Got fired by locums within 10 minutes for requesting the ED physician to not admit patient before being assessed

[doctorsun]

Hello,

I got a signout from an ED physician re: admission for diagnosis that can be easily treated as outpatient based on national guidelines. While on phone, ED physician replied to my request to hold patient until seen to assess if admission appropriate with "no no no no no. You don't have a choice, the patient was already admitted. do you know who I am? I am the director... I am your superior." Told him that he can't force another physician to care for another patient or a hospitalist to admit, let alone without first assessing the patient so he replied "where do you come from" and just kept babbling. Went to see the patient and refused admission. Long story short, ED physician comes 10 minutes later to the floor stating "you're fired. Leave the premises ASAP" and making threats "remember my name" showing off his hospital tag, being disrespectful, egomaniac, etc. Acting like a child basically. I requested to discuss with locums, and 5 minutes later received call from "CEO" of locums asking her who gave green light to terminate service and she stated basically "take you things and go." Asked her for reason and she replied that it was because of what just happened. Claimed that the decision to accept a patient is not up to ED physician, which is also stated in the locums contract itself, but she claimed that it was. Then she tried to talk over me and I cut the conversation short stating I expect the money for services already provided to be paid in full and the rest I will obtain through litigation.

Mind you, I still had patients I had to take care of on the floor and the ED physician assumed hospitalist position while working in the ED after my termination. Also, in my short time working there, had to deal with problematic admissions and always provided reasoning based on guidelines, scores, etc. In return, had ED nurses etc showing up on floor and questioning reason for another refusal to admit because "husband measured low bp a home" and throwing a little childish fit etc.

My question is how would you go about dealing with this vs. locums (litigation) and vs. Physician (reporting)?

Thank you

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[rokshana]

Hello,

I got a signout from an ED physician re: admission for diagnosis that can be easily treated as outpatient based on national guidelines. While on phone, ED physician replied to my request to hold patient until seen to assess if admission appropriate with "no no no no no. You don't have a choice, the patient was already admitted. do you know who I am? I am the director... I am your superior." Told him that he can't force another physician to care for another patient or a hospitalist to admit, let alone without first assessing the patient so he replied "where do you come from" and just kept babbling. Went to see the patient and refused admission. Long story short, ED physician comes 10 minutes later to the floor stating "you're fired. Leave the premises ASAP" and making threats "remember my name" showing off his hospital tag, being disrespectful, egomaniac, etc. Acting like a child basically. I requested to discuss with locums, and 5 minutes later received call from "CEO" of locums asking her who gave green light to terminate service and she stated basically "take you things and go." Asked her for reason and she replied that it was because of what just happened. Claimed that the decision to accept a patient is not up to ED physician, which is also stated in the locums contract itself, but she claimed that it was. Then she tried to talk over me and I cut the conversation short stating I expect the money for services already provided to be paid in full and the rest I will obtain through litigation.

Mind you, I still had patients I had to take care of on the floor and the ED physician assumed hospitalist position while working in the ED after my termination. Also, in my short time working there, had to deal with problematic admissions and always provided reasoning based on guidelines, scores, etc. In return, had ED nurses etc showing up on floor and questioning reason for another refusal to admit because "husband measured low bp a home" and throwing a little childish fit etc.

My question is how would you go about dealing with this vs. locums (litigation) and vs. Physician (reporting)? If you wouldn't, no need to reply. Not looking for advice to move on, such is life, etc.

Thank you

Name and shame…
Make sure you get paid for any shifts that were cancelled in <30 days.
And yes, would talk to lawyer about what can be done…
But let other locums know the name of the hospital…and that ED guy… and the locums company… so we can avoid them.

There is a FB pg for locums physicians… wpuld post there as well.

Oh and file a NALTO complaint against the locums company.

 

[HemeOncHopeful19]

Should have demanded the locums CEO put everything in writing rather than a phone call IMO

 

[doctorsun]

Should have demanded the locums CEO put everything in writing rather than a phone call IMO

Crossed my mind at the time but having dealt with this company it would've been a waste of time. Doubt a "CEO" of a company that claims that a hospitalist has no right to refuse a patient even though it is written in my contract, orientation, etc (which she's signed on as well), and in general, with such unprofessional behavior from start to finish of our business transaction would do anything but mock a request to put it in writing. She wasn't even the CEO, she just identified herself as such.... However, having seen the patient I did leave a short note detailing the assessment and what occurred. I also left a quick note for patients I was following on the floor to ensure I have some evidence I didn't simply abandon my patients.

 

[dozitgetchahi]

Hello,

I got a signout from an ED physician re: admission for diagnosis that can be easily treated as outpatient based on national guidelines. While on phone, ED physician replied to my request to hold patient until seen to assess if admission appropriate with "no no no no no. You don't have a choice, the patient was already admitted. do you know who I am? I am the director... I am your superior." Told him that he can't force another physician to care for another patient or a hospitalist to admit, let alone without first assessing the patient so he replied "where do you come from" and just kept babbling. Went to see the patient and refused admission. Long story short, ED physician comes 10 minutes later to the floor stating "you're fired. Leave the premises ASAP" and making threats "remember my name" showing off his hospital tag, being disrespectful, egomaniac, etc. Acting like a child basically. I requested to discuss with locums, and 5 minutes later received call from "CEO" of locums asking her who gave green light to terminate service and she stated basically "take you things and go." Asked her for reason and she replied that it was because of what just happened. Claimed that the decision to accept a patient is not up to ED physician, which is also stated in the locums contract itself, but she claimed that it was. Then she tried to talk over me and I cut the conversation short stating I expect the money for services already provided to be paid in full and the rest I will obtain through litigation.

Mind you, I still had patients I had to take care of on the floor and the ED physician assumed hospitalist position while working in the ED after my termination. Also, in my short time working there, had to deal with problematic admissions and always provided reasoning based on guidelines, scores, etc. In return, had ED nurses etc showing up on floor and questioning reason for another refusal to admit because "husband measured low bp a home" and throwing a little childish fit etc.

My question is how would you go about dealing with this vs. locums (litigation) and vs. Physician (reporting)? If you wouldn't, no need to reply. Not looking for advice to move on, such is life, etc.

Thank you

Lmao. So now you’ve seen why certain hospitals have to resort to getting locums docs to fill the slots - from what I’ve seen, hospitals that rely on locums are often total ****shows. The interesting thing is that they usually don’t mess with the locums docs much, because they know they don’t have much leverage against you. Here, they apparently do.

Also, please name the hospital and the locums organization so that the rest of us can avoid it. (You’re not losing anything for yourself here by mentioning who this is.)

