Emerging Trends in Discharging Disruptive Dialysis Patients: A Case Study

Abstract

At the end of the 2009 calendar year, 399,000 End-Stage Renal Disease (ESRD) patients received dialysis as their treatment method, according to the U.S. Renal Data System. In addition to the consequences of their ESRD, patients on dialysis experience many challenging emotional, physical and financial burdens. Steps need to be taken to ensure safety when a patient is a threat to the rights and safety of other patients and staff. Severe cases of threat and abuse, both verbal and physical, can lead to the offending patient being involuntarily discharged from the dialysis facility. However, the ESRD Networks, as well as the state Departments of Public Health, do not have the authority to mandate that outpatient dialysis facilities accept known disruptive patients. When patients are involuntarily discharged from a dialysis facility, and cannot find another outpatient facility to admit them, they are instructed to go to the nearest emergency room for dialysis care. The Emergency Treatment and Active Labor Act requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. This case study attempts to explore the emerging trends of discharged, disruptive dialysis patients who are denied dialysis services from outpatient dialysis facilities.