Is anyone else surprised the various hospitals were still open to accepting Tricia‘s literal biohazard arse?
EMTALA; if someone presents to the ED in the US, they
have to be evaluated and stabilized within the facility's capability. (Not for free, but billing comes later.)
Frequent flyers will sometimes be noticed by hospital administration, and thus have plans written to work toward an ED discharge and to prevent their admission to the floor proper. But this would be for patients with psychosocial problems compounding less serious conditions: an anxious cannabinoid hyperemesis patient who claims to have stopped smoking pot, hasn't, and needs some antiemetics and a few bags of IVF before she flips out and AMAs again. Easier on everyone to have that happen in the ED, and send incontinent pneumonia grandma to the only open floor bed instead. Or a homeless meth CHF who doesn't take his chronic meds but knows he can come in and receive a short vacation with basic cable and sandwiches and staff to verbally abuse without consequence, in exchange for accepting diuretics. If that guy gets admitted to the floor, it'll be give-a-mouse-a-cookie time and he'll stay for a month because once you
let PT evaluate him, then it's on record that he really shouldn't be living on the street, but no facility will take him because of money, meth, and the fact that he refuses to go anywhere he can't smoke.
Trisha, however, is legit sick now, so once she comes in to the ED it's in everyone's best interest to get her up to ICU where she can be cared for appropriately. Transfering her to another hospital is a different matter: once she's stable and at an appropriate level of care, there's no law saying anyone else has to take her. The hospital she's in has to find another physician and another hospital that will accept her, so unless she's actually a candidate for a procedure that only the second hospital does, it's going to be difficult. And of course,
that hospital has to have a bed.
I have seen sane people with legitimate need sit down with their hospitalist and discuss a plan
on paper to discharge them home to await a stopgap procedure, with the off-the-record plan being for their loved one to drive them <few hours away> to <giant hospital> and present at the ED
there, because that's weeks faster than trying to transfer hospital-to-hospital.
TL;dr: shit's fucked in the US, the ED can't refuse to treat her when she's in crisis, and her care takes so much time and attention that it makes more sense to admit her.
the fact that patients are treated like customers by admin is really an extra special kind of terrible that doesn’t need to be that way.
It's CMS' fault. No argument that Admin sucks, but it's CMS who tied satisfaction to reimbursement, and money is what Admin understands.
Typhoid Mary was such because she was an asymptomatic carrier, so no.
Second point: Typhoid Mary had a
job.
The whole problem was that she wouldn't stop working, even when she was offered a free ride in the interest of public safety.
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