Requesting a Hospital transfer question?

[LoraJ]

My boyfriend's father finally agreed to go to the emergency room yesterday. We were going to drive him to the ER at the hospital where his oncologist is.

I was waiting in the car yesterday as my BF was trying to get him into the wheelchair. I don't know exactly what happened but he was having a hard time getting in the chair and then just started saying "ambulance". So my BF calls 911. Ugh! I wish I had been there to stop that because I knew the outcome. Now we would be limited to which hospital we could go to and it was one he had never been to before.

They were going to send him home yesterday with pain meds. But that wouldn't solve the problem as to why we were there. He has not been able to keep anything down and has been throwing up for days. He's actually constantly been nauseous for a few weeks. His dad insisted on being kept over night because he wants to be observed. But the guy said none of the docs there are familiar with his case and he may end up there for days.

Well, they finally did decide to keep him there. But I am worried that his dad will now miss a critical step in the road to getting better. He has a PET scan scheduled on Thursday at the hospital I was trying to take him to. If he misses that, it could put off his important surgery another month.

My co-workers at work keep saying I should get him transferred to the other hospital, but how does one do that? The other hospital has his whole case file, but they aren't that familiar with him yet since we have only been there once for an initial appointment with the oncologist.

Also, he doesn't have insurance, so I just don't know how willing anyone would be able to accomodate us.

 

[Virgo10]

You need to get a social worker involved. The hospital should have a social service dept. Ask the nurses on the floor where he is or even people at the front/information desk for more information. A good social worker should be able to help you through these problem.

Good luck!

 

[minkydog]

If he is stable enough, you can always sign him out AMA)against medical advice), take him to the PET scan, then on the the ED of your choice. I'll be surprised if they will transfer him, unless they are incapable of taking care of him. You could also pay for an ambulance out of pocket, but you better be ready to open wide your checkbook.

 

[phillybeth]

If you sign him out AMA his insurance will not cover his current hospitalization- I don't recommend doing this.

 

[sugarpie]

I don't know the particulars of his medical condition, but I think your first priority (before transferring to another hospital) should be getting the nausea under control. There are a lot of drugs out there, and if one doesn't work there is another to try. Get the doctor on that. Tell him/her you expect an improvement, be firm but not confrontational. Try to be there for doctors rounds, usually early in the morning. If that's the only problem I wouldn't think it would be neccesary to transfer hospitals, any hospital should be able to handle it. Follow up with his doctor and get an opinion.

 

[LoraJ]

Well, apparently the doctor came by and had no idea why he was even there. I don't know what his dad told him. He has been on a couple of different meds for the nausea, but nothing seems to work. When we call him back in an hour, I will have bf ask him what the doctor said. That does seem like the best solution, getting him on another kind. The ER doctor yesterday didn't even address those meds. Only the pain ones. And the way he did it was very unprofessional. He made it sound like any doctor who would prescribe that kind of pain meds for that type of pain is a moron. The doctor who prescribed this is the oncologist. Now I worry that because of what this guy said, his dad won't have much confidence in the oncologist.

 

[CajunDixie]

He has no insurance at all.....not even Medicare or Medicaid? First thing you need to do is see if he qualifies for either one, the hospital should be able to point you in the right direction for that information. As for transfering him by ambulance hospital to hospital he'd have to sign a ABN stating he knows he is responsible for the cost of the transfer. My ambulance service is a small town one and I accept small payments (even as low as $10 a month) so you might want to talk to the ambulance service itself on that cost. But if at all possible I'd take him by personal vehicle to the other hospital. Before you transfer him though you need to talk to the doctors at the other hospital so they know what to do with him once he is there.......not just sticking him in the ER with whatever Dr. is on duty at the time. Otherwise, you're just racking up more bills for him.

 

[LoraJ]

Thanks for all of the advice. Now I am thinking maybe a transfer won't be necessary sine they may just discharge him today. But before they do that, I want to make sure that they change his nausea precription.

A social worker came by yesterday and said that he may now finally qualify for medicaid. She asked if he had more than $2000 in the bank or in assets. We said no. Then she said "in the last 5 years". Well he did used to have money up until last year when he was out of work for 8 months. He had just started getting more freelance work in January and Feb when he got sick. So when he was first in the hospital he had too much money to qualify. She said she would bring us all of the applications for that and for charity care for this visit, but she never came back.

