Patient Dumping

[Wino]

A homeless patient is treated and discharged to the street, which is essentially their home, the whole outside is their home; yet somehow people think that it is the responsibility of the hospital to provide a home for this person, otherwise it is considered patient dumping. Why is the Emergency Room or the hospital the answer to all of societies ills. If your a drunk, dump them in the emergency room. If your tired of taking care of your parent, dump them in the emergency room. You have a psychiatric issue, dump them in the Emergency Room?:

[yawnef]

A homeless patient is treated and discharged to the street, which is essentially their home, the whole outside is their home; yet somehow people think that it is the responsibility of the hospital to provide a home for this person, otherwise it is considered patient dumping. Why is the Emergency Room or the hospital the answer to all of societies ills. If your a drunk, dump them in the emergency room. If your tired of taking care of your parent, dump them in the emergency room. You have a psychiatric issue, dump them in the Emergency Room?:

This is not new. I worked in an ER over 30 years ago, and these scenarios were present back then.

Everything old is new again.

[Wino]

This is not new. I worked in an ER over 30 years ago, and these scenarios were present back then.

Everything old is new again.
I agree, this has been a problem for many years, but recently the media has made the ER and the hospital out as the big bad meanie, for discharging these patients without a home. Maybe these patients should be discharged at the capital's front steps, and let them provide placement.

[yawnef]

I agree, this has been a problem for many years, but recently the media has made the ER and the hospital out as the big bad meanie, for discharging these patients without a home. Maybe these patients should be discharged at the capital's front steps, and let them provide placement.

Nothing works. Back then we used to pitch a fit about it - but nothing ever changed. And nothing ever will. As long as there are drunks, and misfits, and mentally disturbed people, there will be dumping.

[jeepers]

I think that you all need to be careful as to what you are saying.

There is a federal law, defining what is 'patient dumping' and then there is the opinion of anyone posting in this thread who define for themselves what dumping is. Two totally different animals.

The example of the homeless person may or may not be illegal dumping, depending upon his mental status. If he's non compus mentus, then yes, that would be dumping. If he's legally competant and wants to get the hell out of Dodge, it's perfectly legal. Matter of fact, to 'keep' him would therefore be against his will. Which could be some sort of unlawful confinement violation.

[geauxtohell]

I agree, this has been a problem for many years, but recently the media has made the ER and the hospital out as the big bad meanie, for discharging these patients without a home. Maybe these patients should be discharged at the capital's front steps, and let them provide placement.

What are you talking about?

ERs were never intended to bed patients for long. They are triage and stabilization centers. I haven't heard anyone in the media or elsewhere expect an ER to house a patient and give up beds that would otherwise be used to save lives.

Do you have a link?

[Wino]

I think that you all need to be careful as to what you are saying.

There is a federal law, defining what is 'patient dumping' and then there is the opinion of anyone posting in this thread who define for themselves what dumping is. Two totally different animals.

The example of the homeless person may or may not be illegal dumping, depending upon his mental status. If he's non compus mentus, then yes, that would be dumping. If he's legally competant and wants to get the hell out of Dodge, it's perfectly legal. Matter of fact, to 'keep' him would therefore be against his will. Which could be some sort of unlawful confinement violation.

Therefore, this person who suddenly became non compus mentus and was sent to the ED, is now the ED and the hospitals responsibility? If the government has decided that this person should be given placement, then the government should do it and the patient should be placed at the capital's steps. Why should the ER and the hospital absorb these costs?

[EmmanuelGoldstein]

Therefore, this person who suddenly became non compus mentus and was sent to the ED, is now the ED and the hospitals responsibility? If the government has decided that this person should be given placement, then the government should do it and the patient should be placed at the capital's steps. Why should the ER and the hospital absorb these costs?

Huh?

If a patient is deemed incompetent to care for themselves (and/or unable to make decisions for themselves), then placement is obtained through social workers/case management.

When I worked the diabetic unit, we used to discharge patients to the street all the time. They were put into a cab and taken off hospital property.

[geauxtohell]

Huh?

If a patient is deemed incompetent to care for themselves (and/or unable to make decisions for themselves), then placement is obtained through social workers/case management.

When I worked the diabetic unit, we used to discharge patients to the street all the time. They were put into a cab and taken off hospital property.

But the hyperbole is soooooo much more exciting!

[CaptainCrunch]

Hospitals should be used as homes for the mentally ill, substance abusers, & drunks.

[Wino]

What are you talking about?

ERs were never intended to bed patients for long. They are triage and stabilization centers. I haven't heard anyone in the media or elsewhere expect an ER to house a patient and give up beds that would otherwise be used to save lives.

Do you have a link?

