Is starting an unnecessary IV fraud?

[lwems]

We took over transport at a local hospital, and we found out what this unnecessary IV stuff is about.

The previous EMS had implicitly trained the hospital staff in how to get everything billed as ALS, even stable, AOx4 wheelchair discharges. The attendings would sign anything you shoved in front of them, regardless of legal risk.

One of our paramedics was onscene, did an assessment, and announced that the patient was wheelchair, offering to call it back in to dispatch to summon a wheelchair van. The attending cheerfully offered to put in an IV, and seemed bewildered when told no, that's fraud.

We didn't have that contract for long.

 

[mycrofft]

Unnecessary IV's are fraud if you charge for them or lie about them.
They can be assault, battery, and medical malpractice too.

 

[vc85]

Unfortunately it is not only hospitals that pull things like this.

For example:

Adolescent male pt. CAOx4, PMSx4, helmet worn, denies LOC, Vitals Within Normal Limits, 3/10 knee and lower leg pain after hitting leg into a pole while snowboarding.


ALS shows up because the caller saw him laying face down on the ground.

ALS proceeds to start a line, run a 1000 bag, and place 4-lead ekg on him.

Two different ER nurses asked why an IV was started with fluids running, to which ALS tried to pass it off as "mechanism of injury". Even better, this isn't the first time that service had tried something similar. I have watched them multiple times sit in the ambulance IN THE ER parking lot for 10 minutes putting an IV in a patient before wheeling them in (i.e. delaying transfer to definitive care).

 

[mycrofft]

Used to see that in 1981. Rural rescue squads would call hospital after hospital to find one willing to give them a radio order for an IV. Embarrassing to listen to it on the med net.

 

[Akulahawk]

Unfortunately it is not only hospitals that pull things like this.

For example:

Adolescent male pt. CAOx4, PMSx4, helmet worn, denies LOC, Vitals Within Normal Limits, 3/10 knee and lower leg pain after hitting leg into a pole while snowboarding.


ALS shows up because the caller saw him laying face down on the ground.

ALS proceeds to start a line, run a 1000 bag, and place 4-lead ekg on him.

Two different ER nurses asked why an IV was started with fluids running, to which ALS tried to pass it off as "mechanism of injury". Even better, this isn't the first time that service had tried something similar. I have watched them multiple times sit in the ambulance IN THE ER parking lot for 10 minutes putting an IV in a patient before wheeling them in (i.e. delaying transfer to definitive care).

Given my own training and expertise, I would have attempted to evaluate the extent of injury, offered first aid "RICE" therapy for pain control and only bumped it up to IV medication for pain if the pain still wasn't tolerable, and even only titrating the pain med to a tolerable level of pain, not a completely snowed, pain's all blotted-out level. I wouldn't have sat in the parking lot for an extra 10 minutes to establish a line/lock to allow those meds to be administered unless those meds were actually needed...

Of course, I might have wanted to sit on scene for a little while to release the kid to the parents, depending upon the actual injury severity. But what do I know...

 

[vc85]

Oh the teenager with the leg didn't even get pain meds, just an IV; they also started this one in the rig, luckily. Medics were called because the initial (incorrect)dispatch information was head and neck injuries.

Apparently this crew treated based on MOI of the dispatch information and not what the REAL MOI and patient condition on scene was.

 

[Roadmedics]

No, just bad medicine

No starting an IV is not fraud. Fraud in this case would require that you say you did something and actually did not. Starting unnecessary IV's is just bad medicine. The risk of phlebitis and other problems should always outweigh unnecessary IV's. My students are not allowed to start IV's just because they need them, the patient must need them first.

 

[blindsideflank]

I can't believe I'm posting in this thread because this topic comes up often at the station and it's obnoxious. The justifications people use for (what if he went into vtach) and arguments against (your Iv could cause sepsis or an embolism).

Generally speaking all patients I carry get a lock. We are tiered so most calls are chest pains, and if I want to trial nitro I get a line, SOB a line is good practice for meds and if you need meds to take control of airway, and altered LOC (which usually comes down to asking someone to get a line while get do a longer exam and history, I fond ALOC usually require a longer exam that leaves people sitting around and I believe this is valuable time to have a line placed)

If these are not high acuity then they go with bls and it's their discretion of what they would like. As a side note, it seems it has been my job to discourage the use of narcan by our bls crews on all ALOC despite no other relevant symptoms.

 

[drjekyl75]

In the area I work it depends on which of the local hospitals I take a patient to. One of them requests a line on nearly every patient. The others not as often. I'm hanging fluids less often and start saline locks about 90% of the time. I've had the hospital request a line, then ask me to lock it and send a patient to triage.

 

[mycrofft]

No starting an IV is not fraud. Fraud in this case would require that you say you did something and actually did not. Starting unnecessary IV's is just bad medicine. The risk of phlebitis and other problems should always outweigh unnecessary IV's. My students are not allowed to start IV's just because they need them, the patient must need them first.

KNOWINGLY starting an IV when it is not necessary and lying about it is fraud. KNOWINGLY incurring an unnecessary fee or financial charge and lying about it is fraud.

If you didn't know any better and didn't lie, it is just excess treatment, since assault and battery require knowledge the contact is detrimental (or if the pt protests).

Roger that on those last two sentences!!!