Patient Dismissals

[plugger]

One of the cruelest practices I’ve seen is patient dismissals – also known as patient dumping.  I’ve heard of a few cases where a non-violent patient is thrown out of their clinic for minor offenses: questioning care, complaints.  Sometimes this can be a death sentence with no other clinic close by taking in the patient and the hospital only doing dialysis when the patient’s labs have reached critical levels – resulting in a slow death; it is a death sentence without a judge, trial, or jury. 

Arlene Mullin-Lane has been involved with these cases off and on for years and is a good friend.  I understand most of these cases are solved behind the scenes and amicably.  However once in awhile there are some hard cases that come up and more drastic measures are required.  Arlene made me aware of a couple of cases going on now in North Carolina and has posted about it at Patient Rights Advocacy: http://www.patientrightsadvocacy.org/forum/viewforum.php?f=3&sid=86c2da2a5d431c694bace88b2dcc9f6c

If she is posting about it and asking me to make people aware of what is going on, things are getting heated.  She and I go way back and I’m more than happy to spread the word.

[livecam]

Thanks Plugger..I checked out the site which I wasn't aware of previously.  This must be sort of a successor site to Dialysisethics which I see is still online but doesn't appear to be terribly active.  In the cases I knew of personally patient dismissal was more of a threat than an actual practice.  When the unit was at wits end with patients who would be disruptive or repeatedly absent this was tried after the "patient contract" process didn't bear fruit. 

[Joe Paul]

One word - SCARY!

[brenda]

No such thing as patient dismissal not her in Alberta anyway. They just put them in isolation. All dialysis programs here are government run so there's no place for anybody to go.

[Romona]

That is horrible!

[plugger]

Sounds like these were non-violent patients.  But anyway, I have some great news!  I talked to Arlene and the two patients from North Carolina have been taken care of.  One patient - Annie - is going to a clinic about five miles from her home.   The other patient - Larry - will be doing home dialysis.  It sounded like quite a battle before I found out about it.

Livecam, I imagine you are right and most of the time dismissal is just a threat - unfortunately there is a few $#*&^!!!!  who will use it.  And yes, the old DE site is still up, used mostly for reference.

[msawyersw]

Hi--a perspective from the other side of the fence--a dialysis social worker.  A patient dismissal is a loss for all involved.  It is an absolute final step when all else fails.  Does anyone remember the old Star Trek movie quote "the needs of the many outweigh the needs of the one"? In my (admittedly limited) experience--20 years in a few Detroit Metro area units), the primary consideration in discharging a patient is whether the the safety of the rest of the patients and the staff and the integrity of the medical facility as a whole is being placed in jeopardy.

The Federal Renal Networks advocate for patients rights and most problems are settled without a patient losing his place in a facility.  All patients have access to the Federal ESRD Network Rights and Responsibilities.  Most(if not all) units have written grievance and discourage policies that are easily accessible to patients.

What kinds of behavior will cause someone to get discharged from a dialysis unit?  Creating a safety risk by one's behavior.
Any threat of violence towards anyone--staff, patient, visitor.  Extreme verbal abusive --not an occasional swear word-- that creates an atmosphere that is not conducive to medical treatment for the staff or the patients exposed to the verbal abuse. Refusing to allow staff to perform the treatment in a safe and prescribed manner.  Refusing to present for treatment, usually to an extent that the staff cannot treat the person safely in the outpatient setting. Illegal behavior on the unit. Harassment of staff or fellow patients or visitors. Refusing to carry any health insurance or accept any help in obtaining any insurance coverage.

 In short, the kind of behavior you don't want to have to face when you go to treatment.

Patients who present problems that are significant but don't present a threat as described above, are counseled, given warnings, etc, and many do better and don't get discharged. Even if a patient is discharged from one facility, he can apply to another, and if he is not a safety risk, can get a second chance to start over. And patients do succeed often the second time around.  Those who don't often have problems that are difficult to manage in a dialysis setting. They can still be treated through the emergency room, which is better equipped to handle security issues and deal with potentially serious medical problems created by extreme noncompliance.   


Best wishes,  Marcia Sawyer, LMSW