I work in an ER and you are say mistaken! Drunks are held in the ED until they are legally sober, which may mean takening up a bed for 16 to 24 hours until they are sober. Patients come in every day stating that they are thinking of suicide, they take up a ER bed for up to 72 hours. Even though they could be watched anywhere to make sure they didn't something stupid. In the ED that I work in, sometimes half the beds are taken up by drunks and people with suicidal ideations that really only want a place to sleep and food for free.

[Chuangtzu]

I work in an ER and you are say mistaken! Drunks are held in the ED until they are legally sober, which may mean takening up a bed for 16 to 24 hours until they are sober. Patients come in every day stating that they are thinking of suicide, they take up a ER bed for up to 72 hours. Even though they could be watched anywhere to make sure they didn't something stupid. In the ED that I work in, sometimes half the beds are taken up by drunks and people with suicidal ideations that really only want a place to sleep and food for free.

Because what we really need is drunken would-be suicides doing the bus dive, right?

[Wino]

Because what we really need is drunken would-be suicides doing the bus dive, right?
Drunks that are medically cleared should be placed at the capital's steps and let them be responsible for these people. People with suicidal ideations, should also be placed at the capital's steps and let them be respnsible for these people. Once they are medically cleared, the ER should not be responsible!

[Chuangtzu]

Drunks that are medically cleared should be placed at the capital's steps and let them be responsible for these people. People with suicidal ideations, should also be placed at the capital's steps and let them be respnsible for these people. Once they are medically cleared, the ER should not be responsible!

I was going to scoff, but I realized you're actually serious.

[Wino]

I was going to scoff, but I realized you're actually serious.
Yes, I am serious. Why should the ER or the hospital be responsible for the costs of these people. If the government is making hospitals and ERs to be responsible for patient dumping, then let them be responsible for the problem, instead of transfering the responsibility and costs to private institutions.

[Chuangtzu]

Yes, I am serious. Why should the ER or the hospital be responsible for the costs of these people. If the government is making hospitals and ERs to be responsible for patient dumping, then let them be responsible for the problem, instead of transfering the responsibility and costs to private institutions.

Because it's better to have the suicide kill herself on the highway, or maybe leave her body lying for her kids to discover. You're right.

[Wino]

Because it's better to have the suicide kill herself on the highway, or maybe leave her body lying for her kids to discover. You're right.
What kind of answer it that! Give me a break, I really don't think you're as ignorant as the statement you stated. Someone suicidal placed in a jail cell, or anywhere elsewhere they are watched, will make a suicide attempt as difficult as in the ER, but they are not taking up an ER bed where more worthy patients are needed!

[Gabby]

This is the kind of think that could be addressed as one small fix that could make a big difference in our health system.

If drunks and suicidal poeple are filling up ER beds on a regular basis, than we need a facility that is not as expensive as an ER to take care of this population for a fraction of the cost.

An ER is not the right place for this.

[Wino]

This is the kind of think that could be addressed as one small fix that could make a big difference in our health system.

If drunks and suicidal poeple are filling up ER beds on a regular basis, than we need a facility that is not as expensive as an ER to take care of this population for a fraction of the cost.

An ER is not the right place for this.
Totally agree! What is our messiah, Pres. Obama, plan to solve this! What is his solution for EDs and hospitals having to dump patients on the streets? I don't believe that he has any answers. His answer is to let hospitals and EDs soak up the costs for these patients, even if it drives community hospitals out of business. I actually think that Obama's plan will drive many hospitals out of business. Medicare and medicaid really do not cover the costs. Every year they try to reduce the benefits that they pay for or the amount that they are willing to pay for these benefits. They claim that they are eliminating fraud, etc... But everyone else that is playing by the rules is suffering by pay that doesn't cover the costs.

[EmmanuelGoldstein]

Patients come in every day stating that they are thinking of suicide, they take up a ER bed for up to 72 hours.

Um, I don't think this is legal.

What do you do in the ER, btw?

[EmmanuelGoldstein]

Yes, I am serious. Why should the ER or the hospital be responsible for the costs of these people. If the government is making hospitals and ERs to be responsible for patient dumping, then let them be responsible for the problem, instead of transfering the responsibility and costs to private institutions.

Our hospital is required to provide a certain level of charity care. (don't have the exact number or percentage, sorry)

[Wino]

Um, I don't think this is legal.

What do you do in the ER, btw?
I am an ER physician, This is legal and happens everyday!

[geauxtohell]

I work in an ER and you are say mistaken! Drunks are held in the ED until they are legally sober, which may mean takening up a bed for 16 to 24 hours until they are sober. Patients come in every day stating that they are thinking of suicide, they take up a ER bed for up to 72 hours. Even though they could be watched anywhere to make sure they didn't something stupid. In the ED that I work in, sometimes half the beds are taken up by drunks and people with suicidal ideations that really only want a place to sleep and food for free.

