I'm assuming the patient is under 18.
If so, social work has dropped the ball.
If you feel the line is truly a danger, then he is at risk when he is discharged from the ED (and you may be risking legal action each time he is discharged from the ED if he later deteriorates).
Get risk management/hospital lawyers involved. Take emergent custody of the patient as you would for any other suspected abuse patient. Remove the abusive family by security.
Risk management will be able to tell you if you need a court order to remove the line.
It gets a little stickier if you don't believe the line is a true emergent danger (it seems like it would be). Again, risk management will be helpful. Although we are obligated morally and legally to provide a medical screening exam in the ED, we may not be legally obligated to change dressings, write prescriptions, etc. In this case, a dressing change is not emergent, and you can tell them that they need to get flushes from their PMD. Given the history, the family will probably become belligerent, security will become involved, and at that point, you cannot discharge the child to belligerent parents.
Lastly, if every other service has "fired" this family, risk management may advise you to do the same.
Niel (not a lawyer)
Sent from my iPad
> On Aug 13, 2017, at 7:49 PM, Lisa Bakhos <[log in to unmask]> wrote:
> Hi, everyone! We have a situation at my facility that we need advice on. Without getting into every little detail (which I could write a book on) Young teenage boy with some medical issues, but a lot of social/psycosomatic/munchhausen type issues. He has been at our facility for several years, but recently has been "fired" from all outpatient services throughout our hospital system. This is because he and the family are continuously abusive (both physically and verbally) and have refused to follow medical advice.
> His last admissions to our hospital were for line sepsis 2/2 him actually sucking on his line with his mouth. Obviously at that time the line was removed and a PICC line was placed. He received a long course of ab and antifungals. Once his course was done, the plan was to remove the PICC line. However, the family refused to have the line removed and literally fled the hospital with the line in place. This was one of the major events that led to his "firing".
> Since he has been "fired" by all aspects of our hospital system, he was also "fired" by the at home care services he was receiving through the hospital.
> That is where our dilemma comes in. Every Sunday, like clockwork, he comes to our ED for dressing changes and line flushes (since he no longer gets home care). They refuse to look for new physicians or new home care, so there is no one technically 'in charge" of this line.
> And looking through his chart, there is multiple documentations in hospital charting that the line is considered unsafe and needs to be removed.
> We have been changing his dressing and writing prescriptions for flushes, but we are basically feeling like we should not be doing this.
> We have already contacting social services, and they have said there is nothing we can do.
> Does anyone have any thoughts?
> Lisa Bakhos
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