Need quick medical/legal advice.

[Smarmie Doofus]

Have a close relative who is part of what can best be described as "the working poor."

Lifetime of low-paid-low benefit jobs. He's in early 60s.

Hospitalized w. a serious but ( should be) non life-threatening lower GI disease...which will probably involve surgery at some point and resection of the bowel.

Problem: hospital is aware of his budget med insurance ( might not have been when they took him in) and has intimated that they want him "out" before he's ready. ( He cannot, in his current shape, take care of himself.)

It's a large "private" ... at least nominally... hospital in a major metro area. (NYS)

Question: What are his legal options? He doesn't want to be discharged til he's at least able to care for himself.

What are the *hospital's* legal options?

I'm going over there to "help" this afternoon.

Anyone have any experience here with this sort of thing?

Thanks.

[Sheldon Cooper]

1. Talk to the hospital social worker and also the patient rights advocate if they have one.

They should be able to get you some answers and help coordinate discharge planning.

[Lochloosa]

4. This

[Smarmie Doofus]

9. Wow.... yeah. The terminology is coming back to me now.

Haven't really dealt w. hosp bureaucracy since my parents died.

Thanks.

[MineralMan]

2. He has health insurance?

If that's the case, the hospital still may discharge him if he doesn't need immediate surgery as a life saving procedure. Is he a military veteran? Legally, the hospital may have to stabilize him, but if there's no immediate surgery indicated, they may not have to keep him as an inpatient.

It's a difficult situation. Time to enlist the aid of the hospital's social services department and see if they can find some way to deal with this that protects him.

Lots of details to be dealt with here, and without being there and knowing all of the information, it's hard to give concrete advice, really.

[Smarmie Doofus]

5. Has health insurance but he himself it as "crummy".

My guess is there's a low cap on hospitalization, which he's probably already exceeded even though they haven't really done anything but cat scan and morphine drip. ( He's in extreme pain.)

No.... not a vet. Too bad; my other sibling is and all of this would be a non-issue.

Good idea re. ss department of hosp.

Thx.

[pnwmom]

15. Under the ACA, there shouldn't be a low cap on hospitalization.

In fact, there shouldn't be any cap.

[Smarmie Doofus]

20. He didn't sign up for it. He planned ( and plans) to sign up in November.

He's insured by some kind of no-name outfit thru his employer.

The Spanky and Alfalfa Medical insurance Co..... or something like that.

[elleng]

3. Some NYS info:

Discharge Notice —
A New York State hospital discharge notice should include information on your discharge date and how to appeal if you disagree with the notice. A discharge notice must be provided to all patients (except Medicare patients who receive a copy of an "Important Message from Medicare&quot in writing hours before they leave the hospital. Medicare patients must request a written discharge notice ("The Important Message from Medicare&quot if they disagree with discharge. If requested, the notice must be provided. Once the notice is provided and if the Medicare patient disagrees with the notice, an appeal can be processed.
Discharge Plan —
All patients (including Medicare patients) in New York State hospitals must receivee a written discharge plan before they leave the hospital. This plan should describe the arrangements for any health care services you may need after you leave the hospital. The necessary services described in this plan must be secured or reasonably available before you leave the hospital.
Discharge Planning —
Discharge planning is the process by which hospital staff work with you and your family or someone acting on your behalf to prepare and make arrangements for your care once you leave the hospital. This care may be self care, care by family members, home health assistance or admission to another health care facility. Discharge planning includes assessing and identifying what your needs will be when you leave the hospital and planning for appropriate care to meet those needs when you are discharged. A plan must Glossary be provided to you in writing before you leave the hospital. Discharge planning usually involves the patient, family members or the person you designate to act on your behalf, your doctor and a member of the hospital staff. Some hospitals have staff members who are called "discharge planners." In other hospitals, a nurse or social worker may assist in discharge planning.

https://www.health.ny.gov/publications/1449/section_2.htm

And I agree, speak with hospital personnel.