 

[michaelrack]

You may want to consider filling a complaint with the state medical board against the ED director

 

[michaelrack]

You probably won't get paid for unworked scheduled shifts if you were let go for clinical reasons. You need to decide if you want to lawyer up or let it go

 

[AlbinoHawk DO]

I would do both litigation and report the guy to the medical board. This is going to be the easiest money you'll ever make. Ask for the full contract time paid plus attorney fees

 

[chessknt]

Agree with the lawyer part (though depending on how much work you lost out on etc it might not actually be worth it), also take it in stride--this hospital obviously needs locums because their admin is made up of incompetent dictators. Not a reflection on you at all. Make absolutely sure your privileges were not terminated or some other action that you will be required to report forever--if they were you 100% need to legally pursue it even if there isnt any money in it to get that fixed.

Don't involve the medical board--that won't go anywhere and might provoke a retaliatory complaint that you will then need a lawyer to defend against (at your own cost). Remember that the director has the resources of a hospital (including political connections you do not understand being from the outside) at his/her command and you do not.

 

[doctorsun]

Also, please name the hospital and the locums organization so that the rest of us can avoid it. (You’re not losing anything for yourself here by mentioning who this is.)

See PM. Feel free to distribute

 

[NotAProgDirector]

I see all of the comments telling you to get a lawyer and you're going to get paid. I'm not sure it's that straightforward, and I wonder if your best strategy is to just let it go.

Although your contract may say you have the right to refuse to admit patients, much of how this works comes down to local culture. It's always a bit of a judgment call whether a patient with a PE or pneumonia or cellulitis needs to be admitted or not. Sure there are all sorts of scores you can calculate and such, but in the end a good dose of clinical acumen is always needed. The locums company is going to argue that you were fired for clinical incompetence, and hence they will state that they owe you nothing. Make a stink about it and they will likely file a complaint to the medical board against you. And they completely control the medical record - if they are as slimy as you suggest, anything could happen. Even if you ultimately prevail, just an ongoing investigation will be reportable when you try to credential elsewhere.

The honest truth is this: when you're a locums, you're supposed to fit into their culture. If when the ED asks you to admit a patient, you just admit the patient even if you think it's not warranted. A short discussion with the ED is fine, but ultimately they are in charge. If you're unhappy with the way they do things, then you end your contract and move onwards. "Fighting the man" as a locums is always going to end badly, for you.

 

[rokshana]

See PM. Feel free to distribute

Please send to me!

 

[doctorsun]

I see all of the comments telling you to get a lawyer and you're going to get paid. I'm not sure it's that straightforward, and I wonder if your best strategy is to just let it go.

Although your contract may say you have the right to refuse to admit patients, much of how this works comes down to local culture. It's always a bit of a judgment call whether a patient with a PE or pneumonia or cellulitis needs to be admitted or not. Sure there are all sorts of scores you can calculate and such, but in the end a good dose of clinical acumen is always needed. The locums company is going to argue that you were fired for clinical incompetence, and hence they will state that they owe you nothing. Make a stink about it and they will likely file a complaint to the medical board against you. And they completely control the medical record - if they are as slimy as you suggest, anything could happen. Even if you ultimately prevail, just an ongoing investigation will be reportable when you try to credential elsewhere.

The honest truth is this: when you're a locums, you're supposed to fit into their culture. If when the ED asks you to admit a patient, you just admit the patient even if you think it's not warranted. A short discussion with the ED is fine, but ultimately they are in charge. If you're unhappy with the way they do things, then you end your contract and move onwards. "Fighting the man" as a locums is always going to end badly, for you.

Hmmm.... the ED MD was so convinced it was pneumonia that he took an abdominal CT and treated the patient with zosyn and flagyl. Was shopping for admission criteria, as they often did in that location, omitted a bunch of findings during signout (this was acknowledged by nurses and administrator on call), administrator on call stated that it was eventually my decision etc.... Patient was young and had a PSI and CURB65 of 0, which was documented by me (didn't write much else about encounter because ED note stated the patient was admitted for pneumonia so that was what I assessed for admission), even though I was not convinced she even had pneumonia. Drug abuser presenting with diffuse pain and just came off influenza A a week prior to presentation. CT finding likely preexisting infiltrate, not that it matters because pneumonia and its severity not based on imaging.

I highly doubt they can make a case of me being incompetent in comparison to him, but I understand your argument. "Better be smart than right." At this point though.... I am not too excited about staying in medicine anyway. Maybe try own clinic before call it a day. Therefore, don't care that much about consequences. I will wait for my money from locums. Had only one day left before finishing with them anyway and did not plan on coming back. Was just trying to push it through another day before this creep MD showed up. However, it would be public disservice if I let this POS physician off the hook that easily. The guy stood in middle of ED in front of staff and patients and was yelling "do you know who I am!? I am your superior. Where are you going? come here!" He couldn't take it that I continued to ignore his rant (after he already did it over the phone), calmly discussed my decision, and walked away despite his attempts to impress. He even yelled next to everyone "just admit the patient and discharge later." It was a retaliatory action in response to not allowing his supposed "superiority" dictate my clinical judgement that this was yet another fraudulent admission. He did what he did after I tried to calmly explain to him that I have to assess the patient before accepting and that it was my decision, and when he refused to listen, told him that he was wrong based on the laws of medical practice and medical board, which I happen to work for. Despite knowing that, this small ghost town POS physician was so confident about getting me fired, as was the locums COO despite going against her own contract... who knows what this guy is doing to other colleagues (I know of at least one who suffered a similar fate) and his patients.

 

[rokshana]

I see all of the comments telling you to get a lawyer and you're going to get paid. I'm not sure it's that straightforward, and I wonder if your best strategy is to just let it go.

Although your contract may say you have the right to refuse to admit patients, much of how this works comes down to local culture. It's always a bit of a judgment call whether a patient with a PE or pneumonia or cellulitis needs to be admitted or not. Sure there are all sorts of scores you can calculate and such, but in the end a good dose of clinical acumen is always needed. The locums company is going to argue that you were fired for clinical incompetence, and hence they will state that they owe you nothing. Make a stink about it and they will likely file a complaint to the medical board against you. And they completely control the medical record - if they are as slimy as you suggest, anything could happen. Even if you ultimately prevail, just an ongoing investigation will be reportable when you try to credential elsewhere.

The honest truth is this: when you're a locums, you're supposed to fit into their culture. If when the ED asks you to admit a patient, you just admit the patient even if you think it's not warranted. A short discussion with the ED is fine, but ultimately they are in charge. If you're unhappy with the way they do things, then you end your contract and move onwards. "Fighting the man" as a locums is always going to end badly, for you.

