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Fri, 24 Jan 2003 08:58:48 -0500

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-----Original Message-----
From: Robert F. Smith [mailto:rfsmith@interaccess.com]
Sent: Thursday, January 23, 2003 11:06 AM
To: trauma-list@trauma.org
Subject: Re: Onto my soap-box!

 ... The Federal regulators do view this as a violation as I understand it
and I believe there are strong historical reasons why this policy came into
being. As with any rule there can be exceptions. The ED should not be used
as a recurrent stop gap solution to issues of providing adequate emergent in
patient care.

Rob Smith 

Dr. Smith,

As always, I much appreciate the content and character of your remarks.  It
helps that I also routinely agree with them.

But I suspect, although I'm no expert, that your Federal Regulators are
mostly concerned about back-transfers under the same admission service
and/or category.  This woman arrived a psych patient, then became a medical
patient.  Bet you catch a break for circumstances.

And while were on the subject of Federal Regulators, I'm sure they'd frown
on a locked psychiatric unit allowing a patient to overdose on
hospital-issued medications.  With that in mind, I'd err on the side of
expedient and cooperative patient management on the part of all players in
the institution.  You're already looking at a Type I violation; let's not
compound things by delaying good care over turf.

Finally, I agree that this case is an outlier; an exception.  I see no
reason to fret that this would set any sort of harmful precedent.

Warmest Regards,

Pret

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<BLOCKQUOTE style="MARGIN-RIGHT: 0px">
  <DIV align=left class=OutlookMessageHeader dir=ltr><FONT face=Tahoma><FONT 
  size=2>-----Original Message-----<BR><B>From:</B> Robert F. Smith 
  [mailto:rfsmith@interaccess.com]<BR><B>Sent:</B> Thursday, January 23, 2003 
  11:06 AM<BR><B>To:</B> trauma-list@trauma.org<BR><B>Subject:</B> Re: Onto my 
  soap-box!<BR><BR></FONT></DIV></FONT>
  <DIV><FONT size=2><FONT face=Arial><SPAN class=190003813-24012003><FONT 
  color=#800000>&nbsp;...&nbsp;</FONT></SPAN>The Federal regulators do view this 
  as a violation as I understand it and I believe there are strong historical 
  reasons why this policy came into being. As with any rule there can be 
  exceptions. The ED should not be used as a recurrent stop gap solution to 
  issues of providing adequate emergent in patient care.</FONT></FONT></DIV>
  <DIV><FONT face=Arial size=2></FONT>&nbsp;</DIV>
  <DIV><FONT size=2><FONT face=Arial>Rob Smith<FONT color=#800000><SPAN 
  class=190003813-24012003>&nbsp;</SPAN></FONT></FONT></FONT></DIV></BLOCKQUOTE>
<DIV><FONT size=2><FONT face=Arial><FONT color=#800000><SPAN 
class=190003813-24012003>Dr. Smith,</SPAN></FONT></FONT></FONT></DIV>
<DIV><FONT size=2><FONT face=Arial><FONT color=#800000><SPAN 
class=190003813-24012003></SPAN></FONT></FONT></FONT>&nbsp;</DIV>
<DIV><FONT size=2><FONT face=Arial><FONT color=#800000><SPAN 
class=190003813-24012003>As always, I much appreciate the content and character 
of your remarks.&nbsp; It helps that I also routinely agree with 
them.</SPAN></FONT></FONT></FONT></DIV>
<DIV><FONT size=2><FONT face=Arial><FONT color=#800000><SPAN 
class=190003813-24012003></SPAN></FONT></FONT></FONT>&nbsp;</DIV>
<DIV><FONT size=2><FONT face=Arial><FONT color=#800000><SPAN 
class=190003813-24012003>But I suspect, although I'm no expert, that your 
Federal Regulators are mostly concerned about back-transfers under the same 
admission service and/or category.&nbsp; This woman arrived a psych patient, 
then became a medical patient.&nbsp; Bet you catch a break for 
circumstances.</SPAN></FONT></FONT></FONT></DIV>
<DIV><FONT size=2><FONT face=Arial><FONT color=#800000><SPAN 
class=190003813-24012003></SPAN></FONT></FONT></FONT>&nbsp;</DIV>
<DIV><FONT size=2><FONT face=Arial><FONT color=#800000><SPAN 
class=190003813-24012003>And while were on the subject of Federal Regulators, 
I'm sure they'd frown on a locked psychiatric unit allowing a patient to 
overdose on hospital-issued medications.&nbsp; With that in mind, I'd err on the 
side of expedient and cooperative patient management on the part of all players 
in the institution.&nbsp; You're already looking at a Type I violation; let's 
not compound things by delaying good care over 
turf.</SPAN></FONT></FONT></FONT></DIV>
<DIV><FONT size=2><FONT face=Arial><FONT color=#800000><SPAN 
class=190003813-24012003></SPAN></FONT></FONT></FONT>&nbsp;</DIV>
<DIV><FONT size=2><FONT face=Arial><FONT color=#800000><SPAN 
class=190003813-24012003>Finally, I agree that this case is an outlier; an 
exception.&nbsp; I see no reason to fret that this would set any sort of harmful 
precedent.</SPAN></FONT></FONT></FONT></DIV>
<DIV><FONT size=2><FONT face=Arial><FONT color=#800000><SPAN 
class=190003813-24012003></SPAN></FONT></FONT></FONT>&nbsp;</DIV>
<DIV><FONT size=2><FONT face=Arial><FONT color=#800000><SPAN 
class=190003813-24012003>Warmest Regards,</SPAN></FONT></FONT></FONT></DIV>
<DIV><FONT size=2><FONT face=Arial><FONT color=#800000><SPAN 
class=190003813-24012003></SPAN></FONT></FONT></FONT>&nbsp;</DIV>
<DIV><FONT size=2><FONT face=Arial><FONT color=#800000><SPAN 
class=190003813-24012003>Pret</SPAN></FONT></FONT></FONT></DIV>
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class=190003813-24012003>&nbsp;</SPAN></FONT></DIV></BODY></HTML>

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Onto my soap-box!