The dreaded pregnancy test

A&OxNone, MSN, RN · Jun 19, 2011

For EMTALA you have to offer a visit with an MD. Couldn't you say something like We would be happy to see you here but fyi you will get better care down the street. Or you could always tell them but make them sign an AMA form to cover you.
This is more of a question then a statement. It just seems silly to go through the charade of checking them in and seeing and MD just to sign them out. I get the liability but you aren't refusing treatment you are just suggesting a better option for the patient.

I hear you when you say you "get the lability" but if you think it seems silly, you dont understand how serious EMTALA is. It honestly is in the best interest of the patient - lets say we had a waiting room full of patients, and just didn't want to take any more - we could just tell new people, hey, we dont really want to see you, you need to drive across town.

We HAVE to provide a medical screening exam. And we can't just let her see the doc and tell her to drive across town to the OB unit after her sceening exam, either - we have to fill out a transfer form, do a nurse to nurse report to the other hospital, and send her by EMS. It's a serious six figure fine if we do it any other way, and after so many violations, your ER gets shut down.

It sounds like a pain, but seriously, if the law wasn't in place, you would be more upset with what goes on then.

Oh, and I should also say - if we dont do these things and you show up in another ER and say "well, so-and-so said they couldnt see me and sent us here," THEY will nail us for an EMTALA violation.

Once, we transfered a patient from our ER to a surgery center that's in our parking lot, because they needed surgery and it was where their surgeon was - a CRNA got ticked off for staying late, reported us, and we had a violation because we technically transfered them to a lower level of care..

Altra, BSN, RN · Jun 19, 2011

Thank you for your answer....I will pass it along to my sister. As a nurse the best I could offer to her as an explanation was "you can't refuse medical services to the ER patient" but that still didn't explain why no one mentioned they couldn't help her there so she could make the decision to stay or to go somewhere else.
She felt deceived and like they were just after her money.
Yes royal fit because she was pregnant and having bleeding and very worried about her unborn child.....I don't think anyone has ever accused a scared pregnant mamma of being rational lol.......
Seems sad to me that in a situation like that legislation trumps common sense

Everywhere I have worked, even the appearance of the slightest suggestion that care would be better provided elsewhere before the medical screening exam has been considered an EMTALA no-no.

Seriously -- this is a BIG deal, and it drives a great deal of ER operations.

Esme12, ASN, BSN, RN · Jun 19, 2011

Thank you for your answer....I will pass it along to my sister. As a nurse the best I could offer to her as an explanation was "you can't refuse medical services to the ER patient" but that still didn't explain why no one mentioned they couldn't help her there so she could make the decision to stay or to go somewhere else.
She felt deceived and like they were just after her money.
Yes royal fit because she was pregnant and having bleeding and very worried about her unborn child.....I don't think anyone has ever accused a scared pregnant mamma of being rational lol.......
Seems sad to me that in a situation like that legislation trumps common sense

Read the posted EMTALA laws. They were enacted to stop hospitals from pre-screening paying patients from non-paying patients. They stopped hospitals from refusing care of patients in labor based upon their their ability to pay or that they weren't a facility that had an OB.

Do you have any idea how many lives and innocent babies this has saved? :idea: What if your sister was in real truoble? What if she was bleeding to death from an abrupted palcenta and without blood products she and her baby would die in the 20 min drive? The ED can deliver babies and then transfer the mother and child. Did you realize that once apatient in the ED. It is the ED's job to find a facility that accepts your sister before they send her and that the present hospital ensures the mother and Baby are safe? :idea: That your sister isn't bleeding to death? Would you rahter the triage nurse tell your sister that they don't have an OB,L/D unit so she had to go else where and never check to see if your sister's life was in danger and have her bleed to death enroute to the other facility? :eek:

This silly little piece of legislation is federal law and can result in hundreds of thousands in fines and lawsuits as well as revoking a hospitals license and medicare/medicaid reimbursement. :smokin: It has saved countless of lives and streamlined a process that was many years ago arduous and painfully lenghtly to provide....:twocents:

