Dismissed Patient in Texas

[plugger]

DialysisEthics has been contacted by a non-violent, dismissed patient in Texas who has been blackballed by the clinics in the patient's area.  The patient is receiving dialysis on only an emergency basis, but it looks like we are rectifying that situation.  I'm posting this because many people don't know one of the things we do - get help quickly due to our contacts in CMS, the dialysis companies, media, and the legal arena.  It pains me think how many dismissed patients haven't known DialysisEthics helps with their situation, and what the consequences have been.  So I feel I ought to get the word out that we still do this sort of thing.

[Rerun]

Please tell us more.  Why was the patient black-balled?  How can they deny services to a patient?

Do you have a link?                       

[Inara]

Physicians have the right to refuse to treat any patient.  No clinic can accept a patient without a doctor.

[twirl]

what is the rest of the story
why was the patient dismissed
health or personality
please tell us more

[plugger]

I'll check and see how much more I can say - I hope you all understand why I've got to be careful.  We hit these situations hard, and we hit them fast when somebody's life is at stake.

[plugger]

We are pretty ticked off at this one, our understanding was this sort of thing wasn't going to happen again.

[BigSky]

what is the rest of the story
why was the patient dismissed
health or personality
please tell us more

That would be the big thing.  The rest of the story. Of the few people I have heard being dismissed they all did something more than once that caused them to be dismissed.

[nursewratchet]

I myself have dismissed patients, after much documentation about many incidents.  I have also been called about patients who have been kicked out of their clinic for various reasons.  They have (in my opinion) been justified to have been kicked out.  These patients are always reviewed with the Dr. and staff.  it is the right of the Dr. and the clinic to refuse a patient for behavior problems.  I'm not talking about someone who is just irritating or non compliant.  Something happened.  Repeatedly.   You also have to consider the bulk of your patients.  If I have an entire clinic full of patients complaining about the actions of 1 patient, then that 1 patient will have to go.  That 1 patient has already been moved to different shifts and days to give a break to the patients that are complaining about the bad patient.  These decisions are not made lightly, but do sometimes have to be made.

[plugger]

That would be the big thing.  The rest of the story. Of the few people I have heard being dismissed they all did something more than once that caused them to be dismissed.

I've watched this for nine years and when it gets to the point Arlene is posting it on the internet, it is serious and I can't recall one of those ever being the patient's fault.  But whatever the story is, you can bet your bottom dollar DaVita and the network are getting the clinic's side of the story.

I'll post about it when I can, but the latest will probably show up on the following thread:
http://www.dialysisethics.org/forum/viewtopic.php?t=5603

[nursewratchet]

That would be the big thing.  The rest of the story. Of the few people I have heard being dismissed they all did something more than once that caused them to be dismissed.

I've watched this for nine years and when it gets to the point Arlene is posting it on the internet, it is serious and I can't recall one of those ever being the patient's fault.  But whatever the story is, you can bet your bottom dollar DaVita and the network are getting the clinic's side of the story.

I'll post about it when I can, but the latest will probably show up on the following thread:
http://www.dialysisethics.org/forum/viewtopic.php?t=5603

I don't know hwo Arlene is, but I can tell you the ESRD network investigates these patients as well, very thouroughly.  My clinic has had the ESRD network ask for patient statements, from ALL patients.  The network always gets both sides, from where I've been anyway...

[Inara]

Nursewratchet, you are now officially my hero. 

(Since there are no further details available at this point, I can only speculate, so forgive me if I overstep any boundaries)

Some patients do NOT deserve dialysis.

And as a dialysis nurse of nearly 9 years, I've seen it all.  At my clinic, years ago, we discharged a full-blown AIDS patient after he pulled his needles out mid-treatment, and tried to STAB ME WITH IT!  Meanwhile, while waiting for the police to show up, he also attempted to injure other patients.   At what point do we, as a people, say NO!???!!! 

Should I be given a death sentence because this patient?  Should my other patients be endangered because this crack-head is angry?  NO.....

I'll say no more until further details are posted, but please realize that there are two sides to every story. 

[paddbear0000]

Inara, all I have to say to your post is YIKES!!!! 

[BigSky]

That would be the big thing.  The rest of the story. Of the few people I have heard being dismissed they all did something more than once that caused them to be dismissed.

I've watched this for nine years and when it gets to the point Arlene is posting it on the internet, it is serious and I can't recall one of those ever being the patient's fault.  But whatever the story is, you can bet your bottom dollar DaVita and the network are getting the clinic's side of the story.

I'll post about it when I can, but the latest will probably show up on the following thread:
http://www.dialysisethics.org/forum/viewtopic.php?t=5603

Hmm a post that mentions nothing to the facts.  Hardly meets the burden of something serious happening.

Non violent means nothing.  No unit needs to wait until violence occurs before throwing a patient out.  A patient makes continued threats against staff or others, throw their ass out period!

[plugger]

I myself have dismissed patients, after much documentation about many incidents.  I have also been called about patients who have been kicked out of their clinic for various reasons.  They have (in my opinion) been justified to have been kicked out. 

