new to rural

[Just Plain Ruff]

One more thing,

With your knowledge of pre-eclampsia, did you feel comfortable with getting a refusal on this patient and allowing her to go by private car?

If you did feel comfortable with it then please tell me why you did not feel that a ambulance transfer was needed for her to go to the receiving hospital?

[MAMed]

Everybody I did not talk the pt out of a transfer. The hospital she was at was sending her to a hospital for eval. They ruled it non-emergent. I stated earlier the legal requirements. I never told the pt that I would not transport. The transferring hospital provided nothing stating why this was medically necessary transfer or why the pt needed to be transported by ambulance. I was therefore required to explain to the pt that they would be billed for milage beyond THE CLOSEST APPROPRIATE FACILITY. The pt then said they would rather go POV without me ever suggesting anything about not transporting.

During orientation I was informed by a regional manner that I was legally required to do this. The county sup has stated that any time we have a transfer that the hospital does not provide the required info we are to contact him as I did. If the hospital wanted the pt transported to this particular destination rather than the CLOSEST APPROPRIATE FACILITY they have been given the option to contract and pay the difference that the pt will be billed for which they have declined to do. So let me state again that I never mentioned anything to the pt about not transporting or other means of transport (which I did state in my original post) nor did I attempt in any way try to get a refusal from the pt and if the transferring hospital had in any way attempted to get the appropriate STATE FORMS (I'm using caps not out of sarcasm but to point out that these are the issues at hand in this matter)filled out, this situation never would have occurred. Incidently the pt presented to the hospital for abd pain and as far as I am aware of no labs were ever drawn. If the hospital was truly worried about the pt they might not have wanted to send the pt to another facility that was about TWICE AS FAR AWAY AS THE CLOSEST OB facility which could treat the pt. And we contacted said facility and they said they would be happy to take her. THE ISSUE WAS NOT ONE OF TRANSPORTING OR NOT BUT RATHER THE CHOICE OF LOCATIONS. THE PT SPONTANEOUSLY REFUSED TRANSPORT.

The reason none of this was mentioned in the first place was that I was asking a question as to how common it was for these small hospitals to try to put bogus transfers on the ambulance service just to get rid of a pt such as the time the same hospital wanted us to transfer a pt they listed on a medical necessity form that the pt could not convey by wheelchair van because sitting upright caused pain and swelling in the pt leg but the pt had a personal wheelchair in the room and was sitting upright in bed when we walked into the room, or the time I transported a nursing home pt in on a 911 call. The pt was ambulatory on scene, complaining of chronic flank pain. The pt refused to get on the stretcher and walked to and from the ambulance, sitting in the jump seat during transport. When I asked why the transport was medically necessary the response was that she needed to go back to the nursing home (it was more connivent to call us rather than a wheelchair transport service).

Spenac had it right when he mentioned fraud.

[MAMed]

Ladies and Gentlemen I ask you to take me at face value that what I did in this case was correct in context of the situation. I don't want to eat up space with more back story but if you are really intersted, PM and I'll tell you.