Re: [EMED-L] problem patients and solutions

From: Anderson, Warner (Warner.Anderson@GIMC.IHS.GOV)
Date: Tue Jan 02 2001 - 07:44:02 PST

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    Are you the only ED in town? If not, I think you could get a simple
    restraining order from a local magistrate. Explain that you are not trying
    to deny health care, but that he is absorbing scarce resources, etc.

    EMTALA does not require you to accept this kind of abuse. Most states have
    laws against defrauding hospitals.

    Judges are not stupid and know when someone's violating their order with
    specious complaints.

    Your hospital probably has a mechanism through risk management for obtaining
    restraining orders against domestic violence partners of employees and so
    on. This would merely be an extension of that.

    Finally, compassion is nearly always a virtue, but enabling is a different
    issue among the hospital employees who provide food etc. We do this as well,
    but we also send these folks off to five days of detox afterward.

            -----Original Message-----
            From: Allen Roberts [SMTP:gruntdoc@PACBELL.NET]
            Sent: Tuesday, January 02, 2001 12:00 AM
            To: EMED-L@ITSSRV1.UCSF.EDU
            Subject: [EMED-L] problem patients and solutions

                We have a "problem patient", and I'm looking to the list members
    who have dealt with this to enlighten me on moral, ethical, and preferably
    EMTALA-approved ways to deal with this patient.

                Basically, this patient is a homeless person with a serious
    alcohol problem. He's taken to using the ED as a Rescue Shelter, sleeping
    in the department until seen for his complaint (2 or 3 times a day); sack
    lunches from compassionate staff; and, as a kicker, sleeping on, or just
    across from, hospital grounds. When confronted that it's a 'no sleeping
    zone', he brilliantly says "I need to go to the ER", necessitating a trip
    back to us, and not going either away or to jail. Per our EMTALA gurus,
    anyone on "hospital grounds" can get a MSE by asking for one, and our MSE's
    are defined as a physician evaluation. He refuses the Shelter, as they have
    rules and kick out patrons who continue to drink, and he's not interested in

                As a second issue: is it an EMTALA violation to treat this
    patient "differently", i.e., no sleeping, no sack lunches, etc? There is a
    difference of opinion amongst our staff.

                So, those of you who have constructively dealt with this issue,
    how did you do it?

            Please respond off the list, and I'll post meaningful replies to the
    list (anonymously, if need be).

            Allen Roberts, MD

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