Just looked over the volume4 issue2 summer 2008 issue of “WE Kan” “Live and Give” headline news “Changes for Quality” In it there is a section that tells what we on dialysis can look forward to in the yrs ahead. " A 30 day written notice before a facility can involuntarily discharge a patient, unless there is a more urgent safety threat""
Maybe the more enlighten can tell me outside of the common sense discharge need. I don’t think I have to list the ones everyone with common sense will know. I’d love to hear or seeing in writing what a person on life line can do that would let a Dr. nurse etc say go home and die. Common sense tells us that if a center is discharging a person why would another center take the person?
Every dialysis patient knows they better watch what they say or they could get “dumped”. I have spoken with many, many patients and they ALL express this sentiment. It depends on the clinic. I have been in a number of clinics, myself, with some being better than others, but can’t say I felt completely free to state my true opinions re my care in any of them. Staff, too, feel like they are walking on eggshells in these type clinics. They whisper things to patients to help them, because they are not allowed to freely educate patients. It’s all about a crammed schedule and keeping the clinics profitable. The dietitians and social workers in these type clinics are also told not to spend too much time with the patients- just give them the bare essentials and move on. How do I know this?- some of the honest ones have told me.
So, even though there have been regulations about dismissing patients unjustly, I have known of numerous cases where it has occurred. Even if there is a new regulation that states the patient must be given 30 days notice, I’m sure there is a way around it as I have witnessed many regulations that are circumvented for the convenience of the clinics. The state surveyors are “outta sight outta mind” and/or patients don’t know their rights or are too over-powered to use them- violating clinics cut corners whenever they feel like it. Sometimes, the state surveyors even know the clinic personnel on a first name basis. They call ahead to warn them that a survey is coming up.
These type clinics don’t educate and they don’t want informed patients. They simply want patients that will stick out their arms, allow them to put the needles in and then go to sleep, causing them less work. Patients who ask too many questions and want accurate answers to their health care issues are falsely labeled non-compliant. These are the patients they want to get rid of and often do.
Often times, a company has a monopoly in a city, so if the patient is “dumped” he can not get into one of their other clinics. But even if the company does not hold a monopoly, nephrologists often stick together and block the patient from getting care somewhere else in that city. Even if the patient was to transfer to another city, he needs a referral from the previous clinic, similar to a job referral. So, again, he is blocked if the original clinic paints him/her as a non-compliant patient.
All of this may seem hard to believe- aren’t medical professionals sworn to protect patients’ health and lives? But I believe it happens more than anyone wants to admit. There are wonderful, dedicated doctors and nurses out there and then there are the other type. As I always say, it comes back to enforcement- without true oversight and enforcement, anything goes in Dialysis Land…
Well Jane , I guess the non response we have gotten from DPC , NKF etc on standing up for the rights of the those who are ill speaks more clear than anything they could say, And these groups call on us , everyone in dialysis to stand up for the providers. I guess we do need a new medical set up in our country.
Wow - my husband has been on dialysis for 22 years, and I have never heard of someone being discharged from clinic. My husband has always been very proactive about his care and very knowledgeable about dialysis - he drives the nurses crazy sometimes because he is a perfectionistic about the technique being sterile, etc. - but he’s never come close to being kicked out or felt like he had to watch what he said. Where does this happen? By the way - every clinic should have a posted Patient’s Bill of Rights? Have the folks involved followed this?
I wouldn’t look to the NKF for anything - they are so pro-transplant that I’ve found they could care less about those who either choose to remain on dialysis or who cannot have a transplant for one reason or another.
Hi JenniLee
My hat is off to Your Husband , I take it ? that you folks do home dialysis?
This happen at Davita Exton Pa and Franklin Davita Phila. and yes there are a bill a rights but a new person to dialysis has to turn to the only people we are told that can help us. That group Network 4 in my case were of no help if anything in what I was told by them just backed up what I was having said to me at the centers.
[QUOTE=JenniLee;16334]Wow - my husband has been on dialysis for 22 years, and I have never heard of someone being discharged from clinic. My husband has always been very proactive about his care and very knowledgeable about dialysis - he drives the nurses crazy sometimes because he is a perfectionistic about the technique being sterile, etc. - but he’s never come close to being kicked out or felt like he had to watch what he said. Where does this happen? By the way - every clinic should have a posted Patient’s Bill of Rights? Have the folks involved followed this?
I wouldn’t look to the NKF for anything - they are so pro-transplant that I’ve found they could care less about those who either choose to remain on dialysis or who cannot have a transplant for one reason or another.[/QUOTE]
I wouldn’t count on any of the so call dialysis groups.
The current ESRD regulations have been in effect since 1976. New regulations will take effect October 14, 2008. Under the old regulations and the new regulations, dialysis must fully inform patients of their rights and responsibilities. In addition, the new regulations require that facilities post patients’ rights and responsibilities as well as contact information for the ESRD Network and State survey agency.
I believe the new ESRD regulations make harder for a dialysis clinic to involuntarily discharge a patient for frivolous reasons or because the patient asks questions or advocates for himself/herself.
