Systematic abuse of patient rights.

Posted
by paul1980s paul1980s (New) New Nurse

Specializes in Psychiatric/ addictions.

I feel terrible about the way the organisation routinely and systematically abuses patient basic human rights. I work for a private hospital that belong to one of the largest group in the country, been there about 3 years now, started working in drugs and alcohol unit 18 months ago. I feel hopeless and helpless with my situation, I’m planning to look for a new job after Christmas. I have witness countless admissions where patient are admitted while intoxicated, their blood alcohol concentration are at a dangerous level. Their insurance and financial detail are collected and they sign and agree to paid for any additional cost that their insurance won’t cover. I have seen 2 nurses who brought up the issue in the ward meeting, one of then got transfer to another unit, the other is being investigated by management over a complaints made by an unnamed patient. I got into nursing because I want to help people, not to abuse their rights or be part of a system that exploit vulnerable people financially. The Human Right Commission declined to help, Health Care Commission of Victoria wanted me to approach my employer and discuss the issue. I want to go to the media and expose them but the frontline worker are the one that get their hands dirty.

canoehead, BSN, RN

Specializes in ER. Has 30 years experience. 6,837 Posts

If the patient challenges the hospital, saying they were under the influence when they signed, they may not have to pay. On the other hand, given the meds used to get through detox, and any other scripts the patient might be on, are they ever NOT under the influence of something? The hospital may be getting the signature on admission because if they wait a day, the patient is definitely not on the hook for the first 24h of charges, and paperwork is so easily forgotten.

I don’t find this a violation of patient rights.

paul1980s

paul1980s

Specializes in Psychiatric/ addictions. 3 Posts

The informed consent of a person must be sought before treatment or medical treatment is given to a person in accordance with the Mental Health Act.

The Mental Health Act 2014 requires clinicians topresume that all people receiving compulsory mental health treatment have the capacity to give informed consent to treatment. 

I always thought that our primary role as nurses are advocate for patient protect their rights. Surely I wouldn't want to sign financial contract when under the influence of drugs or alcohol, so why should I be asking someone to sign over their insurance and financial details when they are under the influence of drugs and alcohol. 

Thankyou for your replied canoehead.

 

whatintheworld

31 Posts

Is am MD or PA medically clearing them before they go to the floor ? 

paul1980s

paul1980s

Specializes in Psychiatric/ addictions. 3 Posts

They come through intake, run by non medical personnel,  process without blood alcohol level taken, sign contracts, admitted onto the unit/ward then get tested for alcohol level. Then wait for a few hours to be seen by psychiatrist.

If someone level is 4 to 6 times over the legal limit to drive. That is not informed consent in my opinion.  No one seen to care or question the process, maybe I am out of step with the working of this hospital. I have anxiety coming to work, will this be the throughout the areas, I like to stay in addictions, but if this is the way, then I must consider changing and working in different area after Christmas. Thankyou for you input.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience. 8,058 Posts

If we didn't allow alcoholics to enter rehab when they still have an elevated alcohol level then I'm not sure they would ever be able to enter rehab since they're far less likely to have decision making capacity once they go into withdrawl.

Blood alcohol level is not a useful determinant of whether someone has decision making capacity in terms of alcoholics, the criteria that defines capacity doesn't rely on an alcohol level.

I take it you're in Australia, in which case privately run healthcare providers can charge for services beyond what insurance might cover, this is regardless of whether they are informed of this before hand, the notification that they may be billed for services is more of a fair-warning that what allows them to bill.

hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, SOL (Student of Life). Has 20 years experience. 4 Articles; 4,573 Posts

On 12/5/2020 at 6:50 PM, paul1980s said:

.

The Mental Health Act 2014 requires clinicians topresume that all people receiving compulsory mental health treatment have the capacity to give informed consent to treatment. 

 

So are you talking about patients brought to the hospital involuntarily? This is an important distinction as patients who enter a rehab program (Very different from detox) are almost always Voluntary admits (At least where I work). They cannot be held longer than 72 hours if they are medically stable and alcoholism/addiction is their only problem.

I don't see a violation of patients rights here!

Hppy

 

TheMoonisMyLantern

TheMoonisMyLantern, ADN, LPN, RN

Specializes in Mental health, substance abuse, geriatrics, PCU. Has 15 years experience. 1 Article; 922 Posts

I cannot comment on the legality of what's going on as I don't reside in Australia. But I will tell you that typically substance abusers are much better at being able to understand information and making decisions even when they're using heavy amounts of their chosen substance that those who just episodically partake. In addition it's not uncommon for substance abusers to have "one last hurrah" prior to presenting for detox meaning that most people who do present for detox have consumed their substance of choice pta and if we didn't allow people to sign themselves in for detox before they started to withdraw we'd probably never get anyone detoxed. 

Now, in my area if a person is already in DT's, or so high that they are stuperous, or have a decreased LOC, and they are brought to the hospital, there is what is called "implied consent" meaning that this is assumed they would want medical care that is in their best interest until the time arises that they can refuse care. Over here even if they consented to treatment or "implied consent" and they refused to sign the financial agreement they can still legally be billed because care was, in good faith, rendered to the patient.

In my area inpatient mental health patients and substance abusers don't typically have good insurance, good jobs if any job, or even disability or medicaid meaning the hospital simply doesn't get pain. Can't get blood out of a turnip after all. 

Nurse Pompom

95 Posts

I get what you are saying, however, the "dangerous" alcohol level you're talking about are levels these people are used to. What would send you into a coma is just another day for them. I used to work on a detox unit.

Also, what exactly are we supposed to do, send them back in the street? Send them home to detox cold turkey and die? How is admitting alcoholics so different from people brought in unconscious from DKA and send to ICU to rack up huge bills much more costly than detox? Or a car accident that requires costly exams?