Wednesday, September 13, 2017

Defending Patient Rights

Consent is a tricky issue in healthcare.  Every procedure performed by a healthcare professional requires consent.  It can be obtained in three ways:

Informed Consent – the procedure is explained to the patient (in language they can comprehend), including any options and possible outcomes.  The patient agrees or refuses.  A signed form is sometimes obtained.

Implied Consent – the procedure is explained to the patient and they indicate with their body language that they consent (e.g., rolling up a sleeve for a blood draw or sticking out a tongue for a strep culture).

Assumed/Presumed Consent – the patient is unconscious, but it is assumed that they would want life-saving measures taken as needed.  Once the patient becomes conscience, informed consent is obtained.

The distinction between these consent lines is sometimes blurred, but for liability purposes, healthcare professionals should obtain informed consent on any invasive procedure.  Using language the patient understand is crucial – we don’t want patient’s agreeing to something simply because we suggest it – that is considered paternalism and prevents the ability of a patient to make an informed choice.  A culture of patient autonomy depends on providing as much information to the patient as possible and allowing them to make an educated choice.

Enter the situation in Salt Lake City.  A nurse was recently arrested for refusing to draw blood from an unconscious patient.  The patient could not give informed consent, was not under arrest (which causes an individual to lose certain rights), and the blood draw was not for medical purposes.  The police officer forcibly removed the nurse from the hospital in handcuffs.  She was later released and not charged.  The police officer was put on administrative leave and the incident gained national attention.  As a result, the hospital created a new policy – all police officers must stay out of clinical areas and must go through a liaison versed in health law and ethics.  There is also an ongoing federal investigation.

What can we learn from this incident?

1.  Healthcare administrators need to make sure that healthcare professionals understand patient rights, including consent.  

2.  Hospitals and HCO’s need to have clear policy for outside authority – including police, firefighters, federal agents, etc.

3.  A clear chain of command needs to be in place to avoid situations from escalating to violence in a healthcare setting.
Obviously, it is easy to look at this situation and list all the problems.  It would be better to use this issue as a teachable moment.  Here we have a healthcare professional ready to defend patient rights to the end.  That is an amazing culture for a HCO to have developed.  Follow up is needed to ensure the support for that healthcare professional exists beyond just her own integrity.




Valerie Connor, MA CCC-SLP; MS CHES