Hospital Patients Behaving Badly

There is an acute exacerbation of angry patients occurring at this time.

EDITOR’S NOTE: RACmonitor will be producing an occasional series on this problem in the weeks ahead.

While angry patients have always existed, there is an acute exacerbation occurring right now, and there is nothing cute “cute” about it whatsoever. I’ve had more conversations in the last few months about this problem than in the prior 29 years of my career, centering on patients who are belligerent, yelling, screaming, and threatening staff. Medical professionals are already overworked. Now they are scared. 

So, what do you do? I think it is helpful to start by focusing on your legal duties. There are two obligations that can conflict. You certainly have a duty to your staff to make sure they’re safe. That responsibility extends to everyone in the building. And of course, you have a duty to your patients, including the obnoxious ones. In particular, you need to be sure that their poor behavior is not a result of a health issue. And that’s why my first tip with any inappropriately behaving patients is to confirm that the issue isn’t medical. If you have a policy regarding aggressive patients, the first bullet point should be “evaluate the patient.” 

If the patient is having a mental health crisis, or is delusional or is hypoglycemic, it’s important to address the medical condition, because that may address the behavior. But the unfortunate reality right now is that many of these aggressively behaving patients are simply angry. Can you terminate the relationship with a patient for behaving badly? Can you discharge them from the hospital? The answer will depend largely on the setting, and the patient’s overall condition. In an emergency room, the Emergency Medical Treatment and Labor Act (EMTALA) is going to make it nearly impossible to send a patient away for being difficult or even violent. If it is the patient’s friend or partner who is acting up, you can bar them from the facility, but the patient is going to be entitled to his or her medical screening – at least up to the point where you need law enforcement involved, and most likely past that point. You may need an officer in the room, but you will still need to evaluate the patient.

Similarly, if a patient has been admitted as an inpatient, the answer isn’t as clear as in the ED, but Medicare’s Conditions of Participation will require a safe discharge plan. In essence, you will need to find someone to take them.

By contrast, in a clinical setting, it’s going to be much easier to discharge a patient. Most malpractice insurers recommend giving a patient 30 days’ notice to find other care before a termination takes effect, but it’s not like this is etched in stone; it’s a risk management recommendation. It is entirely appropriate to consider all of the risks, including the risk to your staff. If the patient’s behavior is bad enough, it may be worth taking the risk that the patient will complain to a medical board or bring a malpractice action.

I have more thoughts on this, but I can’t cover them all in this segment. Fortunately, two of my colleagues are doing a free webinar on this topic. That webinar is available on demand here:  

The bottom line is that sometimes, patients channel the one-hit wonder band Rusted Root, saying, in essence, “send me on my way.” When they do, you should listen.

Programming Note: Listen to David Glaser’s “Risky Business” report every Monday on Monitor Mondays, 10 Eastern.

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