Is there a limit to how many times you can go to the Emergency Room?
December 2, 2012 8:49 PM   Subscribe

Is there a limit to how many times you can go to the Emergency Room?

Background: My mom got back surgery a couple of years ago. Since then, she's been in almost constant pain. On several occasions, the pain's gotten so bad we either had to call the ambulance or we had to drive her to the ER (not all of cases were because of the back pain, but most were).

So she has gone to the ER several times already (I'm not sure on the exact count since I wasn't around, but maybe at least 5 times in the past two years or so?). On the last occasion, one of the staff at the ER told my dad that if he brings her to the ER again, they'll send him to jail.

Because of that, my dad's really afraid to take her to the ER even when she seems to be in intense pain. We're at a loss at what to do considering we can only go off her subjective level of pain and don't really know if it's a "true" emergency from a medical perspective. We don't want to see her in pain like that, but we also don't want to risk getting jailed...

Question: So is there some sort of limit to how often you can use the ER that I'm not aware of? Can the hospital really send us to jail just for sending her to the ER too often? Is this an empty threat? Or are we inadvertently stepping on some other legal boundary? I'm aware of their disdain for "frequent flyers," but I am not aware of any legal repercussions.

Additional information:
- She has a lot of other medical complications outside of the back surgery. Only going to the ER seems to relieve her problem for awhile when it flares up. The family doctor doesn't seem to be of help and no other specialist wants to treat her because she has so many risky complications (and no money).
- Both my parents don't really speak English, so I'm not sure if they just told my dad that as a threat and to get the point across that she's unwanted.
- My parents are also on government healthcare, so private health providers are pretty much out of the question, unfortunately. Any sort of good preventive/maintenance care seems unlikely...

I also looked up the EMTALA and they seem to include intense pain that could bring about bodily harm as one of the things that count as an emergency:

(1) The term “emergency medical condition” means—
(A) a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in—
(i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,
(ii) serious impairment to bodily functions, or

This seems to apply in her case.

Sorry for the long post! Thanks for any help and light anyone can shed on this!
posted by anonymous to Law & Government (21 answers total) 2 users marked this as a favorite
No-one can answer any question on the legality of something if you don't explain where you are.
posted by pompomtom at 8:56 PM on December 2, 2012 [2 favorites]

I guess it's possible that they're thinking something along the lines of domestic violence is happening?
posted by elizardbits at 8:56 PM on December 2, 2012 [3 favorites]

You say your parents don't speak English that well; is it possible that your father misinterpreted what the staff member said? It's possible that your mom has been labelled as a drug seeker (rightly or wrongly) and there were mixed messages of some kind going on. Your parents should have some sort of interpreter when seeking medical treatment/advice.
posted by xyzzy at 8:58 PM on December 2, 2012 [7 favorites]

Is there an immigrants' association for people from your parents' background? Maybe they could help you navigate these visits?

I have been to the ER a lot, some time ago due to an ongoing health issue and more recently due to a ridiculous serious of medical coincidences. No one has ever said that I would go to jail if I came back. Unless your father misunderstood, I find myself wondering about racism or anti-immigrant sentiment. What exactly do they mean? If your mother is hit by a bus, your dad can't bring her in? That's obviously ridiculous.

Can you call the hospital front desk and ask them to direct you to patient relations or someone similar? That person should be able to clarify for you what their treatment policy is. Get their phone number so that if you do have some problems in the future, you can call them and complain. Also, ask them what their policy is about getting translators. In some hospitals, they are supposed to get one for you if you need one, not just dink around in the hopes that you bring your own.

Also, do your parents have friends locally who can go with if they need to go to the ER? I've been in a couple of situations where some bigoted jerks mysteriously straightened up and flew right when I went along on such trips because I'm white and middle class.

ER personnel can always call the cops on someone in the ER if they appear to be dangerous or refuse to leave (although god knows this gets abused - there was that horrible tragic story of the woman who wouldn't leave the ER, claiming leg pain, and the cops dragged her away and she died of a DVT in her leg while she was in jail. She was a woman of color, so I'm sure race was a big piece.) But that is not the same thing as calling the cops if someone shows up.