That's great. You referenced some media backlash about this, so link?

[Wino]

That's great. You referenced some media backlash about this, so link?
I don't need to give a link, I live this!! Find your own links to verify or refute what I have introduced!!!!

[EmmanuelGoldstein]

I am an ER physician, This is legal

Not without a court order.

[EmmanuelGoldstein]

I don't need to give a link, I live this!! Find your own links to verify or refute what I have introduced!!!!

lol

You make the claim, you back it up. That's how it goes 'round these parts.

[EmmanuelGoldstein]

Drunks that are medically cleared should be placed at the capital's steps and let them be responsible for these people. People with suicidal ideations, should also be placed at the capital's steps and let them be respnsible for these people. Once they are medically cleared, the ER should not be responsible!

You'd think someone with a doctorate would know how to spell "capitol".

[Wino]

Not without a court order.
Obviously you don't live in Florda, It's called a baker Act. Look it up for yourself!
You need to educate yourself on the laws of Florida and I'm not going to do it for you!

[Wino]

lol

You make the claim, you back it up. That's how it goes 'round these parts.
Back up your own claim!

[Wino]

You'd think someone with a doctorate would know how to spell "capitol".
Yes, a mispelling must mean your ignorant and too stupid to have an opinion. You make me sick!

[Wino]

That's great. You referenced some media backlash about this, so link?
What media backlash did I reference?

[EmmanuelGoldstein]

Obviously you don't live in Florda, It's called a baker Act. Look it up for yourself!
You need to educate yourself on the laws of Florida and I'm not going to do it for you!
Probably because you can't.

I know what the Baker Act is.

The person must be evaluated immediately and cannot be held involuntarily for more than 72 hours. (all involuntary examinations involve law enforcement) Within that time frame, they must either be released, voluntarily registered with either an outpatient or inpatient mental health facility, OR a court order obtained to involuntarily admit them to a mental health facility.

If (according to your post above) you're simply holding someone for 72 hours, that's not according to the law. As an ER physician, you should know that.

[EmmanuelGoldstein]

What media backlash did I reference?This:

I agree, this has been a problem for many years, but recently the media has made the ER and the hospital out as the big bad meanie, for discharging these patients without a home. Maybe these patients should be discharged at the capital's front steps, and let them provide placement.

[EmmanuelGoldstein]

Back up your own claim!

I did. Your turn.

[EmmanuelGoldstein]

Yes, a mispelling must mean your ignorant and too stupid to have an opinion. You make me sick!

Physician, heal thyself.

[Wino]

Probably because you can't.

I know what the Baker Act is.

The person must be evaluated immediately and cannot be held involuntarily for more than 72 hours. (all involuntary examinations involve law enforcement) Within that time frame, they must either be released, voluntarily registered with either an outpatient or inpatient mental health facility, OR a court order obtained to involuntarily admit them to a mental health facility.

If (according to your post above) you're simply holding someone for 72 hours, that's not according to the law. As an ER physician, you should know that.


Once again your ignorance is apparent, you obviously are not a physician and have no idea how a baker act affects the ED. Just try transfering a patient to a mental health facility. You live in utopia. Come back to earth!

[Wino]

Physician, heal thyself.
You obviously have a problem, I hope you find help!

[Wino]

I did. Your turn.
Try again!

[EmmanuelGoldstein]

Once again your ignorance is apparent, you obviously are not a physician and have no idea how a baker act affects the ED. Just try transfering a patient to a mental health facility. You live in utopia. Come back to earth!
lol

I understand more about it than you seem to think.

[Wino]

lol

I understand more about it than you seem to think.

No you don't!

[EmmanuelGoldstein]

You obviously have a problem, I hope you find help!

You need some alprazolam. Write yourself a 'script, doc.

[EmmanuelGoldstein]

No you don't!

lol

Yes I do!

(your turn)

[Wino]

lol

Yes I do!

(your turn)
Just because you think your an expert, does not make you an expert! Say it as may times as you want, but your ignorance won't change.

[EmmanuelGoldstein]

Just because you think your an expert, does not make you an expert! Say it as may times as you want, but your ignorance won't change.
Me rubber, you glue, etc.

Why don't you go into another specialty since this ****es you off so badly?

[Wino]

Me rubber, you glue, etc.

Why don't you go into another specialty since this ****es you off so badly?
Why don't you try to give a civil answer, and respond with a fact or at least a coherent thought, that might back up whatever your belief is, whatever that is? What is your answer to the problem, or maybe you think there is no problem.