Now he doesn't have a penny to his name. But I don't understand the 5 years thing? Does he have to live for 5 years without a penny to his name before he can qualify? Right now my boyfriend is paying for his rent and meds and it is very draining on him. We want to move him to a smaller apartment but he's been to sick to deal with it.

 

[bananiem]

He has colon cancer, correct? Could it be that the nausea and vomiting is due to a tumor obstruction in the intestine? I would think nausea meds wouldn't do anything if that is the case.
to you!

 

[CajunDixie]

Right now my boyfriend is paying for his rent and meds and it is very draining on him.

Not sure how other states work but in my area we have an office where we refer people who need help getting medications. Not sure of the official name but we call it Medication Assistance and they are very good about either helping the patient themselves or finding them the help they qualify for in our area. People around here can inquire about help through their township trustee. And the township trustee can also help with paying for rent and again suggesting other places that will help pay for rent like the Salvation Army and the local Housing authority. You need to really talk to someone about finding out all the resources that are available to him.

 

[LoraJ]

Not sure how other states work but in my area we have an office where we refer people who need help getting medications. Not sure of the official name but we call it Medication Assistance and they are very good about either helping the patient themselves or finding them the help they qualify for in our area. People around here can inquire about help through their township trustee. And the township trustee can also help with paying for rent and again suggesting other places that will help pay for rent like the Salvation Army and the local Housing authority. You need to really talk to someone about finding out all the resources that are available to him.

Thanks.
We'll try and hunt down the social worker today and see what she can do. Also, I will call the American Cancer Society and see if they can give me some numbers to call for help.

Bananiem, yup it's colon cancer. The whole thing is so frustrating because it doesn't seem like any doctors are telling him what you just said. It's like "here's some meds, have a nice day".

 

[sugarpie]

Does his oncologist know he's in the hospital? Call his office and let them know. Maybe they'll have some input on what the best course of action is, regarding his medical condition.

I hope you're all hanging in there. Sounds like a very stressful situation.

 

[minkydog]

A social worker came by yesterday and said that he may now finally qualify for medicaid. She asked if he had more than $2000 in the bank or in assets. We said no. Then she said "in the last 5 years". Well he did used to have money up until last year when he was out of work for 8 months. He had just started getting more freelance work in January and Feb when he got sick. So when he was first in the hospital he had too much money to qualify. She said she would bring us all of the applications for that and for charity care for this visit, but she never came back.

Now he doesn't have a penny to his name. But I don't understand the 5 years thing? Does he have to live for 5 years without a penny to his name before he can qualify? Right now my boyfriend is paying for his rent and meds and it is very draining on him. We want to move him to a smaller apartment but he's been to sick to deal with it.

I don't think so . I think she was looking for a "timeline". Medicaid will not kick in unless the patient has less than $2000 in assets, I believe. Some people try to circumvent teh system by transferring assets to other people(wife, son, cousin) so they can qualify without losing their property and money. Your FIL timeline fits with his story. I would doubt that would be a big problem.

 

[LoraJ]

I don't think so . I think she was looking for a "timeline". Medicaid will not kick in unless the patient has less than $2000 in assets, I believe. Some people try to circumvent teh system by transferring assets to other people(wife, son, cousin) so they can qualify without losing their property and money. Your FIL timeline fits with his story. I would doubt that would be a big problem.

That's good to know. Hopefully we'll get more direction today from the social worker.

She also thinks we should get a 24 hour nurse for his home. My boyfriend just can't afford that. We've already set up a home health aide, but we can't afford much more than that.

 

[Disney Doll]

My goodness, this is such a difficult time for you guys!!!!

If I understand your situaiton correctly, DBF's DF (from here on known as DFIL for ease of typing) is recently diagnosed with colon cancer, and has been seen once by an oncologist that does not have priveleges (the right to treat someone) in the hospital DFIL is currently in. Compounding that are DFIL's lack of insurance and money, in addition to what sounds like his denial of his situation.