Do tell us what offenses are enough to issue a death warrant, if my daughter ever has to go back to dialysis (God forbid) I would like her to know what to avoid.  I do know the patient in Texas isn't holding staff hostage, but I will tell the daughter to avoid that one.

[RichardMEL]

YIKES indeed re the HIV+ patient. That IS scary, and worrying and....

We've had a few patients I *know* the staff would have loved to dismiss, but I am not sure you can down here - or at least I do not know what the rules are (I might have to ask if there's ever an appropriate time). I have seen security called a few times, but I've never seen anything like the above. Clearly it has to be serious... and certainly if other patients (and staff) are at risk you have to think about everyone involved. I imagine here if they had a troublesome patient like that they would stick them in an isolation room. I am not sure.

[bette1]

I don't think anyone should be denined dialysis, but at our unit we are all adults, and people need to behave in a way that respects others.  I don't know the whole story, and I am reserving judgment.  However, I can imagine situations where a non-violent patient could make dialysis misarable for everyone else at the unit.  What should the staff do in that case?  It's a difficult situation

[RichardMEL]

OK I asked one of the managers at my unit yesterday about this.

She told me that here in Australia the public health care system *nobody* can be dismissed because patient care is required for everyone - no matter what. She went on to tell me that apparently there's a patient in Alice Springs (middle of the country) who is so aggressive/violent that the hospital has to send a security guard to pick him up, *sit with him* through treatment, and take him home... yep, 3 times a week....

Private units though can dismiss patients. She works at one sometimes and she says they have kicked some out for various reasons (but didn't go into detail).

I thought that was interesting given this thread/conversation.

[Hanify]

I think it's the same here.  They have prisoners who come in with security guards for the whole time too.

[YLGuy]

Sometimes I feel like a prisoner locked to the chair.  I just don't need any security guards.  Think I'll get time off for good behavior?

[nursewratchet]

I myself have dismissed patients, after much documentation about many incidents.  I have also been called about patients who have been kicked out of their clinic for various reasons.  They have (in my opinion) been justified to have been kicked out. 

Do tell us what offenses are enough to issue a death warrant, if my daughter ever has to go back to dialysis (God forbid) I would like her to know what to avoid.  I do know the patient in Texas isn't holding staff hostage, but I will tell the daughter to avoid that one.

Since you are asking, here goes:  Try not to expose yourself and masturbate in the open, while in the clinic.  REPEATEDLY... Try not to make LOUD, and FIlTHY comments to both staff and patients.  Probably not a good idea to cuss at the top of your lungs, or throw food at people, whether staff or patients.  Don't repeatedly pull out your needles.  Don't have a BM in your pants, every treatment, either because you don't want to get up to go, or won't ask to go, and then refuse to be cleaned up or get yourself cleaned up. The smell is overwhelming, and by the time you leave, the chair is almost impossible to clean.  EVERY treatment, for a person who walks unassissted.  REALLY???  Avoid any of these behaviors and you should be good to stay in the clinic of your choice.  And remember, all of these behaviors have occurred in my clinics, resulting in being kicked out, and NONE of them were violent.

[BigSky]

Do tell us what offenses are enough to issue a death warrant, if my daughter ever has to go back to dialysis (God forbid) I would like her to know what to avoid.  I do know the patient in Texas isn't holding staff hostage, but I will tell the daughter to avoid that one.

Since you are asking, here goes:  Try not to expose yourself and masturbate in the open, while in the clinic.  REPEATEDLY... Try not to make LOUD, and FIlTHY comments to both staff and patients.  Probably not a good idea to cuss at the top of your lungs, or throw food at people, whether staff or patients.  Don't repeatedly pull out your needles.  Don't have a BM in your pants, every treatment, either because you don't want to get up to go, or won't ask to go, and then refuse to be cleaned up or get yourself cleaned up. The smell is overwhelming, and by the time you leave, the chair is almost impossible to clean.  EVERY treatment, for a person who walks unassissted.  REALLY???  Avoid any of these behaviors and you should be good to stay in the clinic of your choice.  And remember, all of these behaviors have occurred in my clinics, resulting in being kicked out, and NONE of them were violent.

  

[nursewratchet]

I could go on and on.  The behaviors I listed were the ones not to graphic to discuss. 

[thegrammalady]

I could go on and on.  The behaviors I listed were the ones not to graphic to discuss.

i always wonder if people who behave like you described need mental help.

[nursewratchet]

Some do, and some probably just don't know how to behave in public, or may do it because they are so angry at whatever.  Either way, they can't do it in public...

[Chris]

I would have to wonder why you would be worried about your daughter. At a young age you shouldn't have a big problem unless she is an out of control brat.
I'm all for using duct tape on patients though to shut them up so others can rest  (This was done in court that was on the news  Defendant deserved it )

I'm with Nurseratchet, I would have kicked/dismissed those patient's too! ooohhh Boy, that strench I can't stand! Bleach smell would be my friend on that day, just not on any other dialysis day.