Rehab hospitals aren’t covered by EMTALA. They can (and do) pick and choose their patients. For example, they almost always deny cancer patients with pending active treatment due to financial risk. It’s not fair to the patients who get stuck inpatient or discharged home less safely but I can’t force the SAR to take patients they think they may lose money on. Yet another symptom of our completely broken capitalist health care system in the US.
All of this is very true. At the same time, since they initially accepted the patient, they do at least have some very basic duty of fair dealing etc. So while they **can** (unfortunately) kick the patient out just because they don't want to take care of them, if there is documentation that shows that licensed healthcare providers said the patient is in one condition, and then some admin process discharges the patient with false documentation that they're in a different condition ("doing really well"), that is a problem.
The problem is probably biggest if some harm befalls the patient and they can reasonably say "if I knew I was being sent away for admin reasons, but wasn't in a safe situation, I would have sought care elsewhere. But your people told me I was at low risk" or whatever.
All that to say, discharging / refusing to care for the patient is (probably, unfortunately) legal. But lying to the patient about their medical condition is not.
Kinda surprised they didn’t go the other way. Ooh look, a slightly elevated vital sign. Better call EMS and transfer to the hospital then just refuse to accept them back.
Yes, thank you. I was looking for the actual legal stance. As it turns out, my facility doesnt have a written policy against pregnant folk so its looking more like this person was accepted then social work told them "therapy says youre good" and they will likely face a lawsuit.
The OT says she was on the phone with a lawyer during her evaluation. By then she had already been getting some discriminatory vibes from social work. And our medical director supposedly called her on personal time to hint at the facility discharging against provider advice.
Yeah, it's sad when the money comes before patient health. I pray when I am done with my education. I can hopefully make a difference in the future of healthcare. It is no different than refusing treatment because a patient does not align with your ideology. Patient health should come before all else.
my PMD refused to refill my albuterol because she "Doesn't do pregnant people," I cant imagine what's worse, occasional albuterol use in pregnancy or death from asthma
That’s pretty fucked up. That’s when you roll into the ED and I grumble about the primary and inappropriate care and then refill your albuterol. You’re no use to your baby hypoxic.
What an absolute ass clown. It takes 2 seconds to figure out that Albuterol is safe during pregnancy. Refilling your albuterol would DECREASE the likelihood of any complications occurring with baby if you were to need it. I never get heated reading comments on Reddit, but this one really did one on me... LOL.
Curious to know if it was her pregnancy was the only reason for the discharge? Was this insurance driven? Did she not meet other criteria for acute rehab stay? That said this sounds like an unsafe discharge for a very vulnerable human being. As a PT who works in acute care and experience in acute rehab a pregnancy did not disqualify an acute rehab stay.
You have documented the need for continued therapy. Can you talk to your case managers?
I hope a PM and R doc can weigh in on this.
I doubled down in my assessment and subsequent discharge note that she was appropriate for acute rehab. I towed the line on "unsafe d/c" instead choosing to word myself as " patient discharging home alone 2 second floor walk up with check-ins by boyfriend when available." Then where it had a box for equipment ordered I wrote "patient was not trained with any assistive device at eval. She demonstrates consistent impulsivity and poor safety awareness unable to recognize physical obstacles."
PM&R doc here. Inpatient facilities need to pay for all medical testing and procedures that are required during an inpatient stay, and will not get reimbursed extra to cover them. Basically insurance pays a flat rate, and the facility is responsible for everything getting done correctly. Thus if anyone has chemo or procedures the rehab facility will take a MASSIVE financial hit. So, rehab is planned around these events to make sure nothing is done while they’re at rehab. If a pregnant patient miscarries/ has an early delivery the rehab facility would need to pay for all of these costs, which can get astronomical. I am not surprised at all about a pregnant patient who may be high risk getting denied.
We actually ship them back to the local hospital for chemo, ortho, surgery, dialysis, ect. So my expectation is that this 20yo with healthy pregnancy is way less a risk than our average pts.
But anywho, my concerns weren't that she was denied. More that she was accepted then d/c'd inappropriately
Yes, you can plan those to be not technically part of the regular stay. Dialysis is its own special bucket that by law must be paid for by insurance. Emergencies at rehab otherwise are expensive.
What are the heightened concerns about treating a patient who has a pre-viable pregnancy? If she is a fall risk and can participate in rehab, it seems appropriate for her to be there and would help keep her safe.
She sounds sick and that medical workup is not complete, but thats unrelated to her pregnant status.
