Need Help FAST Please. RE: Inappropriate discharge

Nurses General Nursing

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Hello friends

I need some serious help here....

I have a serius and ethic delemia to figure out fast.

I have an ethical delemia and need some good advice. In my 120 bed LTC facility (I am a DON) I was MANDATED and instructed by my corporate office that I MUST discharge a lady to the hospital tody...because she owes 56, 000to the facility. Ok.. I ordered stat labs, to include a CBC, BMP, UA, dig level and an EKG.. (in hopes to find a reason to send her out.. tests were uneventful.. EKG Sinus brady with S-T elevations and HR 57, labs good except for low dig level at 0.53 (has no meds for a week, pharmacy cut off her orders because she owes them 10,000, the CBC - RBC is a little low at 3.56 (I asked if the doc could admit for anemia)

Long story short: MD ran a bunch of tests probably did a 10,000 work up. and NO DICE>. She has nothing that warrents a hospital stay.

Primary MD was willing to do a direct admit as long if something justified could be found.. well, 7 hours later she is ready to come back:

I have a direct order from corporate that she is NOT to return back under no circumstances. but there is no case for an admit. In fact she is alert and keeps telling the ER that "I have nothing wrong with me" I asked if she could stay because of the finacial debt, they said it is not their problem (understandable) Now if I bring her back, I, the DON and the administrator get fired..:angryfire

I have to go with my gut feelings on this and do what is ethically correct, I do not want to be facing the board of nursing for failure to take her back from an unneccessary ER send out.

Choices:

1) do not take her back per corporate mandate and face AHCA tomorrow with a possible big fine and a big tag, and possibly have personal charges brought against me by the board of nursing

2) accept her, and face getting fired tomorrow for allowing her to return to the faciltiy.

I want to call the hospital and have her sent back because it is the ethical and legal thing to do, regardless if I get canned tomorrow..

What are your thoughts on this. We are under Florida laws.

Thanks in advance to anyone who can offer help.

Wow..this may sound off-key, but this is truly what I would call an "ER dump" patient... The patient was sent to the ER basically for the LTC to wash their hands and intentionally not accept the patient back into their facility. I've never before seen such an out-right false transfer of an LTC patient such as this. Labs were done, showing no true need for Emergency Services, yet the patient was transferred...were they transferred via EMS (without medical justification)? This would mean a) an EMS unit was taken out of service for a non-essential transfer when it could have been needed for a medical emergency, b) an ER bed was utilized as well as medical services that weren't needed, c) an inpatient bed was probably taken that could have been used for someone else with medical needs, and c) we've just created even more debt for this patient that wasn't needed, won't be paid by the patient, and will be paid for by the tax-payors. Sigh..

Sorry, I'll get off my soap box now, but this burns me. I hope you did the right thing.

Jen911

Specializes in Emergency.

I have been on the receiving end (the ER) of patients like this. After we have have done a $10,000 - $20,000 work up (yes, that's what it will cost if you do multiple CTs, a VQ scan, a Doppler study, plus the routine labs and x-rays, sequential EKGs, etc.), and cannot find a reason to admit the patient, I have been told by the nursing home that they will not accept the patient back. No one has actually told me that it was related to financial reasons; they will usually say that they don't think it is "appropriate" to return the patient to the nursing home.

This is my response: There is not a medical reason to admit this patient to the hospital He will be returning to his home - your nursing home. That is where he lives. If you refuse to let him come back to his home, I will report your facility to JCAHO and the state and you personally to the BON.

I actually have to make this speech every couple of months. So far, it has been effective. But one day it won't. On that day, I will report that facility and that nurse to everyone that I legally can.

I am a night shift supervisor in LTC in Florida. If the hospital won't admit her, I believe you must take her back. Social services needs to step in and get busy. When she comes back, she has to have her meds or she WILL go to the ER with CHF soon and then who will be held accountable? The facility will have to pay for them until arrangements are made for medicaid or she finds an alternative place to live. I do not understand your corporate office. I think I would take her back because you know it's the right thing to do and then, with a clear conscience, deal with what comes next. Like someone else said, there are plenty of nursing jobs out there, but not for you if you don't have a license. Good luck! I hope it works out.

i don't know Fl laws. In NY, this is called patient dumping. I thought this was a FEDERAL law, where fines of up to $25,000 are levied against facilities that do this.

consider posting this in the ER thread, unfortunately, this is common, especially in the holidays so staff can have off, or family gets a break:angryfire

Call your hospitals licensing agency and report this, better a whistle blower than an active party, call your state boards for advice if in fear of any decision that would be viewed detrimental. If your JCAHO certified, call them for help. Start calling, speak to your family and find a way to get out.