No…respectfully disagree… I’ve worked locums off and on now for 12 years…
At my first assignment, another locums told me…you will have people asking you to do this and do that… ultimately you need to to practice medicine the way you practice medicine…it is ultimately my license… if a place wants you to do something that goes against the way you practice… you give your 30 days and dont work there…culture is about the way the nurses handle things or if you do a f2f sign out or over the phone… it is not compromising your medical ethics and practice because they practice poor medicine and expect you to do so…
Frankly in the OP situation, I would have talked to the pt, see if they are ok with going home , written an H&P and then discharged from the ED… dude can be insulted up the wazoo, but can’t actually do anything…discharge from the ED is the big middle finger to that ED doc… but not much they can do.

And my locums contracts specifically say if my shifts are ended with < 30 days notice… I get paid…doesn’t matter the reason.

And NALTO is there for a reason… locums companies tout their NALTO certification… they don’t want anything to happen that could make them lose it.

 

[doctorsun]

Lmao. So now you’ve seen why certain hospitals have to resort to getting locums docs to fill the slots - from what I’ve seen, hospitals that rely on locums are often total ****shows. The interesting thing is that they usually don’t mess with the locums docs much, because they know they don’t have much leverage against you. Here, they apparently do.

You should absolutely litigate and report this to every relevant institution possible. Not enough physicians sue in bad situations.

Also, please name the hospital and the locums organization so that the rest of us can avoid it. (You’re not losing anything for yourself here by mentioning who this is.)

Worked both locums and full time. Not that different....

 

[chessknt]

Hmmm.... the ED MD was so convinced it was pneumonia that he took an abdominal CT and treated the patient with both zosyn and flagyl. Was shopping for admission criteria, as they often did in that location, omitted a bunch of findings during signout (this was acknowledged by nurses and administrator on call), administrator on call stated that it was eventually my decision etc.... Patient was young and had a PSI and CURB65 of 0, which was documented by me, even though I was not convinced she even had pneumonia. Drug abuser presenting with diffuse pain and just came off influenza A a week prior to presentation. CT finding likely preexisting infiltrate, not that it matters because pneumonia and its severity not based on imaging.

I highly doubt they can make a case of me being incompetent in comparison to him, but I understand your argument. "Better be smart than right." At this point though.... I am not too excited about staying in medicine anyway. Maybe try own clinic before call it a day. Therefore, don't care that much about consequences. I will wait for my money from locums. Had only one day left before finishing with them anyway and did not plan on coming back. Was just trying to push it through another day before this creep MD showed up. However, it would be public disservice if I let this POS physician off the hook that easily. He did what he did after I tried to calmly explain to him that I have to assess the patient before accepting and that it was my decision, and when he refused to listen, told him that he was wrong based on the laws of medical practice and medical board, which I happen to work for. Despite knowing that, this small ghost town POS physician was so confident about getting me fired, as was the locums COO despite going against her own contract... who knows what this guy is doing to other colleagues (I know of at least one who suffered a similar fate) and his patients. As others have stated, part of the reason that physicians and especially hospitalists are treated the way they do is because they don't act.

They issue is that if you do make a big fuss they can make life very difficult for you. If you are retiring from medicine it doesnt matter but if you need an active medical license and/or ever plan to work in a hospital again they can make it very awkward/difficult and, if they prevail, impossible. You need to check with their staffing office and get a copy of your file in a month (including actions taken against you). If there is anything bad on that (and you arent retiring) you need to get a lawyer and work on fixing it. Getting $$ from the locums company is small potatoes compared to a medical boards complaint or a bad report from a hospital that will show up for all future employers/hospitals. If there is nothing on there then just letting them win is a core tenet of internal medicine you should know by now. Keep in mind if a board complaint is filed against you you are obligated to report it to every state you are actively licensed in right now, some of which might take actions against your license depending on the nature/severity/local culture.

I have done stupid admits before and just discharged the same day. I dont even tell the doc requesting admission, just admit pt, apologize for a big bill theyll get from someone, then discharge. Done, earn some units, move on.

 

[doctorsun]

They issue is that if you do make a big fuss they can make life very difficult for you. If you are retiring from medicine it doesnt matter but if you need an active medical license and/or ever plan to work in a hospital again they can make it very awkward/difficult and, if they prevail, impossible. You need to check with their staffing office and get a copy of your file in a month (including actions taken against you). If there is anything bad on that (and you arent retiring) you need to get a lawyer and work on fixing it. Getting $$ from the locums company is small potatoes compared to a medical boards complaint or a bad report from a hospital that will show up for all future employers/hospitals. If there is nothing on there then just letting them win is a core tenet of internal medicine you should know by now. Keep in mind if a board complaint is filed against you you are obligated to report it to every state you are actively licensed in right now, some of which might take actions against your license depending on the nature/severity/local culture.

I have done stupid admits before and just discharged the same day. I dont even tell the doc requesting admission, just admit pt, apologize for a big bill theyll get from someone, then discharge. Done, earn some units, move on.

The issue here isn't stupid admissions. We all do them. Besides, when you admit and discharge same day, the responsibility of something going wrong falls on you, not the ED physician, not to mention all the superfluous work. The issue is admitting without notifying attending, doing you the favor of a rushed and incomplete signout because you're supposedly inferior and have no choice, and when you request to assess the patient before admitting, telling you that you have no choice. Then going on a rant "first you don't want to give me your personal phone number, then this. Where did you guys come from!? (he had issues like this with other attendings in the past), the patient is admitted, you have no choice, do you know who I am!? I am your superior" etc. Despite that, I went to assess the patient (because I knew they might use it against me if I didn't) and calmly stated I refuse admission based on two widely accepted criteria while he was shouting down the hall "come here. Do you know who I am!?" again.

 

[doctorsun]

And NALTO is there for a reason… locums companies tout their NALTO certification… they don’t want anything to happen that could make them lose it.

unfortunately, this locums not part of NALTO. Had some free time and wanted to make some extra bucks. Bad decision.

 

[dozitgetchahi]

Agree with the lawyer part (though depending on how much work you lost out on etc it might not actually be worth it), also take it in stride--this hospital obviously needs locums because their admin is made up of incompetent dictators. Not a reflection on you at all. Make absolutely sure your privileges were not terminated or some other action that you will be required to report forever--if they were you 100% need to legally pursue it even if there isnt any money in it to get that fixed.

Don't involve the medical board--that won't go anywhere and might provoke a retaliatory complaint that you will then need a lawyer to defend against (at your own cost). Remember that the director has the resources of a hospital (including political connections you do not understand being from the outside) at his/her command and you do not.

Great point. I think most doctors don’t realize just how political the state boards actually are - and how beholden they are to hospitals etc. Also, there are well documented cases of crosstown rival practices filing false board complaints/PHP reports about each other’s doctors. A retaliatory complaint is very easy to make and requires a lot of time and money to defend against.

