House Dr. doesn't allow hospice in facility

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Specializes in Med-Surg/home health/pacu/cardiac icu.

I'm new to geriatrics so I need some help. I have a patient who is end-stage COPD and end stage pancreatic cancer. She is in horrible pain all the time and our house Dr. is not managing her well with her meds. He states that he doesn't want to give more pain meds because it will rush her death. Ok, what the h*ll!!! She is in crying out all the time. I suggested maybe a hospice consult. He got very angry with me and said,"If I call in hospice on all my dying pts., I wouldn't have any patients left. It's better to keep them around so I can get reimbursed. Hospice is NEVER allowed in this facility and with my patients." I don't know what to do. I want to be a patient advocate but I also don't know if this is a normal attitude in a SNF. What would you do for your patient, who is not having an easy death?

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Specializes in Mental and Behavioral Health.

That is really quite an astonishing attitude that doctor has, I must say. It sounds like he cares more about getting reimbursed than about his patients suffering. At my LTC, us nurses are trained to do the hospice care. We call and get the comfort measure orders. The doctors are always very compassionate, and give us what our patients need. (Roxinal 5mg SL or SVN q4 hours PRN pain, Ativan 1mg q6 hours PRN anxiety or agitation , and acetaminophen supps q 6h PRN for pain or fever >100.) If I were in your situation, I don't know what I would do. For sure, I would do something. I would be honor-bound to do something to help these suffering patients, up to and including reporting this to the state, and to the AMA.

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Specializes in Hospice.

Pancreatic CA is painful!!! I have actually seen palliative sedation have to be used for a case because of the pain. Please, oh please advocate for your patient. Is there family available? Hospice is an entitlement, not a privilege. I wish you the best!

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Specializes in Ante-Intra-Postpartum, Post Gyne.

Report him to the medical board.

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If he really said "It's better to keep them around so I can get reimbursed." then report him. But that sounds pretty fishy to me that anyone would openly say something like that. Its one of those things I read and think.... Maybe the poster is reading into what the Dr. said when he didn't really use those exact words outloud.

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Specializes in Med-Surg/home health/pacu/cardiac icu.

He did use those exact words. I'm not exaggerating what he said or reading into anything. That is why I don't know what to do for this patient. She just cries and moans all the time. She does not eat or talk. I just feel it is such a horrible death.

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Specializes in nursery, L and D.

At this point your MD isn't meeting the pts needs and you need to go up your chain of command to report this, ASAP. Is this fool your medical director? If he isn't, give the director a call and ask for appropriate pain control for your pt. Your supervisor, DON, admin. needs to know of the situation and they don't need to sit on it for a week. Something needs to be done to get the pt out of pain now.

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Specializes in Hospice/palliative care.

You need to contact a family member as well as iwell as the director of your SNF right away! As a hospice RN I deal with pain and death on a daily basis, and firmly believe that no one should have to die in pain. ADVOCATE!!

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Does your state have an ombudsman for LTC facilities? In addition to taking this to higher-ups, go to the ombudsman. And report him to the state medical board.

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Specializes in Med-Surg, ICU, ER, Geriatrics.

Definitely, report him!! Hospice is a great thing for the patients, family and the staff of the facility. This Dr. should not be practicing if he has that attitude! Be the patients advocate.

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Does your state have an ombudsman for LTC facilities? In addition to taking this to higher-ups, go to the ombudsman. And report him to the state medical board.

I would first go to the hospital administration, this is a patient advocacy issue and should be addressed by them along with encouraging the family to ask for hospice consult and notifying the ombudsman. http://www.ltcombudsman.org/static_pages/help.cfm

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I would contact your local hospice directly.

I work for a hospice as a home health aide. We see patient's in SNFs all the time. Anyone can refer a patient to the hospice I work for. Anyone, nurse, family member, friend. Call them. If the patient is appropriate for hospice care and wants to be on hospice, the medical director of the hospice will become one of the patient's doctors. As I understand it, the hospice care is paid for by medicare and the SNF care is still payed for by medicaid. There is much misinformation about hospice. Please call your local hospice to find out what they can do in general and for this patient, directly.

Good luck. Let us know how it goes.

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