Ask a Nurse Attorney, January 2010
Nurses, welcome to “Ask a Nurse Attorney.” This section is designed for licensed nurses to ask questions to a nurse attorney. If you have a question that you would like to have answered, please feel free to e-mail Lorie@brownlaw1.com. If your question is selected, it will appear in the upcoming issues of Nursing Focus.
Dear Nurse Attorney,
Recently, a physician on the cardiac care unit where I work discharged a patient who I felt was too unstable to go home. I questioned the physician about the discharge and the physician told me that the patient’s insurance companywould not authorize payment for any additional days in the hospital. The patient went home without harm but if something would have happened, would I have been responsible?
Concerned R.N.
Dear Concerned R. N.,
You posed an excellent question and have every right to be concerned. With changes in reimbursement, and health care reform, it is not cost-effective for hospitals to keep patients when they are no longer getting reimbursed. However, if a patient’s condition is such that discharge may cause the patient harm, you have a duty to notify the physician and to express your concerns. I would contact the physician and tell him, objectively, why you feel that the patient is not ready to be discharged. If the patient has a documented medical problem in which acute care hospitalization is still required, the physician also has a duty to keep the patient hospitalized. If the patient is discharged and harm results because of his premature discharge, both you and the physician may be liable.
If it is a situation where there is a poor home environment or the patient’s needs may not be met after discharge, you have an obligation to get the social work department involved. The key to these types of situations is early discharge planning because if discharge planning was initiated early, many of these situations can be avoided. If the situation is a documented medical problem which requires acute care hospitalization and you do notify the physician and the physician still insists on discharge, you need to thoroughly document your conversations with the physician and call the nursing supervisor. If the nursing supervisor agrees with your evaluation of the patient’s status, she may need to call the physician herself or contact the medical director.
Not only does the nurse have a duty to contact the physician when a patient is being discharged too early, the nurse also has a duty to contact the physician when the home environment does not have the supplies, staff and/or equipment necessary to adequately to take care of the patient. The nurse in that situation must then recommend transferring the patient to another facility which has those services.
Lorie A. Brown, R.N., M.N., J.D.
“ASK A NURSE ATTORNEY”
Lorie A. Brown, R.N., M.N., J.D., of Brown Law Office, Indianapolis, Indiana, (317) 465-1065, is a practicing nurse-attorney who represents nurses for licensing issues before the Board and for contracting matters. The views expressed in this column are those of the author. www.EmpoweredNurses.org.
