Is this Ethical or Legal?

[ernoc333]

Our Administration recently reprimanded several ER Doctors and Nurses. The reason- several patients with very very minor problems (ie: Very minor Contusions, Acute Rhinitis, Bumped Acrylic Fingernail, Superficial Paper Cut) had requested "Strong Pain Medicines" (ie: Morphine, Fentanyl, Dilaudid IM/IV and presciptions for Oxycodone, Hydrocodone to go) and didn't get them. While they didn't receive these medications due to the ER doctors didn't feel it was Clinically Indicated, the patients did receive appropriate interventions, such as X-Rays, CT scans, crutches, ice packs, elaborate wound care, Motrin, Tylenol, wheelchair service, etc.

The Reprimand/Verbal Policy by our Managment: All patients who ask for Strong Pain Medicines should get as much as they want, without knocking out their Respiratory Drive- even if it's not Clinically Indicated. Rationale? "Customer Service"..."Happy Customers are less likely to complain and less likely to Sue." "Give them all that they want." Might sound unbelieveable to some of you, to others maybe I sound callous, but for me it brings up Ethical Questions, the Hippocratic Oath & the Ethics of Business Practice.

The Question: Is this Legal or Ethical? What about the Hippocratic Oath? "Do No Harm"? Are we harming these people by giving them Medications that aren't clinically indicated, or are we harming them by allowing them to "Suffer" from Contusions, Sinusitis, Broken Fingernail, etc without the benefit of Opiates? Should we do interventions (medication and non medication) that aren't Clinically Indicated just because patients ask for them, just to make them happy? Are we monopolizing business from other Hospitals by doing this?

To note, our ER already has the unspoken policy of "give the customer whatever he or she wants", even if not Clinically Indicated, in terms of everything else, and our Community knows and expects this. For example, a young and very healthy patient had a superficial paper cut that we couldn't even see, but we did all she requested, wheelchair service, Irrijet Wound Care, Bulky Dressing, Vicodin Orally and Presciption, Meal, Refreshments to friends in Waiting Room, Personal Phone calls to concerned friends and family. No kidding, this is typical AND EXPECTED BY MANAGMENT at our facility.

Also what I see that is detrimental with this practice is that our ER staff is overloaded with the Customer Service Demands of the not-sick patients, and hence Critical Care patients don't get the care they need. Critical Care patients can't complain, while not sick patients can complain and ask for unlimited things. And our management, not being Clinical Practitioners, don't see the reasoning of this.

[Murse901, MSN, RN]

If this isn't a completely fabricated story, I'd find another hospital to work for.

When a member of corporate gets a DEA number, then he/she can prescribe all the narcotics he/she wants. Until then, it's the MD's DEA number and license on the line, period.

[ellakate]

My opinion is that they are promoting unethical and illegal behavior by facilitating delivery of controlled substances to treat paper cuts. Unethical because the patient is being allowed to dictate treatment, not the physician. Illegal because controlled substances are being prescribed inappropriately and administered irresponsibly.

BTW, your hospital is probably responding in this way to get more business.

The inherent problem with this approach is that drug seekers will come to your hospital for customer service and not health care. One approach is to give the administration what they want. In other words, let the ‘customers’ have IV drugs, but then let them sleep it off before they can safely go home. Then management will be unhappy that there are no ER beds. Then they will have to decide whether to deliver medical care or deliver controlled substances, causing potential harm to people when there is no clinical indication.

There is only one person that gives the IV or pill. If you happen to be that person, please remember that you do not have to give a med if it is against your best clinical judgment. Ask your supervisor to give the med. Believe me, if you gave a med and a patient had an adverse reaction, this same ‘happy customer’ would be first in line to sue you.

[Ruby Vee, BSN]

is this for real? it boggles the mind!

i'd run, not walk, to the nearest nurse recruiter for a different facility!

[ernoc333]

Thank you all for your replies. Yes, this is for real. I and a doctor have brought this up recently, and basically were put in our places. What really concerns me too is all of your surprised responses...it raises red flags that what we do at our facility isn't common practice and maybe really far from the norm. I have tried to bring up the subject of giving Opiates only for THERAPUTIC reasons, only to be squashed.