First...his comfort and care. They need to find an anti-nausea medication that works for him. I have used Compazine, Tigan, and Zofran in the past...many folks seem to have good results with Zofran. Reglan and some of the Pepcids, Nexiums etc.(acid blockers) in conjunction with the anti-nausea stuff also seems to help. Sometimes it takes a few days of trial and error to determine the best combination though. You should also be thinking about some form of alternate nutrition, such as hyperalimentation (super charged IVs) or tube feeding. If this hospital has an oncology (cancer) unit, DFIL needs to be on it, if he is not already. Insist on that. Call his original oncologist (the one that has seen him once) and let him know what is going on. If he does not have priveleges at the hospital where DFIL currently is, perhaps he has a colleague who does, who could take his case and then the original oncologist and new colleague can consult, with the new colleague writing the orders at the hospital for DFIL's care. If he is in pain, request that a pain specialist sees him, if they have one (they may not, as that is a fairly new specialty area). If they do not have a pain specialist, then ask someone to evaluate putting him on a long-acting pain medication, such as oral OxyContin or a Fentanyl patch, with a short-acting pain medication for "breakthrough" pain. When my DMIL was terminal with cancer, she was on a Fentanyl patch 50 mcg with Percocet as needed for breakthrough pain. The Fentanyl patch held her pretty well most of the time, so she very rarely nedded a Percocet tablet. As far as the PET scan scheduled at the other hospital...if the hospital he is currently in does not have a PET scanner, they often have "deals" with hospitals in their area that do, to allow their patients to be brought there via ambulance, have the PET scan done, and then be returned to the first hospital. I would also ask your DFIL to tell the hospital that they can discuss his condition with you and your DBF, if your DFIL so desires. If I am not mixing you up someone else, and I don't think I am, you DFIL has been sort of "closed" to any discussion regarding his health status, but decisions will have to be made in the next few weeks whether he likes it or not, even if those decisions are just to keep him comfortable at home with no treatment other than pain meds, nausea meds etc. With colon cancer, nausea and vomiting could be the symptoms of the tumor obstructing part of his intestines, so that should be ruled out before he is sent home. A surgical consult coudl be in order to determine that. I would also add that sometimes the best person to begin these discussions with are the staff nurses and nurse manager of the unit he is on...we can often gently "suggest" treatments, ideas etc. for the doctor to consider.

The ER doctor not addressing all the meds is not unusual...they are there to treat the acute symptoms...get things a little under control, so to speak, and then the patient is moved to the area where further, and more appropriate, stabilization will occur. Now, his lousy attitude...well, that's not acceptable but not unheard of unfortunately, in any department of the hospital. There are good and bad everywhere. Reporting him to his superior would be they way to handle that, if you have the energy.

The insurance thing is his other issue. He needs insurance. The social worker says he may now qualify for Medicaid, which is great. If he does qualify for Medicaid, I believe it goes back retroactively to the date the application was completed, so the sooner you get in that, the better. Her question about spending in the last 5 years referred to some folks who will transfer money and property into others' names in an effort to divest themselves (on paper) of their assets so they can qualify for Medicaid. Fraudulent behavior, so to speak. In your DFIL's case, that does not seem to be the issue, and once they check into that briefly, that should not come up again.

I will tell you with hospitals that you need to advocate for the patient. They are big places, with many people in them, many of who have the same or worse problems than you. While your DFIL is your focus (which is as it should be) the social worker may be dealing with 25 other people in the same boat. If she says she's going to be there this afternoon, and she doesn't show up, you need to ask his nurse to get a hold of her, remind her of who you are and what your situation is, and be prepared to have or be able to get the information she will need from your DFIL, which may include income tax forms, bank statements etc.

You need to ask the doctor questions, politely insist that he give you some time to discuss DFIL's case. I would recommend you write down questions/concerns as they arise, so you can discuss everything in a somewhat organized fashion...doctors, like all folks, do appreciate it if you don't waste time. Of course, all of this discussion between DBF and doctor will need to take place with yor DFIL's permission due to the lovely HIPAA regulations that we all have to abid eby now ...hopefully DFIL will realize that this is not something he can go through alone or ignore, and he will give the healthcare folks his permission to discuss the situation with your DBF & you.

Best of luck to you. I am a hospital nurse for 23 years, so I know how frustrating they can be sometimes. I also have insurance and homecare experience. PM if I can be of any help to you.

 

[minkydog]

Excellent advice, Disney Doll. I agree 100%. My only addition would be to try to get the Dad to appoint a healthcare power of attorney--someone who can make decisions for him when he no longer has the ability. He probably will resist this, but he needs to be prodded--things happen: My beloved step-dad didn't have one and he endured 10 days of torture prior to his demise. On the other hand, I practically forced my bio-dad to make one--in the end he was very glad he did and I was able to make decisions for him that eased his end-of-life experience.