The Patient Absconded

There's a phenomenon here I don't see in the US of patients "absconding." It's a fairly common occurrence here--it seems to happen at least daily & with very sick patients who unquestionably should be in the hospital. It almost exclusively occurs with the indigenous patients. They will literally pull out their IVs & vanish. In the US, we more commonly have the opposite problem of patients who are not sick enough to be in the hospital but refuse to leave.

To illustrate this point, we admitted a young Aboriginal woman with a condition called ITP (idiopathic thrombocytopenia) where the body, for unclear reasons, destroys its platelets, which can result in life-threatening spontaneous bleeding. She'd previously been treated with immune-suppressing medications for her ITP & as a result developed a blood stream infection with two different types of bacteria, one being melioid. On Friday, she just took off with a platelet count of three (normal platelet counts should be in the high 100s at least), dangerously low potassium level, & two bacteria infecting her blood stream.

When this happens we notify the police & they try to track down the patients, but I still haven't figured out the legal aspects of restraining patients against their will in the hospital so that we can provide them with potentially life-saving treatments. In most cases, someone convinces the patient to return or they'll eventually get sick enough that they return of their own volition. In the US, if one is deemed to have decision-making capacity, even if that decision is a very bad one, we have to respect it & have no grounds for holding someone against their will unless they have a disease that poses a threat to the community, like active tuberculosis.

"Absconding" needs to be put in its cultural context--the hospital environment is extremely repellent & frightening to most Aboriginal patients. Most live in remote villages with no previous contact with large, cold, air conditioned buildings. For many, English is their 4th or 5th language, & even if they seem to speak it well, they generally don't understand half the medicalese we say to them. On top of this, we make them take medications & do noxious things to their bodies like putting in IVs & taking blood. To them, the hospital is a prison, & absconding is their prison break.