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Do i have the right to refuse service to a patient known to have bedbugs?

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  1. rufus

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    Posted 5 years ago
    Thu May 28 2009 16:32:31
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    I work for a non profit Mental Health agency. We have an out patient day program. Our patients come from various group home settings. We are seeing bed bugs becoming more of a problem in the residences. Our Safety Commitee wants to know the rules and regulations reguarding if we are able to refuse service if we know they have bed bugs in their group home.

  2. blazing

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    Posted 5 years ago
    Thu May 28 2009 16:37:37
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    LOOK HERE!

    YOU know what bed bugs are! You don't need anyone to add two and two for you... you know it's four!

    If others are ignorant or want to adopt policies you don't feel right with, that's THEIR business!

    Don't be bullied into something you don't feel comfortable with. People have to learn to trust their instincts. If it doesn't feel right, don't do it. In the end, you will not be led astray. Businesses and agencies are all about a profit, no matter who pays for it in the end. Don't be used.

  3. ActionK9

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    Posted 5 years ago
    Thu May 28 2009 16:46:18
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    I have been performing more and more "sweeps" to facilities like yours and while I do not know the "rules", i do know that in NJ, you cannot turn away patients for bed bugs. It has been quite an issue and I am currently working a case in which the patients arrive by van and in the past were bringing bags, clothes, etc. into the facility. The bugs spread from a coatroom area to the directors office. She in turn brought them to her own home. I know they had looked deep into the do's and don'ts and currently they can only enforce that the patients leave the belongings in the van. We do monthly sweeps and just stay on top of any new infestations. It is certainly a touchy subject, i would look to your board of health and see what advice they can lend.

    Best of luck,

    Todd

  4. BBcoukHome

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    Posted 5 years ago
    Thu May 28 2009 16:58:41
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    hmmm , you want to refuse them access to treatment because they may pose a risk of spreading bed bugs by living in the same building as those whose areas are infected?

    I would have thought that you might be able to use actual risk of transmission as a need to take special precautions with someone known to have an issue with bed bugs but I don't think it is ethical to decline access to treatment of a person known to be living with bed bugs much less someone you simply suspect.

    Yes your organisation has a duty of care towards the staff to minimise the risk of transmission to staff and other patients but this can be worked out with a risk assessment starting with do they actually have a problem with bed bugs themselves. If they do then take steps to reduce the risk of transmission but if they do not do not treat them differently because they happen to live near someone who has a problem.

    The same property, the same building, the same street, neighbourhood, city or town when you start restricting people on the grounds of how close they live to an infestation rather than knowing the facts of if they have a problem its a slippery slope and you had better be prepared for someone to one day say "no sorry you cant play with us because you live closer than 100 miles from a known infestation of bed bugs because someone will always take it one step too far".

    If your safety committee want to know the rules and regulations I suggest you respectfully remind them that establishing the organisations procedures to deal with such risks is their job. Most people do it by researching the legislative framework in the city or state that you are in and basing the guidelines from there. Just remind them that it needs running past the ethics committee before implementing as I suspect they will have a lot to say about it.

    David

  5. BBcoukHome

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    Posted 5 years ago
    Thu May 28 2009 17:00:12
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  6. BugsInTO

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    Posted 5 years ago
    Thu May 28 2009 17:45:11
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    Hi
    You've had lots of good answers above, but I am adding my two cents.

    The focus of the Health & Safety Committee should be to bring this issue to light as a workplace hazard. It's not about refusing patients. It's about getting on board with combating this problem.

    Your organization and related organizations can work together to research, develop and deploy protocols to stop the spread of bedbugs. Education and detection are a big part of this.

    If our Public Health workers can go in and inspect hugely infested premises and never bring bedbugs home, your workers can learn the same techniques. I had a Public Health Inspector in my front hallway (a lovely person) and we talked for nearly 1/2 an hour and I noticed that the whole time, she shifted her obviously very heavy bag from one arm to the other BUT she never once put it down. That's training.

    If the residences you serve have bedbugs, your agency has legitimate issues to raise with them about establishing containment control procedures.

    Remember, a person does not have bedbugs. It's not a contagious disease.

  7. DougSummersMS

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    Posted 5 years ago
    Fri May 29 2009 0:23:47
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    Here are some guidelines for social workers that work in infested homes.

    http://www.nysipm.cornell.edu/publications/bb_guidelines/files/bb_guidelines_nyc3.pdf

  8. parakeets

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    Posted 5 years ago
    Fri May 29 2009 7:51:01
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    I was denied medical treatment because I have bedbugs. I consulted with a lawyer and I was told it was legal in my case. Ethical? Probably not, but apparently it didn't violate any existing laws where I live.

