# No information scenario



## joo (Nov 14, 2007)

Scenario. You work for a transport company. You transport out of a nursing home / VA hospital that refuses to give any information out about the patients. No medications, no allergies, no past medical--NOTHING. Patient cannot talk because he has a trachestomy, and is really not able to write for you. Your taking him for radiation therapy in an ambulance. 

Second scenario: Your transporting a patient out of this VA hospital and cannot get any information even if the patient doesn't talk. Maybe he/she doesn't know the medications your on, or maybe doesn't know anyting about the treatments they are getting.
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This is the problem I face almost everyday. I can get information about my patient when I get to the destination (sometimes hour + away with traffic), but I don't know anything about him. I do take him on a daily basis so I'm pretty familiar with him.

The biggest issue I face is with this VA facility that will not give out any information about their patients whatsoever. I've heard of many people refusing to transport the patient. My biggest thought is the "what if?" factor. What if the patient goes into cardiac arrest and and ALS arrives and I have nothing. With they try to pull my card? I'm just worried it's going to bite someone in the rear. The facility says to treat him "To take him to the nearest ER and they will treat him accordingly."

I feel as if I/we are taking a huge risk with this facility and I personally worry about transporting out of this VA. When you ask for info from a nurse they state "We've be instructed not to give you any information." This even occurs sometimes when coming out of the ER. I will ask to talk to a doctor and the doctor(s) have said "You fall in the scope of hippa, I don't understand". The facility has made a full mandatory "Do not give out any information" statement.

Complicated isnt it?

What would you do? Would you just transport without information if your patient can/cannot talk?


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## medic001918 (Nov 14, 2007)

A facility should be able to provide information to a transporting crew, otherwise they are being negligent in their transfer of care.  If this is an ongoing problem, you need to talk to your supervisors and have them handle the situation with the facility.  You said you're a transport company, so I'm going to assume these are transfers.  If they don't want to give the information, I would refuse to transport the patient.  Once you have the patient on your stretcher, you have assumed care and are responsible for that patient.

Since the hospital has made a mandatory statement that refuses to give information, they are being negligent.  Copy one of their statements if you can and bring it to your supervisors.  I'm sure that they can get together and work it out, especially since if you're doing transfers out of there they have a contract with your service.  They will have the contracts and the proper ability to ensure legal compliance.

Shane
NREMT-P


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## jrm818 (Nov 14, 2007)

Ditto - the facility is nuts, and no information = no transport.  Have your people speak to thier people, but rember that there is personal liability that goes along with this.  Even if your company says transport them anwyays - there is a personal risk that the company may not care about.  CYA.


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## ffemt8978 (Nov 14, 2007)

The private transport company I work for is actually owned by one of the local ER docs (there's a story there I may relate at a later time).  As such, he was aware of the lack of information that was being given to the transport crews by SNFs/clinics.  To combat this, he wrote into our protocols that we can refuse transport if we feel the facility is not providing us enough information to safely transport that patient.  We are to call him and get his approval before we leave, giving him a chance to chew on the staff a little bit.

We haven't had much of a problem with this lately, though.


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## BossyCow (Nov 14, 2007)

I'm thinking, since its VA, your supervisor should cc his congressmen when he writes to them.


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## Ridryder911 (Nov 14, 2007)

Short & simple, no info, no go. Transferring hospitals have to give adequate and appropriate transfer information according to COBRA regulations (even Federal ones). Ask to to speak to the charge nurse politely, and inform them that unless you are able to obtain information, you will have to decline the transfer. 

Be sure to inform your supervisor of the situation prior to next transfer, if this does not work your administration needs to speak to the transfer officer at the V.A. 

R/r 911


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## Anomalous (Nov 14, 2007)

joo said:


> . I will ask to talk to a doctor and the doctor(s) have said "You fall in the scope of hippa, I don't understand". The facility has made a full mandatory "Do not give out any information" statement.



They obviously have no idea what HIPAA is.


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## joo (Nov 15, 2007)

Ridryder911 said:


> Short & simple, no info, no go. Transferring hospitals have to give adequate and appropriate transfer information according to COBRA regulations (even Federal ones). Ask to to speak to the charge nurse politely, and inform them that unless you are able to obtain information, you will have to decline the transfer.
> 
> Be sure to inform your supervisor of the situation prior to next transfer, if this does not work your administration needs to speak to the transfer officer at the V.A.
> 
> R/r 911



Can you show me the COBRA regulations?


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## Ridryder911 (Nov 15, 2007)

http://www.dol.gov/ebsa/regs/main.html
http://www.emedicine.com/emerg/topic737.htm

It is actually, under COBRA sub definition of EMTALA ...

_The transferring hospital must send copies of all medical records related to the emergency medical condition. If the physician on call refuses or fails to assist in the patient's care, the physician's name and address must be documented on the medical records provided to the receiving facility.

Qualified personnel, with the appropriate medical equipment, must accompany the patient during transfer._

A pertinent medical history, treatment information should be given to the receiving hospital, transport team, that will be responsible for the patient while in transit. 

If your company refuses to deal or handle with this in an appropriate manner, I would highly suggest seeking another employer. This should had never occurred or continue. You as well as the service is held liable for the patient while in transit. A simple nurse report, as well they are required to receive a document from the physician for why the patient needs ambulance (unless they have a contract with V.A.) is usually required for payment. 

Again, discuss this with superiors. There are many other sites, that goes into further detail. 

Good luck, 

R/r 911


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## triemal04 (Nov 15, 2007)

I'm not sure, but at least for the first scenario, as you described it and from what I know of COBRA guidelines, I don't think you're required to have any paperwork.  If all you were doing was taking the guy to a scheduled treatement for his chronic condition...unless the facility needed all his info...can't see that it's required.  (be nice to have, but I don't think mandatory as it's not any kind of emergent situation, it's a routine treatement for him, and he's not staying).  The second...don't know from the info given.  

At minimum, you should have paperwork that identifies who the patient is, what his medical hx is, and what his code status is.  At minimum.  I'd push for more, even if you're only taking him to an appointment (reading it'll help with your learning if nothing else).  If you're taking him to another facility to stay, then you need everything.  Period.  They don't give it, then you don't transport.  Especially if it's any type of "emergency" situation.  There's nothing like showing up and realizing that the sending hospital didn't actually give you a copy of the pt's CT after they said they had.  Makes people a little upset sometimes.


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