Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision
making fast, even if you’re not a doctor or a nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED“ and in last week’s episode I answered another question from our readers and the question was
My Husband In The ICU Is Doing Better? Why Does The ICU Team Is Pushing In Withdrawal Of Treatment?
You can check out last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED“ I want to answer questions from one of my clients Melanie as part of my 1:1 consulting and
advocacy service! Melanie’s dad is in critical condition and wants to transfer him to another private ICU for further treatment.
My Dad is In Critical State and I Want to Transfer Him to Another Private ICU. Will They Reject Him?
“You can also check out previous 1:1 consulting and advocacy sessions with me and Melanie here.”
PART 1
Melanie: I am. I am. I am totally sick and tired, and I don’t want to invest energy into something that’s not gonna bring much gain, and frankly even if, that complaint process could take days before anything’s done about it
.
Patrik: Look, I can hear your frustration and I totally get it, right, but given that you have been banging your head against the wall with any of those consultants, I do believe you’re not achieving anything in there, and I’m almost bound to say you’ve got nothing to lose by escalating it. The end, if your dad deteriorates, and they’re not doing anything, that could be the end of it, but if you do escalate it, you will get a response. You
will get a response there’s no doubt about that.
Melanie: But it doesn’t mean they’re gonna do anything if he does deteriorate and we’re in this complaint process, that the doctor’s gonna change his mind on anything.
Patrik: It might not but it might put things on hold, and they may just review your dad’s situation, and that might bide you time. I can tell you what the doctors are doing at the moment. They’re doing what they’ve always done. That’s how they operate. If they can manage it on a level where you’re not taking this any further, well great for them because they get their way. But given that you want something else to what they’re offering
you, I really do believe that in order to bide time, I do believe, especially with the long weekend coming up.
Melanie: Mm-hmm (affirmative) okay. So, I would need to phone that person, would I?
Patrik: Phone or even email.
Melanie: Mm-hmm (affirmative).
Patrik: The other thing, and again, I’m looking at this, it’s a long weekend coming up. Your dad won’t be in a private hospital before next Wednesday. Nothing’s going to happen tomorrow. Nothing’s going to happen at least until Tuesday then because of the long weekend, and I do believe that given what their line in the sand is, I do believe that in order to raise awareness on an executive level, I do believe that you almost need to do that.
Besides the energy that you need to invest in that, what else are your concerns around that?
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Melanie: That they’re gonna present the medical, in the best interest of the patient argument, and then we’re rehashing that all over again, and we’re gonna get in our way with it.
Patrik: Okay but at the moment given that they have drawn that line in the sand that this is what we’re offering, I do believe that it needs to be taken out of a clinical level. A CEO is often not a doctor. A director of nursing yes is a clinical person, but again is not a doctor. You will find, well I hope you have found that at least the nurses are more sympathetic towards you than the doctors are. I hope I’m right there but I might
not.
Melanie: Some are and some aren’t.
Patrik: I do believe it needs to be taken out of a clinical level, and out of the environment.
Melanie: So do you think, so if I email, do you think, it’s Friday tomorrow, so it’d have to go tomorrow wouldn’t it?
Patrik: It would have to go tomorrow, especially with the long weekend coming up.
Melanie: Yeah.
Patrik: If I was you, I would probably ring them and say to them, what’s your email, or I’m sure I could find their email for you, but ring them, ask them for the email, and say, “hey I’m going to send you an email and make a formal complaint, blah blah blah.”
Melanie: You think the liaison officer could facilitate that? Or should I …
Patrik: Absolutely yes. Absolutely yes. Absolutely yes. And I think you should be almost framing it around, look we want to take our dad into a private hospital. We are concerned that if he deteriorates that he might not reach that goal because of their line in the sand.
Melanie: Sorry say that again, we wanted to take dad into private hospital …
Patrik: But because of the potential for deterioration and the ICU not wanting to offer further treatment if there is deterioration …
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Melanie: Hang on, hang on, I’m writing this down.
Patrik: Yeah. I can email it to you.
Melanie: Oh yeah, you can email me that’s great, yeah.
Patrik: But you understand what I’m saying because they’re not offering anything beyond what they’re doing at the moment and because he’s still critical, if he deteriorates and they’re not offering to resuscitate him, that you are unable to achieve your goal …
Melanie: Well, will the resuscitation be, like, we’ve got that back to apnea, he wouldn’t budge on that, and asystole, do you think that’s unreasonable?
Patrik: I think it is unreasonable. I really do. I really think it is, and the reason I’m saying that is you know we’ve talked about this the day before, and you know your dad. You and your family know your dad. You wouldn’t be doing all of this if you wouldn’t think that your dad would get through this, and you wouldn’t do all of this if you think your dad wouldn’t want this, right? And I do believe that in your email you also need to
make a statement about quality of life, right, because that’s been a big argument for the doctor hasn’t it. Well again what’s quality of life? It’s a perception, and it’s his perception that your dad won’t have any quality of life. Well, you have another perception.
Melanie: And we don’t know yet, we don’t know.
