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House Dr. doesn't allow hospice in facility



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Aug 21, 2009 09:26 PM

House Dr. doesn't allow hospice in facility

by KY RN

I'm new to geriatrics so I need some help. I have a patient who is end-stage COPD and end stage pancreatic cancer. She is in horrible pain all the time and our house Dr. is not managing her well with her meds. He states that he doesn't want to give more pain meds because it will rush her death. Ok, what the h*ll!!! She is in crying out all the time. I suggested maybe a hospice consult. He got very angry with me and said,"If I call in hospice on all my dying pts., I wouldn't have any patients left. It's better to keep them around so I can get reimbursed. Hospice is NEVER allowed in this facility and with my patients." I don't know what to do. I want to be a patient advocate but I also don't know if this is a normal attitude in a SNF. What would you do for your patient, who is not having an easy death?

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12 Comments
No. 1
from arelle68
Old Aug 21, 2009, 09:50 PM
Updated Aug 21, 2009 at 09:57 PM by arelle68

Default Re: House Dr. doesn't allow hospice in facility
That is really quite an astonishing attitude that doctor has, I must say. It sounds like he cares more about getting reimbursed than about his patients suffering. At my LTC, us nurses are trained to do the hospice care. We call and get the comfort measure orders. The doctors are always very compassionate, and give us what our patients need. (Roxinal 5mg SL or SVN q4 hours PRN pain, Ativan 1mg q6 hours PRN anxiety or agitation , and acetaminophen supps q 6h PRN for pain or fever >100.) If I were in your situation, I don't know what I would do. For sure, I would do something. I would be honor-bound to do something to help these suffering patients, up to and including reporting this to the state, and to the AMA.
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No. 2
from dosamigos76
Old Aug 21, 2009, 10:28 PM

Default Re: House Dr. doesn't allow hospice in facility
Pancreatic CA is painful!!! I have actually seen palliative sedation have to be used for a case because of the pain. Please, oh please advocate for your patient. Is there family available? Hospice is an entitlement, not a privilege. I wish you the best!
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No. 3
from HeartsOpenWide
Old Aug 21, 2009, 10:50 PM

Default Re: House Dr. doesn't allow hospice in facility
Report him to the medical board.
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No. 4
from BA2009
Old Aug 22, 2009, 12:00 AM

Default Re: House Dr. doesn't allow hospice in facility
If he really said "It's better to keep them around so I can get reimbursed." then report him. But that sounds pretty fishy to me that anyone would openly say something like that. Its one of those things I read and think.... Maybe the poster is reading into what the Dr. said when he didn't really use those exact words outloud.
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No. 5
from KY RN
Old Aug 22, 2009, 03:18 AM

Default Re: House Dr. doesn't allow hospice in facility
He did use those exact words. I'm not exaggerating what he said or reading into anything. That is why I don't know what to do for this patient. She just cries and moans all the time. She does not eat or talk. I just feel it is such a horrible death.
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No. 6
from crissrn27
Old Aug 22, 2009, 07:03 AM

Default Re: House Dr. doesn't allow hospice in facility
At this point your MD isn't meeting the pts needs and you need to go up your chain of command to report this, ASAP. Is this fool your medical director? If he isn't, give the director a call and ask for appropriate pain control for your pt. Your supervisor, DON, admin. needs to know of the situation and they don't need to sit on it for a week. Something needs to be done to get the pt out of pain now.
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No. 7
from GloryB
Old Aug 22, 2009, 09:00 AM

Default Re: House Dr. doesn't allow hospice in facility
You need to contact a family member as well as iwell as the director of your SNF right away! As a hospice RN I deal with pain and death on a daily basis, and firmly believe that no one should have to die in pain. ADVOCATE!!
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No. 8
from tencat
Old Aug 22, 2009, 09:06 AM

Default Re: House Dr. doesn't allow hospice in facility
Does your state have an ombudsman for LTC facilities? In addition to taking this to higher-ups, go to the ombudsman. And report him to the state medical board.
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No. 9
from geriNurse1
Old Aug 22, 2009, 09:30 AM

Heart Broken Re: House Dr. doesn't allow hospice in facility
Definitely, report him!! Hospice is a great thing for the patients, family and the staff of the facility. This Dr. should not be practicing if he has that attitude! Be the patients advocate.
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