If you are not in a region with an immigrants' association, call or email one in the nearest big city and ask for advice.
posted by Frowner at 9:08 PM on December 2, 2012 [11 favorites]

Also, if you can figure out where the left-wing social workers are in your town/the nearest big city, there might be someone who can advise you. If I were trying to figure that out here, I would google things like "social services anti-racist". This whole thing sounds to me like this hospital does not want "unprofitable" patients on government healthcare who have tricky conditions and need extra care with language.

I know it is ridiculously unlikely, but if for some reason you are in Minneapolis, Abbott Northwestern is IME an excellent hospital ER where people are not jerks.
posted by Frowner at 9:15 PM on December 2, 2012

I doubt very much that the number of visits could result in legal trouble for your dad. It seems much more plausible that he misunderstood, the staff person thought there was some kind of abuse happening, or the staff person was either joking or messing with your dad.

However, using the ER for pain management seems completely unsustainable. If your mom is routinely getting to emergency levels of pain, and her current healthcare plan and physician/medical team can't (or doesn't seem able to) address it, she needs some type of social worker or other advocate to help her get the proper care. Seconding suggestions to get an immigrant rights organization, social worker, or other community support involved.
posted by Meg_Murry at 9:27 PM on December 2, 2012 [27 favorites]

I have some thoughts on the larger problem, which seems to be frequent use by non-English speakers of the ER for pain management and other unspecified conditions resulting in poor communication about follow-up.

1. Most hospitals should be able to arrange for free translation services, whether in-person or by-phone. You would help your parents tremendously by finding out what's available and how they can access it, especially when you're not there to help them.

2. You say your parents have government insurance. I assume you mean Medicaid or Medicare, in which case your family doctor and specialists are getting paid something, even if it's not as much as they would like, for helping your mom. But they may not doing a good job if she's a frequent flyer in the ER. Or maybe she is leaving their offices without understanding the instructions they give her. Doctors may be able to call someone to help with translation. You or another advocate could help your mom by at least going with her to her appointments to talk about the ER visits and what constitutes an emergency from a medical perspective. They should be able to help your mom better identify when she needs to go to the ER and when she might be able to wait until the doctor's office is open. Also, Urgent Care is a middle ground that may be available in your area, and may be covered by insurance. That's something you could find out with a few phone calls (and remember to ask about translation services at Urgent Care, too).

3. Sudden need for pain medication - it seems like your mom's pain isn't well managed. Why not? Has she seen the doctor recently? What is s/he doing to keep track? Is she taking the right dose? Is she refilling her prescriptions on time or running out of medication? These questions apply to all the other conditions that have brought her to the ER. Again, talking with her doctors will help straighten this out.
posted by paindemie at 9:31 PM on December 2, 2012 [4 favorites]

I used to get a lot of flack at the ER for taking one of my children to the ER. Fortunately, my child's symptoms abated. However, our family doctor offered to write a note on a prescription pad outlining my child's medical problems, stressing that these were serious and valid concerns, and letting them know they could call (or request doctor on call) to confirm his file. I have it handy, in case we need to go in and run into an ER doc who thinks we're just overreacting to his symptoms.
posted by Chaussette and the Pussy Cats at 9:33 PM on December 2, 2012 [5 favorites]

On the last occasion, one of the staff at the ER told my dad that if he brings her to the ER again, they'll send him to jail.

This is absolutely unacceptable, and you should clear it up right away. Find out if the hospital has a patient advocate, and talk to that person about this. If not, talk to someone in charge at the emergency department.
posted by grouse at 9:52 PM on December 2, 2012 [10 favorites]

No, it's not true that they could send you to jail, assuming you're in the United States. I'm an ER doctor and so I think I'm in a good position to answer this question.

