Well, what I've long suspected about the hospital in the town where I work is, in fact, true: DNR indeed does mean "Do Not Treat". The EMTs won't even transport someone to the ER if their advanced directive says "comfort measures only", even if they're in obvious DIScomfort. Why? Because some group of high-ranking muckety-mucks has decided that treating the sick is not a 'cost-effective' use of the hospital's services.:angryfire
I couldn't believe it when I read about this in the newspaper. Then I actually heard about it again from the paramedics I called today for a resident who was having severe back pain from an unknown cause. They were very sympathetic, but they told me the order had come down NOT to transport anyone to the ER unless they were, essentially, a full code and had one foot already in the grave. In other words, if a patient is elderly and/or has a DNR order, the hospital won't even 'treat 'em and street 'em' anymore. They won't even LOOK at them.
I am so angry right now I could spit nails. Naturally, I don't believe in using the ER as a primary care provider, but for crying out loud, when one of my residents is desperately ill or in pain and I don't know why---and their PCP isn't responsive to their needs---where else are we supposed to turn for help? And God help you if you're over 65 and on Medicaid.......you can't use the ER, but you also won't be able to find a PCP willing to take you anymore.
The thing that really burns me up is the fact that our Greatest Generation paid into the "system" literally for DECADES, and now when they need help, it's not there for them. In fact, the healthcare conglomerate here in our area treats them like parasites. Unfortunately, the organization is a monopoly, so it's the only game in town. And now it's turned every standard of decency I can think of on its ear: you're welcome to use the ER if you have private insurance and/or are young and 'productive', but if you're elderly, frail, and/or poor, the hell with you.
Yep, this really makes me look forward to old age..........when my body starts failing, I think I'll just walk way, way out into the wilderness and let nature do what it will, as our ancestors used to do when they sensed that their time was near. It beats the heck out of begging for some small share of mercy and being treated like a "useless eater", as one Adolf Hitler used to put it.:angryfire
I've read the entire thread and attempted to sort out emotions r/t the health care system as a whole from the details particular to the situation described in the OP.
1. OP states that an individual CEO of a particular hospital has stated in some public forum that a hospital will not treat those with DNRs in the ED of that hospital. If he/she has been foolish enough to make that public statement, I would hope that the hospital's own risk management dept. (attorneys) have already *educated* him/her on EMTALA, 'cause that will never fly.
2. A particular EMS provider refused to transport the OP's resident to the ED. Check the EMS transport laws in your state. If you called a private non-emergency service and they refused to transport, call 911.
3. From reading years of the OP's posts, I am confident that she did everything in her power to light a fire under the butt of the resident's JERKOFF of a PCP. I'd be very clear about this with the resident and the family: on Date X I called PCP,MD at 0830, 1030, 1230 and 1430 re: resident's back pain. At 1530 I received an order for 1 T3 tab, which did not relieve pain. PCP did not respond to further pages, so I attempted transport to the ED so that resident could be evaluated by another MD.
I suspect that calls to the media, congressmen, etc. will not get much attention unless they relate specific facts about a specific case, and not venting about health care in general.
And for some reason, the toppers at their conference tables, slowly dwindle down the list of their perceptions of "evil doers" and guess who's shoulders that falls on?
Documentation vs negligence vs hospital policy vs pt's wishes and family wishes.
IMO the OP was in the presence of patient with substantial increased pain with no recourse from usual procedure.
What was that oath we all said ( or should have) and the Doctor's oath?
Silly it comes down to pointing fingers like shooting bullets to resolve an issue that could potentially save a future lawsuit and give competent care......
I'm sorry but I thanked Michael Savage for his statement of opinions expressed only and thanked the bb for allowing him to do that . Other than that I totally agree with the OP, and go back to treating patients like they are one of our own. Would you want your mother to receive Tylenol, when as an experienced nurse your assessment tells you there is something else going on? Using resources (911), (attending doc) (ER services) and seeing in front of your eyes a patient that needs further (than from their usual base care) care is doing what it takes at that moment.
