Alcohol Screening (revisited) and HIPAA

[Ronald Gross]

22 years!!!   Cool, Dude!  Then you know exactly what I/we am talking
about.  We are talking about (1) screening for substance abuse that DOES
get a social service consult every single time and (2) treatment, and
yes that applies to every single trauma patient that I/we care for where
I come from.
Ron
>>> <statman2500 at aol.com> 8/19/2006 11:25 PM >>>
Well dude.....the discussion centered around the appropriateness of
blanket BALs being drawn.  The discussion did not involve DTs, however
if you believe that you must pull something out of the hat go for it. 
So does this mean that you hold all patients with elevated BALs to
screen for DTs?  Of course not.  Trauma in itself is not a clinical
indicator for ETOH and tox screens.   
 
      Since you made the decision to assume, we all know what that
means.  With 22 years of ER experience, I believe I might have seen one
or two patients with greater than 400 BALs.

-----Original Message-----
From: rgross at harthosp.org 
To: trauma-list at trauma.org 
Sent: Sat, 19 Aug 2006 7:08 AM
Subject: Re: Alcohol Screening (revisited) and HIPAA


Dude, I am going to assume that you have never cared for a patient
that
sits there and carries on a conversation with you - and your ETOH is
0.0
and his is >400!!!  Those are the ones that DT when they hit 250, and
when you hit 250 you're comatose and drooling on the couch!!

GIve me a break.  ETOH and tox screens ARE clinically indicated.  The
only fraud perpetrated is when we fail to care for the patient as best
as we can and then bill for the care!

Ron

>>> <statman2500 at aol.com> 08/19/06 12:08 AM >>>
Why do members of trauma teams continue to add to the futile list of
unnecessary labs on so called trauma panels? Certainly if a test is
indicated, it should be done.  However, collecting a BAL on an alert,
oriented, appropriate pt with no clinical indicators ranks right up
there with CBCs on MVA patients complaining of ankle pain. 
Priceless...no,  Useless...yes.  What do you do if a pt has a BAL of
.09
and wants to leave AMA? In Texas a BAL of .08 is neeeded for DWI.  But
guess what, the patient is not driving home if they totaled their car
on
the freeway.  It's illegal for them to drive, not walk.  Certainly it
is
preferable to release the pt to a family member.  There is not a law
in
the nation that allows a physician or nurse to restrain a patient
based
on their BAL level.
 
      Another issue of a blanket policy advocating BALs on trauma
patient involves billing fraud.  Ordering and billing for a laboratory
test that is not clinically indicated or have a diagnostic value may
constitute fraud.
 
      And not trying to throw stones but you stood up in the middle of
the firing range.  Since when (and why) does a clinical nurse have
access to resolution of patient billing (CAN WE SAY HIPPA VIOLATION)
that is resolved usually weeks after the patient is discharged. 
Billing
is the responsibility of the business office, not the ER registration
clerks.

-----Original Message-----
From: bensonblues at comcast.net 
To: trauma-list at trauma.org 
Sent: Fri, 18 Aug 2006 7:05 PM
Subject: Alcohol Screening (revisited)


Drug and alcohol abuse and trauma are very closely linked. If folks in
Detroit 
would drink responsible and stop using crack cocaine, from my
estimate,
the 
trauma case list would be reduced to little old ladies with fractured
hips (and 
occasionally these girls have had a nip of brandy prior to their
fall).

I am not opposed to mandatory screening in trauma patients (Level I,
II, or 
III), but the question remains: What to do with the data, other than
use it for 
medical care.
 
In terms of intervention, we don't have the resources. I suspect that
the only 
coucelling they get is from me, telling them that they might want to
rethink 
their vises and behavior - as the surgical team takes them off to the
OR. They 
are seen by Social Work postop (who are over-worked, understaffed, and

underpaid), but the best that the law allows (unless they are being
charged with 
a crime) in terms of intervention is referral to outpatient services -
which 
will usually only see them if they have insurance.

I recall a study done in Baltimore many years ago. They screened
trauma
victims 
for EtOH and drugs of abuse and found (as I recall): a majority of
victims had 
EtOH and another substance on board, followed by EtOH only, followed
by
nothing, 
followed by marijuanna. In other words, in terms of being a trauma
victim, you 
were more likely to be a victim if you were straight than if you
smoked
pot. 
Obviously, we don't encourage our patients to toke down as a way of
avoiding 
becoming a trauma victim. But, this illistrated the problems
interpreting data 
obtained by dredging patient records.

DB
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