ASSEDO 201 Posts Nov 27, 2007 Interesting topics. I see over-utilization more than under-utilization. Sometimes a decision needs to be made to pull the vent, instead of letting a patient rot on the vent. The outcome would be the same, only quicker.As far as low income, I see families in all walks of life making weird decisions. Today an elder lady was dumped at our ER as the family wanted her to go to a nursing home. The hospital could not admit her, because she did not meet medical necessity to be inpatient. Family didn't want her because of dementia. Family refused to pay for a sitter.