[EmmanuelGoldstein]

Why don't you try to give a civil answer, and respond with a fact or at least a coherent thought, that might back up whatever your belief is, whatever that is? What is your answer to the problem, or maybe you think there is no problem.
I tried. You turned it into a ****ing match.

Yes, there is a problem. ERs are being abused. I agree with you. There are two places I could never work. ER and peds. People tell me how 'hard' my job must be. Nothing compared to that. I might be able to work a VA ER. That way it would only be (mostly) old men. I can deal with old men.

Regarding what you say about people dumping their elderly in ERs, if that happens here the SWs make a call to APS. I remember years ago, everyone just sorta looked the other way. No longer.

[Wino]

I tried. You turned it into a ****ing match.

Yes, there is a problem. ERs are being abused. I agree with you. There are two places I could never work. ER and peds. People tell me how 'hard' my job must be. Nothing compared to that. I might be able to work a VA ER. That way it would only be (mostly) old men. I can deal with old men.

Regarding what you say about people dumping their elderly in ERs, if that happens here the SWs make a call to APS. I remember years ago, everyone just sorta looked the other way. No longer.
Thank God we are back to a civil conversation! I would welcome you to come a spend some time with me and actuallly see what is going on. Drunks and psych patients do take up a lot of beds. How do we change this? Whenever a family does not know what to do with their family member, they bring them to the ED. The insurance industry, medicare and medicaid will not pay for an admission to the hospital unless certain criteria is met. Family being unable to care for mother or father, does not meet that requirement. Therefore the patient has to be admitted for some reason, for 3 days, to meet these requirements and for the hospital to be paid and the patient to be able to be placed in a home, etc....
When Obama is stating that certain tests are repeated, and the physician are unaware,from the Emergency standpoint,
A chest X-Ray changes hour from hour. Believe it or not, but some patients go to one ED and get tests done, are unhappy with the outcome and go to another ED and get the same tests done. They do not let the ED physician know about previous testing.

Unless Tort Reform happens, unneccessary testing will always happen to prevent lawsuits.

[Z_only1]

Because it's better to have the suicide kill herself on the highway, or maybe leave her body lying for her kids to discover. You're right.
So do you actually speak from exprience or is this aa back handed bloviation that you read from recovery.org ....efficiency.

[EmmanuelGoldstein]

Thank God we are back to a civil conversation! I would welcome you to come a spend some time with me and actuallly see what is going on. Drunks and psych patients do take up a lot of beds. How do we change this? Whenever a family does not know what to do with their family member, they bring them to the ED. The insurance industry, medicare and medicaid will not pay for an admission to the hospital unless certain criteria is met. Family being unable to care for mother or father, does not meet that requirement. Therefore the patient has to be admitted for some reason, for 3 days, to meet these requirements and for the hospital to be paid and the patient to be able to be placed in a home, etc....
When Obama is stating that certain tests are repeated, and the physician are unaware,from the Emergency standpoint,
A chest X-Ray changes hour from hour. Believe it or not, but some patients go to one ED and get tests done, are unhappy with the outcome and go to another ED and get the same tests done. They do not let the ED physician know about previous testing.

Unless Tort Reform happens, unneccessary testing will always happen to prevent lawsuits.
True, but I know what he was talking about. I see it happen every day. Perhaps you don't see it as much working where you do, but it's not uncommon for consultants not to read each others' reports or what they've ordered---or for the admitting to re-order tests already done in the ER prior to admission. I spend a lot of time calling and asking if they want these repeated; most of the time they admit they weren't aware of the duplication.

From a personal perspective, I had a ton of bloodwork done at one doc's, then the same tests done at another within a week rather than the second doc simply getting the results from the first (with my permission of course). I understand that diagnostics change from minute to minute even, but it was unlikely that my A1C, lipids/cholesterol and electrolytes were going to change to any great degree within that time frame.

I've cared for patients admitted for the sole purpose of placing them in a NH or whatever. That's not quite the same thing as a family dumping them in the ER. Many times these folks are trying to care for their elderly relatives and are simply overwhelmed. Or the older person refuses to allow help. That happened with my grandmother. She was clearly becoming confused and unable to care for herself, yet was adamant that she wasn't going to leave her home and no one was going to move in to help her. That caused a big rift in my family; she had to be declared incompetent (which she clearly was) and placed in a facility where she'd have 24 hour care.

I work in a teaching hospital, and I'm convinced that a lot of unnecessary testing and procedures are done for the purpose of educating the residents. I also have a problem with putting the patient through the expense (and often discomfort) of diagnostics that won't change the course of treatment in any way---they are ordered simply to satisfy the physician's (and sometimes the family's) curiosity. I've had docs admit as much. I think that is completely unethical.