  9. suspicious

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    Posted 5 years ago
    Fri May 29 2009 7:58:23
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    I can't even wrap my head around the fact that you came onto this forum to ask such a question. I can't. Of course, you cannot refuse service to these people. Whether it is legal or not, does not matter. They are people that need help and that is what you do?...Right?. You help PEOPLE that need HELP?

    I would think that rather than wasting time on whether or not you should HELP these PEOPLE you would be concentrating your energy on how you could control the BB issue!

  10. DougSummersMS

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    Posted 5 years ago
    Fri May 29 2009 9:31:29
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    Rufus
    There is a natural product that is labeled for bed bugs, fleas & mites that might be useful for home visit workers in some situations.

    The active ingredient is cedar oil & the company that make it claims that it can be safely sprayed directly on a person or their belonings. I haven't tested the claims that it has a repellent effect on bed bugs, but I have used it effectively to repel mosquitoes & other flying biting insects.

    A rational protocol of simple precautions can provide a measure of protection for workers that perform home visits. Pest management professionals deal with infested buildings on a daily basis & very rarely bring bed bugs home.

    Use of regular K9 screenings for your office & vehicles could provide early detection of any infestations. Policies need to be drawn up to provide assistance & pest control services to any worker that experience an infestation due to exposure to bed bugs while performing their job.

    Refusing to provide services to people that have been identified as being affected by bed bugs isn't going to protect you from infestations that haven't been identified yet. The only way to be sure would be to end your agency's practice of providing home visits or allowing clients to enter your offices altogether.

    Where do we draw the line.... Do we post a large scarlet colored BB on the door of an affected residence & refuse to provide any public services because a worker might be exposed to an insect infestation?... Do we refuse to allow police, fire or paramedical personnel to enter an infested building? ... Sorry, but bed bugs are going to be a fact of life for the next couple of decades.... Deal with it.

    I am afraid that your agency needs to learn to cope with this emerging issue, if you are going to continue to provide home visits or you might as well just close your doors, sell your vehicles & start training your workers to provide all of their services by phone.

  11. buggyinsocal

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    Posted 5 years ago
    Fri May 29 2009 12:05:35
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    It would also seem wise to think about ways to make the office space less inviting to bed bugs, easier to inspect for bed bugs, and easier to treat for bed bugs.

    Bed bugs are, unfortunately, a pest of exposure, and as they gain a more widespread foothold, we're only going to see more people with them in various places. Educating yourself and the rest of the staff as to what to look for, replacing upholstered furniture with easier to clean and inspect furniture, creating spaces and protocol to isolate the belongings of patients with infestations that don't dehumanize them or make them feel dirty but that do protect other people from possible infestation, and avoiding setting a precedent of turning away people with infestations while not doing anything to prevent people who have infestations but who don't know it are all much better approaches than making someone who had bed bugs feel like a pariah.

    At least one person on this board was refused medical treatment because of bed bugs, and when that person responsibly informed the provider, the provider demonstrated a staggering lack of knowledge about bugs by suggesting an alternative that exposed the provider to a much greater risk of infestation than the original treatment would have. I would personally feel much safer now working in a work place that had a good protocol in place and regular screenings because of regular exposure than a workplace that had little known exposure and no plan to deal with it.

    You and/or your safety committee probably don't/doesn't want to be that provider that treats people like pariah's out of ignorance and in so doing puts itself at greater risk. Remember, plenty of clients who don't come from group homes may have bed bugs at home and not know it. With people coming from infested group homes with good protocols, you've got a better chance at getting people to follow the steps needed to avoid bringing hitch hiking bugs with them.

    In addition, bed bugs can cause pretty significant sleep deprivation and anxiety, both of which are likely to be bad for other pre-existing mental health conditions. Your patients with bed bugs, therefore, are more likely to need your help than those clients without them.

    Yes, there are some people with mental health issues who aren't going to be as good at following the protocols that will help avoid the spread, but I would think that the only way such individuals might get help was from a professional.

    But I'm pretty sure that the Hippocratic oath is pretty clear, and while I'm not a professional, I know what my emotions say about where cutting someone with mental health issues off from treatment while undergoing a stressor that isn't life threatening to me falls on that ethical continuum, regardless of what's legal or not.


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