Hospital discharge law creates gap for patients in need

The ‘expedited limited healthcare fiduciary’ provision tacked onto the changes in conservatorship law is the kind of solution that can become a problem if not monitored closely.

It is another example of our “whack-a-mole” social safety net policies, in which each solution seems to reveal another problem with no readily discernible solution.

As the 2013 legislative session ended, an amendment was tacked onto the bill that revised and improved Tennessee’s conservatorship laws, creating a process for hospitals to discharge patients who are incapable of making decisions about leaving.

Hospitals can now petition the court to appoint an “expedited limited healthcare fiduciary” to make decisions about discharging a patient who no longer needs hospital care. The law was in place on July 1. The Tennessean reported that Saint Thomas and Vanderbilt hospitals have filed 12 petitions since then (11 patients were transferred to nursing homes; one patient had not yet been discharged).

“Our experience has been primarily with homeless patients who had no place to be discharged to and no one to act on their behalf,” Saint Thomas spokeswoman Rebecca Climer told The Tennessean. She added that a conservator, who also must be appointed as part of the petition, makes arrangements “to fulfill the physician’s discharge order and admission to another facility for an appropriate level of care.”

As one court-appointed attorney ad litem, the person who is responsible for looking out of the patient’s interests, told a client, “… (the hospital) was not a Hyatt Regency; we had to find him another place for him to stay.”

Hospitals are not hotels, just as jails are not mental health treatment centers, yet we seem to prefer to address difficult social problems by shunting problems to institutions where we avoid dealing with them.

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Hospital discharge law creates gap for patients in need