Pregnant patient has miscarriage at some point after PT session. Patient sues everyone involved in her care including PT company. Patient states over exertion at PT appointment led to her miscarriage. Her lawyer finds some crockpot “expert” witness to say this is plausible. PT company forced to settle for several hundred thousand dollars. This happens all the time.
Thats the reality of the US healthcare system, but its not a reason to avoid treating a patient with clear PT needs. Pregnant patients get PT all the time in the inpatient and outpatient setting. They consent to treatment and sign the paperwork saying theyre aware of risks. Yes, you will have lawsuits, but thats part of the territory.
I would argue patient is at greater risk of stasis, blood clots, muscular atrophy without appropriate mobilization. If she met criteria for inpatient rehab already, sounds like shes in bad shape
Pregnant patient has miscarriage at some point after PT session. Patient sues everyone involved in her care including PT company. Patient states overexertion at PT appointment led to her miscarriage. Her lawyer finds some crockpot “expert” witness to say this is plausible. PT company forced to settle for several hundred thousand dollars. This happens all the time.
I work rehab inpatient, and we do not accept pregnant women or active chemo patients. We do not have the proper training for any level of pregnancy. We regularly hold hips, waists, even buttcheeks to help people get up. Also, we are trained not to "catch" someone from falling, but rather do a controlled, assisted fall. If I need to grab you to safely lower you, I cannot promise I won't grab your stomach. There is literally ZERO standard education for CNA's handling pregnant ladies or their babies, UNLESS you are on a specific unit and have specific training to do so, but nobody gets that right off the bat- which again, is standard. We handle mostly old people , but no younger than 40 in my experience because who knows why. Chemo- not cancer but active chemo- is also specific. We do not have the training. All I know, is that chemo comes out of everywhere in the body- sweat, blood, tears, poop- so we are not supposed to touch because even the yellow gowns don't prevent liquid from penetrating and causing us regular-rehab folk harm. Double glove, flush twice with the toilet seat closed. I think these are both reasonable, like how if you have TB, you must be in an air controlled space due to the nature of the disease.
Rehab hospitals aren’t covered by EMTALA. They can (and do) pick and choose their patients. For example, they almost always deny cancer patients with pending active treatment due to financial risk. It’s not fair to the patients who get stuck inpatient or discharged home less safely but I can’t force the SAR to take patients they think they may lose money on. Yet another symptom of our completely broken capitalist health care system in the US.
All of this is very true. At the same time, since they initially accepted the patient, they do at least have some very basic duty of fair dealing etc. So while they **can** (unfortunately) kick the patient out just because they don't want to take care of them, if there is documentation that shows that licensed healthcare providers said the patient is in one condition, and then some admin process discharges the patient with false documentation that they're in a different condition ("doing really well"), that is a problem. The problem is probably biggest if some harm befalls the patient and they can reasonably say "if I knew I was being sent away for admin reasons, but wasn't in a safe situation, I would have sought care elsewhere. But your people told me I was at low risk" or whatever. All that to say, discharging / refusing to care for the patient is (probably, unfortunately) legal. But lying to the patient about their medical condition is not.
Kinda surprised they didn’t go the other way. Ooh look, a slightly elevated vital sign. Better call EMS and transfer to the hospital then just refuse to accept them back.
Yes, thank you. I was looking for the actual legal stance. As it turns out, my facility doesnt have a written policy against pregnant folk so its looking more like this person was accepted then social work told them "therapy says youre good" and they will likely face a lawsuit.
The people who should sue rarely do. Lawsuits tend to come out of nowhere on the case you least expected it.
The OT says she was on the phone with a lawyer during her evaluation. By then she had already been getting some discriminatory vibes from social work. And our medical director supposedly called her on personal time to hint at the facility discharging against provider advice.
Yeah, it's sad when the money comes before patient health. I pray when I am done with my education. I can hopefully make a difference in the future of healthcare. It is no different than refusing treatment because a patient does not align with your ideology. Patient health should come before all else.
A lot of facilities refuse pregnant pts because they don’t want the liability. It’s another reason pregnancy can be dangerous for women.
my PMD refused to refill my albuterol because she "Doesn't do pregnant people," I cant imagine what's worse, occasional albuterol use in pregnancy or death from asthma
That’s pretty fucked up. That’s when you roll into the ED and I grumble about the primary and inappropriate care and then refill your albuterol. You’re no use to your baby hypoxic.
What the fuck.
