Patients who "cheat" and drive home - page 4

by Lilme04 14,941 Views | 62 Comments

I work at an endoscopy center (and a freestanding surgery center). A few times, we've had patients lie to us about how they are getting home, and they've ended up returning to their cars, and driving home. Of course we find this... Read More


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    I wish we could let patients leave by cab after simple procedures, but the local cab companies won't accept liability and refuse to take patients.

    I just feel like our hands are tied as healthcare providers trying to limit risk as well as make sure patients are safe.
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    Quote from RNsRWe
    Our policies at my endoscopy center (ASC) make it a non-issue, really.

    The patient knows well in advance of the requirement for a driver home. They are reminded the day before. Upon arrival at our facility, the admission nurse will inquire as to who the driver is, where they are, etc. MOST of the time, the driver is either standing there with them when this question is asked, or a name and phone number is provided at that time.

    Our facility has people in and out in less than two hours, so it's typically not a problem for our patients.

    A taxi home is fine, IF they are accompanied by a responsible adult to get them home. Our anesthesiologists insist on that: a taxi cannot just drop you at the curb and buzz away.

    [...]

    As for the other suggestions: no one would be willing to pay for a medical transport when they can get a friend/relative/co-worker for free, and that's the HUGE majority of our patient demographic. I realize it's not easy for everyone, but honestly, out of thousands of cases a year, they just manage to do it. Those TWO did not. And if someone does cancel because they have no ride, or WE cancel them for that reason, they FIND a ride and reschedule. No problem.
    What a short-sighted and privileged response. It's not a problem because thousands of people manage it all the time. What about the thousands you never see because they simply can't arrange it. I know people who have no family, and it's all well and good to say "get a friend" but how many friends do most people have who can or will take off work to drive a friend to a procedure. I've had several procedures in the last year and my parents drove from their home over an hour away in order to get me a ride each time. My daughter is underage and I'm divorced. If my parents were gone or infirm, I would have had only one option - a taxi. If that wouldn't be sufficient, then I would have to elect not to have the procedure. I believe that in the healthcare profession we need to meet people where they are, and try to find solutions for their health issues, not point to all the people who don't have those obstacles and say "why can't you be like them?" The fact is that lots of people are in situations too varied to name, which put them in a situation where they simply do not have anyone to take responsibility for them after a procedure. Several options have been floated here, and I think some of them (or some combination of them) would work. A hard-and-fast rule of "can't get someone to take care of you, reschedule - or just don't have - the procedure" does not address the patient's needs and situation.
    redhead_NURSE98! and llg like this.
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    At any of the facilities I work for they will not proceed to pre-op patient if they don't have a ride nor someone to take care of them at home. The facility had been sued before for a patient driving home after a procedure and causing an accident. Good rule is they need to have a ride after anesthesia and someone taking care of them afterwards.
    RNsRWe likes this.
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    Quote from theantichick
    What a short-sighted and privileged response.
    And what a judgmental and inaccurate one on your part, just now. I responded to the OP's problem with people who lie that they have a way home after being anesthetized, and then don't. She wanted to know what others did about that. I ANSWERED her.


    What about the thousands you never see because they simply can't arrange it. I know people who have no family, and it's all well and good to say "get a friend" but how many friends do most people have who can or will take off work to drive a friend to a procedure.......
    You seem to be under the impression that it's my job to see how many other people who have difficulty arranging a ride we can possibly get in the door. I do not work for a hospital, but rather a private facility that specializes in endoscopy procedures, and we are packed with patients daily. I have to manage the safety of those we DO HAVE, not the ones who never schedule with us because of the many and varied difficulties of getting a ride.

    I believe that in the healthcare profession we need to meet people where they are, and try to find solutions for their health issues, not point to all the people who don't have those obstacles and say "why can't you be like them?" The fact is that lots of people are in situations too varied to name, which put them in a situation where they simply do not have anyone to take responsibility for them after a procedure. Several options have been floated here, and I think some of them (or some combination of them) would work. A hard-and-fast rule of "can't get someone to take care of you, reschedule - or just don't have - the procedure" does not address the patient's needs and situation.
    Again, you're being overly harsh, and I'm not sure why....none of the patients that come to our elective procedures facility HAD to be there. None of them had no other choice, which is what you imply when you go on and on about "needing to meet people where they are". There are two hospitals virtually within walking distance of my facility, and anyone in any dire straights could GO THERE. So yes, our "hard and fast rule" that our anesthesiologists--who put their licenses and expectation of lawsuits on the line--insist on IS reasonable.

    Not every healthcare facility, and not every healthcare provider, caters to those who have absolutely zero options. It's insulting that you take the tact that we don't address our patients needs and situation....the reality is, our patients DON'T drive stoned, they DON'T get injured or injure someone else by being discharged while under the influence of drugs. Seems to me we're very MUCH taking into consideration not only THEIR health but the health of others they might accidentally hurt if we just turned them loose.

    Many of our patients DO have difficult times getting rides, I know that for a fact. I ALSO know that they prefer the quality of care and the ease of our facility over other endoscopy centers AND the hospitals...so they manage, yes.

    Our GI docs, anesthesiologists and nurses work this way in this facility to AVOID the legal nightmare that the OP described. No thanks.

