delemma in the ER..what would you do?

Noney · Oct 29, 2003

Talk to your NM.

The biggest thing you need to decide is: if you don't go to the ethics committee is it going to bother later? Can you live with not acting on this? How many problems do you think acting on it may cause you? Are you thick skinned enough to handle any backlash?

You said other people involved in the code are willing to back you. Do you trust them? The fact that they offered makes it sounds like they were bother by the incident thierselves.

Good luck with whatever you decide to do. Keep us updated.

Noney :)

jemb · Oct 29, 2003

1) Complete an incident/unusual occurance report, complete with quotes, names of witnesses, etc.

2) Submit a cordial letter (not in complaint mode) to your ethics committee. Outline your concerns about the "possibility" that patients are being used for MD's to practice certain skills that are not necessary for the particular patient, and without the knowledge or consent of the patient or family. Use the example of the patient in your post. Do not name the doctor -- this will be discovered when the ethics committee looks at the patients records. Be sure to mention that the patient or insurance is being billed for these unnecessary procedures.

3) If you get no results from the ethics committee, contact your local media source --newspaper or tv station news. You won't be able to give them names and specifics ( remember our friend HIPAA?), but approach them with the concept of 'patients being subjected to unnecessary procedures without their consent for the benefit of the physician', and that the patients and their insurance carriers are being billed for these procedures. ( Of course, if you work in a teaching hospital, implied consent may apply.)

I understand that you're concerned about creating hard feelings with the other docs, but , as you said to him, if it were your family member...

If the other docs are decent people, they will not regard your concern as "turning in the other doc". If they are not decent people, then why should you care what they think of you?

Who knows, you may even stop one of the other docs from trying that stupid stunt at another time? Sometimes peole only do what they think they can get away with.

BTW, many years ago, I worked in a teaching hospital. I thought he hour long codes were disgusting, but it was a teaching hospital and that's how they learned.

Isn't that where the term "practicing medicine" came from?

stevierae · Oct 29, 2003

Originally posted by 2muchfun
I About an hour after this happened he apologized to me, but he still doesn't think he did anything wrong as far as the code situation. I told him if that were my family member and I found out what he was doing, I would sue him. YIP, looked him straight in the eye and said it. He was nice the rest of the shift, but I still wanted to twist his balls off.

I just don't know I will do next... what would you do?

Good for you for putting tha prima donna resident in his place.

Yeah, he apologized and was nice after thinking about it for a while, because he knows you've got him by the cochones for making an inane comment like that--"We're PRACTICING, OK?" Jesus, how would he feel if that was HIS grandmother? How does he think HER family would have reacted, had they overheard him?

Go to the ethics committee and tell 'em everything you saw and heard. What he did was way out of line. The attending ER doc might not back you publicly--these good ol' boys clubs are everywhere--but I'll bet he will when he is called to task by the ethics committee for allowing this on his watch.

Are you saying she was down and without CPR for 40 minutes before it was intitiated in your ER? Did he really think there was any hope of successful resucitation, that is, a non-brain damaged or even living patient, under those circumstances?

vossy · Oct 29, 2003

first of all, congratulations on acting the way you did. So many nurses take this crap and stay there, only to complain later. You took a stand. But it must feel bad, that your action wasn't enough to stop this dr. I don't know about the culture in your hospital, but I think a second conversation with this guy is important. Tell him preciesly why you where mad, like you did to us. Let him know that you are shocked and worried about ethics and ask him to spell out exactly why he did and how he would handle it in the future. If this conversation is not goimg to satisfy you, if he gives all the wrong answers, the ethics committee sounds like a good idea. Before hand I would ask (non hostile) other dr's how they see this. If you go ahead with a formal complaint, do it after you talked about it at lenght. Don't be emotional, this will backfire.

Most of all I wish you good luck, judging from youre story, you really don't need my advise, you know what to do. Take care!

2muchfun · Oct 29, 2003

I sincerely appreciate all the replies. As for the length of time this resident was down, that is questionable since she was A&O at the ECF at the time of the report call, about 40 min prior to arrival. I would like to think that she hadn't coded at the ECf and neither the facility staff nor the squad didn't respond, although...she arrived in arrest and the squad was just rolling her on into a regular bed when our nurse noticed she looked "strange" and got a closer look and said, "I don't think she's breathing." Squad says, "Uh, yeah, don't guess so." Well that's another delemma I guess. Anyway, I missed about the first five minutes of the code, it was in progress when I walked in.

The attending that night is one of my favorites, I don't think he even knows what went on unless Dr. Wacko told him, I doubt it. I want to make sure I don't make anyone look bad who might need a heads up before the ethics committee gets hold of this. I plan to talk to my NM, and I think she is out of town this week.

Thanks again for the replies and support.

Katnip, RN · Oct 29, 2003

Besides the "practicing", and I know it's done, but not in a situation like this, I'm curious to know why the ambo crew didn't notice that she was dead? Or why they didn't do anything about it?

itsme · Oct 29, 2003

Full codes in long term care..... It sometimes amazes me which residents are full code. It seems like no one wants to educate the family, alot honestly think that CPR will make gramma "all better" again. I wish there was a video they could watch of a full code in progress on a 90# little lady with alzheimers. Full with sound, so they could hear the ribs crack. I dont mean to sound gross with that or not compassionate, it is my compassion for these old people that m akes me think like this. I would never want to go thru that as an old lady, adn I am sure if people realized what it entails, they would not want there loved one to go tru it either.

2muchfun · Oct 29, 2003

This was one on those situations where the pt had only been admitted to the ECF for aprx 24 hrs. I remember from the telephone incomming report that her medical hx really wasn't ll that bad for a late 80's pt. I fully understand initiating the code. However, most docs, after a couple rounds of meds and defib, would have probably approached the family, while staff continues CPR, advised them of her status and prognosis before making all-out efforts. This happens a lot in these circumstances and the docs are very good at directing the families to make the humane decision.

ceecel.dee, MSN, RN · Oct 30, 2003

You did absolutely, undeniably, the RIGHT thing!

Be sure you are heard by the ethics committee.

Be very careful about patient encounters under his direction of his orders are not WRITTEN.

P_RN, ADN, RN · Oct 30, 2003

You are absolutely right...no question. After you report to your NM and she goes with you to the ethics board, I think you should also notify the Medical Board of your state and the Nursing Board also. JCAHO would LOVE to find out this.

fab4fan · Oct 30, 2003

I wonder if this resident would have been willing to care for the woman if he'd brought her back in a PVS?

Good for you for having the moxie to take this to the ethics committee!