They are required under EMTALA to give your mother a medical screening exam. However, they are not required to treat exacerbations of her chronic pain, nor should they unless there are extremely extenuating circumstances (and no, having a horrible flare-up of chronic pain does not count as an extenuating circumstance).

Generally speaking, people with chronic pain exacerbations should not be going to the ER for pain relief. That is not appropriate medical care, and your mother needs to find a better way to get her pain addressed (I could go into the many reasons, but I won't, unless you want me to, in which case, MeMail me). I'm assuming you're implying that she cannot have back surgery because of her other medical problems, but surgery is not the only answer to pain control. I'm also assuming that she is going to the ED to get narcotic medications (opiates) and I think this is one of the roots of the problem here - although you may correct me if I am wrong but saying that "going to the emergency room is the only thing that was making her better" along with the behavior of the staff is what makes me suspect this.

Because of the rising problems with narcotic abuse and misuse, more and more emergency departments are getting serious about their pain medication usage protocols - and for good reason. Studies show that narcotics are dangerous drugs and that their increasing use is associated with death in patients. Here is a sample pain medication policy that I would recommend you take a look at.
posted by treehorn+bunny at 10:24 PM on December 2, 2012 [42 favorites]

There is most probably an ombudsman or patient advocate at the hospital. This person seems like the first port of call to contact about this. They can arrange a translator (either in person or by phone) if that will help with the language barrier. It all could have been a big misunderstanding, there could be a really nasty staff member in the ER, or there could be something else that the hospital needs to know about.

Ultimately, your mom needs a way to get professional and stable pain management care without anybody being threatened with jail. As Meg_Murry says, using the ER as her primary source of pain management care is not sustainable. Perhaps a social worker at the hospital or elsewhere in the community can suggest appropriate resources? Having a real pain management plan in place will certainly help your mom's quality of life, and will be a help if she does experience more severe pain because you'll have a plan in place for dealing with it.
posted by zachlipton at 10:28 PM on December 2, 2012

Yeah, they likely view your mother as "drug seeking/abusing". Going to the ER is not ideal for pain management. Her primary care doctor should be able to provide her with better/stronger pain meds that she can take as needed or prescribed to prevent or treat the flair-ups.
posted by saradarlin at 10:47 PM on December 2, 2012

My mother has cyclical vomiting syndrome, and the main hospital in her town has told her she's not "allowed" back in their ER. I'm not sure why -- did they think she was taking up too many bags of saline? It sounds as though your mother and mine have both had the misfortune to be tangled up with some shitty ERs. Some people simply have emergencies on the regular. On the other hand, no one has ever threatened to send my mother to jail for her ER sojourns.

I would certainly believe that your mother is being hassled for racist/xenophobic reasons. That bullshit is never surprising, and you should follow up on the suggestions in this thread on how to confront that. (I feel so bad for your father, by the way. He probably could use some support right now.) this point your mother kind of is a drug seeker -- although maybe not the addict kind. Her pain plan is: Go to the ER and get they heavy stuff. You've even said that she only improves when she is treated in the ER. That's a somewhat plausible situation, but the ER staff has to exercise doubt. It's a big deal to be the gatekeeper for such powerful, addictive medication. It's always going to sound fishy for someone to say, "I am in horrible pain, all the time, and nothing helps but [insert addictive, often-abused pain drug that would make anyone feel pretty good]".

On preview: What treehorn+bunny said.

I understand that your mother probably feels incredibly overwhelmed and helpless in this situation, but her current plan of "Suffer suffer SUFFER GO TO ER" is not going to cut it. She has a serious chronic pain condition. If her doctor won't help her, you guys need to find her one who feels like doing their job.
posted by Coatlicue at 10:47 PM on December 2, 2012 [5 favorites]

Quite simply, this isn't what the ER is for. Even single ER visits are astronomically expensive for whoever is footing the bill. This is why insurance companies and managed care organizations push very hard to offer preventive services and promote standing relationships with compatible primary care providers because they allow patients to receive adequate, proactive care for less cost.

