Tuesday, April 19, 2011

Inmates and Asylums

As a segue to Panda's 'Heroes of the Revolution" screed, and with synchronicity, this email just found it's way into my inbox. It is from one of the ERs where I occasionally make a cameo as a highly sought after expert in emergencies (like running out of your oxycontin on a Friday evening). This email has been only slightly altered from it's original form and this is, exactly, what ER medicine has come to, and I believe Michael Moore would be even worse as a patient than this toolbox, but that's another story. The "customer" in the ER is always right, and this is true even when, outside of the ER, and exhibiting the same behavior, they would be arrested and taken to jail, or beaten to a bloody pulp with abandon.          
Effective immediately:

When Michael Moore presents to Bumfoodle ER, immediately notify Bumfoodle Police Department. Request officers be dispatched to the ER to supervise the entire encounter.

If possible, avoid all contact with Michael Moore until officers are present. The exception is if Mr Moore has an obvious life or limb threatening emergency or has been without a hamburger for more than thirty minutes. In this circumstance, use caution and never deal with Mr Moore by yourself.

Mr Moore's repeated demands for narcotics, violent behavior, and threats of bodily harm are not to be taken lightly.


  1. In another vein - what happened to Drackman's blog??

  2. Frank isn't Frank anymore either -- deep cover I think, probably new ID, probably female.


  3. I don't see the problem with this. A potentially dangerous patient has been identified, and a policy has been put in place that the police be present during his care so that the safety of the staff can be ensured. What else do you suggest? That the nurses and doctors refuse to treat him? That they kick him out of the ED by force? Please offer some viable alternatives.

  4. Yes William,
    This IS what I'm suggesting. We should be able to refuse to check him in as a patient if it is determined he does not have a medical emergency. And who better to do that than an Emergency Physician that already knows the patient? Vital signs, history, another demand for narcotics? Leave or be arrested. The end. The way it is now, this waste-of-carbon delays care for everyone else inthe ER, commits assault with his threats every time he comes in, is costing the taxpayers tens of thousands of dollars, and all because we are not allowed, as the subject matter experts, to tell him "no".

  5. I'm a new reader and this is just sad. It's the drug seekers like this that make it nearly impossible for some patients with numerous medical problems get the meds they need at the time. I see the same set of docs go to the same pharmacy and (gasp) never take more than what I am prescribed. Yet have been to the ed and treated like one of the scumbag seekers. It's dis-heartening. I now am very reluctant to even contemplate going in for an emergency after the way I was treated

    It should not have to come to an email like this. They abuse the system left and right taking up valuable time needed for true emergencies. I was a paramedic and saw plenty use us as a "free ride" to the hospital.

    Should the medical professionals really be subjected to violence for oxygen wasting douche-bags??

    I say you should all get hazard pay anytime one comes in. Frequent flyers after their 3rd visit should be charged according to their visit number (ie 4th visit 4 x the pay scale). Although it's tough enough to get them to pay anything (including respect to those treating them)

    Ok sorry for the rant it just chapped my ass and felt good venting it! Love your blog and am enjoying going through the archives. I'm only using anon until I can figure out how to do a profile (not very computer savvy! )

  6. 911,

    Maybe I'm missing it, but I'm not seeing how this email prohibits ED staff from properly triaging the patient. All it says is that "if possible," the PD ought to be there for safety's sake. Still not seeing the problem.

  7. The email is not really the point William, the email is an excellent statement of what it means to practice EM 25 years after EMTALA, which forbade us from refusing service to anyone ever for anything in the ER. This guy does not, or at least has not had to date, an emergency Medical condition, and even though we all know this we are forced to check him in and "treat" his narcopenia or face his wrath. He does not pay for his ambulance rides... You do. He does not pay his ER bills... You do. He should be turned away at the door or forced to go elsewhere for his care... Like the prison infirmary... Instead we are left to wonder, if, each time he comes in, he will attack one of us, so we pull a squad car off the street to cone in and stand by as we DO NOTHING. He belongs in jail, but instead he gets the same treatment as a patient with an emergency condition. He, and thousands like him, have taken over the ER, and we, the experts... The ones "in charge" are powerless to stop it. If you think this is as it should be, then please, come down and work in the ER... Everyone else is leaving

  8. Actually, on several occasions I have had security escort people out of the department who were abusive or threatened violence to me or the staff. I document on the chart that the patient posed a significant risk to our safety, appeared to have no Emergency Condition that would justify restraint or commitment, nut that the patient's demeanor and threats precludes any attempt at care.

    I've had people arrested on two occasions for assault on the staff. One lady told me that if I didn't give her drugs she would,"Kick my fucking ass."