Patrik: Exactly, I do believe that needs to go in there as well as to support your current stand.
Melanie: And what did you call it? The goal? You know how they’re saying …
Patrik: Goals of care?
Melanie: Goals of care, yeah.
Patrik: Right.
Melanie: We would probably put something in about that as well.
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Patrik: Absolutely. Absolutely. Goals of care, I am wondering whether, so all I found out today from the office of the public advocate was that you could bring in whoever you want because that was the only question that I’ve asked, right. I’m wondering what their stance would be as well on, in terms of, okay you are trying to buy time, let’s just say you are trying to buy another week for your dad after today to get him to a private
hospital. What their stand would be in order to look at the NFR, and again I’ll give you another example here. So, client I was working with here at Monty public ICU before
Christmas, their situation was as follows:
Patrik: The ICU was saying we’re going to stop treatment on Thursday the tenth of November at 1:00 p.m. We’re going to withdraw life support and your loved one will probably die, so the family went back to the court here in Victoria and got an extension. Now they were Chinese nationals and their goal was to fly their family member out to Beijing which they achieved in the end. It was either flying him out to Beijing to another ICU, or
getting him into another private ICU in Melbourne, but the court actually ruled in favour of the family saying, yes all they want is to buy time either to get him to Beijing or to a private ICU, and the Monty ICU, all they wanted to do was, well we’re going to stop treatment at 1:00 p.m. tomorrow. He will probably die. All our problems are solved. I mean that’s not what they said, but that was their stand.
Patrik: So, I don’t think you need to go to court, but I do believe now that you’ve got a clear end goal to get into a private ICU, I do believe that an organisation like the public advocate will support that.
Melanie: Mm-hmm (affirmative). Okay.
Patrik: So, what I am wondering is, you know you could make that complaint to a CEO and I believe that that’s the right thing to do, especially now with the goal to private ICU, it’s very tangible, right? You can say, hey I want him in this private ICU in the next few days. Number one, it’s very tangible, right, and you could say to support your argument, you could ring the office of the public advocate you could describe your
situation to them and see what they say, and again I would be very happy to make that phone call for you and see what they say.
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Melanie: Mm-hmm (affirmative).
Patrik: But I don’t, look I totally get how frustrated you are. I totally get it, but there are ways.
Melanie: Yeah when you put it like that, I would be prepared to do that, and if you could help me with the email, I mean I’ll send it from my email account.
Patrik: Exactly. Exactly.
Melanie: And yeah well if we can get that to them tomorrow before the long weekend, yeah, so that the NFR can be put on hold for now …
Patrik: Correct. Until you’ve got the private ICU bed lined up.
Patrik: It’s very tangible. It’s foreseeable. Right? And at the end of the day your dad might be at Wunderpool for the next few weeks if he keeps improving. They don’t want that. Even if he keeps improving, they don’t want that, and you know that by now.
Melanie: So, a private hospital isn’t gonna reject my dad unless there’s no beds, right?
Patrik: They shouldn’t. They shouldn’t.
Melanie: So, given that he’s in a pretty critical state and he’s been that way for seven weeks, they won’t sorta go, “oh no we don’t want to take this person.”
Patrik: Look, they may, they may, but that’s not how you should present that to the Wunderpool CEO and that’s also now how you should present it to the public advocate if you want to get them involved.
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Melanie: Yeah.
Patrik: Right? Your goal is to get him to a private ICU. Now everything else, at this point in time it’s all about buying time around the NFR and looking for a private ICU. Yes, they might say …
Melanie: Well and also it’s not just the NFR it’s also limited support.
Patrik: Correct. Yeah.
Melanie: Cardiac support. Ventilation support. Yeah.
Patrik: That’s right. Which in essence is just an extension of the NFR. Right? Yes, you are absolutely right, some people at St. Georgia or at Prince of Vales Private or at St. Ernest’s they might say, “oh seven weeks ICU, what happens next? Is it going to be another seven weeks with us?” And some ICUs might be perfectly fine with that, right? We’ll never find out, but the first step or at least the most critical thing is to manage
that NFR, and managing that NFR is taking it out of the clinical environment, and bringing it up to the CEO level or to a public advocate level.
Melanie: Mm-hmm (affirmative). Well we could do both couldn’t we?
Patrik: Absolutely. I think you need to do both.
Melanie: Mm-hmm (affirmative). Yeah okay, but I really do want to stick to the ventilation support theme because that’s bothering me a lot.
Patrik: From my perspective Susan, once this NFR is off, okay so have you, I’ll send you an NFR form in a moment when we close this call, I’ll send you an NFR form because what it says, have you had a close look at the NFR form?
Melanie: They showed us the NFR form that they signed with regards to my dad, but yeah there were things that were crossed that were relevant and things that weren’t that were irrelevant.
Patrik: So they would have kicked some boxes. Right. But basically what you need is you need no NFR form with no limitations whatsoever. I think that would be the ideal outcome wouldn’t it?
Melanie: Mm-hmm (affirmative).
