Faking seizures?

[ERDoc]

It's cool that you guys were able to arrange that for her. I think it brings up a great time for some mental ruminating. Let's make it a hypothetical cleaning person in a hypothetic hospital somewhere else. Is there an EMTALA mandate here?

[paramedicmike]

Good question and I think an argument could be made either way.

Wheeling her into the ER while seizing or immediately thereafter? Probably.

Wheeling her to a quiet area to recover outside of the ER? Not necessarily.

[paramedicmike]

Yes, I was purposefully being vague.

[Grodo]

I appreciate the "mental ruminating" regarding legal liability. It's pretty obvious that we as a school need to set up something like the care plan you guys mentioned; for this student, as well as any hypothetical future ones with chronic health conditions. It's in the works. But I don't think she'll want to have her family involved. Although I don't know much, what I know is enough to suspect some seriously complicated (and emotionally charged) history there.

I will say this: I don't see the student daily (it's three nights a week), and in the two plus years that she's been coming to us, I have witnessed her having a seizure five times, including last week. Only once have I truly been tempted to call an ambulance, and that was this last time, because she had more than one seizure on the same day. I don't feel like "overcharging the 911 system" is really an issue here.

The student is pretty good at outlining why she'd rather "the system" stay away, though. I talked to her about it at length two days ago. She pretty much echoes what scubanurse has said. Sarcasm included.

Apparently, the usual storyline goes something like this: an ambulance is called. In the best-case scenario, the EMT's are cordial and accommodating, and they ask bystanders if they know which hospital she wants to be taken to, so that when she regains the full extent of her wits, she can talk to someone who's at least read her file. Worst case, they refuse to take her wheelchair with them if it's dirty, or they think they're entitled to treat her roughly because her spasticity makes her post-ictal phase "look weird"; so they decide she's either faking, or has told the people who called the ambulance abject lies about what's really going on with her.

Then she gets to the hospital where, roughly half an hour after the seizure that triggered the call, give or take, she can usually answer the first available doctor's questions pretty coherently. Meanwhile, she gets an IV "just in case", for access if she starts seizing again. And maybe, if she runs into a particularly thorough (or particularly skittish) ER doc, a CT will be done. After that, she has to wait anywhere between one and five hours for the bloodwork to come back, which will inevitably tell them that her meds are at a therapeutic level. So they send her on her way with the recommendation "to go see your neurologist ASAP", and maybe a prescription for some Valium derivative "to take in addition to your usual meds until you can see your neurologist". Never mind if it's the middle of the night by the time that happens.

Side note: she hates Valium and all of its siblings (or so she says), because it's addictive and "exposure to addictive substances never ends well in my family".

Having heard that story, I can no longer fathom why she would want to fake something like this.

Edited December 19, 2014 by Grodo

[ERDoc]

Sorry for the confusion. My "mental ruminating" comment was directed at Ruff and his comment about the housekeeper. There are a different set of rules/laws that affect things that happen on hospital property. As for your situation, it sounds like you and the pt are on the same page and headed in the right direction.

[Just Plain Ruff]

Yeah, Doc, most of the time the lady only needs a place to lie down and come around. We have treated her if her seizures didn't resolve but rarely were we required to intervene. She always made it clear that she didn't want treatment, that her seizures would resolve and they always did without issue.

It worked out in her favor 99 percent of the time.

I don't think we ever considered a EMTALA aspect Doc, not ever. Maybe we probably should have but I don't work there anymore so I don't really have anything invested in it anymore.