    She left in handcuffs. Will I get sued? Don't care. It's not going to fly anyway.

  9. Indeed Panda, At my residency hospital we had a holding cell in the ER and two Armed Sherrif's deputies there at all times. It was an easy thing to do to have someone arrested for assay or battery. Not so in the state where I currently work... The police would not arrest patients in the ER I works two jobs ago, the security guards were unarmed and over 80 years old, and there was no metal detector. I did, still, manage to get one repeat offender sent to jail but was roundly criticized by the administration for doing so... She was sentences to three mints for assault but stayed 9 months because she kept assaulting the jail guards. At the place where I guest-star now the cops will come in and escort folks out, but will let them go in the parking lot.

  10. Hey All This is 100% off topic and I apologize if this seems rude, but I am a regular reader of this blog and thoroughly enjoy it. So here is my question.


    How are DPMs (Podiatrist) viewed in the medical field. Are they taken seriously. Do they get to practice medicine as a MD would, or course within the limits of the practice (ankle foot). What do you think their career outlook is like, and have any of you met a Podiatrist first hand.

    Anything would be helpful! thanks for your time.

    I ask this question because I am considering podiatry. BTW my feelings wont be hurt if you are blunt with your statements like: They are Jokes etc! I just want truth, and actual feelings about the profession from others.

  11. Avo.
    Kudos for asking the question that got me to rise from my coffin...wait, thats not till Sunday.
    and whats the whole deal with Easter anyway?, its basically the Dracula story in the daytime.
    Anyway, Podiatrists are like our other Health Care Provider Bretheren. There somewhere above Nurse Practitioners, below PAs, and WAY below the #1 of the Food Chain, CRNAs, cause whoelse can make half a million(with overtime)with 2 years of training(College doesn't count)
    and for some reason Speach Pathologists are always smokin hot, I think its something to do with the Oral Board Exam...
    That Bein Said, Podiatrists suffer from the stereotype that there Foot Freak Wierdos, you know, like how OB/GYNs are Pervs, Shrinks are Crazy, Anesthesiologist are junkies, and ER docs are arrogant a-holes who didnt have the hand-eye coordination for surgery...
    TBS(That Bein Said)REAL foot freaks, like me, I mean, NEVER go into Podiatry, cause think about it, your dealin with feet SO jacked up they have to go to a friggin Specialist, Toejam, Fungus, Hammer Toes..
    In fact if you go into Podiatry they give you a free bowl of soup..
    Might look good for you though,

    Frank, "I'm not Dead, Yet" Drackman

  12. Podiatry is very location and institution dependent... Some major medical centres have them on staff right alongside Ortho... Others do not. At least twenty years ago the rap was that it was for folks that couldn't get into med school, but that turns out to be crap... They do some complicated surgeries and there are good ones and bad ones just like we have on our side.

  13. Hey again. I really appreciate your responses! I would like to ask however, if any of you have met a podiatrist and how "well off are they, or did they seem". I have been reading blogs of podiatrist (but they are old blogs cant seem to find more recent ones) where there are many podiatrist who are bitter about going into the profession. They say the schools lie with promises of a "fulfilling career" and you just end up in debt barely making it due to student loans you need to pay off and the "very low income made". Of course money is never the driving force for a career choice, but it definently plays a factor for me because like anyone else I want to be able to take care of my family....and to buy other things *cough* plasma TV etc.
    Thanks in advance,

  14. Dear Anon, Podiatrists are great guys. Never met one who wasn't a great guy and they all seem happy..I've worked in a Pod/Ortho training hospital and they all got along great..I think they make good change too..

  15. http://www.bls.gov/oes/current/oes291081.htm


  16. when i was a wee lad fresh out of residency i had a patient claiming he had chest pain (near weekly visits for the same) pull a knife on me in the ED. i had the police haul him away. as he left he says to me "what about my chest pain?"

    i responded, "you will not be seen for your chest pain today." he didn't so much as get an ekg. he could drop dead from an MI and it's better than our tech getting stabbed trying to do an ekg on him as far as i was concerned.

    911, you say:
    >This IS what I'm suggesting. We should be able to refuse to check him in as a patient if it is determined he does not have a medical emergency

    i would take that further and say if you behave this way, you lose the right to check in in the future, even if you are having a medical emergency.

  17. joebob,
    funny your comments make you seem like a hard-ass neanderthal... i'm right there with ya... but apparently no one else is.... these people can't help it... they have a disease... show some compassion.... how would you like it if you were an addict? huh? how about that?

  18. and that reminds me of this truism as well....

  19. i wasn't a sociopath until i started practicing emergency medicine.

  20. That would be a good title for my book.