Dismissed Patient in Texas

[paddbear0000]

I know patients at my clinic get dismissed if they repeatedly refuse to show up for their treatments.

[Inara]

Try not to expose yourself and masturbate in the open, while in the clinic. 

AMEN!!  I've dealt with many of these patients, both men and women.  And, for the record, trying to do it on the sly doesn't usually work...it's pretty obvious what's going on.....I refer to it as "the spank-it blanket maneuver". 

[YLGuy]

What I read is appalling!  I cannot even imagine, nor do I want to, what the things people have done that you cannot post here.  I am sitting here shaking my head. 

MANY of these patients???  Am I in the wrong center? What about HD is in the least bit arousing?

[Hanify]

It sounds like we need to start an equivalent of the mile high club!  Any takers.  Hmmm, might be a bit difficult in a chair.  What about in the snug Kickstart? That might be possible.

[Chris]

I'm just glad it didn't happen in my presense if it did happen at my clinic. But if I go back, I'm bringing one of those rolls of tissue paper from the docs office to line my chair. Something you just wish you never read about on what happens.

[RichardMEL]

A reminder of some of the difficult things nursing/medical staff (of any sort, not just dialysis related) have to deal with - obviously the vast majority of patients are compliant, or at least not too annoying and work within the acceptable rules of society and the unit.. and others... don't, can't, or are not willing to. That is very sad for a number of reasons and I, too, hate to think about what might be going on in some units that can't be posted. yikes!

As for masturbating in the unit.. umm.. ewww. I haven't seen that (or indulged for the record!!!) and hope I never do. but the whole BM thing.. oh my... I've seen a few "accidents" but nothing like what was described.

[paddbear0000]

Thankfully I have not had to experience any of these things at my clinic! Maybe because I am the only one during my session who doesn't need to be wheeled in on a stretcher and lowered in to my chair. Almost every single patient is rather immobile for some reason.

[plugger]

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.

Well I will say you do have the icky factor going, however nothing you have described would bring a sentence of capital punishment to most US citizens - so why are dialysis patients different?  If punishment or counseling is in order, shouldn't it be the same punishment or counseling they would receive if the offense was done elsewhere?  We don't deny life-sustaining requirements to the worst of offenders - food or water - but it is ok to do it to someone on dialysis who got icky?

It does look like you did address the one extreme end of the spectrum of people who get dismissed.  How about the other end?  My recollection is people have been dismissed for wearing sunglasses in the clinic (overhead lights were bothersome), complaining about poor care from inexperienced inept staff, questioning care, etc...

Just in my short experience with my daughter there is no doubt if the roles were reversed I would have been booted.  She was the very compliant patient and I was the one the charge nurse seemed to have problems with.  I was insistent on getting her off reuse and questioning their way of figuring dry weight - heard about these critline devices.   I got dragged in once during a workday because the nurse didn't like me "challenging" her after finding studies on reuse and asking how many times they were doing reuse on my kid.  Then I got told by the nurse if I didn't like the way they did things I could take my daughter to a tweedle-dum clinic 30 miles away.  Then I heard I was getting blamed for things I didn't even do!  Yes, I was the Great Satan there for awhile.  I was lucky I had DialysisEthics behind me and she got the transplant soon.

Anyway, back to business.

[plugger]

Great news! The patient in Texas has been assigned to a clinic and will be receiving dialysis on a regular basis. When I talked to the patient on the phone, I was told the patient was accused of clamping a line and causing air to back up into the machine - patient talked to manufacturer and manufacturer said that couldn't happen. Also the doctor expressed dismay that the patient wasn't reaching dry weight - patient says this was due to weight gain. We can be happy a tragedy has been avoided.

[Hanify]

Anyone who masturbates incessantly or does number 2's in the chair is obviously mentally challenged and should be treated as such.  I'm presuming in these cases there would be ongoing help for these poor souls?  It reassures me that I could never be a nurse though!

