Friday, December 25, 2015
When a patient stays on the psych ward, they must be medically stable. For example, no tubes such as intravenous lines, feeding tubes, catheters. If they need psychiatric care and medical care, they need to be on a medical floor.
When a patient on the psych ward needs medical interventions, they transfer to a more appropriate setting, either short or long-term.
A patient was sent out for fainting. Diagnosis was some kind of systemic infection. He stayed on a medical floor for a week. One morning, I got a call from the case manager from the medical floor that the patient could return to psych.
Somehow this is now my job to coordinate such transfers. My supervisor emphasized that this has always been my job.
So the case manager faxed some preliminary paperwork to my office area after we discussed that I cannot access the electronic medical record that exists in the rest of the world. I quickly noted that the patient had an active order for intravenous (IV) antibiotics. "No IVs on the psych ward," I advised the case manager.
The case manager knows this, but she tried to pretend that maintaining the IV on the psych ward was fine because the patient would still be in a medical setting. After several phonecalls back and forth, with my supervisor listening outside the door, the case manager said that the doctor would discontinue the IV and order oral antibiotics so the transfer could happen.
"Okay, fax those orders," I told the case manager. If it's not in writing, there is no proof.
This was still morning. Before I left for lunch, I left a voicemail message for the case manager to fax the orders and I would call her when I returned from lunch.
After lunch, nothing. I called the case manager several times to try to protect my butt, leaving messages that I was still waiting for additional information in the fax. My supervisor hung on every word.
About an hour before my shift ended, I called the psych ward that would be receiving the patient and told the nurse that I was having difficulty securing information and that the transfer may not be able to happen today. I continued to try to reach the case manager without success.
Just as I was about to leave for the day, the case manager called, irate. "Your fax machine broke, so I sent over a hundred pages to the ward where the patient normally stays. What do you mean you didn't get any of it?"
"Why didn't you return my phonecalls that clearly indicated, since this morning, that I didn't get any additional paperwork?" I asked the case manager.
"Because of HIPAA," the case manager explained. "I called you to tell you that the doctor discontinued the IV, but your supervisor answered. She told me that you are not allowed to receive information about patients because of HIPAA, so I can't talk to you. She also said to fax records directly to the patient's floor because you are not allowed to handle them."
I called the nurse on the ward. "Oh yes, it's all here," the nurse confirmed.
"Why didn't you tell me this when I called you and said that I had not received any information?" I asked of her.
"Because your supervisor called here and told me that I can't discuss patients with you because of HIPAA. She told me that I can't tell you that the patient's records are here," the nurse said.
At this point my supervisor appeared. "Why hasn't the transfer been set up? We will be in trouble if we didn't fill an empty bed."
I asked her if she told people to stop conferring with me about the patient.
"Well, yes. HIPAA is the law. I have to protect patients according to the law," she said.
"Protect them from what? You told me to set up this transfer and then went behind my back and told people to ignore me. Then you pretended to not know why I couldn't complete this task?"
"I follow the law," she answered, as if she was making sense and was justified under some higher good.
I fired off an email to a bunch of people explaining that that transfer was not arranged because the case manager and ward nurse became under the impression that I was not authorized to facilitate the transfer as instructed by my supervisor.
Nobody answered my email. I don't know if my supervisor was able to block my outgoing emails.