Patient is inpatient in an acute care facility due to dialysis non-compliance. Patient had to have security called during admission due to behavior. Patient is verbally abusive to staff and threatens lawsuits any time he doesn't get his way. Patient is to be discharged but claims he will file a lawsuit if discharged without a perm cath for dialysis, he says it hurts when they dialysis through a newly matured fistula. Doctors schedule the placement for the following evening, with orders for him to dialyze and be discharged.
Orders are carried out, patient discharge is completed within 15 minutes of returning to floor. Patient gets ready to go, taxi is called. Patient calls out that he needs his nurse, nurse responds and patient states that he can't leave because no one is at the house he stays at and he won't just sit out in the cold all night.
This is actually quite common in our facility, patients are discharged and we even pay for their cab home but then they refuse to leave. Typically, the patient is put in the cab and sent on their way, even if it is to a homeless shelter. Sometimes security has to be called to escort the patient to the cab.
There are a few things that make this a more ethical dilemma. The discharge is at 2200 on a very cold night. The patient is blind. Patient has been walking up and down the hall on his own and going outside to smoke. Patient is receiving IV pain medication and gets very upset when it is not given when he asks for it, even after being told that he can have it at 00:00.
Do you ask the doctor to allow the patient to stay another night even though there is no medical necessity? If so, do you put stipulations such as no IV pain medication?
Do you call the cab and send him on his way to wherever he wants to go?
