Refusal to take care of patient

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Lee123

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I am curious if there are any legal cases regarding this topic: Let's say a patient is rude, or the anesthesiologist finds the patient offensive. For example, the patient has Swastikas on his body. Can the anesthesiologist recuse himself from caring for the patient if the case is ELECTIVE and there is no one else willing to take care of the patient?

We can also say that there is no obtained consent and the only obligation to the patient is the assignment on the morning schedule. I am curious if anyone has faced this type of situation and what is done.

A similar situation can be this:

"After speaking with the patient, the patient or spouse says: 'You better take good care of him or I will sue you." What is to be done?

Could these patients successfully win a lawsuit citing descrimination? Could the second example win a lawsuit for failure to take care of the patient after a threat?
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We had a similar situation where I did residency. Catholic residents and staff were not required to provide care for tubal ligations. There are similar situations for practitioners with religious objections to birth control prescriptions and abortions. To my knowledge, you are free to refuse care to anyone so long as it is not an emergency. I think you are obligated to find someone who will provide the care they seek.
 
The institution may have a duty to provide care, maybe not the individual.

Don't exactly know how that is resolved when everybody refuses, but my understanding is that a pt can expect the hospital to care for him.

Not a lawyer, just what I have read.
 
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I think those are two different things - a rude and abusive patient is not the same as a patient that's personally offensive.

If a patient tells me to f*** off, they'll have to find another provider. But simply because you don't like what the patient looks like or represents? That's a far more slippery slope to start down. Swastika on their arm? Not gonna do it? OK - what about a Muslim with an anti-American tattoo? What if YOU are Muslim and your patient is Jewish? You gonna put Dzokar Tsarnaev to sleep for his gunshot wounds or let him die for what he did in Boston?
 
If you find yourself frequently not wanting to take care of patients who have different personalities or different beliefs than yours then maybe you should be doing something other than patient care.
Having issues with certain patients or certain groups of patients although might not be addressed directly by your superiors for fear of litigation, it will most likely cost you your job down the road.
That said, from a legal point of view you have no obligation to provide care to any patient as long as it's not an emergency and there are other physicians available in the same institution or somewhere else who would provide the same service.
 
Planktonmd said:
If you find yourself frequently not wanting to take care of patients who have different personalities or different beliefs than yours then maybe you should be doing something other than patient care.
Having issues with certain patients or certain groups of patients although might not be addressed directly by your superiors for fear of litigation, it will most likely cost you your job down the road.
That said, from a legal point of view you have no obligation to provide care to any patient as long as it's not an emergency and there are other physicians available in the same institution or somewhere else who would provide the same service.
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In anesthesia during normal working hours, most of us can probably find a colleague to assume care for a patient we'd rather not take care of with the understanding you will pay them back in some way, shape, or form. The problem is nights and weekends when there might be nobody else around. Refusing to care for a patient that needs an urgent/emergent procedure is probably illegal in some or most places regardless of your personal feelings if you cannot immediately arrange for someone else to care for them. Being on call gives you a duty to that patient as soon as it is deemed necessary for them to have surgery and you have to follow through with that duty.
 
If an elective patient had some hugely offensive tattoo, I would describe myself as a member of that minority (if possible), as part of the informed consent. Taking care of an dingus is not about him, it's about me. He would get the same dedicated care as all of my patients; I would just not enjoy it.

Rather than avoiding patients, I find myself avoiding certain surgeons.. It's all those invisible tattoos, on their lonely neuron, that are the problem.
 
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Refusing to provide anesthesia because of a tattoo? Are you serious?



What if the patient has a massive swatika on their belly that isn't revealed until after they're asleep? Are you going to treat them differently? Will you refuse to conclude the case?
 
Once had a patient with a swastika and Adolph Hitler tattoos. Funny thing was that he was the only white person in the OR. He might have felt little awkward. One or 2 unprofessional comments may have been uttered after he was asleep
 
I just go on autopilot and think about the medicine whenever I have a patient whose values offend me (swastika types) and I would rather not take care of. I have refused to care for three elective surgeries on patients for medico legal issues.
 
dr doze said:
I just go on autopilot and think about the medicine whenever I have a patient whose values offend me (swastika types) and I would rather not take care of. I have refused to care for three elective surgeries on patients for medico legal issues.
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'medico legal issues'

care to elaborate? would be interested to know what they were...
 
nimbus said:
Once had a patient with a swastika and Adolph Hitler tattoos. Funny thing was that he was the only white person in the OR. He might have felt little awkward. One or 2 unprofessional comments may have been uttered after he was asleep
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The interesting thing is that, if I bust on someone for, let's say, promiscuity or drug use, everyone comes down on me like "well, that was in their youth, probably, and maybe they're totally different people now." So shouldn't the same thing be said about Mr. Neo Nazi tattoos? What if he was a big white supremacist when he was 18 and got tats and now he's 50? Shouldn't the same people say that we shouldn't make any assumptions or hold his past against him?
 