I've worked with several managed care organizations on various projects in several different states (I'm assuming your mom lives in the US). Every program I have encountered includes a variety of services and guideposts to nudge members into building better relationships with their healthcare providers and stay out of the ER. These include member services reps, hotlines, social workers, translation services, etc., provider matching, even reasonable transportation, all free of charge. Why? Because it's LOADS cheaper to offer all these things than to stand back and watch members with chronic health conditions run up the bills in the ER.

What's more, the programs I have seen also allow family members to advocate on behalf of the member who needs care. This is where you come in. Please ask your mother for her health plan contact info and permission to call on her behalf. Then call the number, explain the situation, and ask for advice. The rep can likely recommend a different PCP. You can likely also request a case worker/social worker to help. The objective is to keep patients like your mom from getting overwhelmed and using the ER as default.
posted by mochapickle at 11:28 PM on December 2, 2012 [4 favorites]

I think your mom is better served at finding a doctor that can deal with her issues without having to resort to emergency rooms. The emergency room isn't really for that type of issue. If it is solely a money issue then the emergency room is the more expensive option.
posted by JJ86 at 5:45 AM on December 3, 2012

It also sounds to me like this is drug-seeking behavior, or that is the ER's interpretation.

Does your mom have a primary care physician/family doctor? I think that's really the route to approach this through.
posted by J. Wilson at 5:52 AM on December 3, 2012

First, (assuming you are in US because of mention of EMTALA) get the list of doctors in their area who will take patients on Medicare. It is longer than you think. Getting IN with said doctors may be difficult, but there will be a pretty robust list -- including "private" providers.

Second, talk to the hospital ombudsman about this situation and make sure it is reported.

Third, your parents need a local advocate. A hospital or state social worker who works with the elderly is probably your best bet, though I think an immigrant resource center may also be very helpful. You can speak with the hospital ombudsman about this, or contact your state's eldercare hotline (link to 50 state resources here) and say, "I've got a parent, on medicare, trying to manage chronic pain, who has limited English ability, and we are having trouble finding a doctor willing to help." A social worker will have the resources to help your parents navigate this problem and get the situation under control, since the ER really isn't the right place for pain management.

Also, can your parents keep a log of your mother's pain and related symptoms? Doctors and social workers will need to know how serious it is.
posted by Eyebrows McGee at 6:11 AM on December 3, 2012 [2 favorites]

My mother relies mostly on Medicare and goes to a pain clinic to manage her chronic neck and back pain (the result of a motorcycle accident when she was 19). I would suggest you go with your mother to her next regular doctor's appointment and discuss getting a referral to a pain clinic.
posted by cooker girl at 7:13 AM on December 3, 2012

To follow up on my distand cousing Treehorn+Bunny's post, I used to have horrible back pain, I'm experiencing some sciatica now, as the result of an accident where 2 of my discs ruptured.

I only went to ER once for pain. They put me through the wringer because it looked for all the world like I was seeking pain meds. Right up until they did the reflex tests. When my left leg and food didn't react at all. Then I was able to get some meds.

After awhile though, it's not sustainable. You can't live a normal life while taking shit-tons of opiates. Also, you build up tolerances, so they don't work any more.

I bought a book about living with chronic pain, and I did the exercises. It helped SO much.

I eventually got injections of steroids into my spine. Not a walk in the park, but it worked for me.

The point is, drugs aren't the only way to relieve pain. There are therapies, exercises, self-hypnosis, and other pain management methods.

Help your mom explore all the options.
posted by Ruthless Bunny at 9:17 AM on December 3, 2012 [1 favorite]

My mom is nearing the end of a terminal illness and she is taken by an ambulance to the ER just about weekly. No one has ever said anything to my dad about it except to suggest that she be placed in hospice care.
posted by amro at 10:54 AM on December 3, 2012

Stopping by here again, I just wanted to say- trust me, 5 visits in 2 years is not a frequent flyer in any ER. We've got people who come by more than once a DAY.
posted by treehorn+bunny at 11:11 PM on December 5, 2012

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