[EmmanuelGoldstein]

Drunks and psych patients do take up a lot of beds. How do we change this?It's always been like that. Perhaps for a private hospital in an upscale area, it might not be as common.

[Wino]

True, but I know what he was talking about. I see it happen every day. Perhaps you don't see it as much working where you do, but it's not uncommon for consultants not to read each others' reports or what they've ordered---or for the admitting to re-order tests already done in the ER prior to admission. I spend a lot of time calling and asking if they want these repeated; most of the time they admit they weren't aware of the duplication.

From a personal perspective, I had a ton of bloodwork done at one doc's, then the same tests done at another within a week rather than the second doc simply getting the results from the first (with my permission of course). I understand that diagnostics change from minute to minute even, but it was unlikely that my A1C, lipids/cholesterol and electrolytes were going to change to any great degree within that time frame.

I've cared for patients admitted for the sole purpose of placing them in a NH or whatever. That's not quite the same thing as a family dumping them in the ER. Many times these folks are trying to care for their elderly relatives and are simply overwhelmed. Or the older person refuses to allow help. That happened with my grandmother. She was clearly becoming confused and unable to care for herself, yet was adamant that she wasn't going to leave her home and no one was going to move in to help her. That caused a big rift in my family; she had to be declared incompetent (which she clearly was) and placed in a facility where she'd have 24 hour care.

I work in a teaching hospital, and I'm convinced that a lot of unnecessary testing and procedures are done for the purpose of educating the residents. I also have a problem with putting the patient through the expense (and often discomfort) of diagnostics that won't change the course of treatment in any way---they are ordered simply to satisfy the physician's (and sometimes the family's) curiosity. I've had docs admit as much. I think that is completely unethical. All doctors train at teaching hospitals, and yes unnecessary tests are ordered until the resident realizes that those tests are unneccessary. Since you are so up to date on healthcare, you can deny care that you deem unneccessary. But if later, you decide that care should have been given, you will sue those doctors that were agreeing with the care you wanted, and the lawyer will make the doctor out to be the most evil person that ever existed.

[ladymudd]

Where I work, Psych pts must be evaluated by an ER doc. If the patient is found to be suicidal, then and only then can we hold them with a 72 hour hold signed by the doc. The pt is then transfered to our psych unit. All other's are discharged and released.

[EmmanuelGoldstein]

All doctors train at teaching hospitals, and yes unnecessary tests are ordered until the resident realizes that those tests are unneccessary.Here, the attending has to sign off on their notes and orders. Since you are so up to date on healthcare, you can deny care that you deem unneccessary. As a patient I can. As a nurse, I can only notify the docs that these tests are duplicates. But if later, you decide that care should have been given, you will sue those doctors that were agreeing with the care you wanted, and the lawyer will make the doctor out to be the most evil person that ever existed.For me, it would have to be pretty bad before I'd consider filing suit.

[EmmanuelGoldstein]

Where I work, Psych pts must be evaluated by an ER doc. If the patient is found to be suicidal, then and only then can we hold them with a 72 hour hold signed by the doc. The pt is then transfered to our psych unit. All other's are discharged and released.
That's how it is here, too. Someone from mental health services evaluates them too and they are held over to psych for 72 hours if they're kept involuntarily. There must be a hearing within that time (or by the following weekday if this falls on a weekend) for them to be 'committed' for a longer period.

[Gaetano "Tommy" Lucchese]

Drunks that are medically cleared should be placed at the capital's steps and let them be responsible for these people. People with suicidal ideations, should also be placed at the capital's steps and let them be respnsible for these people. Once they are medically cleared, the ER should not be responsible!

Holy mackerel, they just 302 (eta: the PA designation for involuntary commitment, it's 730 in NY and 5150 in CA) them and turf them to a mental-health facility.

[Gaetano "Tommy" Lucchese]

I am an ER physician, This is legal and happens everyday!

Could be because publicly-funded hospitals are required by law to treat the indigent.

I'm surprised as an emergency medicine guy you don't know this.

I was just a lowly medic and I know the legalities surrounding this issue.

[jeepers]

Holy mackerel, they just 302 (eta: the PA designation for involuntary commitment, it's 730 in NY and 5150 in CA) them and turf them to a mental-health facility.

5150 in CA

Floor patients: Call the country hospital psych unit evaluation team. They come by and evaluate the patient. If they meet the criteria, they're committed for 72 hours in THEIR psych unit. Bye bye in an ambulance.

However, I've had patients who've tried to kill themselves and end up in the ICU. They're made one to one and are on suicide watch. They're not transferred until they are stable and they are evaluated several times a day to see if the situation has changed and to assess if the treatment plan is to be altered, etc.