Part of the problem is that our policy is to treat the Pain NUMBER. Of course, we rate EVERYONE'S pain on a 0 to 10 scale at arrival. So if a patient with a Paper Cut rates his or her pain 10/10 and they leave with no Pain Medications on Board and a 10/10 pain, regardless of what the patient looks like (talking on cell phone, eating potato chips, laughing), regardless if we did other non medication interventions, we are chart audited, reprimanded, etc.

Whatever happened to Treating the Patient not the Number, and Approriate Treatment Interventions?

[BabyLady, BSN, RN]

I was taught that if you have a patient that came in asking for a very strong narcotic and says that, "_______ is the only thing that works for me."

It was a dead giveaway for a potential addict.

Studies show that pain is undertreated in healthcare facilities...but this is going overboard.

If you ASK and someone ADMITS that they are an addict...then that is medical justification on why they would need something stronger b/c something weaker simply won't work...but the physician or nurse needs to ask and encourge the patient to be truthful...especially if they really are in pain b/c yes, addicts get injured too and they have a right to have their pain controlled.

However, if someone with non-chronic pain comes in with normal VS and no indicators of being in pain....if I was a physician...a good one could use the argument that it wasn't medically warranted and they are not going to put THEIR license on the line by over medicating someone that doesn't need it..b/c the physician is risking getting sued over that as well.

[Lacie, BSN, RN]

Run dont walk to the nearest exit!!! I find it difficult to imagine the medical directors, etc would stand for this. I would be contacting CMS, someone regarding this practice.

[ernoc333]

The ER Lead MD and Nursing Manager of our Department stated that we- MDs and RNs- are to give pain medicines in this way. The subject was reinforced at the last Department Meeting.

[Katnip, RN]

I would tell them I will not do such a thing unless it's in writing. And if they put it in writing I'd send it to the state's hospital association, Joint Commission, CMS, and while I was at it, the State's Attorney General.

If they won't put it in writing and there are several witnesses, you get together, write up a document stating this is what you were told. Get everyone to sign it, and send it to you're state's hospital association...etc. And just in case there were threats to people's jobs, what the heck, send a copy to your state Labor Board. And then you do this :trout: to those administrators. Maybe it will wake them up.

I'm evil.:angryfire There is no way I would tolerate such a thing.

Seriously. They have no right whatsoever to dictate a physician's medical practice. It's unethical, it's illegal, amoral, and any other bad thing I can think of.

I'm in a cranky mood to begin with. Can you tell?

[pca_85]

Two words: how stupid. No wonder people brag about how easy it is to get painkillers.

[classicdame, MSN, EdD]

Please ask your Administrators to provide me with name and address of your hospital so we can refer all our junkies to you and not have them clog up the ER waiting room. I bet you will be VERY popular soon.

[Medic/Nurse, BSN, RN]

fight.

flow.

flee.

three choices for everyone - stay and fight, go with the flow or flee.

personally, i have been in enough effed up situations that i'd be running from that place so fast - anyone watching my departure would be convinced that the building was on fire.

the bottom line - obtaining controlled substances by fraud is a felony - everywhere. sounds like the folks that dictate clinical practices are not the ones accountable. i guess the only question is - how many healthcare providers will face actions on their respective licenses and registrations? another bonus - anyone stupid enough to participate will surely be crucified by the employer that dictated such a practice: "well, the ______ is responsible for safe practice and legally bound to follow the law". so in essence, i can imagine that the very employers that "encouraged" such clinical practices will be able to wash their hands of anyone that finds themselves in a pickle. come on, the folks that are "dictating" this practice have nothing to lose - hopefully, that will settle any issues you have with the practice.

as a fun little project - i'd make sure that the front page of the newspaper let everyone in on it - not just the professionals that are suffering their way out of a job! maybe the police and state, federal dea will be amused as well.

attention drug addicts and dealers - our lady of healing gives out all the narcotics you can demand. just raise a little h%&& - we are here for you!!! you want it - we got it - come and get it! bonus: you don't even have to pay the bill!!!!

losing battle - run before you are a casualty of the war!

practice safe!

go press-gainey! go press-gainey! go press-gainey!

:eek:

.

sorry, that is so not funny - but i just cannot delete it!