Need Help FAST Please. RE: Inappropriate discharge

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Specializes in ER, ICU, Nursing Education, LTC, and HHC.

Hello friends

I need some serious help here....

I have a serius and ethic delemia to figure out fast.

I have an ethical delemia and need some good advice. In my 120 bed LTC facility (I am a DON) I was MANDATED and instructed by my corporate office that I MUST discharge a lady to the hospital tody...because she owes 56, 000to the facility. Ok.. I ordered stat labs, to include a CBC, BMP, UA, dig level and an EKG.. (in hopes to find a reason to send her out.. tests were uneventful.. EKG Sinus brady with S-T elevations and HR 57, labs good except for low dig level at 0.53 (has no meds for a week, pharmacy cut off her orders because she owes them 10,000, the CBC - RBC is a little low at 3.56 (I asked if the doc could admit for anemia)

Long story short: MD ran a bunch of tests probably did a 10,000 work up. and NO DICE>. She has nothing that warrents a hospital stay.

Primary MD was willing to do a direct admit as long if something justified could be found.. well, 7 hours later she is ready to come back:

I have a direct order from corporate that she is NOT to return back under no circumstances. but there is no case for an admit. In fact she is alert and keeps telling the ER that "I have nothing wrong with me" I asked if she could stay because of the finacial debt, they said it is not their problem (understandable) Now if I bring her back, I, the DON and the administrator get fired..:angryfire

I have to go with my gut feelings on this and do what is ethically correct, I do not want to be facing the board of nursing for failure to take her back from an unneccessary ER send out.

Choices:

1) do not take her back per corporate mandate and face AHCA tomorrow with a possible big fine and a big tag, and possibly have personal charges brought against me by the board of nursing

2) accept her, and face getting fired tomorrow for allowing her to return to the faciltiy.

I want to call the hospital and have her sent back because it is the ethical and legal thing to do, regardless if I get canned tomorrow..

What are your thoughts on this. We are under Florida laws.

Thanks in advance to anyone who can offer help.

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Specializes in CVICU-ICU.

I do not work in LTC anymore and I dont know the FL laws for LTC but the one thing about this situation that caught my attention was the fact that she is in LTC and hasnt received any of her meds for a week because of $$$....right there I would think would be a huge legal issue for the facility.

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Specializes in Onc/Hem, School/Community.

I wish I had an answer for you. I hope everything works out OK for you. Let us know how it goes. Could the LTC be in legal jeopardy for not taking her back? Is there a county/state facility she could be admitted to? Good luck.

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Specializes in Anesthesia.

The hospital should have a discharge planning department. These people can work magic in finding places that accept Medicaid. Hopefully this patient has a family who will assist in finding a place for her.

Just some random thoughts.

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Specializes in Cardiac/ED.

Contact immediately the patients Ombudsman! The number should be posted. That clears you...if that doesn't work-protect your license at all cost...even it means termination...you can always get another job but only if you still have your license. But I am sure the Ombudsman will take care of it fast, this type of treatment probably qualifies as elderly abuse, your county DA may have to get involved along with social services.

Goodluck to you and especially your patient.

P.S. Unnecessary tests fry me to no end...what a waste of resources trying to find something wrong. I bet they placed her in even more debt!

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What's more important, your job or the potential loss of your license? Do you really want to work for a facility like this?

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Specializes in Emergency.

This situation sounds really sticky and I'm sorry for your experience. I've heard of this happening before - facilities "dumping" patients for owing money. By sending this patient to the ED for no clear reason is wrong in itself. But by sending this patient to the ED and not accepting them back? Shameful.

Your facility is washing its hands of this patient and the problem isn't solved. Why should this hospital have to carry the burden of this patient's financial difficulties with your facility? Obviously, if your facility doesn't accept her back, the hospital will have to find someplace for this patient to go. And what if they cannot find a facility to take this patient? The hospital is going to have to eat the cost. I've heard of patients who have stayed in the hospital for MONTHS because no facility would accept them due to financial circumstances.

This type of behavior places an undue burden on the entire health care system, drives up health care costs for everyone, and is unfair to the hospital that you sent this patient to. Most of all, it is unfair to the patient.

You have a license with the state, not your facility. Keep that in mind. Your facility can tell you to do anything they want, but you need to be willing to deal with the consequences.

Take a look at this link regarding Florida's "Resident Rights" from the Department of Elder Affairs:

http://ombudsman.myflorida.com/ResidentRights/Residents%20Rights%20Discharges%20and%20Relocations.pdf

Here's a helpful article:

http://www.sptimes.com/2007/02/27/Lifetimes/Nursing_home_can_t_di.shtml

Florida statutes: look at letter "P" and number "4" (at the bottom of the page)

http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=Ch0400/SEC022.HTM&Title=->2006->Ch0400->Section%20022#0400.022

If I were you, I'd contact Florida's Ombudsman program: http://ombudsman.myflorida.com/index.jsp

From what I've found online, what your facility is attempting to do is illegal and frankly, it looks like your facility has already engaged in illegal activity by falsely transfering a patient with no medical need for treatment. You need to find out the laws in your state and get in contact with persons who will know what is legal and what isn't. Personally, I'd rather be fired for doing the right thing than lose my license for doing the wrong thing. You WILL be able to get another job, I guarantee it. Please update us, as this is a very important for all nurses to be aware of.

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Specializes in med-surg.

I shuddered when reading your post. This is a problem that going to be increasing as the years go by. Do you really want to work in a facility that engages in this behavior? We are supposed to advocates for the patients. If you lose your license you can't help where you are needed.

Contact the Omsbudsman--get someone out of bed if you have to. Social services at the hospital may be able to help you contact someone.

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Specializes in Med/Surg, Ortho.

Is there any family? Maybe its time the patient move back home with family assistance. If she has nothing wrong with her why is she in the LTC in the first place? If she has nothing wrong, and she wants to go back to her home why should she need to stay in LTC.

But, anyway,, if she hasnt had any meds for a week, i think that may be a problem for the facility. Kind of sounds like neglect to me.

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Specializes in Utilization Management.

Agree with Kmoonshine here, Monica. If Corporate wants to kick her out of the facility, they can just trot on down here and do it themselves.

Don't waste your license and livelihood on these idiots.

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Specializes in Trauma ICU, MICU/SICU.
The hospital should have a discharge planning department. These people can work magic in finding places that accept Medicaid. Hopefully this patient has a family who will assist in finding a place for her.

Just some random thoughts.

NOt if the pt. wasn't admitted. Why should the hospital fix the mess the SNF has created.

I say OP, you should do what's right and accept pt. back and report your facility to the BON. They'll be very interested to hear that the pt. hasn't been given meds and that your facility attempted to dump her on the hospital.

This really burns me up!

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There should be a procedure for discharging a resident for something like nonpayment. Here, we can discharge a resident "against their will" if they and their POA or guardian are given 30 days notice, but we have to have just cause like nonpayment, grossly disruptive behavior, or something like that. We can also discharge if we somehow become unable to meet their needs (like if they get a feeding tube or need IV therapy or if they need daily transport for something).

What is going on with you sounds illegal to me...someone should have intervened on her behalf LONG before she owed the facility and the pharmacy so much $$$...good luck!

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