Tough situation.  Did you contact hospital Social Services or directly to Child Protective Services?  I would write a very strongly worded letter to your Child Protective Services with copies to whomever should know about this case.  Alternatively, or in addition, send the case to your ethics committee.

That's all I have.  Good luck.


Pamela S. Murphy, MD, FAAP

Mendy's Place, Children's Emergency Center

HonorHealth Deer Valley Medical Center

Lead Physician

Myelomeningocele Planning Clinic

Children's Rehabilitative Services, District Medical Group

From: Pediatric Emergency Medicine Discussion List <[log in to unmask]> on behalf of Lisa Bakhos <[log in to unmask]>
Sent: Sunday, August 13, 2017 3:58 PM
To: [log in to unmask]
Subject: Advice from the group...

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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