And my big Screw You award of the evening  …goes to the nursing
home (and the nursing home doctor) who sent their discharge
failure to my ED tonight with copies of their medical record and
a hand-written order on the chart “Discharge patient to
Emergency Room”.  The patient was accompanied by a social worker
who was trying to effect this discharge, as they had been unable
to do for several days.  To this individuals’ minor credit, when
it was explained that a) there seemed to be no emergency
condition, b) that an emergency screening exam would take place,
and that c) at the conclusion of that exam, if no emergency
condition was found, the patient would be discharged Right Back
To Them, and that d) any failure to take the patient back would
result in a blizzard of reports to any and every state agency
who would listen about their attempted dump, they acquiesced and
took their patient back.   Every day I go to work and think I’ve
seen it all, and every day I’m surprised, in some way.   You’d
think I’d learn.