If You Can't Do the Time...
Often you can tell what's happening at the scene of an emergency even before you begin your response. When someone reports an "unconscious man in an ATM machine," for example, you know that you will arrive to find a homeless man taking a nap. That's what it aways turns out to be.
So, when we saw on the ambulance's computer screen that we were responding to a "thirty-five-year-old male, unconscious after shoplifting," we knew that he wasn't unconscious at all. He was hoping to land in a hospital instead of in jail.
We weren't the only ones to pick up on this. We arrived at the department store to find a bunch of firefighters and a trio of security guards staring at a man on the floor. None of them seemed to be particularly concerned, because they all knew what was really happening.
"He stole a bunch of sunglasses," the fire lieutenant reported to me. "The security guard grabbed him as he was going out the door, and he started to have this kind of seizure thing."
The man was awake, but when I asked how he was feeling, he made only a groaning sound. I could have assessed him further, but there wasn't any point. He would continue the charade as long as necessary to avoid being arrested.
Instead, we lifted him onto the stretcher and wheeled him to the ambulance. "Is he under arrest?" I asked the security guards. "Does anybody want to accompany him to the hospital?"
The guards shook their heads. It wasn't worth their while to guard him over twenty dollars' worth of merchandise. We put him inside the truck and closed the doors.
I knew how this call would turn out. We'd bring him to the hospital, and when nobody was looking, he'd run away. This kind of thing happens all the time. I saw it first when I was still working as an EMT. We picked up a woman who'd been arrested on a similar charge, and who, like this man, was pretending to have a seizure. We brought her to the Massachusetts General Hospital, and as I opened the ambulance door, she shoved her way past me and ran up the street. I wasn't going to chase her, because there wasn't any point. What would I do if I caught her? Force her to stay in the hospital, to be treated for a condition she didn't have?
I wasn't going to go through that again. Instead, It made sense to get right to the point. "Here's the situation," I said to the man, who was still groaning. "The store doesn't want to press charges. The security guards are gone. You're free to leave if that's what you want to do."
The man lifted his head. He looked around the ambulance. "My God," he moaned. "Where am I?" He knew perfectly well where he was. It wasn't exactly an Oscar-winning performance.
"Listen to me," I said. "You're free to leave. Nobody's going to stop you."
Hearing this, he jumped up from the stretcher. He looked out the back window, and then out the side window. "I can't leave!" he said in a panic-stricken voice. "The police will get me!"
"There are no police," I told him. "Only security guards. And they're all gone. You can leave. Nobody's going to stop you."
"My bike!" the man shouted, looking out the window with greater urgency now. "Where's my bike? I left it right there by that streetlight!"
That would have been a bit of ironic justice, I thought--for the thief to have his bike stolen while committing his crime. But then the man sighed with relief. He'd spotted his bike. It was right where he'd left it.
Slowly he opened the ambulance door. He stepped out cautiously, obviously concerned that we'd set some kind of trap for him. When he saw that there really weren't any police officers out there, he straightened up, hopped on his bike, and pedaled furiously away to freedom.
I don't like the way this call ended. As trivial as the theft may have been, it's wrong to let shoplifters get away with their crimes. Retailers lose millions of dollars to petty criminals each year, and we certainly don't want to send the message to shoplifters that they can evade prosecution simply by faking an illness.
But what choice is there? Denying care to a patient who appears to be faking could prove disastrous. Those are the calls that turn into lawsuits.
At the same time, though, it makes no sense to tie up the ambulance with an unnecessary transport, when everyone knows that the guy will flee the moment he lands at the emergency department.
The least bad option, as I see it, is simply to play the game.