[Smarmie Doofus]

7. Wow. I was gonna print it out til i clicked the link.

Now I just think I'll carry the laptop w. me.

Mother o' jeepers.

Guess it's back to school time for me. More stuff I don't wanna learn.

Thanks.

[Smarmie Doofus]

14. That download helped immensely today when I met w. hosp. SW and docs.

Thanks a bunch.

[elleng]

16. Great!

I'm pleased it was helpful.

[TwilightGardener]

6. I wonder if the hospital could arrange a skilled nursing facility to take him

for a little while?

[Smarmie Doofus]

8. I'm thinking that's what they're thinking.

Hence the idea of surgery LATER as opposed to surgery NOW.

There may be a medical consideration but I'm worried that they're more worried about not getting paid for the operation. ( Which I can understand. I don't see how they WILL get paid for an operation like that.)

[Liberal_in_LA]

10. kick so more can respond

[Hekate]

11. Kick. Let us know how this goes.

Best of luck.

[Smarmie Doofus]

13. Thanks. He's still in hosp. Tuesday nite.

They've made intimations that they want to put him out but have backed off given him written notice.

I'll avoid the graphic details ( but when your colon and large intestine are not functioning you can imagine the immediate problem)
but he sensibly pointed out to head doc that if YOU guys can't get that under control HERE.... how am I going to control that by myself at home?

The've agreed to keep him til his digestion is normal, so to speak.

[elleng]

17. Sounds like a 'good' concession to me.

[HereSince1628]

12. He's the right age for having served during VN, I suppose a social worker

has mentioned that, but on the off-chance that's not so, you should know the VA has programs for vets who have little income.

You can check eligibility under the clickable sub-title "priority-5"

http://www.military.com/benefits/veterans-health-care/va-health-care-eligibility.html

[REP]

18. Get them to commit to a diagnosis and prognosis

If his large intestine really is shut down, that is indeed a life-threatening condition; besides a rupture, there's a lot of other things that can go wrong (BTDT with a very close relative). What tests have they done and what are the results? Why are they delaying surgery if a colectomy is indicated? What do they expect to happen at home?

Once a colectomy is done, he'll have at minimum a temporary colostomy (the resection isn't done at the same time if there is a significant amount of colon removed). He will probably need to be in a skilled nursing home afterward for at least six weeks; some colectomy patients need to relearn how to walk after their procedure.

[Smarmie Doofus]

19. Good questions, all.

Tests: AFAIK, just a cat scan so far. They've put off colonoscopy for 6 weeks as scan indicates a perforation or tear in colon which would be exacerbated by the stretching and bloating involved in colonoscopy.

There IS an infection now. Treating it w. antibiotics. (Which may be exacerbating the diarrehea.... the immediate problem .)

Severe pain has subsided w. the anti-bio treatment and he's off the morphine drip. He can walk to the bathroom ( 10 feet away) w.o too much difficulty now.

Long term options as explained to him are pretty much identical to what you say. No one mentioned 6 week stay in skilled facility. ( Nor will I, frankly. I'm too young to die.)

I believe they're prescribing 6 weeks of low-fiber diet plus continued anti-biotic regimen to eliminate infection. Then the colonoscopy to confirm what they already suspect and then the knife. ( This is HIS understanding of their explanation to HIM.)

Does that part make sense to you?

Again.... the overriding concern is: he really is not going to ever be able to pay this hospital for this kind of extensive treatment. And they MUST realize that. So.... is he really being given the best available medical advice?

[REP]

21. If he had a tear or rupture, he'd be dead from sepsis now

Tears and ruptures in the bowel aren't a "watchful waiting"' sitch; it's a surgical emergency. The abdominal cavity has to be cleaned by the surgeons with a rupture/tear in the bowel.

It's possible he doesn't understand what he's been told. See if he'll allow the doctors to discuss it with you and explain whether or not there is an actual tear or rupture in the bowel or not.

If he has megacolon, colectomy is probably the only viable treatment.