Parental Obstruction of Care

[Mimsy909]

We are currently experiencing a most trying series of events in our unit and I would love to know if anyone else has experienced something similar and how your management supported you, your co-workers and/or the family. Briefly, and complying with HIPPA, we have a child who has been diagnosed with a potentially fatal, progressive disease. The parents have thrown up roadblocks to care starting in June that include refusing to speak with residents, calling attendings and hospital presidents at home in the middle of the night when a dose of Tylenol is ordered, shutting off infusions of dobutamine (for one), calling nurses criminals, stupid, threatening to find a nurse's wedding and 'trashing' it. They have left the PICU, with the child, no monitors or suction/O2/etc. and have disappeared in the building, PICC lines have been pulled out. They agree with a plan at rounds in the a.m. but when nobody is around in the p.m. they begin a campaign to discredit all that was decided upon. *Did I mention one of the parents is a physician who is employed by the corporation that includes our hospital?* The child is a sweet, sad little thing who does not need ICU level care. We have been forced to 1:1 the child for direct visualization of the parents 24 hrs. a day. The more confident, boundary setting nurses have never been assigned to this child. The younger or more malleable nurses have been bearing the brunt of this psychosocial nightmare. Child protection is involved and has noted there is ample evidence of obstruction of care and charges could be filed. Refer again, to *. Recently, our entire management team left the state for 2 days for a conference. We felt abandoned and wasn't sure we would be backed up if child protection was indeed called. Please share a story or two with me so I can help my coworkers know that we are not alone in this crazy situation.

[vamedic4, EMT-P]

Munchausen's anyone?

Get the police involved at a higher level. Social work too. They're dangerous.

On second thought, maybe this doctor is just a prick who's on a power trip. Someone needs to stand their ground and tell this guy off ( in the ever so nicest way, of course). Your management isn't doing anyone any favors by assigning this child to nurses who are ill prepared to handle this challenge.

I'm sorry you're going through this. Get your nursing supervisor's input if your management is not able to help.

DOCUMENT EVERYTHING!!!!!!

[mama_d, BSN, RN]

Not a peds nurse, but when we have someone in charge of decisions doing such things with one of our adult patients, risk management becomes very involved, as well as multiple layers of management from all applicable departments. They also get our most hard-assed nurses; giving new grads a patient like this sounds like a nightmare. Make sure that everyone is documenting their behinds off on this one!

[justme1972]

Munchausen's anyone?

It's not Munchausen's b/c the parents did not intentionally inflict the illness on the child.

The parents are probably both borderline personalities and they are feeding off each other...and the end result means their child is not getting the care that they need.

Personally, I could care less if management is out of town or what, because it's your butt that will be nailed to the wall and possibly your license if anything happens to that child and you DON'T call, especially knowing what you know that is surely documented.

The hospital ethics committee needs to work with social services to see if an emergency legal order can be issue on the child, barring the parents from coming to the hospital until the child can be treated.

That child clearly does not have time for red tape and pulling out PICC lines, etc...that amounts to, in my mind, child abuse.

I would also explore in your state how much legal power the physician has in barring those parents from that child because if the parents do something and it's on the grounds of the hospital, there could also be a huge amount of legal liability there too.

[tryingtohaveitall]

hmm, i disagree that it's not munchausen's. pulling out invasive lines that have to be put back in? shutting off dobutamine? those are harmful to the patients and they are doing it. sure sounds like munchausen's to me. the below section is from www.mbpexpert.com

munchausen by proxy (mbp) - the basics

mbp/fdp is not a formal dsm-iv mental health diagnosis. it is a recognized form of maltreatment.

many mbp maltreatment cases happen within the outpatient setting, rather than inpatient settings.most mbp maltreatment cases are confirmed through solid circumstantial evidence; very few are confirmed through direct evidence such as covert video surveillance.there is virtually no physical or psychological-behavioral-mental health problem that cannot be exaggerated and/or fabricated and/or induced.

exaggerate: the perpetrator deliberately embellishes a genuine problem.

fabricate: the perpetrator deliberately makes up a problem story - or makes it look as if a problem exists.

induce: the perpetrator deliberately causes a problem to exist.

exaggeration/fabrication cases should be considered as potentially lethal as cases in which inducing is suspected or confirmed.a caretaker may perpetrate mbp maltreatment through one or a combination of exaggeration, fabrication, or inducing. the perpetrator may change methods throughout the life of the case

this sounds like a really tough case. i'm sorry the staff isn't being back by administration. they need to have the hospital attorneys involved intimately with this case and strong physicians and nurses consistently dealing with the family. we recently dealt with a somewhat similar case that was very difficult on the staff.

good luck to you!

[tryingtohaveitall]

One other comment, many/most of the Munchausen's cases I have dealt with started with a true illness with the child. My theory is that the family/parent started enjoying the attention and couldn't take the lack thereof when the child was doing better. This has also made it all the more difficult for the staff to get the physicians to believe that the family was doing anything, because the child does have real physical problems that the parent makes worse.