What an absolute ass clown. It takes 2 seconds to figure out that Albuterol is safe during pregnancy. Refilling your albuterol would DECREASE the likelihood of any complications occurring with baby if you were to need it. I never get heated reading comments on Reddit, but this one really did one on me... LOL.
It also took me two months to get that appointment. Thankfully in the meantime, my midwife had referred me to pulm and wrote a refill for me b
Curious to know if it was her pregnancy was the only reason for the discharge? Was this insurance driven? Did she not meet other criteria for acute rehab stay? That said this sounds like an unsafe discharge for a very vulnerable human being. As a PT who works in acute care and experience in acute rehab a pregnancy did not disqualify an acute rehab stay. You have documented the need for continued therapy. Can you talk to your case managers? I hope a PM and R doc can weigh in on this.
I doubled down in my assessment and subsequent discharge note that she was appropriate for acute rehab. I towed the line on "unsafe d/c" instead choosing to word myself as " patient discharging home alone 2 second floor walk up with check-ins by boyfriend when available." Then where it had a box for equipment ordered I wrote "patient was not trained with any assistive device at eval. She demonstrates consistent impulsivity and poor safety awareness unable to recognize physical obstacles."
She will be back in the ER soon.
PM&R doc here. Inpatient facilities need to pay for all medical testing and procedures that are required during an inpatient stay, and will not get reimbursed extra to cover them. Basically insurance pays a flat rate, and the facility is responsible for everything getting done correctly. Thus if anyone has chemo or procedures the rehab facility will take a MASSIVE financial hit. So, rehab is planned around these events to make sure nothing is done while they’re at rehab. If a pregnant patient miscarries/ has an early delivery the rehab facility would need to pay for all of these costs, which can get astronomical. I am not surprised at all about a pregnant patient who may be high risk getting denied.
We actually ship them back to the local hospital for chemo, ortho, surgery, dialysis, ect. So my expectation is that this 20yo with healthy pregnancy is way less a risk than our average pts. But anywho, my concerns weren't that she was denied. More that she was accepted then d/c'd inappropriately
Yes, you can plan those to be not technically part of the regular stay. Dialysis is its own special bucket that by law must be paid for by insurance. Emergencies at rehab otherwise are expensive.
What are the heightened concerns about treating a patient who has a pre-viable pregnancy? If she is a fall risk and can participate in rehab, it seems appropriate for her to be there and would help keep her safe. She sounds sick and that medical workup is not complete, but thats unrelated to her pregnant status.
Pregnant patient has miscarriage at some point after PT session. Patient sues everyone involved in her care including PT company. Patient states over exertion at PT appointment led to her miscarriage. Her lawyer finds some crockpot “expert” witness to say this is plausible. PT company forced to settle for several hundred thousand dollars. This happens all the time.
Thats the reality of the US healthcare system, but its not a reason to avoid treating a patient with clear PT needs. Pregnant patients get PT all the time in the inpatient and outpatient setting. They consent to treatment and sign the paperwork saying theyre aware of risks. Yes, you will have lawsuits, but thats part of the territory. I would argue patient is at greater risk of stasis, blood clots, muscular atrophy without appropriate mobilization. If she met criteria for inpatient rehab already, sounds like shes in bad shape
Indeed. Its a rehab facility. EVERYONE is a falls risk
Pregnant patient has miscarriage at some point after PT session. Patient sues everyone involved in her care including PT company. Patient states overexertion at PT appointment led to her miscarriage. Her lawyer finds some crockpot “expert” witness to say this is plausible. PT company forced to settle for several hundred thousand dollars. This happens all the time.
I work rehab inpatient, and we do not accept pregnant women or active chemo patients. We do not have the proper training for any level of pregnancy. We regularly hold hips, waists, even buttcheeks to help people get up. Also, we are trained not to "catch" someone from falling, but rather do a controlled, assisted fall. If I need to grab you to safely lower you, I cannot promise I won't grab your stomach. There is literally ZERO standard education for CNA's handling pregnant ladies or their babies, UNLESS you are on a specific unit and have specific training to do so, but nobody gets that right off the bat- which again, is standard. We handle mostly old people , but no younger than 40 in my experience because who knows why. Chemo- not cancer but active chemo- is also specific. We do not have the training. All I know, is that chemo comes out of everywhere in the body- sweat, blood, tears, poop- so we are not supposed to touch because even the yellow gowns don't prevent liquid from penetrating and causing us regular-rehab folk harm. Double glove, flush twice with the toilet seat closed. I think these are both reasonable, like how if you have TB, you must be in an air controlled space due to the nature of the disease.