[tx-con]

Anyone see the story about Mrs. Obama's alleged involvement in patient dumping?

http://www.americanthinker.com/2009/03/michelle_obamas_patientdumping_1.html

Apparently she either authored or coauthored a plan that would send sick people away from the ER at her hospital.

[geauxtohell]

What media backlash did I reference?

This media backlash:

I agree, this has been a problem for many years, but recently the media has made the ER and the hospital out as the big bad meanie, for discharging these patients without a home. Maybe these patients should be discharged at the capital's front steps, and let them provide placement.

I referenced it for you again, since you ignored it when EG pointed it out to you.

As an aside, with your profile name and status, you seem to have a real disdain for the homeless. At what point during your medical education did you lose your empathy?

[geauxtohell]

Could be because publicly-funded hospitals are required by law to treat the indigent.

I'm surprised as an emergency medicine guy you don't know this.

I was just a lowly medic and I know the legalities surrounding this issue.

Bingo.

[Wino]

Where I work, Psych pts must be evaluated by an ER doc. If the patient is found to be suicidal, then and only then can we hold them with a 72 hour hold signed by the doc. The pt is then transfered to our psych unit. All other's are discharged and released.
Yes, I would be nice if you could just transfer them to a psych unit, but many hospitals do not have psych units and if they do, many times there are no beds available and the patient remains in the ED taking up a much needed bed. The ER doc does evaluate the patient, making sure that there is no medical problem, but the patient only has to say that they are thinking of suicide and the patient is held until a psychiatrist releases them.

[Wino]

Could be because publicly-funded hospitals are required by law to treat the indigent.

I'm surprised as an emergency medicine guy you don't know this.

I was just a lowly medic and I know the legalities surrounding this issue.
By law, everyone that comes to an emergency room gets a "medical screening exam", you are not allowed to ask about their insurance or ability to pay. It does not matter if the hospital is publically funded or not.

[Wino]

This media backlash:



I referenced it for you again, since you ignored it when EG pointed it out to you.

As an aside, with your profile name and status, you seem to have a real disdain for the homeless. At what point during your medical education did you lose your empathy?
Tell me why is it the hospital's responsibility to find these patients a home?

[pennysworth56]

Anyone see the story about Mrs. Obama's alleged involvement in patient dumping?

http://www.americanthinker.com/2009/03/michelle_obamas_patientdumping_1.html

Apparently she either authored or coauthored a plan that would send sick people away from the ER at her hospital.

Yep this came out a few months ago after a kid was bit by a pit and had his lips tore off.
And the hospital sent him home after stopping the bleeding. And ended up at another
hospital across town and the doc there said he should have been sown up when it happened.

The first hospital was in the south of Chicago.

penny

[Gaetano "Tommy" Lucchese]

By law, everyone that comes to an emergency room gets a "medical screening exam", you are not allowed to ask about their insurance or ability to pay. It does not matter if the hospital is publically funded or not.

Hospitals around here, they ask you for your insurance information during triage, if you're conscious, and if not, immediately when you wake up. Definitely before you see a doctor. I wouldn't doubt the same holds just about everywhere, because these are public hospitals. Private hospitals will bounce you to a public hospital in a blink, unless it's like a Catholic hospital.

[Flipple]

By law, everyone that comes to an emergency room gets a "medical screening exam", you are not allowed to ask about their insurance or ability to pay. It does not matter if the hospital is publically funded or not.

Actually, no, if the hospital is not a participating Medicare hospital, EMTALA does not apply.

[Mohawk5]

Looks like there's another First Lady that is going to bomb on health care as well.

[Flipple]

Hospitals around here, they ask you for your insurance information during triage, if you're conscious, and if not, immediately when you wake up. Definitely before you see a doctor. I wouldn't doubt the same holds just about everywhere, because these are public hospitals. Private hospitals will bounce you to a public hospital in a blink, unless it's like a Catholic hospital.

IF that's true, those hospitals are in violation of EMTALA, and are at risk of vicious fines. That WAS true in the 60's and 70's, which is why EMTALA arose in the first place.

[Gaetano "Tommy" Lucchese]

IF that's true, those hospitals are in violation of EMTALA, and are at risk of vicious fines. That WAS true in the 60's and 70's, which is why EMTALA arose in the first place.

It's not that they don't treat you if you don't have it, but they do ask.

[Flipple]

This media backlash:



I referenced it for you again, since you ignored it when EG pointed it out to you.

As an aside, with your profile name and status, you seem to have a real disdain for the homeless. At what point during your medical education did you lose your empathy?

