Medical-legal Issues in the Agitated Patient: Cases and Caveats

INTRODUCTION More than any other area of emergency medicine, legal issues are paramount when caring for an agitated patient. It is imperative to have a clear understanding of these issues to avoid exposure to liability. These medico-legal issues can arise at the onset, during, and at discharge of care and create several duties. At the initiation of care, the doctor has a duty to evaluate for competence and the patient’s ability to consent. Once care has begun, patients may require restraint if they become combative or violent. If restraints are placed, the physician has a duty to protect the patient and should fill out all appropriate paperwork as they have decided to take away the patient’s liberty. Use of restraints may precipitate issues of battery and false imprisonment. Finally, prior to discharge, the physician has a duty to determine if there have been any direct threats made regarding a third party and if there is a duty to warn. These medico-legal issues will be illustrated using actual court cases. The purpose of this paper is to educate practicing emergency physicians (EP) on high-risk legal issues concerning the agitated patient, so that liability can be avoided.