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1. Elective case on a patient who had an open lawsuit against me. Surgical Complication from previous surgery. I refused to even speak to her. Case had to be rescheduled to another day because of the hour (I was on call) and partner wouldn't stay for this pt.

2. Patient with very specific demands-insisted on no narcotics, straight regional only for a major abdominal surgery, convinced that she was allergic to all narcotics (not nausea, true allergy). Gave her the usual talk, Why her belief was almost certainly wrong, low incidence of true allergy to preservative free fentanyl, etc. would try to avoid, but couldn't guarantee, etc.. Wouldn't budge. I told her that I refused to be hamstrung that way and that she needed allergy testing before proceeding. She then relented, but I refused. She threatened to sue earlier in the conversation if she received narcotics.

3. Post partum tubal on an anticipated difficult airway. Refused regional. I refused to do the case. Said come back in six weeks if you want general.

Interestingly patient 1 was totally cool. Patients 2 and 3 complained about me.
 
ruralsurg4now said:
The interesting thing is that, if I bust on someone for, let's say, promiscuity or drug use, everyone comes down on me like "well, that was in their youth, probably, and maybe they're totally different people now." So shouldn't the same thing be said about Mr. Neo Nazi tattoos? What if he was a big white supremacist when he was 18 and got tats and now he's 50? Shouldn't the same people say that we shouldn't make any assumptions or hold his past against him?
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Not exactly relevant to medical history. Also someone who was embarrassed by those tattoos, I would think they would make an effort to remove them or blend them into new body art. I take care of Mr. Neo-nazi, mechanically and dispassionately. But I wouldn't cry if he got hit by a bus leaving the hospital.
 
dr doze said:
Not exactly relevant to medical history. Also someone who was embarrassed by those tattoos, I would think they would make an effort to remove them or blend them into new body art. I take care of Mr. Neo-nazi, mechanically and dispassionately. But I wouldn't cry if he got hit by a bus leaving the hospital.
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Neither would I, but then again I also wouldn't cry if the promiscuous or drug-using patients got hit by the two buses behind that bus.
 
ruralsurg4now said:
Neither would I, but then again I also wouldn't cry if the promiscuous or drug-using patients got hit by the two buses behind that bus.
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Those don't bother me. The promiscuous and drug user have no intent to harm others. They are just indifferent. Not so the neo-Nazi. Just my $.02.

I was always looking for promiscuous females to help achieve their goals in my youth. It was in fact a major priority in college. You could say that it was my Prime Directive.;)
 
dr doze said:
True that my avatar is cynicism. It does most accurately describe my outlook on contemporary health care delivery. But my last hook up was 30 years ago. Still married to her.:):love:
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How romant:barf:ic.
 
dr doze said:
1. Elective case on a patient who had an open lawsuit against me. Surgical Complication from previous surgery. I refused to even speak to her. Case had to be rescheduled to another day because of the hour (I was on call) and partner wouldn't stay for this pt.

2. Patient with very specific demands-insisted on no narcotics, straight regional only for a major abdominal surgery, convinced that she was allergic to all narcotics (not nausea, true allergy). Gave her the usual talk, Why her belief was almost certainly wrong, low incidence of true allergy to preservative free fentanyl, etc. would try to avoid, but couldn't guarantee, etc.. Wouldn't budge. I told her that I refused to be hamstrung that way and that she needed allergy testing before proceeding. She then relented, but I refused. She threatened to sue earlier in the conversation if she received narcotics.

3. Post partum tubal on an anticipated difficult airway. Refused regional. I refused to do the case. Said come back in six weeks if you want general.

Interestingly patient 1 was totally cool. Patients 2 and 3 complained about me.
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K... I get #1 and 2. But what is the reason behind refusing #3? I think I must be missing something....
 
Spinach Dip said:
K... I get #1 and 2. But what is the reason behind refusing #3? I think I must be missing something....
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Full stomach, difficult airway, elective case and a patient that refused the safest anesthetic. Maybe she looked like this.

SSS_21-08-2011_EGN_04_SCN190811HAIRa_fct500x308x24_t460.jpg


Name that syndrome… :hungover:
 
You guys get bent out of shape over nazi tattoos? Really? You do realize most the *****s with nazi tats just did it at one point thinking it make them look dangerous or rebellious or different. Even if they are true white supremacists, which is rare, most of them just live out in the boonies by themselves and talk big without hurting anybody. I've seen lots of stupid tattoos, including swastikas and most the people in my operating rooms just snicker and continue to do their jobs professionally without even thinking about it.

