dionysusigma]

As stated in Post #15 of this thread, verbatim:


Hey! Relax!

I brought up this matter (more or less... gave him a similar situation) with the doc just now, and he said the following:

"Yeah--I'd treat them as fast and as best I could, but then send them on, with a priority referral, to St. Anthony's (a local hospital) where they're MUCH better equipped. As for the 'Emergencies go to the ER' policy, that's like if someone fell off their roof or a heart attack or something like that--don't come to us, go to the ER! But if someone was seriously injured in a car wreck not far from here, I'd be there doing my best until the paramedics arrive."

Me, in my first post: Anyway, when told they should go to the ER instead of here (which is our policy--emergencies must go to Emergency Rooms), they produce a gun and threaten whomever is working the desk.

I apologize for being misdirecting in my original post. It's the fruit of not thinking and not knowing. :banghead:

 

[Khaotic]

Yeah, I caught that the first time - what I was pointing out, is what if they are refused treatment at the ER itself, as happened to me ?

And then get radically-violent ?

Hardware did a good job of explaining what seems to be the best way to handle it - I was just sharing the viewpoint of someone who's actually had to use violence to procure medical care, since having 'been there', I know the mindset of the person making the threats.

Sorry if I was less than clear.

-K

 

[Dionysusigma]

Oh... I see. My bad.

It's not my business, but why would an ER refuse treatment for injuries of that nature (unless, of course, the patient got there in an ambulance)?

Edit: Kicking myself again.

[My treatment] came as a direct result of physical force threat, against an HMO doctor who flatly refused a referral to a surgeon because it would cost his company too much to actually provide the medical care they promised.

Under violent threat of force, this doctor issued a referral, which was recieved, followed up on... it was still a damned near thing.

You can check with Revdisk if you disbelieve, he's seen the paperwork firsthand--the 'system' is notorious for stalling off the medical care of poor, underinsured/uninsured people in hopes that they will simply die and save them the trouble.

Unfortuantely, I know what you mean. That's why more and more private practice physicians (such as the one for whom I work) are going independant from HMOs, PPOs, and several insurance companies. I kid you not, we actually got a check in about a week ago from an HMO that was $0.14 for a minor surgery. When the patient heard this, they were (understandably) furious until the Doc said that they could pay off the rest of their bill with a couple of pies (said patient is married to a pastry chef).

Trouble with doctors and lawyers today--the ones who only do it for the money destroy the reputations of those who do it to truly make a difference.

Those were some good pies, too...

 

[Khaotic]

Trouble with doctors and lawyers today--the ones who only do it for the money destroy the reputations of those who do it to truly make a difference.

So true, and absolute props to Orthopaedic Surgeon Jose B Corvera, M.D. - for being one of those who does make a difference.

He doesn't have to work almost exclusively on low-income folk for a pittance, when he's skilled enough to be with a bigtime medical group, the fact that he chooses to is worth tremendous respect.
-K

 

[cidirkona]

If I've got a gun pointed in my face, I'm not going to to ponder if they really mean to shoot me or not to get their point across... after all, they've already loaded it, drawn it and pointed it at my face.

-Colin

 

[coylh]

Why is a robbery for medical care different than a robbery for cash? Or food?

 

[Dionysusigma]

Cash could and would be used for anything--drugs, more illegal guns, overly-flashy rims with spinners

Food is slightly different. It tends to be shoplifted more than it's robbed for. I have heard occasions of shoplifters being caught and fighting back with a gun... but much less than I've seen people go into a store, load up on food, and get the heck outta Dodge before anyone can react. Or they hide two cans of something, and pay for the third. But rarely (IME) have people (around here, anyway) killed for food.

One could find a decent meal for free if they look hard enough. As far as cash goes, yeah right. Completely free medical care when you need it right then and there to save your life is admittedly nearly impossible to find. There're varying levels of desperation at work with these.