I also agree that getting a lawyer here may not be as straightforward (or as effective) as you might think. Take it from someone who has been in a couple of these seriously messed up medical employment situations before - it is often very hard to get an attorney to even take one of these cases, never mind to prevail in court. (If this hospital system is one of the main ones in the area, a lot of attorneys will be more or less afraid to take the case.) And any such lawsuit is going to be a very long process (at best) that may take years to reach any sort of conclusion - which may not be in your favor.

 

[chessknt]

The issue here isn't stupid admissions. We all do them. Besides, when you admit and discharge same day, the responsibility of something going wrong falls on you, not the ED physician, not to mention all the superfluous work. The issue is admitting without notifying attending, doing you the favor of a rushed and incomplete signout because you're supposedly inferior and have no choice, and when you request to assess the patient before admitting, telling you that you have no choice. Then going on a rant "first you don't want to give me your personal phone number, then this. Where did you guys come from!? (he had issues like this with other attendings in the past), the patient is admitted, you have no choice, do you know who I am!? I am your superior" etc. Despite that, I went to assess the patient (because I knew they might use it against me if I didn't) and calmly stated I refuse admission based on two widely accepted criteria while he was shouting down the hall "come here. Do you know who I am!?" again.

Honestly social reflexes should have made you even more agreeable to do whatever this person wanted and make them stop noticing you. This is a crazy person who has been empowered (for some reason) over you. It doesnt matter that your ego got bruised because you didnt get to have an opinion on the admit--next time just do whatever you need to do to make this person go away.

There is no medicolegal consequence of an unnecessary admission and I have absolutely worked in places where ED admits people before even talking to me so it isnt like that is completely unheard of.

 

[doctorsun]

Honestly social reflexes should have made you even more agreeable to do whatever this person wanted and make them stop noticing you. This is a crazy person who has been empowered (for some reason) over you. It doesnt matter that your ego got bruised because you didnt get to have an opinion on the admit--next time just do whatever you need to do to make this person go away.

There is no medicolegal consequence of an unnecessary admission and I have absolutely worked in places where ED admits people before even talking to me so it isnt like that is completely unheard of.

Nothing got bruised, I simply acted professionally while he acted like a child. If anything, got a kick out of it though I would've loved to act otherwise and shut him up but knew it would be used against me. As for consequences, there absolutely are. If you admit and discharge and something happens to patient you discharged because of negligence or you missed something, which we all do even in patients who don't meet admissions criteria, you're screwed. That is why some hospitals require hospitalist to see and at least leave a consult note even if patient not admitted -- because they'd rather sacrifice the hospitalist while appeasing the ED with whom they have a common money making goal. Hospitalist specialty is 2nd? 3rd place in terms of litigations against nowadays? Sure not unheard of, I worked in such places as well but not places in which you are the only physician with no subspecialty support, no coverage, and very few resources. If you allow that in such places, you are basically giving other physicians the license to ruin your livelihood so that they can get a better night sleep rather than make a quick phone call for proper placement.

 

[Señor S]

If you really want to fight it, go to a lawyer that specializes in employment and see if they think you have a reasonable claim for damages against the locums agency. If the first lawyer won't accept the case on a contingency basis, shop it around to a few more lawyers...if nobody is willing to take the case on contingency, then you don't actually have a case and need to let it go.

Forget about the state medical board. Who are you even going to report? The ED guy? For what? That's a non-starter and a waste of time imo; only exception might be if you can play an identity-based angle (you are female and the ED guy is male and you thought he was being sexist, you are POC and you felt the white ED guy was being racist).

I agree with @chessknt that if the locums agency is going to claim you had privileges revoked you absolutely need to fight that and get a lawyer, even if means paying out of your pocket.

 

[chessknt]

Nothing got bruised, I simply acted professionally while he acted like a child. If anything, got a kick out of it though I would've loved to act otherwise and shut him up but knew it would be used against me. As for consequences, there absolutely are. If you admit and discharge and something happens to patient you discharged because of negligence or you missed something, which we all do even in patients who don't meet admissions criteria, you're screwed. That is why some hospitals require hospitalist to see and at least leave a consult note even if patient not admitted -- because they'd rather sacrifice the hospitalist while appeasing the ED with whom they have a common money making goal. Hospitalist specialty is 2nd? 3rd place in terms of litigations against nowadays? Sure not unheard of, I worked in such places as well but not places in which you are the only physician with no subspecialty support, no coverage, and very few resources. If you allow that in such places, you are basically giving other physicians the license to ruin your livelihood so that they can get a better night sleep rather than make a quick phone call for proper placement.

I mean the issue with this logic is that it's the exact same attitude the ED physician had and runs contrary to your own assessment that the patient was safe to discharge. If pt is ok to discharge, then discharge. If pt is admitted without the subspecialty needed, initiate a transfer of the appropriate urgency and document that it was admitted prior to your input.

 

[anonperson]

Nothing got bruised, I simply acted professionally while he acted like a child. If anything, got a kick out of it though I would've loved to act otherwise and shut him up but knew it would be used against me. As for consequences, there absolutely are. If you admit and discharge and something happens to patient you discharged because of negligence or you missed something, which we all do even in patients who don't meet admissions criteria, you're screwed. That is why some hospitals require hospitalist to see and at least leave a consult note even if patient not admitted -- because they'd rather sacrifice the hospitalist while appeasing the ED with whom they have a common money making goal. Hospitalist specialty is 2nd? 3rd place in terms of litigations against nowadays? Sure not unheard of, I worked in such places as well but not places in which you are the only physician with no subspecialty support, no coverage, and very few resources. If you allow that in such places, you are basically giving other physicians the license to ruin your livelihood so that they can get a better night sleep rather than make a quick phone call for proper placement.

How is your risk any different based on what you did versus admitting and then discharging? You saw the patient and didn't feel they met admission criteria and documented as such. If they ultimately have a bad outcome, you will still be involved in the litigation.

 

[The kitchen sink]

I see all of the comments telling you to get a lawyer and you're going to get paid. I'm not sure it's that straightforward, and I wonder if your best strategy is to just let it go.

Although your contract may say you have the right to refuse to admit patients, much of how this works comes down to local culture. It's always a bit of a judgment call whether a patient with a PE or pneumonia or cellulitis needs to be admitted or not. Sure there are all sorts of scores you can calculate and such, but in the end a good dose of clinical acumen is always needed. The locums company is going to argue that you were fired for clinical incompetence, and hence they will state that they owe you nothing. Make a stink about it and they will likely file a complaint to the medical board against you. And they completely control the medical record - if they are as slimy as you suggest, anything could happen. Even if you ultimately prevail, just an ongoing investigation will be reportable when you try to credential elsewhere.