Esme12, ASN, BSN, RN · Jun 19, 2011

Ok as for the question about who would put an IUD in a Virgin ? Well my doc for one and I did have to be put out for it , I have pcos and can not take or stand any of drugs they have tried , It was that or a hysterectomy witch (a witch has abroom....it's which) I still might end up with because its not working .
And as for the 2nd yes I really am a full virgin about 11 years ago when i go out of high school I was attacked at my frist job at a co-worker who said I looked like his kid "sick " I was able to get away right before he well "un virgined " me
be he did anuff (enough) to me that I never want to ever have sex I cannot even stand for a male to touch me .

I was not making any statement about the accuracy or truthfullness of your statement or your situation. What a horrible:eek: nightmare to live through....I am so sorry you had to suffer through your pain. I was, however, addressing as to why the ED does things that seem irrational or stupid to the non ED person's eye. Unfortunately we have an unusual amount of people that have some belief that o lie is better than the truth and if they lie long enough it will come true ie: If I ignore I'm pregnant it will go away...So before we hurt you or anyone's baby we check! It prudent medicine and a standard of practice. Like that show...."I didn't know I was pregnant" I have personally delivered several babies on girls/women with abdominal pain that we not sexually active so our questions are not personal nor a statement to your individual credibility......((HUGS))

Trekfan · Jun 19, 2011

Now thats one for the books !!

Trekfan · Jun 19, 2011

I was not making any statement about the accuracy or truthfullness of your statement or your situation. What a horrible:eek: nightmare to live through....I am so sorry you had to suffer through your pain. I was, however, addressing as to why the ED does things that seem irrational or stupid to the non ED person's eye. Unfortunately we have an unusual amount of people that have some belief that o lie is better than the truth and if they lie long enough it will come true ie: If I ignore I'm pregnant it will go away...So before we hurt you or anyone's baby we check! It prudent medicine and a standard of practice. Like that show...."I didn't know I was pregnant" I have personally delivered several babies on girls/women with abdominal pain that we not sexually active so our questions are not personal nor a statement to your individual credibility......((HUGS))

Understood , Sorry did not mean to snap at you I just do not think that I should have to explain why , when I go to a doctor ,ER,or for a test just to keep people from stairing at me and joking when they get outside the room :devil: I had to have somthing done a few weeks ago and the nurse told me that I was deformed ! It turns out I am not and that the nurse just had not ever seen a full virgen !

Esme12, ASN, BSN, RN · Jun 19, 2011

Now thats one for the books !!

People lie.... :cool: I had a late teen early twenty something that lived at home come to the ED with severe abdominal pain. We were in a very affluent neighboorhood. Her parents brought her in....doubled over. As I was triaging her I noticed her pain that doubles her over was very cyclical..... :idea: and she was reluctant to get undressed. She swore she had never been sexually active and was currently on her menses and was "like clockwork". I practically threatened her and took advantage when she was doubled over to "help her" onto the stretcher as I pried off her pants........I saw a head!!!!!!!!!! :eek: As I called loudly to the ED MD that I needed OB and the in house pedi as well as an incubator......My patients having a baby!!!!!!!!!!!!! Her parents in unison shout "She's pregnant???????? :eek: :eek:"

A healthy full term baby girl was born and however they wroked it out....went home a happy family.

That is why we do pregnancy tests.....:)

Esme12, ASN, BSN, RN · Jun 19, 2011

Understood , Sorry did not mean to snap at you I just do not think that I should have to explain why , when I go to a doctor ,ER,or for a test just to keep people from stairing at me and joking when they get outside the room I had to have somthing done a few weeks ago and the nurse told me that I was deformed ! It turns out I am not and that the nurse just had not ever seen a full virgen !

Being a virgin is nothing to be ashamed of...and some people just can't hide their ignorance. :uhoh3: That is not your problem!!!! and shame on them for their unexcusable behavior. In medicine the two words we should never say.........always and never!!!!!!!! Because there is always an exception to the rule. I know you didn't mean harm. But I realize that in writing it's sometimes difficult to grasp meanings because you can't read the body language or facial expressions. So I wanted to be sure you knew my meaning!