[Chris]

Movie quote fits on patients who become bothersome to others, especially the ick factor and abusive - "Needs of the many out weigh the needs of the few" , which fits into the business part of dialysis clinics. After all they are a business who provide a service for profit. Let one person disturb compliant patients who may go off and transfer to another clinic and loose lots of money, or deal with the problem causer and loose less money. The clinic should at least try to find the patient another clinic in the ethical stand point of view, but if no one wants to take that patient and the patient does not show any willingness to change, then it's up to them to find another center. Of course this is regarding patients with normal mental capacity

[Chris]

Anyone who masturbates incessantly or does number 2's in the chair is obviously mentally challenged and should be treated as such.  I'm presuming in these cases there would be ongoing help for these poor souls?  It reassures me that I could never be a nurse though!

But there are people who do in in spite too, but a doc can determine that through proper examination by a psych visit.

[paddbear0000]

Great news! The patient in Texas has been assigned to a clinic and will be receiving dialysis on a regular basis. When I talked to the patient on the phone, I was told the patient was accused of clamping a line and causing air to back up into the machine - patient talked to manufacturer and manufacturer said that couldn't happen. Also the doctor expressed dismay that the patient wasn't reaching dry weight - patient says this was due to weight gain. We can be happy a tragedy has been avoided.

That's good to hear. Unfortunately it sounds like it's the clinic staff who are the problem makers though and they could use some training in professionalism.

[BigSky]

That's good to hear. Unfortunately it sounds like it's the clinic staff who are the problem makers though and they could use some training in professionalism.

Not sure how you get that since there is no proof whatsoever that is happening.  In fact we only hear part of a story from one side on this whole event.  And that part of what the patient claims sounds mighty fishy.

Seems there is far more to this.

[nursewratchet]

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.

Well I will say you do have the icky factor going, however nothing you have described would bring a sentence of capital punishment to most US citizens - so why are dialysis patients different?  If punishment or counseling is in order, shouldn't it be the same punishment or counseling they would receive if the offense was done elsewhere?  We don't deny life-sustaining requirements to the worst of offenders - food or water - but it is ok to do it to someone on dialysis who got icky?

It does look like you did address the one extreme end of the spectrum of people who get dismissed.  How about the other end?  My recollection is people have been dismissed for wearing sunglasses in the clinic (overhead lights were bothersome), complaining about poor care from inexperienced inept staff, questioning care, etc...

Just in my short experience with my daughter there is no doubt if the roles were reversed I would have been booted.  She was the very compliant patient and I was the one the charge nurse seemed to have problems with.  I was insistent on getting her off reuse and questioning their way of figuring dry weight - heard about these critline devices.   I got dragged in once during a workday because the nurse didn't like me "challenging" her after finding studies on reuse and asking how many times they were doing reuse on my kid.  Then I got told by the nurse if I didn't like the way they did things I could take my daughter to a tweedle-dum clinic 30 miles away.  Then I heard I was getting blamed for things I didn't even do!  Yes, I was the Great Satan there for awhile.  I was lucky I had DialysisEthics behind me and she got the transplant soon.

Anyway, back to business.

Nobody is denying access to life saving treatments.  They can get it a hospital if they have to.  If a child is repeatedly disruptive in school, they are not denied an education, merely sent to an alternative school.  Life saving treatment is NEVER denied, but you don't have to subject an entire clinic of staff and patients to unacceptable behaviors.  Like Big Sky said, two side to all of this. 

[Inara]

Well I will say you do have the icky factor going, however nothing you have described would bring a sentence of capital punishment to most US citizens - so why are dialysis patients different?  If punishment or counseling is in order, shouldn't it be the same punishment or counseling they would receive if the offense was done elsewhere?  We don't deny life-sustaining requirements to the worst of offenders - food or water - but it is ok to do it to someone on dialysis who got icky?

You make it sound as if no one on dialysis in an out-patient setting should be dismissed for any reason.  There ARE reasons, and it is never taken lightly. 