    By the way, when YOU eventually HAVE a license to lose, as I see you are still a student, perhaps you will view things differently. I hope, at least, you'd be far less judgmental of those who DO this job.
    Last edit by RNsRWe on Aug 30, '12 : Reason: afterthought
    Altra likes this.
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    Quote from HollywoodDiva
    At any of the facilities I work for they will not proceed to pre-op patient if they don't have a ride nor someone to take care of them at home. The facility had been sued before for a patient driving home after a procedure and causing an accident. Good rule is they need to have a ride after anesthesia and someone taking care of them afterwards.
    Exactly. A hundred times over.

    I certainly can't help patients if I've lost my license by discharging someone inappropriately or the facility I work in closed because of the financial loss in a suit.
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    Quote from NurseMikki
    I wish we could let patients leave by cab after simple procedures, but the local cab companies won't accept liability and refuse to take patients.

    I just feel like our hands are tied as healthcare providers trying to limit risk as well as make sure patients are safe.
    Agreed. And honestly I was shocked when the cabdrivers in both instances I described were willing to sign the line and take responsibility.....but, it turned out, these patients were also very regular customers of the cab company and so were "known" to the drivers. Considerations made for them, etc.

    In my shoes, right now, I'm keeping the patient I HAVE right now, TODAY, safe, as well as the strangers on the road who might be injured if they drove upon discharge.
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    Quote from RNsRWe
    Our policies at my endoscopy center (ASC) make it a non-issue, really.

    As for the other suggestions: no one would be willing to pay for a medical transport when they can get a friend/relative/co-worker for free, and that's the HUGE majority of our patient demographic. I realize it's not easy for everyone, but honestly, out of thousands of cases a year, they just manage to do it. Those TWO did not. And if someone does cancel because they have no ride, or WE cancel them for that reason, they FIND a ride and reschedule. No problem.
    You are fooling yourself. You say there is no problem, that it is a non-issue only because it is not a liability issue for you. It might be a MAJOR problem for your patients. How many people in your community need the procedure but are not scheduling it because they don't have a guaranteed ride home? You don't know. All you see are those people who have solved their problem in a way that satisfies your requirements. Alll the other people -- you are not seeing them -- and therefore you are not considering their needs.

    That's the problem! Health care systems are not considering the needs of people who can't arrange for their own rides home. That's a major problem for the patients. It just doesn't seem to bother you, personally. You don't seem to feel any sense of responsibility for making your services available to the general community. That's sad. It's a shame so many facilities and people within the health care system only care about problems that effect them personally -- and don't care about the health of their community.
    Last edit by llg on Aug 30, '12
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    Quote from llg
    You are fooling yourself. You say there is no problem, that it is a non-issue only because it is not a liability issue for you. It might be a MAJOR problem for your patients. How many people in your community need the procedure but are not scheduling it because they don't have a guaranteed ride home? You don't know. All you see are those people who have solved their problem in a way that satisfies your requirements. Alll the other people -- you are not seeing them -- and therefore you are not considering their needs.

    That's the problem! Health care systems are not considering the needs of people who can't arrange for their own rides home. That's a major problem for the patients. It just doesn't seem to bother you, personally.
    Not fooling myself at all. Did you read my follow-up post? The OP asked how other facilities handled this situation, AND I ANSWERED it. You just don't like the answer, which is that we limit our liability by limiting the patients who have this problem. The hospitals, as well as perhaps other centers, are either more willing to take them in or less inclined to "check". So, there you go with the people who can't get a ride: they just DON'T come HERE. Why do you think that SHOULD bother me....that they go somewhere else? And don't think they don't--news travels in a small community, believe me.

    A private facility is not a charity; we do not have to take in every single patient who ever wanted these ELECTIVE procedures. We consider very carefully the healthcare of those people who ARE our patients, by making sure they leave safely (see above posts).

    Interesting thing is, it's not like all our patients are rich. Far FAR FAR from it. Many are quite poor, and have Medicaid. They don't have a car. So what do they do? They grab a relative who also doesn't drive AND a taxi--which, btw, Medicaid pays for as a 'medical transport'--and here they come.

    What would bother me, personally, is if I had to sacrifice someone's physical safety. And with these policies in effect, I don't have to.

    It's interesting that no one questions why the MDs won't consider doing procedures/anesthetizing the patients who have no drive home.....and yes they are doing EXACTLY what I'm talking about: limiting liability, so THEY don't lose their shirts/license/medical practice and have their patients lose their doctor's care altogether.
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    Now we are getting to the real problem, which is access to health care for all Americans. Bottom line:MILLIONS of people in America do not have ready access to adequate health care, or ancillary health services. Some communities have ambulance cabs that transport patients home cheaper than an ambulance--used quite a bit for patients such as hip replacement. We, as nurses, cannot solve that problem. Politicians can solve the problem. Google "Physicians for a National Health Care Program."

    At this time I live and work in Germany. The Deutsches Rotes Kreuz has different levels of ambulance service, from simple transport to extreme trauma. In serious situations the notaerzt, or emergency physician is dispatched to the scene. All citizens have basic health care from the government. In addition, people can purchase additional health care insurance is desired. Bottom line, again: Everyone has basic access.

    We, as individual nurses, and our affiliated organizations, surgery centers, clinics, hospitals etc. have to protect ourselves from litigation (another national problem) or we will be out of work/business. We, as individuals, do not have the resources to do everything for everyone.

    Your voices are heard--but not by the people who can change health care in America.
    Altra and RNsRWe like this.
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    trufflelilyRN, you hit the nail on the head. Bang.


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