Deformed??? Really??? shame on her!!!!

All the best..

Trekfan · Jun 20, 2011

People lie.... I had a late teen early twenty something that lived at home come to the ED with severe abdominal pain. We were in a very affluent neighboorhood. Her parents brought her in....doubled over. As I was triaging her I noticed her pain that doubles her over was very cyclical..... and she was reluctant to get undressed. She swore she had never been sexually active and was currently on her menses and was "like clockwork". I practically threatened her and took advantage when she was doubled over to "help her" onto the stretcher as I pried off her pants........I saw a head!!!!!!!!!! As I called loudly to the ED MD that I needed OB and the in house pedi as well as an incubator......My patients having a baby!!!!!!!!!!!!! Her parents in unison shout "She's pregnant????????:eek:"
A healthy full term baby girl was born and however they wroked it out....went home a happy family.
That is why we do pregnancy tests.....:)

I? I? do not know what to say ? what was she going to do ? just stand there and have the baby in her pants ? was she showing ?

Well a friend of mine who was pregnant called me one night and said she way having cramps ,a little later she called me and was upset because she had peed on her moms couch " At this point it starts to click as to whats happing" she had her baby later that night and do you know she was 9 months and never showed ?

Esme12, ASN, BSN, RN · Jun 20, 2011

I? I? do not know what to say ? what was she going to do ? just stand there and have the baby in her pants ? was she showing ?
Well a friend of mine who was pregnant called me one night and said she way having cramps ,a little later she called me and was upset because she had peed on her moms couch " At this point it starts to click as to whats happing" she had her baby later that night and do you know she was 9 months and never showed ?

DENY, DENY,DENY........I believe it doesn't exsist therfore it is true! The mind is an amazing organ. :uhoh3:

She was a bigger girl and baggy clothes were popular at the time. She had NO CLUE she was pregnant. She actually screamed that she couldn't be pregnant because she had never had sex.....???? :confused: I don't know the ending details because we delivered the baby and she was admitted to OB.......but I suppose that because those little suckers swim.....if the timing is right.....it only takes one..... :smokin:

So when we ED nurses do that eyeroll thing......it's usually because we've been burned.....

psu_213, BSN, RN · Jun 20, 2011

We give virgins pregnancy tests all the time before radiological imaging. It's a policy to have confirmed proof that the patient is not pregnant- we can't just go by the patient's word. If you're post-menarche you get one, and with the dropping average age of menarche that means I'm getting Hcg on 8 year olds sometimes.

We were just talking about this at work the other day. A few years back (before I worked at the ED), a pt came in and needed a CT. The pt swore up and down there was no way she could be pregnant. The doc let her go for the CT without an HCG. Well, the CT showed a fetus. Not sure how it turned out, but now any 'eligible' female has an HCG done if humanly possible.

Raven Sierra, BSN, RN · Jun 20, 2011

We give virgins pregnancy tests all the time before radiological imaging. It's a policy to have confirmed proof that the patient is not pregnant- we can't just go by the patient's word. If you're post-menarche you get one, and with the dropping average age of menarche that means I'm getting Hcg on 8 year olds sometimes.

Agreed. DH is a rad tech, and he gets to ask the uncomfortable questions all the time to girls with their moms there. Moms usually get pretty upset and think he's a pervert. Fortunately, DH is very diplomatic and explains quickly WHY they have to do a UPT on a 9-year-old. But he had one former co-worker who worded the question badly (co-worker was also male): "So, have you had sex?" Mom didn't like that one so much; she thought it was a pick-up line.

We standardly test every female who has reached puberty age, unless she is critical and cannot wait for a UPT. We never ask if they're a virgin, partially because it seems that some people don't get basic biology. My roommate in college, for example, did not account for the fact that there are highly-motivated swimmers who will take advantage of any opportunity to fertilize. :smackingf