Diagnosis: Recurrent Gallbladder Cancer
Treatment: Transfer to Hospital for End of Life care
The Transfer to Hospital for End of Life care is not medically necessary.

The patient in this case is a woman with recurrent gallbladder adenocarcinoma. She was treated previously with surgery and chemotherapy. She presented to the hospital with a one day history of abdominal pain. She has a prior history of gastric outlet obstruction treated with gastrojejunostomy. She had abdominal pain, nausea and vomiting before presenting to the emergency department. Her pain did not respond to oral Dilaudid.

The patient was admitted and treated for pain. Celiac plexus nerve block was recommended, but she deferred. Palliative care was consulted. It was decided to transfer to Hospital for end of life care.

Records indicate that this patient had pain at her PTC tube site, which was the reason for admission. She had met with palliative care, and nerve block was recommended. Progress notes indicate that the plan was for the nerve block followed by discharge. It was noted that she wanted to wait three weeks to have the nerve block performed. There is no documentation indicating that she had pain or any other symptom that was sufficiently difficult to control such that she would require continued acute care inpatient admission, especially when the plan had been discharge, and there was no indication that her pain significantly intensified. There is also no documentation that she had any other symptom or acute medical condition that would have required continued acute care hospitalization. Finally, records also do not support the need for inpatient hospice based on either uncontrollable symptoms or rapid progression of her disease process with expected imminent death. Therefore, based on provided records there is no support for the medical necessity of transfer to Hospital.