Why a patient waited 80 hours in the ER for placement

by erdoc85, MD

When I arrived for my shift this am, I was passed off the following patient.

EMS responded to a 50-year old guy laying alongside the Interstate. He had no idea who he was or how he got there. He complained of knee pain and shoulder pain. They were kind enough to tote him to my ER where his evaluation revealed that he had a fracture of his clavicle and tibial plateau (knee). Neither requiring anything to be done except a knee brace, a sling and a walker (since he can’t use crutches with a broken collar bone).

We learned that he had been to our ER several times, homeless and with a history of schizophrenia. On two occasions, he had tried to assault the nurses. On each occasion, he escaped before anything was done to or for him.

After a nap and a meal, he told the staff that he had been working in the oil fields in Costa Rica when he got a call from Brazil that his mother had died, so he was hitch hiking to his home in Rhode Island. While the car was speeding down the Interstate, someone had opened the door (from the outside) and pulled him out of the car, leaving him injured along the side of the road.

So, after he was medically cleared, the mental health people evaluated him and decided that he was psychotic but it was a holiday weekend and all of the intake personnel at the psych hospitals that accept Medicaid were taking the weekend off. The Mental Health and Mental Retardation (MHMR) folks would be happy to return on Tuesday to try and place him somewhere.

Trauma service wouldn’t admit him since he didn’t have any serious trauma issues. Ortho wouldn’t admit him since he didn’t need any in patient ortho care. Medicine wouldn’t touch him since it certainly wasn’t a medicine issue.

So, the guy laid around in our ER for almost 80 hours waiting for “placement.”

Late this afternoon, when we really needed our rooms, we contacted MHMR again and tried to lean on the caseworkers to do something with him. That’s when they informed us that in order to place him in a psych facility, he would have to be freely ambulatory without braces or assistance. The psychiatrists wouldn’t take him since they “wouldn’t feel comfortable” with his orthopedic injuries.

And so he remained the in the ER.

“erdoc85” is an emergency physician who blogs at M.D.O.D.

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