Patrik: Okay, yeah. So again, it’s pretty clear what you want. Take the NFR off and that would take
everything else away. That means your dad is for full treatment for full life support with no limitation.
Melanie: Yeah. But can we say that in the email though?
Patrik: Absolutely. And I think even that you are sending this in an email, I do believe you also need to attach the other two documents that are sent to you I really do believe to sort of support that argument around what the policy says and even around what the critical care society says because all of these intensives are part of the critical care society. This is a document that they’ve released but it’s all lip
service.
Melanie: Could we reference those because I won’t be able to attach those. I’ll be sending it from my phone because I’ll be at the hospital.
Patrik: That’s fine.
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Melanie: If we just reference them and have links to wherever they sit online or something.
Patrik: Yeah, I can do that. I can do that. Or what I can do is when I send the email I can attach them, and you could forward them from the phone as attachments, but if you don’t want to or if you can’t …
Melanie: I’m just worried that the trail, if I send it from my phone, if there’s a trail of you sending me stuff previously then I don’t want them to …
Patrik: Oh yeah no, no. No, no. Fine. Fine.
Melanie: I’ll just copy and paste it, because I’ll be doing it on my phone, I’ll copy and paste it into a new email.
Patrik: Yeah. No, no. Okay. That’s fine. Okay so what I’ll do then next is I’ll formulate an email just with the outline. You can change the wording. Are you normally, are you writing emails is just something you do in your professional life, or?
Melanie: Yeah, yeah, so what’s the question again? I do write emails.
Patrik: Okay I will write an email but feel free to add on or change it.
Melanie: Yes.
Patrik: That’s what I’m asking. I will reference those two documents.
Melanie: Mm-hmm (affirmative).
Patrik: I’m just trying to think. And then, so tomorrow would it be difficult for you to contact patient liaisons?
Melanie: No.
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Patrik: Okay. Speak to them, see what they say, and if you feel like it’s not going anywhere with them, I would go straight away onto director of nursing or CEO.
Melanie: Ahh. Okay. So, I’ll just talk to them and say we want to get him into private facility and we want, so basically what you just said, whatever’s in your email, that we want the NFR lifted until we’ve done that.
Patrik: Great.
Melanie: And any limitations on care, including ventilation support.
Patrik: Correct.
Melanie: We want all that lifted until we’ve been able to get him out. The other thing I have here is what if we get resistance from the hospital about transferring him. How do we deal with that?
Patrik: Yep. I don’t think you will get resistance on a CEO level. The resistance you might get is on a clinical level, and that’s why I think it’s so important to try to take this out of a clinical environment for now. The doctor’s stand in ICU will be a transfer to a private ICU will be, from their perspective, will make no sense to them whatsoever because they perceive your dad not having any quality of life in the future. That’s
their perception. That’s, you know, the way they think, and that’s why I think it’s so important to take it out of a clinical level for now and then deal with it on a clinical level once we have arranged a bed. Then we can go back on the clinical level, but for now I think it needs to go out of the clinical level.
Melanie: Yeah okay, so let’s do that as a first port of call and then still start the process of looking for a bed in a private facility as soon as get that up, as soon as possible, and then could the intensive care at Wunderpool, could the doctors there say it’s too risky to transfer him?
Patrik: No, I’ll tell you why not, no no not at all. People like this example with the patient they flew from Melbourne to Beijing on a ventilator. People are getting flown around on bypass machines in helicopters from rural New South Wales, Rural Victoria, to Melbourne or to Sydney. So
no.
Melanie: So, if they’re moving, if it’s an hour drive for example, would it be done through an ambulance.
Patrik: Oh yeah. Yeah it would be done though ambulance.
Melanie: So the ambulances are equipped for resuscitation, ventilation?
Patrik: Absolutely, absolutely.
Melanie: Okay.
Patrik: Patients being driven and flown around in very critical conditions, right? So that is not my concern at all.
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Melanie: Okay. Okay. Alright, that doesn’t make sense to me Patrik, so now I’m just gonna focus my attention on getting him into a private facility.
Patrik: And it needs to now, it needs to be escalated to a nonclinical level because the clinical level, hey will just regurgitate what they’ve been telling you for the last seven weeks probably. Needs to get away from that for now so nonclinical people can deal with that, and nonclinical people can look at how can we buy time?
Melanie: Yeah. Okay.
Patrik: And the CEO is most likely a nonclinical person, and being a nurse, I would really hope that some of the nurses are more understanding of your situation than the doctors are, and even on the director of nursing level. Even though they are public hospital employees I hope that there is some compassion somewhere for your situation.
Melanie: Yeah.
Patrik: And what are your thoughts around the office of the public advocate?
What are your thoughts around that?
Melanie: So, would that just be to get advice from them?
Patrik: Look again given that it’s a long weekend, I think that a phone call to them is, given how helpful they were today, I don’t think you’ve got anything to fear.
Melanie: Could you make that call on my behalf?
Patrik: Absolutely. Absolutely.
Melanie: Oh, thank you.
The 1:1 consulting session will continue in next week’s episode.
Kind Regards
Patrik
