Risk Management

The High Cost of Refused Care

July 1, 2021

Dear OMIC Insureds:

Consider these patient situations: 
1.         A patient calls to report symptoms suggestive of endophthalmitis but refuses to drive to a satellite office where the ophthalmologist is working that day;

2.         A patient who recently had cataract surgery calls the surgeon to complain of headaches unrelated to the surgery but won’t agree to see her primary care physician;

3.         A glaucoma patient refuses to come in for a follow-up visit to perform visual fields and check the optic nerve but wants the ophthalmologist to keep refilling her prescription, or a comprehensive ophthalmologist refers a patient to a glaucoma expert for surgery but the patient won’t go; and

4.         The parents of a minor patient with retinoblastoma won’t agree to surgery.

These are just a few examples where patients of OMIC-insured physicians have refused care. These patients and parents gambled that they could beat the odds of not only vision-threatening but life-threatening conditions. All these patients sustained harm, and all sued their ophthalmologist when they did.

In this Bulletin, we explore the high cost to patients and physicians alike when care is refused, and we recommend ways to reduce this liability risk.

Who may refuse care? 
Adults: Physicians may be uncomfortable when care is refused, but recognize that adult patients have the legal right to consent to, or refuse, recommended care. Adult patients are presumed to have decision-making capacity if they appear to understand their condition and the risks associated with the recommended treatment, and are able to communicate their wishes. In some situations, it may be necessary to have the patient examined by their primary care physician to assess them for cognitive impairment.

Minors: Patients who have not reached the age of majority, generally 18 years of age, do not usually have the legal authority to consent to or refuse care.

Risk Management Recommendations:
1.        Clarify and document why care is refused.
Determine the reason for the patient’s refusal. Ophthalmologists and staff are often quite frustrated when patients refuse recommendations, and just as often make assumptions about the reasons.  A simple, straightforward approach can be very effective: “You’re not willing to have the surgery? That is certainly your choice, but I would like to understand your decision. Can you tell me more about it?”

2.       Educate the patient and obtain informed refusal.
While courts have recognized the patient’s right to refuse treatment, they have consistently ruled that the decision must be an informed one.

3.       Monitor ongoing and repeated noncompliance.
OMIC’s claims data shows that ophthalmologists confront noncompliance and refused care, but often do not always adequately warn their patients of how such noncompliance puts them at risk.

4.        Duty to report neglect.
Physicians have both a duty to a child to provide needed care, as well as a duty to report suspected child abuse or neglect.

Learn more on this topic:
The following resource links provide additional information on this topic and guidance on how to protect your patients and reduce liability risk:

OMIC Risk Management Digest –  High Cost of Refused Care. Volume 23, No.1, 2013

OMIC Risk Management Recommendations
Noncompliance: A Frequent Prelude to Malpractice Lawsuits

Documentation Tools
Informed Refusal of Care- Consent
Preauthorization to Treat Minors – Consent

If you have questions, please contact OMIC Risk Management by calling 1-800-562-6642, enter 4 for the Risk Management group, or email us at riskmanagement@omic.com.

Regards,

Hans K. Bruhn, MHS, OMIC Risk Manager

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