Really? You guys take those stupid tattoos that seriously? That's nuts!
 
Surfer said:
You guys get bent out of shape over nazi tattoos? Really? You do realize most the *****s with nazi tats just did it at one point thinking it make them look dangerous or rebellious or different. Even if they are true white supremacists, which is rare, most of them just live out in the boonies by themselves and talk big without hurting anybody. I've seen lots of stupid tattoos, including swastikas and most the people in my operating rooms just snicker and continue to do their jobs professionally without even thinking about it.

Really? You guys take those stupid tattoos that seriously? That's nuts!
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To me, the swastika is the symbol of absolute evil. I take it seriously.
 
dr doze said:
To me, the swastika is the symbol of absolute evil. I take it seriously.
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I think his point was that most people these days with swastikas aren't actually Nazis or neo-Nazis, they're just wannabe tough guys. It sort of doesn't matter because I'm pretty sure that nobody yet has said "I can't take care of that guy with a swastika tattoo." I mean, if I got to choose who I took care of simply based on whether I approved of them as people, I'd have a pretty open schedule.
 
dr doze said:
To me, the swastika is the symbol of absolute evil. I take it seriously.
Click to expand...

What if they have teardrop tattoos for the several people they've murdered?
What about all the race and ethnic bias that is not presented in tattoo form?
If you refuse to care for biased people, you might as well quit.
 
ruralsurg4now said:
I think his point was that most people these days with swastikas aren't actually Nazis or neo-Nazis, they're just wannabe tough guys. It sort of doesn't matter because I'm pretty sure that nobody yet has said "I can't take care of that guy with a swastika tattoo." I mean, if I got to choose who I took care of simply based on whether I approved of them as people, I'd have a pretty open schedule.
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He didn't say he wouldn't take care of that patient.

A swastika is absolutely offensive and disgusting to a lot of people, just like the n-word is to others.
 
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In police shootings, the police often got taken to the other hospital, and the non-police were sent to my hospital. We also got the drunk drivers who crashed into families. It is easy to be kind to those that are kind. It is hard to be kind to those who aren't kind or good.

From a legal perspective, you should check your group's contract with the hospital for what you will and will not provide anesthesia services. Fulfill those obligations.

If someone sues you, you have no more to their medical records. A threat to sue is close, so why should we create more medical records that we won't have a right to use.
 
Impromptu said:
If someone sues you, you have no more to their medical records. A threat to sue is close, so why should we create more medical records that we won't have a right to use.
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??? You're missing a few key words. However - it looks like you're implying that you can't use the patient's medical record if you are sued. That's not correct.
 
jwk said:
He didn't say he wouldn't take care of that patient.
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That's true. I was just noting though that it doesn't really matter, as far as being a physician goes, what our opinion is. Unfortunately, for the most part, we don't get to choose who we take care of. I guess that's unfair, but we've all been so thoroughly indoctrinated by our training that we're used to being initially forced to take care of objectionable people and then later we're totally inured to doing so. I have heard of doctors refusing to treat people who they knew were lawyers, though, but that's anecdotal and probably more urban legend than anything.
 
One can often find an excuse to cancel a case. Even if it is not the reason.
 
Lee123 said:
I am curious if there are any legal cases regarding this topic: Let's say a patient is rude, or the anesthesiologist finds the patient offensive. For example, the patient has Swastikas on his body. Can the anesthesiologist recuse himself from caring for the patient if the case is ELECTIVE and there is no one else willing to take care of the patient?

We can also say that there is no obtained consent and the only obligation to the patient is the assignment on the morning schedule. I am curious if anyone has faced this type of situation and what is done.

A similar situation can be this:

"After speaking with the patient, the patient or spouse says: 'You better take good care of him or I will sue you." What is to be done?

Could these patients successfully win a lawsuit citing descrimination? Could the second example win a lawsuit for failure to take care of the patient after a threat?
Click to expand...

This is America. Anyone can sue anyone for anything. But to prove discrimination they have to be part of some protected class and that you have violated their civil rights. In other words you can't not take care if someone because they're black. But you are free to not take care of someone because they are an a-hole. Pain doctors fire patients all the time. Now, you have to put this in the context of your practice situation and weigh the pros and cons.

This topic is strange to me. At a level one trauma center I've taken care of gang bangers who came from gun battles in the streets and drunk drivers who killed kids, I took the best care I could of them all. The only difference was if they died I didn't care as much. Although in my experience the drunk drivers hardly ever die.
 
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