The honest truth is this: when you're a locums, you're supposed to fit into their culture. If when the ED asks you to admit a patient, you just admit the patient even if you think it's not warranted. A short discussion with the ED is fine, but ultimately they are in charge. If you're unhappy with the way they do things, then you end your contract and move onwards. "Fighting the man" as a locums is always going to end badly, for you.

Or you admit the patient. And then discharge them. And continue getting paid.

 

[rokshana]

The issue here isn't stupid admissions. We all do them. Besides, when you admit and discharge same day, the responsibility of something going wrong falls on you, not the ED physician, not to mention all the superfluous work. The issue is admitting without notifying attending, doing you the favor of a rushed and incomplete signout because you're supposedly inferior and have no choice, and when you request to assess the patient before admitting, telling you that you have no choice. Then going on a rant "first you don't want to give me your personal phone number, then this. Where did you guys come from!? (he had issues like this with other attendings in the past), the patient is admitted, you have no choice, do you know who I am!? I am your superior" etc. Despite that, I went to assess the patient (because I knew they might use it against me if I didn't) and calmly stated I refuse admission based on two widely accepted criteria while he was shouting down the hall "come here. Do you know who I am!?" again.

I would have said…No I don’t…exactly who are you? Though I really don’t care about some small fish in some godforsaken hospital…

 

[rokshana]

unfortunately, this locums not part of NALTO. Had some free time and wanted to make some extra bucks. Bad decision.

That is a red flag 🚩 right there…

 

[anonperson]

To everyone saying lawyer up.. Easier said than done.

First have to find a lawyer who is comfortable with employment law/contracts. Then they have to be willing to even take the case. In my prior legal issues that came up, a lot of lawyers weren't interested in what they considered small time employment issues where there was no six figure payday.

The hourly rate for lawyers is getting absurdly high and they have no shame in billing their hours.

How much money is even on the line? It may come out to be a wash.

 

[doctorsun]

I would have said…No I don’t…exactly who are you? Though I really don’t care about some small fish in some godforsaken hospital…

I had to remain respectful so asked "I don't" and once he replied "I am your superior" I asked him "how is it relevant to me assessing a patient before I admit him" at which point he just kept repeating himself "I am your superior. do you know who I am? I am your superior" in middle of ED making a fool of himself

 

[doctorsun]

How much money is even on the line? It may come out to be a wash.

Approximately $3k. I don't plan on litigating locums if they pay me in full unless they initiate disciplinary actions against me, in which case they leave me no choice. This locums currently has a USA vs locums litigation involving nine states. At this rate, they will be wiped off map without my aid.

Reporting the ED physician is a separate issue -- he obviously has a conflict of interest that he has no issue applying on himself and coercing other physicians to apply, and he tries to coerce physicians to apply practices that are unsafe to them and to patients among other things and that are against medical board and contract itself. Not to mention his ridiculous incapability in managing the specific patient around whom this event occurred.

 

[doctorsun]

How is your risk any different based on what you did versus admitting and then discharging? You saw the patient and didn't feel they met admission criteria and documented as such. If they ultimately have a bad outcome, you will still be involved in the litigation.

I didn't admit the patient so the patient wasn't under my care. Once you admit, he is. Makes a big difference. The ED MD could have accepted my assessment and let patient go from ED or not and seek a transfer. Just like when a cardiologist or GI or ... is consulted and states patient can be treated as outpatient. Had similar occurrence with another ED MD who wanted to admit a patient because of asymptomatic hypomagnesemia and "husband took low blood pressure at home." It was a readmit after ED MD promised husband 3 night stay for placement then admitted to obs even though didn't have to be admitted. So I discharged and husband came right back, now demanding inpatient. They made a big fuss about that one as well, ED nurse turned ED manager came to floor with attitude demanding admission etc. Went to see patient (because had no choice) and relayed my assessment. Can it get you involved in litigation? Sure. But not with same weight as admitting and discharging. Not to mention, a lot of things can happen (and did happen during my short tenure in this hospital) after you admit patient, especially in rural hospitals whose staff isn't top notch, and then you're definitely the focus of litigation.

Regardless, you can't admit a patient without assessing first and without being given the opportunity to assess. In most cases, it only took a professional conversation over phone with the ED physician explaining choice. In this case, went to assess patient and left a note because, first of all, if patient needed admission he would be, and secondly, otherwise their argument would be "Hospitalist did not bother assessing patient before refusing admission" which they have done with other physicians.

 

[doctorsun]

I mean the issue with this logic is that it's the exact same attitude the ED physician had and runs contrary to your own assessment that the patient was safe to discharge.

Unfortunately, it is not the ED physician who assumes care over patient so can't rely on his attitude, and this is not only reasonable but based on law. Admitting physician relies on his training, logic, clinical judgement and assessment of patient to decide disposition and treatment of his patients. Not on another's, especially if other physician's professionalism and assessment contradicts standard of care, medical board, contractual obligation, ethical conduct, etc. The locums and hospitals don't include you being the deciding factor in contracts out of goodness of their heart. Believe me, ED and admin would prefer admissions to be sole discretion of ED and that it is the official and lawful manner to practice medicine if they could. Now, if I signed a contract stating admission decisions solely of ED physician, I would not even post. But not only did I sign a contract stating "patient is to be admitted only if admitting physician concurs with emergency physician," I had the COO of locums firing me over the phone 10 minutes after refusing admission stating that the reason for termination was because it was not my decision.

Understand why this is getting such push back because unfortunately, this is the reality of hospital medicine. Not criticizing you or others because it may be suitable to your personality, preference of practicing, personal experience, reality of your working environment, etc, and appreciate and take into consideration all feedback. Still, it is a reality or a preference that is easily exploitable by entities that don't care if you lose your livelihood if something happens to a patient if it means they can get five more minutes of sleep or a little extra padding for their wallet.

 

[doctorsun]

Or you admit the patient. And then discharge them. And continue getting paid.

Disregarding the superfluous work, committing your limited resources to people who don't require your care, cooperating and thereby promoting a working environment that disregards your livelihood and patients' well being, being an accomplice to fraud, etc -- admitting, discharging, and continuing to get paid sounds great. It is a somewhat simplistic solution that is mostly presented as only solution by administrators and ED personnel that at least some attendings would reconsider had they been exposed to litigation against physicians who did just that out of naivety or seeking the path of least resistance etc. That is, attendings not considering possible consequences other than your picture perfect one.

 

[dozitgetchahi]

Approximately $3k. I don't plan on litigating locums if they pay me in full unless they initiate disciplinary actions against me, in which case they leave me no choice. This locums currently has a USA vs locums litigation involving nine states. At this rate, they will be wiped off map without my aid.