This is what the new regulations say under Section 494.180 Governance: The medical director ensures that no patient is discharged or transferred from the facility unless –
(1) The patient or payer no longer reimburses the facility for the ordered services;
(2) The facility ceases to operate;
(3) The transfer is necessary for the patient’s welfare because the facility can no longer meet the patient’s documented medical needs; or
(4) The facility has reassessed the patient and determined that the patient’s behavior is disruptive and abusive to the extent that the delivery of care to the patient or the ability of the facility to operate effectively is seriously impaired, in which case the medical director ensures that the patient’s interdisciplinary team—
(i) Documents the reassessments, ongoing problems(s), and efforts made to resolve the problem(s), and enters this documentation into the patient’s medical record;
(ii) Provides the patient and the local ESRD Network with a 30-day notice of the planned discharge;
(iii) Obtains a written physician’s order that must be signed by both the medical director and the patient’s attending physician concurring with the patient’s discharge or transfer from the facility;
(iv) Contacts another facility, attempts to place the patient there, and documents that effort; and
(v) Notifies the State survey agency of the involuntary transfer or discharge.
(5) In the case of immediate severe threats to the health and safety of others, the facility may utilize an abbreviated discharge procedure
In an effort to help clinics resolve problems before they become conflicts, a manual was created and provided to all dialysis clinics called Decreasing Dialysis Patient Provider Conflict. You can read about its development and read this manual at: http://esrdncc.org/index/decreasing-dialysis-patient-provider-conflict
In my opinion, no patient should be discharged for advocating for him/herself, unless of course, they do so in a disruptive or abusive way. My husband has never had a major problem while doing hemo in a facility, although one time when he was on PD a nurse was refusing to order his supplies, etc. He took that complaint to the doctor, who owned the center, and he took care of it. We do hemodialysis at home now, using the NxStage portable machine, so of course the interactions with the center are much less now.
I don’t know the situations under which patients were discharged - there have been many occasions when my husband has had to tell a nurse that they were about to contaminate him or break procedure in some way, but he does it in as nice a way as possible, realizing that the nurses are caring for many patients at once - even with dialyzing at home, our philosophy is that we backstop each other to avoid problems like that. The bottom line is, it’s my husband’s life on the line, and he is going to watch what is going on very carefully to make sure there isn’t a problem - I can’t imagine any clinic having a problem with that. I cannot fathom discharging a patient without finding another placement for them - that’s a death sentence! I do know that there are a lot of patients who are not compliant with treatment recommendations, but I’ve never heard of anyone being discharged for that, either.
It sounds as if, from what is being said in this forum, that the problem lies with clinics that are very crowded, where patients feel that their care is being compromised, but are labeled troublemakers for speaking up. If that is the case, one option might be to make an appointment with the treating nephrologist and discuss it with them privately. If they are not responsive, I would follow the steps given by Beth in her email. It may be that the nurses in some facilities feel so overwhelmed with work during dialysis sessions that this is not a good time to ask questions or make complaints. Another avenue might be to discuss things with the clinic social worker.
Your right on no person if on dialysis or working ing dialysis should have to deal with very disruptive or abusive person
[QUOTE=JenniLee;16343]In my opinion, no patient should be discharged for advocating for him/herself, unless of course, they do so in a disruptive or abusive way.
I think that Beth has said she knew of people who have been dicharged for reasons that would not be real cases that should have a person discharged, I think it was Beth?
I don’t know the situations under which patients were discharged -
Your right on the units being over crowed, I don’t find fault with most staff it is folks in charge. There are ones who are making the rules. And they will blame the higher up the ladder
It sounds as if, from what is being said in this forum, that the problem lies with clinics that are very crowded, where patients feel that their care is being compromised, but are labeled troublemakers for speaking up. If that is the case, one option might be to make an appointment with the treating nephrologist and discuss it with them privately. If they are not responsive, I would follow the steps given by Beth in her email. It may be that the nurses in some facilities feel so overwhelmed with work during dialysis sessions that this is not a good time to ask questions or make complaints. Another avenue might be to discuss things with the clinic social worker.
Thanks for bringing up an interesting subject.[/QUOTE]
I know that you have a compelling interest in patients’ legal rights, and apparently in involuntary discharge. Would you mind sharing a little bit about the kinds of things you’ve run into where you felt your rights were violated? It might help us figure out if there is someone we could call on to answer the kinds of questions you have. They’re just not clear in my mind yet.
I really don’t know if sharing my story now as I have (i think over the time I’ve been on this board) have told of the issues I come across. But the sad fact of life in dialysis is that there are no legal people who stand up for the person on dialysis. Plugger and I were on a page that I at least had hope would help people in dialysis with real legal issues,but too many people went on to that site just to stir up trouble. I guess you missed some of the issues I posted on, like I said I think Beth posted a while back on knowing of people who had be discharged. My story is now in the hand of the state now anyway.
[QUOTE=Dori Schatell;16353]Hi Bob,
I know that you have a compelling interest in patients’ legal rights, and apparently in involuntary discharge. Would you mind sharing a little bit about the kinds of things you’ve run into where you felt your rights were violated? It might help us figure out if there is someone we could call on to answer the kinds of questions you have. They’re just not clear in my mind yet.[/QUOTE]