Situation: 92 yr old currently in the hospital (CA) is being bullied to discharge (ER on Friday night, admitted later that next morning) to a SNF to continue IV meripenem treatment (for MDR urinary infection).

Family has been in and out of this and another hospital (which has discriminated and withheld treatment due to patient’s age) in the county and only have 11 days available for SNF stay. Home health agency which has been supporting for 3+years has recently given notice that they cannot continue as the level of care needed is beyond their capacity.

Right now, my priority is ensuring the patient is receiving the appropriate medical consults (successfully advocated for ID doctor that had previously treated the patient in this hospital see him and provide evaluation). Next, is a urology consult to evaluate the existing suprapubic catheter he has placed.

There are multiple additional layers of complexity as you can imagine and expect. The wife and son in my opinion have done a remarkable job advocating for him up to now; much of what they have shared regarding their prior experience with the two hospitals is disturbing.

Right now I am attempting to maintain open communication with case manager, patient relations manager, hospitalist (although he got very defensive when I shared my questions on next steps for evaluation and expectations prior to discharge), nurses, and consulting physicians (in contact by phone with PCP and have open channel to him established).

The situation is ugly, and the family is trying to prevent the transition to SNF right now, at least until the full course of IV AB treatment as confirmed by the ID doctor through 9/7. I am also working on the OPAT policies approach, since IV antibiotics in the outpatient setting must meet certain criteria. I asked the case manager to share the policy of the hospital/institution and they have yet to produce it.
This document should help support my arguments but I am still mining it for useful information. (https://www.idsociety.org/practice-guideline/outpatient-antimicrobial-parenteral-therapy/#IntroductionandBackground)

From your experience, are there any other levers to address here? There is clear medical negligence if not during this admission certainly in previous admissions. I’ve reached out to the quality and safety officer of the hospital to let them know this can turn into a much uglier situation for everyone. Still waiting on a reply.

I am already working on an appeal against the suggested discharge; which is something the family had attempted on a previous admission but did not succeed as the reviewer of the appeal only depends/reviews the notes in the hospital record and follow that as a fact, these notes had been adjusted repeatedly (family has proof of the modifications) until they were able to meet the criteria for discharge. That hospital went further and threatened to put the patient in custodial care removing the existing power of attorney the wife has in place. The hospital has outwardly declared to the family that they won’t treat homeless nor patients of a certain age.

If anyone would be open to consulting with me on this I would very much welcome and appreciate it, thank you in advance.

I am working many angles but want to do try and do more and “be louder” due to the severity of bullying they are experiencing.

Any input or advice is well received and appreciated!

Thank you!