Reporting the ED physician is a separate issue -- he obviously has a conflict of interest that he has no issue applying on himself and coercing other physicians to apply, and he tries to coerce physicians to apply practices that are unsafe to them and to patients among other things and that are against medical board and contract itself. Not to mention his ridiculous incapability in managing the specific patient around whom this event occurred.

No lawyer is going to take this case with $3k on the line. If you have to end up defending yourself, obviously that is a different story.

 

[rokshana]

I didn't admit the patient so the patient wasn't under my care. Once you admit, he is. Makes a big difference. The ED MD could have accepted my assessment and let patient go from ED or not and seek a transfer. Just like when a cardiologist or GI or ... is consulted and states patient can be treated as outpatient. Had similar occurrence with another ED MD who wanted to admit a patient because of asymptomatic hypomagnesemia and "husband took low blood pressure at home." It was a readmit after ED MD promised husband 3 night stay for placement then admitted to obs even though didn't have to be admitted. So I discharged and husband came right back, now demanding inpatient. They made a big fuss about that one as well, ED nurse turned ED manager came to floor with attitude demanding admission etc. Went to see patient (because had no choice) and relayed my assessment. Can it get you involved in litigation? Sure. But not with same weight as admitting and discharging. Not to mention, a lot of things can happen (and did happen during my short tenure in this hospital) after you admit patient, especially in rural hospitals whose staff isn't top notch, and then you're definitely the focus of litigation.

Regardless, you can't admit a patient without assessing first and without being given the opportunity to assess. In most cases, it only took a professional conversation over phone with the ED physician explaining choice. In this case, went to assess patient and left a note because, first of all, if patient needed admission he would be, and secondly, otherwise their argument would be "Hospitalist did not bother assessing patient before refusing admission" which they have done with other physicians.

You document, pts family demanding admission. Will admit however does not meet any criteria for acute care hospitalization… that usually gets a response

 

[timpview]

Getting tied up with the medical board ESPECIALLY with a nut job sounds like a headache I would not want anything to do with… especially since an unhinged MD can cause you a lot more problems than you could possibly imagine.

Want an accusation that you abandoned your patients? that you refused hospital admission? Want them pulling your charts? Things can get nasty quick all in the name of how one interprets “patient care.”

You want some kangaroo court where you’re guilty until maybe being proved innocent flipped around on you.

Likewise with a lawyer. Obviously no one is going to accept that so it’s a moot point.

I admire you sticking to your guns. Maybe you survive in medicine, maybe you don’t but there’s a reason why many of us take the path of least resistance and it has nothing to do with being complicit with fraud, etc like your post above.

In the long run your sanity and job security can only handle so many of the episodes that’s are already tagged on you. No matter how unjust it is you’re now THAT doc that “got fired” from a locums job and banned from that company. That stuff adds up and no one is going to take the time and energy to get your side.

 

[doctorsun]

No lawyer is going to take this case with $3k on the line. If you have to end up defending yourself, obviously that is a different story.

Undoubtedly. I had a Nalto locums dropping me 3 days before start of shift, providing no excuse other than "client changed mind" after giving me hell during credentialing (though completely clean record), despite 30-day clause in contract, costing me more than 30K. After seeking representation to no avail decided just to drop it. Then another Nalto locums did a similar trick and I didn't sue. In this case, 3k is assuming they pay me for previous work. If not, it's 20k-ish, but this time can't afford such loss and will be more aggressive in seeking legal action.

 

[NotAProgDirector]

The way the ED person managed this / treated you is unacceptable. You're correct to be upset / disappointed.

I worry your understanding of how medmal would play out is incomplete. If the ED asks you to admit someone and you decline, and then something bad happens to them, I expect you'd absolutely find yourself on the hook for that. And in fact, since you're a locums, you'll have a different medmal coverage so they would almost certainly try to blame you for the problem. "If only you had admitted the patient you would have found the problem / monitored them and seen they were worsening / etc". In many ways, I think declining to admit someone increases the medmal risk. You are correct that once you admit them, they may then be exposed to further badness (C Diff, etc) which could be a problem.

I completely agree with you that you're owed for prior shifts.

In a perfect world, the decision to admit someone is shared between ED and IP provider. If the ED feels a patient needs to be admitted and the IP decides to decline, it leaves the ED doc in a very tough spot. Transferring the patient to another hospital is also expensive, complicated, and many hospitals are full.

The locums company is almost never going to "back you up". The hospital is their client, it's where they get their income.

Overall, I think you're looking at this as a black and white issue ("it says in my contract that I get to make admission decisions") when it's actually always very grey, no matter what your contract says.

 

[The kitchen sink]

Disregarding the superfluous work, committing your limited resources to people who don't require your care, cooperating and thereby promoting a working environment that disregards your livelihood and patients' well being, being an accomplice to fraud, etc -- admitting, discharging, and continuing to get paid sounds great. It is a somewhat simplistic solution that is mostly presented as only solution by administrators and ED personnel that at least some attendings would reconsider had they been exposed to litigation against physicians who did just that out of naivety or seeking the path of least resistance etc. That is, attendings not considering possible consequences other than your picture perfect one.

Of course I do not agree with unnecessary admissions. I also do not agree with the unprofessionalism you described by the ED physician.

But other than what I presented, what else could you viably do?

Is there a mechanism that decides what needs to be done if there is a disagreement about admission from the ED to hospital?

If so, why wasn’t that process followed?

Did you speak to the hospitalist director / CMO, and then allow them to make an administrative decision?

You would still likely have to document a consultation / admission + discharge regardless.

Can you explain to me how the liabilities differ in each scenario? I don’t seem to understand the nuance like you do

 

[doctorsun]

I worry your understanding of how medmal would play out is incomplete. If the ED asks you to admit someone and you decline, and then something bad happens to them, I expect you'd absolutely find yourself on the hook for that.

Conversation becoming less focused and more presumtive than intended but don't care -- info may come useful to others. I was not at all looking at this black / white. I had multiple very soft admissions throughout week and had conversation over phone with locums rep after they attempted to admit for "husband took low blood pressure at home" admitting they've had issues with that in past with multiple other physicians and working on it. Yet, some justified OBS IMO so I admitted. In some instances, told ED physician this is borderline but if you think should be admitted, will take to OBS -- after assessing the patient. I've been working in the grey zone throughout my time there. If it was black and white, 95% of patients I've encountered there would not be admitted. In fact, only about 5% of my patients were inpatients during my tenure there, and one was already refused by insurance.