This is unethical immoral and inhumane. Our elderly are disposable:angryfire , this patient needs an advocate, I hope your family situation allows to to be one. Please report back... we all need to know what to do about this. I'd love to tell you what to do...... but it's safe and easy to judge from my end so it's not the same.

If she has resources and her POA is not paying the bill, this is neglect and needs to be dealt with in that way.

If she has no resources, your social worker should have been on it like a frog on a bug before it got this bad, because Medicaid will pay for nursing home care, even it if is not rehab, for someone on Medicaid (I believe the assumption is that we do not want poor sick people homeless).

If she is being deprived of needed medical care because she cannot pay, this is a job for your Board of Health. They take anonymous tips. They will come in fast--I reported a poor soul who was neglected beyond belief in a veteran's home. The state agency was appalled, took my complaint (I gave my name on the condition it never be released and they kept their word). When I finished, they said they'd be out there within a month. I said, he's a hospice patient, end stage dementia, he won't last that long. They were there the next morning (probably would have anyway, it was a sick, sick situation!). The result? The DON who allowed this left the agency, the hall he was on got a good going over and no longer deserves (as much) the moniker of "worst hall" in their facility, and my patient died clean and peacefully when his time came.

There are government agencies to whom you can turn. We pay them to do a job. They cannot do it without us letting them know about situations like these.

Good luck to you. Do something--anything. You'll feel good for a very good reason.

Specializes in ED.

I'm sorry to ask this (I'm a year into med/surg), but what is an "ombudsman"?

If it were me, I would gladly take the firing over the losing of a liscence and mistreatment of a patient. LTC is a buisness but we are patient advocates first right?

I'm sorry to ask this (I'm a year into med/surg), but what is an "ombudsman"?
An ombudsman is an advocate to whom you can go with disagreements, dilemmas, like that, and they are supposed to help things be done the right way.

I think we should all take a deep breath here and see that this DON has been put into a bad situation, was pressured to do this but knows it was wrong and is now trying to do the right thing and has come to us for advice. I applaud your honesty in coming forward with your situation. We all need to see the truth about what is going on here so we can learn from each other, stand up to coorporate bullies and be the best patient advocates we can be.

I'd have replied "Would you please put that in writing and fax it to me?"

I hope she's keeping a good journal on all this.

I don't see why YOU as the DON are on the hot seat. This should be the problem of your gutless Administrator/facility owner, who, BTW, should burn in hell for all eternity for being so greedy.

Just an aside - I say more power to this woman, who apparently is doing as well without all those poisons (meds) as she ever did with them.

I don't really know what you should do except cover your behind. DO NOT jeopardize your own license, under any circumstances. You need to be able to live with yourself, too, so do the right thing.

How did this case ever get to this point? Is there no social worker/discharge planner? Whose job was it to keep an eye on financial matters? That person should be getting on the phone and locating a new home for this woman.

And this is, again, another reason that America needs insurance for all, health care from cradle to grave for all. I hope no one here thinks that there is any way that this is right and proper - this poor old woman has to be gotten rid of because she's broke and your license and livelihood are on the line because of the money mess. Are the low castes in India any worse off than the poor in this country? Reading this, I'd say not.

I really think you should send this post to your Senators. They need to know what life is like for the masses. This type of horror could happen to any of us. No real answers but I wish you good luck.

Oh, maybe you should just quit and not give them a chance to fire you. It would serve them right, the greedy mongrels. What runs through their veins - ice water?

Specializes in Emergency.

BTW, it is illegal to fire an employee for refusing to engage in illegal activity/break the law. This falls under federal law and is considered discrimination. Just google search the following: terminate employee "refusing to break the law". Also, if you contacted the state to get involved in this matter or filed a report, you cannot be terminated if your claims were made in good faith. This is called retaliation.

You actually have the upper hand in this situation. Don't let their threats intimidate you.

I think you know what you need to do. Obviously, if you were going to go through with management's request you wouldn't be here looking for advice.

Specializes in ED, critical care, flight nursing, legal.
I'd have replied "Would you please put that in writing and fax it to me?"

I hope she's keeping a good journal on all this.

Get everything in writing and request something from the Corporate Counsel (the facilities attorney) noting that he is aware of the requests from administration and the instructions to perform unnecessary testing to try an effect a transfer. I presume, but am not certain, that the actions requested by the administration to get her out and then not accept her back to your facility are illegal, and once the attorney is made aware of those requests, he will be forced to recommend against it or face possible malpractice charges and/or sactions from the state Bar Association.

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