List Archives

Sat Jul 21 13:37:44 BST 2007

EXCELLENT-- as usual, Pret.

Charlene Morris
happy with my current degrees, but considering a PhD someday

On 7/20/07, Bjorn, Pret <pbjorn at emh.org> wrote:
>
> I'm willing to take either physician or administrative call, given that
> this is the Trauma-List.  On "the internets," nobody knows you're a dog.
>
> 1.  The patient is NOT underage (19) given any statute with which I'm
> familiar.  But then, I'm not familiar with Texas (for which I and
> certainly Texas are grateful).  In Maine, if she's pregnant and living
> independently, she's emancipated -- even if she's twelve.  She has made
> the requisite decisions to survive in the world and become pregnant,
> after all.
>
> 2.  The first and overwhelming rule for EMTALA, albeit unwritten, but
> ESPECIALLY in the setting of active labor, is "Do the right freaking
> thing and let the lawyers clean up the details."
>
> 3.  Even IF a psychiatrist's note recommends otherwise, competency is a
> LEGAL issue, not a clinical one.  If a judge has not declared her
> incompetent, then see #2.  Else, you and the psychiatrist (or the
> anesthesiologist or the OB/Gyn or the EM clinician or a passing podiatry
> fellow) can declare appropriate analgesia as being in the best interests
> of your supposedly incompetent patient and her pending progeny.
>
> 4.  This girl is in active labor and in extreme pain.  You're mucking
> around with administrative approval for long-distance charges to
> estranged grandparents while delaying her care and permitting her
> suffering.  Moreover, the intended content of your communication with
> Granny would inevitably include details of the patient's protected
> health information (including, conspicuously, her mental illness and her
> pregnancy).  This is not only an absolute HIPAA (one p, two a's)
> violation, it's a patently stupid approach.  CNN's gonna love this
> story, and your hospital will suffer for the inevitable attention.
>
> Treat the patient.  Do the right frigging thing.  Inform your lawyers
> and your admins, but NEVER ask their permission for practicing
> appropriate and utterly defensible clinical medicine.
>
> Pret Bjorn, RN, MD*, MHA*
> Bangor, ME USA
>
> *as far as you know
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com
> Sent: Thursday, July 19, 2007 11:07 PM
> To: trauma-list at trauma.org
> Subject: Table Top Test - CALL to you "an on call medical supervisor"
>
>
> This is a real time Table Top TEST for ALL persons willing to take
> physician
> or administrative Call.   We live with this  DAILY.     I have had at
> least 6
> frustrating policy, system,  ethical, moral, and ethical issues just
> this
> afternoon.    Not  any were patient safety issues (YET), but were close
> to system
> issues which  cause frustrations.    This is real time, and NOT any
> HIPPA
> violations.   Take this table top and keep your own  score.     I will
> leave a
> space between decisions.
>
> You get from a senior faculty to assist with a problem, relating to
> legal
> and ethical policies as well as a rapidly unfolding clinical  need.
>
> A 19 year old woman is in full labor, with her first pregancy.  It is  a
>
> tough progress and she is in a great deal of pain.   She has reached  a
> stage
> where most women are clinically ready for a spinal block to aid in the
> progress
> of the delivery.    She is underage and  unmarried.   She has not
> revealed the
> name of the baby's  father.   No parents are present.     Can she give
> PERMISSION for the spinal anesthesia?
>
>
>
> Good try, but we have a problem.     She is severely  hampered by a
> mental
> health problem and the psychiatriast has written note in  the chart that
> the
> patient cannot give permission for herself.     The chief of obstetrics
> strongly
> desires that a spinal anesthesia be  administered.    NO PERMISSION
> available
> from the  patient.    No parents, available.   No father  available.
> Anesthesia service states that they cannot give spinal  anesthesia
> without permission
> either from a fully aware patient, a surrogate  permission giver, or an
> ad
> lidum.
> What to do?
>
>
>
> While calling for help, it is discovered that there is a phone number in
> the
> purse of the patient of a grandmother in a distant city.   Can  this
> grandmother give permission?
>
>
>
>
>
> GOOD ANSWER and you had a good thought there.   Permission is  granted
> from
> administration to use HCHD funds to call this very long distanced
> telephone
> number and the grandmother answers the phone.      GREAT STROKE OF LUCK.
>
>
>
> Problem.   This grandmother has already disowned her own children  and
> only
> vaguely knows of even the existence of this now your  patient.     She
> states
> that she cannot and will not give  permission and states some words I
> cannot
> print here.      She hangs UP.     What to do?
>
>
>
>
>
> One of the faculty has a good friend that is a family court judge
> (actually
> a neighbor).     She calls that judge for  "advice"    It is 5:20 PM and
> the
> judge and court are CLOSED for  the week end.   "Call back Monday"
> message is
> heard.      What to do?
>
>
> You guessed it.   The chief of OB calls YOU and asks for the  options?
>
> I now ask you to answer this  inquiry?    If you wait long enough to
> find a
> court person, the  baby will be delivered with great pain and suffering
> and a
> huge amount of  horrible screams heard two floors down .     The nurses
> are
> crying that something be done.   The patient is getting more and more
> mentally
> disturbed.   The medicines to be used to sedate her or to  treat her
> psychiatric diagnosis can harm her  baby.         HELP
>
>
>
>
> Woops.    It is late.   I will have to give you  the next installment
> tomorrow.
>
> K Mattox
>
>
>
>
> ************************************** Get a sneak peek of the all-new
> AOL at
> http://discover.aol.com/memed/aolcom30tour
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>

List Archives

For your convenience, find the Trauma List Archive Below

Table Top Test - CALL to you "an on call medical supervisor"