Clinical Dilemma

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I have been asked to post this for another member who wishes to remain

anonymous.

Clinical Dilemma

Please do not respond directly to me but rather to the list with your

comments.

The problem is this:

We are a small acute care hospital that provides inpatient and outpatient

services primarily to adult/geriatric population.

We have received a referral for PT " strengthening and therex

2x/week " for an 18 you female with a diagnosis of birth CP/CMV. This

patient is well know to our facility as we have provided PT services for

her each summer while school is out. She is currently w/c bound, blind, ?

hearing, dependent in all ADLs and is contracted x 4 extremities. The

mother has been taught ROM repeatedly and is resistant to performing home

ROM stating that " it's your job " . Mom has now decided that she

will no longer be sending her daughter to school as she is 18 and she

expects to have PT services at our facility. The patient has Medicaid

coverage.

Knowing that PT will not provide any improvement in her function or

ability to interact with her environment and that it would strictly be

for maintenance ROM which Medicaid will not cover I feel that we do not

have to provide these services. The referring MD is unsupportive,

although he understands our point of view he feels that " if the

mother wants it " we should provide the services.

If anyone on the list serv has had a similar experience or can offer

suggestions on how to deal with this situation it would be greatly

appreciated.