Ever wonder what kind of barriers us hospitalists run into when trying to do the right thing? How about an 89 year old woman with widely metastatic cancer who presented with a bowel obstruction. She was actively dying and her family desired here to be transferred 60 miles to her home town nursing home under full end of life, symptom driven, comfort care measures so she could be close to family and friends in her final moments. Sounds reasonable to me. That's the family we should all strive to be. So what's the problem?
Nurse manager: Happy. The nursing home won't accept the patient because they have an NG. Can we get rid of it?
Happy: You've got to be freakin' kidding me. The gal is dying from a catastrophic bowel obstruction and necrosis and the nursing home won't accept her because she's got an NG hooked to suction for comfort?
Nurse Manager: I guess it has something to do with state and federal laws that require a registered nurse to be on site for patients with a nasogastric tube.
She's dying. Let her die in peace. It doesn't matter who's staffing the nursing home. Nurse. LPN. Med aide. Who cares. You just can't screw this up. Here's a perfect example of rigid, irrational government regulations that cause unintended consequences of pain and suffering when lawyers trump common sense. She's checking out of this earth and your Senators in shiny protective armor won't let her die in peace because they think an RN is necessary to manage a dying patient's nasogastric tube and God forbid the Joint Commission would frown upon a dying families wish for their mother to be close to home. I wouldn't wish this inhumanity on anyone.
