Nursing Homes Oust Unwanted Patients With Claims of Psychosis
https://www.nytimes.com/2020/09/19/business/coronavirus-nursing-homes.html
This was unfortunately too common a practice before COVID-19 and even more so now. Demented patients are hard to care for as they can’t speak up for themselves and require 24/7 care, but this doesn’t mean we shouldn’t do everything we can to care for them. I have zero issue with sending patients to the ED for evaluation as it is my job to ensure there is not a medical reason for these outbursts.
However, refusing to take patients back after being medically cleared is absolutely ridiculous and quite frankly against the law. As we are fighting for equity in medical care across this country, this seems to be as good a spot as any to ensure that for profit nursing facilities not complying with the law be penalized in a substantial way. This might be the only way to fix this problem in the short run…take more money away from the facilities that seem to only care about money instead of people.
—Salim R. Rezaie, MD
It’s sad to see our elderly being reduced to a commodity. In this country, we seem to have diminished the sense of human value except in the terms of financial gain or loss.
—Evie Marcolini, MD, FAAEM
This is criminal in every sense, but also a reality for those of us on the front lines in the ED. Elderly patients, especially those in care facilities deserve better and this serves as a prime example for the need to better protect some of our most vulnerable. At the same time, we need to better support the workers in these facilities as they are often ill equipped.
—Andrew Kalnow, DO
Until you’ve worked at a nursing home you will not really know how disruptive some patients can be. These are “group homes,” meaning that when one patient takes up all the time of the staff such that they can’t attend to the needs of other patients, that patient needs to be cared for in a different setting. Sure, sometimes it’s about revenue from a private patient vs. Medicaid. There needs to be a balance of profitability and social responsibility. But that risk is not all on the nursing home operator, but rather on society at large. I think there’s more to this story than the Times lets on.
—Mark Plaster, MD, JD
Nursing home dumping in the 2000s is becoming what patient dumping in the 1980s once was. Refusing to take back patients because of vague behavioral allegations increases healthcare costs, increases the burden on already overcrowded emergency departments, and is likely illegal under the Nursing Home Reform Act (42 U.S.C. §§ 1396r et seq.). Under that Act, nursing homes must give residents 30 days notice before evicting them.
Refusing to accept a resident discharged from the emergency department is a constructive eviction of that resident. The Department of Justice has taken action against nursing homes for violating this Act (see, e.g. US v. City of Philadelphia et al., https://www.justice.gov/crt/nursing-home-reform-act). All it takes is one phone call. Our professional organizations should take a stand against nursing home dumping. It is shameful for NeuroBehavioral Hospital in Crown Point, IN to terminate an employee for pulling back the curtain on this issue.
– William Sullivan, DO, JD
A woman’s brain fluid leaked into her nose after getting a nasal COVID-19 test
https://news.yahoo.com/womans-brain-fluid-leaked-her-150400165.html
We have to be careful of relying on cases and anecdotes in driving medical care as these can lead us down false paths. That being said, the sensitivity of COVID-19 tests is already not that great (≈70 – 80%) depending on which test you use. One of the major issues with this may be simply that we are not swabbing patients correctly.
Like any medical procedure there is a learning curve, but a high standard that must be upheld. This case report highlights the importance of this learning curve and acquiring a pertinent history. Testing is not going to go away anytime soon and is a critical strategy in controlling COVID-19. Therefore, if testing is not going away, then we should spend the time to ensure those performing the test are trained on how to do the test effectively and safely.
— Salim R. Rezaie, MD
So maybe I need to rephrase how I describe the COVID nasal swab and not tell the patient they are about to get a brain biopsy? In reality, we know two things… the person performing the swab did it properly and was definitely in the posterior nares and this was likely to happen. My question is whether it will increase testing sensitivity?
—Andrew Kalnow, DO
Really? How hard is it to train the techs to keep the swab level with the floor of the nasal cavity? This reminds me of the all the training we receive in ATLS about not jamming an NG tube into the brain.
—Mark Plaster, MD, JD
All you who were making fun of last month’s story about Coronapup sniffing for the ‘rona are singing a little bit of a different tune now, aren’t you?
– William Sullivan, DO, JD
Acting Assistant Attorney General Delivers Remarks at the PPP Criminal Fraud Enforcement Action Press Conference
https://www.justice.gov/opa/speech/acting-assistant-attorney-general-brian-rabbitt-delivers-remarks-ppp-criminal-fraud
This reminds me of the people and industries that will gouge or outright cheat soldiers, patients, whomever who depend on their products to survive. I had a dear friend who died of ovarian cancer. It was later determined that her chemo drugs were being diluted by the pharmacist to make more money. And he was hailed by the community for his generosity.
—Mark Plaster, MD, JD
While I am glad, we are policing how funds are being distributed in this country, and the speed in which it was done in such trying times…the fact that this is a problem is representative of attitudes in this country. Instead of coming together for the greater good, we fend for ourselves at the cost of humanity.
— Salim R. Rezaie, MD
On one hand, I hope that these fraudsters go to jail for a long time. On the other hand, the ease with which PPP loans were disbursed troubles me. The statements by Assistant AG Rabbit stated that 5.2 million loans were disbursed – not 5.2 million dollars, 5.2 million LOANS. Of those loans, the DOJ has charged 50 defendants with criminal activity such as purchasing Lamborghinis and jewelry with the funds. There must be a better way to head off such fraud before it happens and not after the fact.
– William Sullivan, DO, JD