We ALL lose a little of our altruistic idealism as we go along, Geaux. A few years getting cursed at, spat on, puked on, screamed at, threatened, and denigrated by people and their families who you are doing your best to help, and it's hard not to. And, yes, the homeless and/or uninsured are more prone than anyone to be abusive, unappreciative, and (it's a fact), litigious.

Wino obviously has some deep wounds along these lines.

[Flipple]

It's not that they don't treat you if you don't have it, but they do ask.

If they are initiating a transfer based on ability to pay, they are in violation not only of the spirit, but of the letter of the EMTALA statute. Again, that SPECIFIC problem was at the root of the formulation of EMTALA.

[Gaetano "Tommy" Lucchese]

If they are initiating a transfer based on ability to pay, they are in violation not only of the spirit, but of the letter of the EMTALA statute. Again, that SPECIFIC problem was at the root of the formulation of EMTALA.

Well, they do it somehow. UPMC is one of the most respected medical systems in the country, probably top three. I doubt they're breaking the law.

[darknessesedge]

A homeless patient is treated and discharged to the street, which is essentially their home, the whole outside is their home; yet somehow people think that it is the responsibility of the hospital to provide a home for this person, otherwise it is considered patient dumping. Why is the Emergency Room or the hospital the answer to all of societies ills. If your a drunk, dump them in the emergency room. If your tired of taking care of your parent, dump them in the emergency room. You have a psychiatric issue, dump them in the Emergency Room?:

are there no more fema trailers for sale?

[Wino]

Actually, no, if the hospital is not a participating Medicare hospital, EMTALA does not apply.
If that hospital has an emergency room, it does apply and would be an EMTALA violation.

[EmmanuelGoldstein]

We ALL lose a little of our altruistic idealism as we go along, Geaux. A few years getting cursed at, spat on, puked on, screamed at, threatened, and denigrated by people and their families who you are doing your best to help, and it's hard not to. And, yes, the homeless and/or uninsured are more prone than anyone to be abusive, unappreciative, and (it's a fact), litigious.

Wino obviously has some deep wounds along these lines.

That's why I suggested he step back and pursue another specialty (or use his specialty in another manner). Burn out can be a bitch.

[EmmanuelGoldstein]

If that hospital has an emergency room, it does apply and would be an EMTALA violation.

His point is it has to be a Medicare participating facility. Which is pretty much all hospitals, minus the VA, Shriner's and Indian Services.

[EmmanuelGoldstein]

If they are initiating a transfer based on ability to pay, they are in violation not only of the spirit, but of the letter of the EMTALA statute. Again, that SPECIFIC problem was at the root of the formulation of EMTALA.

Our ER and outpatient urgent care registrars will get you to sign consent to treat and take insurance info if you have it, but there's no refusal to treat if you don't. Transfers are based upon level of care (which doesn't apply much in our case as we're a trauma hospital), at the request of the patient/family, or if we're at peak census.

[EmmanuelGoldstein]

It was the same at the private hospital I worked for, too. Ability to pay wasn't part of the equation (until after the fact, of course).

[Wino]

That's why I suggested he step back and pursue another specialty (or use his specialty in another manner). Burn out can be a bitch.
It's not that I don't have empathy for my patients that truely need to be in the ED. My point is that EDs are overcrowded and in an attempt to relieve the pressure and open up beds so that patients that have been waiting for hours in the waiting room can be seen, that the homeless and drunks are taking up these much needed beds and delaying the care of others.

[EmmanuelGoldstein]

It's not that I don't have empathy for my patients that truely need to be in the ED. My point is that EDs are overcrowded and in an attempt to relieve the pressure and open up beds so that patients that have been waiting for hours in the waiting room can be seen, that the homeless and drunks are taking up these much needed beds and delaying the care of others.
Homeless and/or drunk doesn't preclude need for medical care. Our hospital has an urgent care department adjacent to the ED that takes some of the pressure off.

Just last week one of my patient's relatives came to me and asked if she should go to the ED. She had a rash from poison ivy exposure. It was such a mild rash, I had to get up close and really squint to see it. Every fiber in my being wanted to scream "HELL NO!" and tell her to run over to the 24 hour pharmacy for some cortaid or calamine... but of course I can't do that. I simply told her that was up to her, but reminded her that there'd been (at least) 4 traumas called since I'd come in (typical Saturday night) and that she was likely to have to wait for a looooong time.

[Wino]

Homeless and/or drunk doesn't preclude need for medical care. Our hospital has an urgent care department adjacent to the ED that takes some of the pressure off.