As for medmal -- to my knowledge, you are not legally responsible for a patient you do not assume care over. Assessing a patient and determining, again, based on sound medical judgement and standard of care, that the patient should not be admitted does not designate you legally as the physician who assumes care over patient and therefore, you can't make decisions regarding this patient's disposition etc. That is left to the ED MD. Obviously, it leaves ED in a less convenient spot because now they might have to do some additional workup and risk stratification (i.e. what they should've done to begin with) to let patient go or attempt transfer. The alternative? You putting all the work and risk on yourself. Admitting and transfering from floor more difficult than ED to ED. Or admitting drug seeking patient not qualifying, this time hoping quasinurse doing shopping on amazon doesn't give wrong medication/dose or that you yourself don't mess up dealing with all the BS around and relying on inaccurate medication reconciliation. You can't admit every person arriving to ED because you might find something wrong during stay. That's not how it works. Nor can you admit every patient the ED physician is, at best, worried about discharging or as in most cases, prefers to dump on you rather than take other steps that take a little more time -- that is a problem for your patient and for you. Whether you choose to still do it and align with them disregarding medical practice, contracts, etc-- your choice and based on feedback, perhaps a choice many make. This hospital has a high turnover of physicians because, reportedly, they chose similarly to me.

In a better though not perfect medical world, I don't have to apply ED criteria to determine if the patient should be admitted like HEART etc. I received several calls from ED to admit HEART 6-7 and I don't even have cardiology. The ED physician should apply them. Some (or many in my experience) of them choose not to do it because they are aware patients meet no criteria and just want to dump and/or hospitalist has no choice but to admit. ED dumps all time. let's not pretend we're in a vacuum in which poor ED physician trying to do right thing and admitting physician denies admission for no reason, nor in a world in which transfer from ED is more complicated than transfer from floor. ED work can be hard though in most cases, especially rural, they're just lazy, don't do nearly appropriate initial workup or management, and do criteria-shopping to dump the patient.

Now, is reality that everyone ****s on hospitalist and nothing can be done about it other than quit or go private? Sure. I'm not new to game and that wasn't why posted. My question was more specific. I.e. I did what I did, followed contract and medical board, only asked to assess the patient before being admitted -- didn't even refuse patient yet. Yet ED and locums responded way they did. Despite widely accepted knowledge of hospitalist being **** on etc, anyone has similar experience / knowledge / educated advice regarding next steps to take? Got some already and seems like concensus is to get money for work I've already completed and forget about rest / weak recommendation to report ED MD in addition.

 

[doctorsun]

Did you speak to the hospitalist director / CMO, and then allow them to make an administrative decision?

The nurses on the floor were trying to help me out so called admin on call, who acknowledged that the ED physician omitted some information when discussing patient with her and that it was required for me to assess patient and eventually my decision whether to admit, as has been the case throughout week (kinda, I played along as long as it was remotely acceptable). I highly doubt this information will be recalled under law though.... As for what can be viably done, don't get me wrong, I am not pushing for action despite advice -- simply asking for advice. I am not trying to change hospitalist medicine's reality -- simply asking if, knowing this reality, something should be done based on others' experience / knowledge / reason.

 

[The kitchen sink]

Undoubtedly. I had a Nalto locums dropping me 3 days before start of shift, providing no excuse other than "client changed mind" after giving me hell during credentialing (though completely clean record), despite 30-day clause in contract, costing me more than 30K. After seeking representation to no avail decided just to drop it. Then another Nalto locums did a similar trick and I didn't sue. In this case, 3k is assuming they pay me for previous work. If not, it's 20k-ish, but this time can't afford such loss and will be more aggressive in seeking legal action.

I find that extremely unsettling that despite the 30-day clause you were unable to find representation to fight for wage theft. As I understand wage theft is taken seriously, so unless theres more to the story I’m not sure why they would not represent you. Did you send a complaint directly to NALTO?
Did you try small claims court? At least you may be able to recoup 15-20K without the need for an attorney. It might be worth seeing what happens.

 

[doctorsun]

I find that extremely unsettling that despite the 30-day clause you were unable to find representation to fight for wage theft. As I understand wage theft is taken seriously, so unless theres more to the story I’m not sure why they would not represent you. Did you send a complaint directly to NALTO?
Did you try small claims court? At least you may be able to recoup 15-20K without the need for an attorney. It might be worth seeing what happens.

After it happened I turned to a few lawyers and at best got a single reply, then got too busy. Absolutely nothing more to story. I've received nothing but praise including "the best doctor I've ever worked with" in multiple locations, very high performance numbers, patient satisfaction, clean personal and professional record, etc. They all of sudden started coming with ridiculous demands during credentialing process prompting me to request to stop process. Locums said "no no, let's do just this one more thing so that deal pulls through" every time. Spent hours more. Then, 3 days before shift "client changed mind. Why? I have no reason for you. Sorry." It happened more than a year ago. Then another Nalto locums did similar a few months ago, canceled I think 7 days before start. Just didn't have the time or patience to deal with it.

 

[chessknt]

As for medmal -- to my knowledge, you are not legally responsible for a patient you do not assume care over. Assessing a patient and determining, again, based on sound medical judgement and standard of care, that the patient should not be admitted does not designate you legally as the physician who assumes care over patient and therefore, you can't make decisions regarding this patient's disposition etc. That is left to the ED MD. Obviously, it leaves ED in a less convenient spot because now they might have to do some additional workup and risk stratification (i.e. what they should've done to begin with) to let patient go or attempt transfer. The alternative? You putting all the work and risk on yourself. Admitting and transfering from floor more difficult than ED to ED. Or admitting drug seeking patient not qualifying, this time hoping quasinurse doing shopping on amazon doesn't give wrong medication/dose or that you yourself don't mess up dealing with all the BS around and relying on inaccurate medication reconciliation. You can't admit every person arriving to ED because you might find something wrong during stay. That's not how it works. Nor can you admit every patient the ED physician is, at best, worried about discharging or as in most cases, prefers to dump on you rather than take other steps that take a little more time -- that is a problem for your patient and for you. Whether you choose to still do it and align with them disregarding medical practice, contracts, etc-- your choice and based on feedback, perhaps a choice many make. This hospital has a high turnover of physicians because, reportedly, they chose similarly to me.

Minnesota Supreme Court Expands Medical Malpractice Liability Outside of Physician-Patient Relationship

The Minnesota Supreme Court issued an opinion in Warren v. Dinter. At issue was whether a physician-patient relationship is a necessary element to sustain a medical malpractice claim. The Court held a physician could be held liable for malpractice, e

www.policymed.com

This is state specific but demonstrates an important example that always assume you are on the hook for a patient the second you learn of them even if you never see them or do anything for them. This is why curbside consults are frustrating because if you dont at least document your thought process in a curbside and get named in a note (which happens 100% of the time in midlevel notes, almost 100% of time in ED notes, and >80% of the time in hospitalist notes) then you are now able to be dragged in and sued and you have no documentation to protect you, just what somebody else wrote about what you told them on the phone.

