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?
I agree with canoehead. My recommendation would not to even let him leave the triage room. As VS are being obtained, have the doc come do an MSE (medical screening exam), then boot him out the door. THen if he does not leave, have cops escort him out for "loitering".
Although I work for a very busy ER, we will have a provider in triage within the next year for MSEs and quick stuff.
Plus, EMTALA guidelines are purposely vague. This allows the powers-that-be to fine even when you thought you were following the law. Proceed with caution, here. How do I know- our facility received 3 EMTALA violations and fines within 18 months. All it takes is this clown calling the state's dept. of health and human services. THey may not believe that assessment by an RN constitutes an MSE, depends on the day, really.
Just hoping someone else can learn from our mistakes. Best of luck to you. I love how these FF can monopolize resources intended for sick people.
Thank you all for your suggestions. I believe all the gas stations/coffee shops have served him with a restraining order. Unfortunately we are the only business in town that can't quite do that. He hasn't paid us a visit for a week, knocking on wood that we are not blessed with his company tonight.
I feel like the situation escalated today! He was seen 7 times in a 12 hour period! Our mental health FINALLY stepped in and he was taken into police custody to be evaluated by mental health and placed in to some kind of treatment. I doubt they got him placed anywhere b/c I've never seen them get any of our patients placed into any kinda of treatment. I don't believe any sane person would come to the Emergency room 7 times in a row just for a cough/cold.
cookienay
197 Posts
I agree with canoehead. My recommendation would not to even let him leave the triage room. As VS are being obtained, have the doc come do an MSE (medical screening exam), then boot him out the door. THen if he does not leave, have cops escort him out for "loitering".
Although I work for a very busy ER, we will have a provider in triage within the next year for MSEs and quick stuff.
Plus, EMTALA guidelines are purposely vague. This allows the powers-that-be to fine even when you thought you were following the law. Proceed with caution, here. How do I know- our facility received 3 EMTALA violations and fines within 18 months. All it takes is this clown calling the state's dept. of health and human services. THey may not believe that assessment by an RN constitutes an MSE, depends on the day, really.
Just hoping someone else can learn from our mistakes. Best of luck to you. I love how these FF can monopolize resources intended for sick people.