Just last week one of my patient's relatives came to me and asked if she should go to the ED. She had a rash from poison ivy exposure. It was such a mild rash, I had to get up close and really squint to see it. Every fiber in my being wanted to scream "HELL NO!" and tell her to run over to the 24 hour pharmacy for some cortaid or calamine... but of course I can't do that. I simply told her that was up to her, but reminded her that there'd been (at least) 4 traumas called since I'd come in (typical Saturday night) and that she was likely to have to wait for a looooong time.
I'm talking about homeless and drunks that have been medically cleared. I work in a 32 bed ED, fast track is closed after 11pm, the homeless have learned how to use the system, when they cannot get a bed at the salvation army, they come to the ED claiming to be suicidal, which obligates the ED to hold on to these patients, once medically cleared, until a psychiatrist clears them in the morning or if we are lucky, able to transfer the patient to a psych treatment facility. Every drunk that EMS finds behind a dumpster or laying in a yard is brought to the ED. Once the patient is medically cleared, our institution will not allow us to discharge the patient until their blood alcohol level is below 80. Many of these individuals have blood alcohol levels in the 300 - 400 level, which means we have to hold them sometimes 12 - 16 hours.

[EmmanuelGoldstein]

I'm talking about homeless and drunks that have been medically cleared. I work in a 32 bed ED, fast track is closed after 11pm, the homeless have learned how to use the system, when they cannot get a bed at the salvation army, they come to the ED claiming to be suicidal, which obligates the ED to hold on to these patients, once medically cleared, until a psychiatrist clears them in the morning or if we are lucky, able to transfer the patient to a psych treatment facility. Every drunk that EMS finds behind a dumpster or laying in a yard is brought to the ED. Once the patient is medically cleared, our institution will not allow us to discharge the patient until their blood alcohol level is below 80. Many of these individuals have blood alcohol levels in the 300 - 400 level, which means we have to hold them sometimes 12 - 16 hours.

Perhaps you should develop a protocol specifically for these folks.

Diagnose them all with obstipation. Strict NPO. Triple-H enemas 'til clear. Sigmoidoscopies, with extra gas so you can see clearly (without versed, as they are intoxicated--- wouldn't want to risk any drug/alcohol interactions). No opioids (worsens the condition, ya know).

Place suicides on Q5 minute checks RTC. Awaken them every 5 minutes and reassess if they're still thinking of harming themselves. 24F caths for UAs to check for serial drug levels every 4 hours or so.

Send the worst stick you have on staff in to draw alcohol levels every hour on the hour.

C'mon. Use your imagination. I'm sure after a short time the word will get around that your ED is not the place to hang.

[hailreagan]

That's why I suggested he step back and pursue another specialty (or use his specialty in another manner). Burn out can be a bitch.


Emma..........don't you think that burnout will increase if this thing goes through?

I do not see how it couldn't.

[EmmanuelGoldstein]

Emma..........don't you think that burnout will increase if this thing goes through?

I do not see how it couldn't.
I don't think it's going to make a difference either way in how his ED is used as a flop-house. As far as patients coming in for minor stuff because they don't have a primary doc? I see that decreasing.

[chuj666]

The reason Americans are fat and pill-poppers is because they have great healthcare. It's better to stay in shape and avoid hospitals, that's why Obama wants socialized medicine, so people take their health responsiblity in their own hands instead of going for the fast fix which doesn't work.

[hailreagan]

I don't think it's going to make a difference either way in how his ED is used as a flop-house. As far as patients coming in for minor stuff because they don't have a primary doc? I see that decreasing.


No..........I'm talking about everything. Bigger volumes at this level of providers.

And those primary docs. will take a long time to book so E.R. visits, I predict, will go up with longer wait times...........

[geauxtohell]

We ALL lose a little of our altruistic idealism as we go along, Geaux. A few years getting cursed at, spat on, puked on, screamed at, threatened, and denigrated by people and their families who you are doing your best to help, and it's hard not to. And, yes, the homeless and/or uninsured are more prone than anyone to be abusive, unappreciative, and (it's a fact), litigious.

Wino obviously has some deep wounds along these lines.

I don't disagree. At this very early point, I find myself getting frustrated at times with patients too (my school teaches out of an inner city hospital that services a medically underserved community). It reminds me of being a grunt and getting to combat. You sign up because you think it's worthy cause, and a part of it is, but underlying combat is the fact that isn't not honor and glory. It's all ****.

That being said, I find it curious that an ER doc would register with the name of "Wino" and have a tag line of "homeless man on the street" and go on a rant about how much homeless people suck.

Seems a little out of orbit to me. Maybe he just had a bad day.

[geauxtohell]

Tell me why is it the hospital's responsibility to find these patients a home?

You are finding them a home a la Opera?

Hyperbole aside:

You were saying about media backlash?