 

[rokshana]

Minnesota Supreme Court Expands Medical Malpractice Liability Outside of Physician-Patient Relationship

The Minnesota Supreme Court issued an opinion in Warren v. Dinter. At issue was whether a physician-patient relationship is a necessary element to sustain a medical malpractice claim. The Court held a physician could be held liable for malpractice, e

www.policymed.com

This is state specific but demonstrates an important example that always assume you are on the hook for a patient the second you learn of them even if you never see them or do anything for them. This is why curbside consults are frustrating because if you dont at least document your thought process in a curbside and get named in a note (which happens 100% of the time in midlevel notes, almost 100% of time in ED notes, and >80% of the time in hospitalist notes) then you are now able to be dragged in and sued and you have no documentation to protect you, just what somebody else wrote about what you told them on the phone.

Which is why I never do curbside consults…even if it’s the ED asking what dose of levothyroxine should they change the pt to because the TSH is slightly elevated…I still put in a note… long enough and I make it an inter professional consult note and bill. That way what I actually said is in the record.

 

[doctorsun]

Minnesota Supreme Court Expands Medical Malpractice Liability Outside of Physician-Patient Relationship

The Minnesota Supreme Court issued an opinion in Warren v. Dinter. At issue was whether a physician-patient relationship is a necessary element to sustain a medical malpractice claim. The Court held a physician could be held liable for malpractice, e

www.policymed.com

This is state specific but demonstrates an important example that always assume you are on the hook for a patient the second you learn of them even if you never see them or do anything for them. This is why curbside consults are frustrating because if you dont at least document your thought process in a curbside and get named in a note (which happens 100% of the time in midlevel notes, almost 100% of time in ED notes, and >80% of the time in hospitalist notes) then you are now able to be dragged in and sued and you have no documentation to protect you, just what somebody else wrote about what you told them on the phone.

I put a short note addressing the reason for which admission was requested - pneumonia based on abdominal CT after patient was diagnosed a week before with influenza pneumonia and completed treatment. I had to put such a note in order to protect myself from them claiming refusal without assessment (though the ED MD demanded admitting without assessment....). But it wasn't an official consult.

If you are officially consulted by ED or another service you need to document that for billing and I'd assume you'd be liable for damage incurred due to your recommendations. But that is an official consult. Worked in hospital that regardless of chance of being admitted or not, ED officially consulted hospitalist for any patient they felt consulting hospitalist for. In this case, physically see patient and note for encounter that is billed. So they first consulted subspecialty hoping that they recommend to admit patient, then hospitalist has no choice because rejecting admission even riskier despite subspecialty recs (had one instance in which subspecialty recommended to admit unstable patient in puddle of own GI blood for non-urgent intevention because the ED provided a "favorable" signout to subspecialty and subspecialty doctor known to be someone who prefers short signouts for a good night sleep -- another example for why assessing before admitting. Had another patient with septic shock due to pyelonephritis and obstructing ureteropelvic stone, AKI. ED and urologist -- sure, admit, I will see her tomorrow. Went to see patient, lethargic, pulse barely appreciable, labored breathing, s/p multiple IVF, no central line, no ICU bed available. Told ED not accepting patient unless emergent intervention and ICU bed, so he called Uro again and Uro complied. Patient was in ICU for a week and hospital for 3 weeks, readmitted to ICU midstay. Again, admission without assessment?). If subspecialty did not recommend admission, next step to consult hospitalist who they hoped will be too scared to recommend discharge. They basically found a way to transfer liability to you or at least increase your liability, reduce refused admissions, but even if they didn't manage to scare you into admitting, still make more money off of your consult. I don't know if there is a ruling in TX that parallels that in MN or how applicable it is when an AP requiring supervising physician is not involved and other specifics in that case. Or I may be wrong, liability is completely of the potential admitting physician, in which case I would be even more concerned of another physician deciding admission without me having practical input or ability to assess before admission.

 

[chessknt]

Which is why I never do curbside consults…even if it’s the ED asking what dose of levothyroxine should they change the pt to because the TSH is slightly elevated…I still put in a note… long enough and I make it an inter professional consult note and bill. That way what I actually said is in the record.

Uh huh. I get phone calls from hospitals I have no way of leaving a note in asking me about ****. I hope for the best but yea--leave a note and if you are calling someone to ask their opinion dont be a ****ing tool and put their name or document the phone call at all if they cant or arent asked to leave a note.

 

[anonperson]

I find that extremely unsettling that despite the 30-day clause you were unable to find representation to fight for wage theft. As I understand wage theft is taken seriously, so unless theres more to the story I’m not sure why they would not represent you. Did you send a complaint directly to NALTO?
Did you try small claims court? At least you may be able to recoup 15-20K without the need for an attorney. It might be worth seeing what happens.

Wage theft is taken seriously if you're a W2 worker. Then you can get the States Labor board to help you out and there are specific penalties. If you're a 1099, it's a gray area and is more of a contractual issue.

That was my experience in the past in CA.

 

[MD46]

Uh huh. I get phone calls from hospitals I have no way of leaving a note in asking me about ****. I hope for the best but yea--leave a note and if you are calling someone to ask their opinion dont be a ****ing tool and put their name or document the phone call at all if they cant or arent asked to leave a note.

What if you say not to put their name in the chart as its a discussion and not a formal recommendation?

Also how does one stop them from just saying they discussed with you and consultant was ok with it even if you said something different?

 

[NotAProgDirector]

Thanks for your responses. I realize this has gone in a somewhat different direction than you expected / planned, but I think it's a helpful discussion.

I completely agree with you that there are ED's that just try to admit everything beyond a scraped knee, either to CYA or because it's easier than discharging them. And I also agree that some ED's will try to admit people simply because discharging them is complicated for social or other reasons. And none of those are reasons for admission. And it clearly sounds like the place you were at was this style, which is really frustrating.

As mentioned above, medmal laws are state specific. But my understanding matches what is above -- that once you're involved in any way (phone call, email, etc), then you're involved -- unless you decline to give any advice or opinion at all. So I don't think that refusing to admit a patient gives you much (if any) protection -- although I could be wrong about that, and again it may depend upon the state.

We solve the problem very simply. The hospitalist and ED discuss the patient. If they both agree the patient can go home, then they go home. If the ED wants to admit and the Hospitalist does not, then the Hospitalist is asked to do a formal IM consult and document in the chart. Note that this does not get the ED "off the hook" in a medmal situation - they could always contact other hospitals to see if they will admit in transfer.

If anyone is an expert in this area, please weigh in.