JPINFV
Gadfly
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The duty to follow the patient's wishes trumps all. Other wise we would be able to over rule an AMA for no better reason than, 'the patient is really really sick.' So the question now is, does hospice and the patient's family OR the nursing home represent the patient's wishes? Which actually brings up another question. If the hospice provider is an RN, why follow the SNF RN over the hospice RN?But there's a duty to care there.
Besides, the SNF RN doesn't care about providing this patient care. The RN just doesn't want the patient to die under his or her care. That's not a valid medical reason to turf the patient.
So you don't mind getting confrontational with the family (who ultimately has to pay the bill for unwarranted and unwanted hospitalization)?So I think you have to transport. It's in everyone's interest to try and smooth things out a little, and not get too confrontational.
Actually, I don't see a document as being nearly as important as deciding who get's to ultimately decide medical care. The SNF RN, the hospice RN, or the family. In most, if not all states, there is already a legal order of precedence for who gets to make health care decisions in an unconscious patient who doesn't have a POA. If, say, the patient's spouse was part of the 10 family members present, I'd have a hard time over ruling their request in favor of an RN who's request basically boils down to "I don't want to deal with this patient any more."That's the question really. Is whether there's a document in place rendering it illegal to transport the patient.