Belive me it will become a rolling snowball, and for those who haven't seen snow, think of the sand sharks at the bearch waiting to see you get stuck so they can charge you to help you out with a tow.
where does it say she had multi-system organ failure?
michael savage- of course it's ludicrous to be treating pain in the ER when the pcp could and should be...
but, since the pcp blatantly dismissed this pt's needs, a trip to the ER is a reasonable, next step.
and the doc who said she's ok, accoring to pt's 'denial' of pain?
all he would have to do is observe her non-verbal cues-
there are just so many unacceptable assumptions in this saga.
rather than spewing our anger at the ER, this pcp needs to be hung by his nails.
tylenol #3, with a through-the-ceiling pain level?
since this pt is seemingly going to have more frequent contact w/her pcp, i'd be addressing the appropriateness of such a relationship.
screen other docs, or find someone who is more liberal in their dispensing of pain meds, (and who is much more sensitive to the needs of the frail elderly) and get her another doctor.
dang, this pcp would have a field day with my nurse's notes.
I have heard nursing home patients called that and worse. Only a true sociopath could talk about other humans this way. I wish sociopaths who make their money off these useless feeders and who are potential useless eaters themselves would be jerked up by the collar and taken to a mirror where they could see what useless is. I hope one day they say it within earshot of the wrong person.:angryfire:angryfire:angryfire
I think that the person who called the elderly "useless feeders" is a useless waste of oxygen. That person obviously is a selfish sociopath who doesn't care. And that person shouldn't be allowed within 10 miles of any vulnerable person.
Specializes in LTC, assisted living, med-surg, psych.
Well, I called our state ombudsman this morning, and just as I thought, she was aghast. She's like a bloodhound when she gets wind of injustice, and she will track down the originator of this so-called policy and chew 'em a new one.
It says on the POLST form, right there in black and white (or in this case, hot pink), that the DNR/comfort measures patient is to be transported "if comfort needs cannot be met in current location". I want to take this document and beat somebody over the head with it until THEIR comfort needs cannot be met in their current location..........AAAARRGGHHHHHH!!!!!
I think that the person who called the elderly "useless feeders" is a useless waste of oxygen. That person obviously is a selfish sociopath who doesn't care. And that person shouldn't be allowed within 10 miles of any vulnerable person.
Well, given that it was Adolph Hitler, I don't think that anyone except maybe Mahmoud Ahmadinejad would argue.
Well, I called our state ombudsman this morning, and just as I thought, she was aghast. She's like a bloodhound when she gets wind of injustice, and she will track down the originator of this so-called policy and chew 'em a new one.
It says on the POLST form, right there in black and white (or in this case, hot pink), that the DNR/comfort measures patient is to be transported "if comfort needs cannot be met in current location". I want to take this document and beat somebody over the head with it until THEIR comfort needs cannot be met in their current location..........AAAARRGGHHHHHH!!!!!
I'd like to meet the person who made that policy in a dark alley so that I can take care of their "comfort measures".
it's not just the old that are devalued, but they were the first to be devalued en mass, hence all the nursing home "abuse", which is perpetuated by under staffing due to corporate greed. one nursing home advocate i was in contact with actually heard the elderly being refered to as "useless feeders,"
well, given that it was adolph hitler, i don't think that anyone except maybe mahmoud ahmadinejad would argue.
it's not just the old that are devalued, but they were the first to be devalued en mass, hence all the nursing home "abuse", which is perpetuated by under staffing due to corporate greed. one nursing home advocate i was in contact with actually heard the elderly being refered to as "useless feeders,"
yes, it was a nursing home reform advocate that told me he was told this by someone in our own government!!!!
Well, given that it was Adolph Hitler, I don't think that anyone except maybe Mahmoud Ahmadinejad would argue.
Adolph Hitler is in good company. I've heard this from doctors also. I've heard them called "useless", "charity cases", "dregs", etc. and by the very people they admire (mostly doctors).
My great-uncle recently died in a nursing home from something that could have been prevented. He was not only a WWII veteran but he was a damn good person, always young at heart with a lively spirit and a good nature. He may have been old but it infuriates me to think someone would talk about him that way, about any person that way because they are old or disabled.
Naturally, I don't believe in using the ER as a primary care provider, but for crying out loud, when one of my residents is desperately ill or in pain and I don't know why---and their PCP isn't responsive to their needs---where else are we supposed to turn for help? And God help you if you're over 65 and on Medicaid.......you can't use the ER, but you also won't be able to find a PCP willing to take you anymore. 
Elvish, BSN, DNP, RN, NP
4 Articles; 5,259 Posts
Do Not Resuscitate does NOT mean Do Not Treat.
You take care of her until she breathes her last.
I know that frustration, Marla. People (even those in healthcare) have a skewed perception of DNRs.