Need Help FAST Please. RE: Inappropriate discharge

[Monica RN,BSN]

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.

[Monica RN,BSN]

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.

Hello Kymmi:

It has been about 3 months and I do apologize for not checking in for updates. This is a wonderful community in which we can learn from one another. I will do my best to sift through these responses and let you know what has happened.

Yes you are absolutly right.. the meds were a big part of my concern as well.

She had no family except for one son who was found to be financially exploiting her money. Social services reported him and an investigation was opened. I quit that job not so long after this whole ordeal went down, so I have no follow up concerning the exploitive son.. (who happens to be an LPN, no less)

I informed corporate that the facility is responsible to provide her meds/ all her needs regardless of payor source.....I was LAMBLASTED by corporate which is not even located in Florida. Their response was WE DO NOT HAVE TO PROVIDE ANY MEDS BECAUSE SHE IS A PRIVATE PAY patient.

I even faxed validation from the AHCA survey tag guidebook.. again, told the same thing, regarding private pay...Oh, I was SOOO flaming mad.

Except for the son, there is no other family.. the son has never visited her in the nursing home, and had his # changed, we even sent law enforcement out to try and track him with last known addy and last known place of employment. No luck with many multiple attempts.

Social services did report him to the agency for exploitation. A 30 day notice was given, but we had no place to discharge to... anyways, I did what was right and accepted her back since she could not be admitted.

[Monica RN,BSN]

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.

yes, the facility could have been held liable for neglect and probably abandonment for failure to accept her back. The only way the facility is released from liability to accept or to not accept is if the resident had a 3 day hospital stay, then she could be placed in another facility. BUT, If she had a 3 day hospital stay then my former facility probably would have WANTED her back because now she would qualify for Medicare reimbursement for up to 100 days. She has been in the facility for about 4 years.

[Monica RN,BSN]

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.

She has been medicaid pending for over a year. She cannot qualify because she has too many assets and some money in the bank.

Outside of medicare (which will pay only if she has skilled needs) she has been a private pay....more custodial than skilled.

no family support system in place.