EMTALA LAWS protecting patient

[nkochrn, RN]

I am SOOO ready to find another job right now, I am absolutely DREADING going back to work again tonight and all because of ONE patient!

We have a 29 y/o patient who comes in frequently, several times a week, sometimes several times a day. He has anything you can think of: Chest Pain, Dizzy, Fingers Numb, stomach pain, back, neck, jaw pain, short of breath. I'm sure he's had some other complaints too. The doctors will no longer see him at the clinic. He doesn't want drugs and refuses to take any medicine given to him. He has had every kind of test imaginable including a cardiac cath. He swears he's been sick for 7 months and he's tired of nobody figuring out what his problem is. He has been seen by our local mental health people who won't do anything b/c they don't think he's a danger to himself or others. Our social worker has contacted another mental health place and not heard back yet. We always have a cop in the building when he comes b/c we don't feel safe though, ecspecially at night when there's only 3 of us in the building.

So 2 nights in a row he has decided to come in, we do our exam and call the Dr. who says it's not an emergency and they are NOT going to come in to see the guy. He throws a fit does a little yelling the first time and decides he's going to keep leaving and coming back. He will leave drive a block away and turn around and come right back. We do the whole thing over again. We saw him 3 times in ER tonight from 2am-4am. It is soooo frustrating b/c there seems to be NOTHING we can do about it. Has anyone ever had any experience with something like this?

[ohmeowzer RN, RN]

yes i know of patients like that. we had a patient on the med/ surg floor , he is homeless with nothing wrong ( c/o chest pain to be admitted). he's refuses all treatment , order big meals , complian about the food , slept unitl noon , get his dilauded, then scream about the care he recieved. he would leave AMA and then go right down to the ER and do it all over again . he would be admitted and here we go again.

there's nothing we can do , the ER just kept treating him, admitting him because he c/o chest pain and it's still going on. you can't refuse to treat someone. i dread to see that dirty old ungrateful man on the unit.

i don't know what to tell you , but i'm not sure there's much you can do. hopefully other people will have some ideas.

[nkochrn, RN]

I know there's nothing we can do, it is just so frustrating! This guy just thinks he's going to find some reason to sue us and make a bunch of money. There is no reason he couldn't work, except it's a small town and everyone knows he's a thief. He was caught on camera stealing something at a gas station. Anybody that knows anything about him is not going to hire him.

[Batman24]

Document, document, document whenever he is in your care. That's the best thing you can do to protect yourself. And I would take a witness into the room with you. All of you should do that if you don't feel safe. Protect yourselves.

[canoehead, BSN, RN]

The physician has to assess them, but there is no law that says they can't do it from across the room.

Once the doc sees them and says they do not have an emergent condition you can call the cops and charge them with abusing emergency services.

Don't feed them, or give them warm blankets, and bring your NM on board with the plan. They are eating up hospital resources. Make up a nursing care plan, and consistently make the ER the least fun place possible and put them in a room away from all the entertaining action. Confine them to the room, with a security guard as necessary. We are legally obligated to treat emergencies as defined by the physician, not the patient. If they aren't dying, and don't cooperate with the limit setting they aren't cooperating with the treatment plan, boot them out.

[nkochrn, RN]

According to our hospital attorney the EMTALA law states that he has to be assessed by an RN and reported to the physician. She has said the Dr. doesn't HAVE to come see him. Makes it a pain for us having to actually deal with him.

We are a rural hospital so there's not always a lot of action in our ER, most of the time he's the only one there when this happens. If there are other ERs I make him sit and wait in the waiting room after hearing his complaint b/c it is not ever an emergency. Our cops don't seem to know what they can do with him and each one of them thinks something different. Our resources are pretty worthless with this deal.

[nkochrn, RN]

Does anyone know where I can find more information about charging people with abusing emergency services?

Apparently this guy made some money off a settlement dealing with a car and is getting strapped for cash again, so is trying to find another lawsuit through the hospital.

[JBudd, MSN]

Your hospital attourney should be looking into that. The other places I can think of would be the state attourney general's office, or the local DA.

When one of our FFs got that bad over a couple of days, the doc wouldn't even see him in a room, walked in with EMS, stood at the desk, was determined to be okay and escorted out. If he is declared non-emergent, and comes back onto the property you can have him arrested for trespass.

That thing about the MD not coming in though, the research I did on EMTALA said clearance had to be an NP or MD, not an RN. That's why we can't refuse them in triage.

[bjaeram]

I believe you can refuse for him to enter the hospital. I know when I was fairly new to our ER they did that to a patient. He was no longer allowed in the hospital under any circumstances. I don't know how they legally went about that. We do have other hospitals in the city that the person could go to.

I would contact your hosptials attorney's and have them figure something out.

[nkochrn, RN]

The hospital attorney has been working on this for months now, but can't find any way to get rid of him. We are the only hospital in town, the closest one to us is 15 minutes away. pt. no longer has a vehicle and borrows a friends. He is being assessed, leaving and returning to be assessed again. We have been told we HAVE to see assess him EVERY time.

ETA: The hospital has also contacted the DA. I believe this has more to do with the fact that mental health won't come to see him and they are run by the county.

[canoehead, BSN, RN]

The physician needs to see him every time, and assess him to his(the doc's) satisfaction. If through a window is to the doc's satisfaction then the patient is on his way much sooner. If the patient walks into triage, gets vitals, glimpses a doc from 10 feet away, and then is unceremoniously escorted off the property his day will get quite boring. Do not engage. No conversation, no food, no TV, no bathroom, if you can move fast enough. (If you don't feed him or let him sit down he'll have to take meal and pee breaks between visits.) The patient will try to push your buttons, get some drama, but you are a blank wall with a chart. Communicate the Zen of your experience with the security guards, and take bets as to who gets the shortest LOS among your colleagues. First triaging that results in 24h without your FF arriving back on scene gets a spa day. Start a pool with a $10 entry fee.

The hospital attorney should be coming up with solutions for you, but he's not. The hourly FF is there for entertainment, not health. Bore them to death, and they'll start annoying the local coffee shop, and THEN the cops can take him away.

[heron, ASN, RN]

If anyone has the time and expertise, try calculating the cost of each nonsense visit and dropping a summary of, say, a weeks' worth of visits on the desk of the administrator. Might light a few fires.