What Are EP's Legal Responsibilities With AMA?
What Are EP's Legal Responsibilities With AMA?
Although the EP is responsible for medical care delivered in the ED setting, every adult of sound mind has the right to refuse medical care, says Catherine A. Marco, MD, FACEP, a professor in the Department of Emergency Medicine at The University of Toledo (OH).
When a patient refuses care, the EP has a duty to inform him or her of the risks involved, and alternatives to the proposed medical intervention, she explains.
For example, a patient may present to the ED with ankle pain, and requests pain control and a brace, but refuses X-rays. In such a case, it is the duty of the emergency physician to inform the patient of the risks of foregoing the diagnostic test and potential consequences, says Marco in this case, a potential missed fracture, delays in healing, nonunion, and chronic pain.
"The physician also has a duty to provide the best possible medical care that the patient will consent to," she says. "Beyond that, patients with decisional capacity should not be forced to undergo interventions that they refuse."
In such circumstances, the patient is accepting responsibility for his or her voluntary refusal of care, says Marco. "Unfortunately, there are still potential legal risks in any scenario," she says. "But with appropriate actions and appropriate documentation, the risk can be minimized and the physician's actions can be defended."
For example, if a patient leaves AMA, and later sues the treating physician for a bad outcome, it would be helpful to the defense to refer to the documentation that all of the appropriate information was given to the patient, and that the patient made a voluntary decision to refuse medical care.
Without the appropriate documentation, the plaintiff's argument might be that the plaintiff was not fully informed, and that he or she would have agreed to therapy, had he or she known of the potential risks.
Marco advises documenting the assessment of decisional capacity, delivery of information, including risks, benefits, and alternatives, the patient's deliberation, the patient's voluntary decision, and reasons for the decision.
"It is also helpful to document patient education and any attempts to work with the patient to resolve their concerns," she says.
Even if the patient refuses to sign the consent form, says Marco, the EP's documentation of the essential elements of the informed refusal process is important.
It is reasonable for the EP to detain a patient until decisional capacity can be evaluated, adds Marco. "It is prudent to follow the steps of delivery of information, including risks, benefits, and alternatives, and attempt to deliver the best possible medical care," she says.
If the situation doesn't appear serious enough to warrant involuntary admission, the EP should document findings at the time of the ED encounter, says Marco, including evaluation of mental status and decisional capacity.
"It is crucial for the physician to meet the standard of care for each individual case," she says. "That being said, there is never a guarantee of what will occur following the ED visit."
It is difficult to predict what juries will be sympathetic to, says Marco. "It is crucial for physicians to provide the best possible medical care for each individual patient. That is always the best defense."
Source
For more information, contact:
Catherine A. Marco, MD, FACEP, Professor, Division of Emergency Medicine, The University of Toledo (OH). Phone: (419) 383-6343. E-mail: [email protected].
Although the EP is responsible for medical care delivered in the ED setting, every adult of sound mind has the right to refuse medical care, says Catherine A. Marco, MD, FACEP, a professor in the Department of Emergency Medicine at The University of Toledo (OH).Subscribe Now for Access
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