We dismissed a male patient today for repeatedly saying filthy, horrific things to the female staff and patients.  This man is a convicted child molester and has been jailed for rape.  He also got a kick out of throwing feces at people.  We sent him to get psych help....refused to go.  So, would you really want this man sitting next to your daughter 3 days a week telling her what he'd like to do to her?  Really?

He has 30 days to find another clinic, but he's been blackballed by all local clinics....with good reason.  We had to hire 2 security guards to sit with him until the 30 days pass.  His treatment will be stopped immediately if he has anymore inappropriate behavior in that time.  I'm sure he'll end up having to go to the hospital for his treatments.  But, he will receive treatment. 

I understand that there are two sides to every issue.  No one should be denied treatment just because they wear sunglasses or are just plain annoying.  I applaud your Dialysis Ethics group for protecting those who deserve it.  But some people just don't belong in a group setting.   

[nursewratchet]

Exactly!  No one is denied treatment, just moved.  The job of the staff of a clinic is to provide SAFE and TOLERABLE treatements to all patients in the clinic.  If it is not safe and tolerable for ALL pateients because of ONE patient, then they will have to have their life saving treatment somewhere else.  That is not "denying treatment", merely providing it somewhere else. 

[kellyt]

I personally know NurseWratchet and I've visited her at her clinic and she runs a tight ship!      God forbid, if I lose my new kidney and have to start dialysis I'm calling her FIRST!   

[Stoday]

In the UK bad patients like the ones identified by Nursewratchet risk being assessed for the "Liverpool Care Pathway".

There's some current controversy because once patients are on this pathway, it's difficult for them to come off (other than the final exit). 

[Chris]

In the UK bad patients like the ones identified by Nursewratchet risk being assessed for the "Liverpool Care Pathway".

There's some current controversy because once patients are on this pathway, it's difficult for them to come off (other than the final exit). 

Is this a mental health institution? Or commonly known as the looney bin.

[plugger]

Exactly!  No one is denied treatment, just moved. 

When a patient is dismissed and blackballed, their only option is emergency dialysis at the hospital when their labs have reached a critical stage from what I understand - a slow death, they might last two months tops.

[Inara]

When a patient is dismissed and blackballed, their only option is emergency dialysis at the hospital when their labs have reached a critical stage from what I understand - a slow death, they might last two months tops.

And? 

Like I said, some patients don't belong in a group setting.  I still await your response to my post....would you or would you not tolerate a convicted sex offender spewing vivid details of what he'd like to do to your child three days a week?  I know I wouldn't stand for it EVER. 

edited for a spelling error

[Chris]

That would be a no brainer for me and I don't have a kid, but thinking of myself. I don't want to be hearing that either.

[nursewratchet]

Dialysis is performed either at a clinic level, hospital level, home setting, or hospital and prison.  All options depending on the patient, both physically, emotionally, or behavior.  These are all OPTIONS, not denials, ever.  Like Chris said, pick how close you want your daughter sitting to the pervert, the smelly guy who throws feces, or better yet, the patient who grabs the crotch of ANYONE who is near.  IF it is OK for you to have her sit next to this patient, she would have to find a clinic besides mine, because I don't tolerate that in my clinics. 

[plugger]

Like I said, some patients don't belong in a group setting.  I still await your response to my post....would you or would you not tolerate a convicted sex offender spewing vivid details of what he'd like to do to your child three days a week?  I know I wouldn't stand for it EVER. 

edited for a spelling error

Guess I didn't answer the post because I think the answer is pretty obvious don't you think?  I feel safe knowing there are people out there like nursewratchet who would put offenders in isolation and would keep offenders from parents who would want to put the hurt on such individuals.

So much for distracting with fear and panic.

I'm a fellow who likes to play the odds.  The odds are telling me the daughter is more likely to run into something like an inexperienced tech who might be intimidated by a questioning, educated patient.  I know how tempers can escalate and a patient will usually wind up losing.  Since my daughter grows more like me by the day, I worry she might wind up a getting tossed because she pushed and somebody might take offense - believe me, I've seen it.  I haven't run into one of your child molesters though.