MD order to NOT allow resident to go to the hospital

[Enthused RN]

I work at a nursing home and I'm still pretty new there.

When I started my shift today, one of the doctors was there. When she saw me walk in, she talked to me about a patient I supposedly "sent out" last night to the hospital. The thing is, she advised us and the resident that while she will not give an order for him to go to the hospital, he can call for ambulance himself. So he did just that the other night. The paramedics show up and I'm a little bewildered but I roll with the punches and give them the obligatory paperwork for continuity of care purposes. Then today, she actually writes AN ORDER to not allow the patient to go to the hospital. She said I'm supposed to call her and hand the phone over to the paramedics next time so she can make them go away. I made the paramedic company aware the other night that there was no physician order on file for him to go and they are aware he is financially responsible, and they still took him. What the heck did she expect me to do? Body block the paramedics from taking the resident??? Does this sound crazy to anyone else? Can't the resident leave the facility of their own free will provided they are AxO? Isn't it entrapment otherwise? I'm starting to see why my co-workers think the place is insane.

[morte, LPN, LVN]

ok then, you are dealing with a psych issue I would think. get a psych referral. and the ED is not the place for a pain consult. I imagine the doc is thoroughly frustrated with this patient. and when the transport isn't paid for, who do you think that company is going to try to come after?

The resident is definitely a frequent flier. The complaints change from day to day but usually it's due to pain (yet declines pain medication from us). I'm not sure why the doctor wants to prevent him from going when the facility is not financially responsible.

[akulahawkRN, ADN, RN, EMT-P]

Give the phone to the paramedics so she can make them go away... That I would like to see. My system and I think most systems do not allow on scene physicians to direct care, not to mention by phone. She either has to be or talk to a medical command physician who could order me as the EMT. It's the equivalent to her thinking she is going to walk into a random hospital and get full privileges.

Generally speaking, this is completely correct. While I, as a Paramedic, might be glad to talk to the patient's physician, I would certainly also oblige that same physician to come directly to the scene and completely take over scene control. I can not accept any orders from a physician that is NOT either a Base Hospital Physician, the EMS Medical Director, or a Physician who is directly at scene who has not accepted total control (and must ride with me and the patient) after speaking with a Base Physician. You see, being that there's an order to NOT transfer the patient, I must therefore consider those calls "scene calls" instead of a transfer between medical facilities. That changes (a little bit) the rules I must go by...

If the patient wants to go, is aware of the financial liability, and so on, I have no issues with transporting that patient. I also have no issues with reporting that particular patient for 911 abuse if that's deemed appropriate.

To the OP: Do what's right for the patient. Consider having a "spare" copy of the patient's info available for those times when that patient does call 911 for an emergent transfer to the Hospital and the Paramedics show up "unexpectedly" for that patient. You're not transferring the patient, the patient is transferring himself. You're also not preventing the transport from happening, which could be considered false imprisonment/kidnapping if you do.

[morte, LPN, LVN]

do you really think you are going to see a penny from that patient?

Generally speaking, this is completely correct. While I, as a Paramedic, might be glad to talk to the patient's physician, I would certainly also oblige that same physician to come directly to the scene and completely take over scene control. I can not accept any orders from a physician that is NOT either a Base Hospital Physician, the EMS Medical Director, or a Physician who is directly at scene who has not accepted total control (and must ride with me and the patient) after speaking with a Base Physician. You see, being that there's an order to NOT transfer the patient, I must therefore consider those calls "scene calls" instead of a transfer between medical facilities. That changes (a little bit) the rules I must go by...

If the patient wants to go, is aware of the financial liability, and so on, I have no issues with transporting that patient. I also have no issues with reporting that particular patient for 911 abuse if that's deemed appropriate.

To the OP: Do what's right for the patient. Consider having a "spare" copy of the patient's info available for those times when that patient does call 911 for an emergent transfer to the Hospital and the Paramedics show up "unexpectedly" for that patient. You're not transferring the patient, the patient is transferring himself. You're also not preventing the transport from happening, which could be considered false imprisonment/kidnapping if you do.

[Alex Egan, LPN, EMT-B]

Yes indeed if it's a 911 call it cannot follow the rules of an interfacility transfer. Also it's just one of the many many patents who call for non emergencys who we know will never pay their bills. We had a frequent flyer with around $17,000 of overdue bills to our service at one point, once a hospital caught on she would switch to another one, all part of an insurance scam.

[Enthused RN, BSN, RN]

To the OP: Do what's right for the patient. Consider having a "spare" copy of the patient's info available for those times when that patient does call 911 for an emergent transfer to the Hospital and the Paramedics show up "unexpectedly" for that patient. You're not transferring the patient, the patient is transferring himself. You're also not preventing the transport from happening, which could be considered false imprisonment/kidnapping if you do.

Hilarious you should say that I should keep a spare copy of his info for emergent transfers because that exact situation played out yesterday. It was a beautiful start to a shift - all of a sudden I see the fire department walking down the hall and I just knew. This time is was chest pain and the doc didn't argue with it. They took him so fast all I could give the paramedics was a simple info sheet. Once they left, I thought to myself - I'm keeping a packet ready for next time! Oh the differences between real world nursing and nursing school! BTW the resident was fine - no significant findings and no new orders when he came back 4 hours later. LOL.