Ethics

[mstere]

Just want to know what your opinion is on this...

A patient is admitted, states he is an illegal alien, has no insurance. The physician declines to call in a consult for this patient's health issue. The social worker tells the patient in frustration that he needs to learn English. The nurse has a legal, moral, and ethical duty to the organization and to the patient. What would you do?

[klone, MSN, RN]

Is this for school/homework?

What do *you* think is the nurse's legal, moral and ethical obligations to the hospital and the patient?

[mstere]

This actually happened to me. Now, looking back on it I realize there should have been more that I could have done. The ANA states my commitment is to the patient. I am not sure what the laws are in regard to this. Also, i was not aware of what power I had convince a physician to do something he was already unwilling to do. Maybe, I could have asked a manager, or someone in ethics at the time. In retrospect, I feel there is always something a nurse can do to help the patient and advocate. Just want to know what your opinion is on how you may have handled. Thanks.

[klone, MSN, RN]

What was the health issue that the physician refused to refer for? What was the scenario?

I work for a "safety net" hospital network where 95% of our patient population is either uninsured or on Medicaid/Medicare. So I have many opinions, but I need to know more context.

[Cuddleswithpuddles]

Could the doctor have refused the consult to reduce the cost for the patient? As far as I understand, consults are a judgment call and not an obligation to the patient unless the patient's condition was grossly mismanaged by a primary MD overextending his/her capabilities. I know some doctors who prefer not to call for consults for more straightforward cases. Not every infection requires an infectious disease consult, not every incidence of uncontrolled HTN and blood sugar require cardiologists or endocrinologists etc.

[ChristineN, BSN, RN]

I work in an area of the country where there is a high immigrant population, and have taken care of many pts that are here illegally. They should be getting the same medical care as pts that are US citizens that have health insurance. Most pts are not willing to tell you they are illegal, because they are worried about substandard care or being deported. I can't help but wonder if there is more to this story, as no doctor would refuse a consult for that reason.

I wanted to add, with my uninsured pts I am good about referring them to free local clinics, including knowing of free clinics for speciality services like GYN. My units keeps handouts for local free health services, so it might not be a bad idea to educate yourself on the local options for your pts.

[Altra, BSN, RN]

In terms of the physician's treatment plan, it accomplishes nothing to consult, make referrals, or otherwise suggest things that the patient does not have the ability to do. In simple terms: "go see this specialist to continue care" could well be "unethical" if it is known that the patient does not have the ability to make appointments, arrange transportation, or meet requirements for financial payment arrangements.

Some health care providers/organizations operate in areas where there are multiple resources to address such barriers to care. Others simply do not have access to those resources.

Obviously I know nothing of the details of the situation with this particular patient, but I encourage you to consider the above, before deciding that there was unethical behavior on anyone's part.

[TriciaJ, RN]

Does your hospital have a patient advocate or an ethics committee? Or even a risk management department? If you are really concerned that a patient is receiving substandard care, those might be useful avenues to pursue.

[KelRN215, BSN, RN]

Did the MD decline to call a consult BECAUSE the patient was undocumented? Because I'm not getting that from your post. Perhaps a consult really was unwarranted.

The Social Worker's comment was unnecessary.

[sapphire18]

"You need to learn English"? Really??

Last time I checked there was no official language for our country...what an awful thing to say...while it may help them to learn some English, it is our responsibility to obtain a translator whether it be in person or via phone, internet, whatever. Completely unprofessional on the SW's part. K sorry I know that was not the point of the thread but this one just hit a nerve. Was this an inpatient situation?

[KelRN215, BSN, RN]

"You need to learn English"? Really??

Last time I checked there was no official language for our country...what an awful thing to say...while it may help them to learn some English, it is our responsibility to obtain a translator whether it be in person or via phone, internet, whatever. Completely unprofessional on the SW's part. K sorry I know that was not the point of the thread but this one just hit a nerve. Was this an inpatient situation?

Any time someone makes a comment about how people should need to learn English to live in the US, I ask them what our official language is. The vast majority of people I ask this do not know that there is no official language of The United States of America.

[Here.I.Stand, BSN, RN]

I'd remind the SW that while her suggestion may be in his best interest, it's not going to happen during this hospitalization. Then call the interpreter. We actually use ours a lot even if the pt does speak English as a 2nd language quite well, but not fluently enough to have a medical conversation.

Can I ask what consult the pt needs? Is it possible that the primary provider is able to manage it him/herself?