Myriad laws specify treatment consent rule

Get form signed consistently, AM cautions

Access departments are playing with fire if they don’t consistently obtain consent for treatment before treatment is given, emphasizes Susan Baxley, corporate admitting manager for Sacramento, CA-based Adventist Health System. Baxley was concerned, she says, after reading in the December 2003 issue of Hospital Access Management that the emergency department (ED) at St. Mary’s Hospital in Leonardtown, MD, sometimes is not able to get the medical consent signed until after care is provided and that, in some cases, people have refused to sign it.

What has happened, explained Natalie Woodburn, RN, a patient registration supervisor in the St. Mary’s ED, is that people who have brought in minors for treatment have refused to sign the consent form because they are afraid of being responsible for the bill.

Baxley points out that the legal requirement for patient consent to treatment is common to all jurisdictions and may be found in court decisions as well as in various statutes and regulations. While she suggests that access managers research the laws of their individual states, Baxley offers some examples from states in which her health system’s hospitals are located:

Those who work in California hospitals, she notes, can consult the California Healthcare Association (CHA) manual, which states in Chapter 1, Section II B, Emergency Treatment Exception, "The physician must initially determine whether the patient is competent to give consent, since the emergency exception applies only when consent cannot be given."

The manual may be ordered from the CHA web site: www.calhealth.org.

For those in Oregon, she cites House Bill 3294, Section 2 (1), which states, "A physician shall obtain a patient’s informed consent prior to administering a proposed procedure to diagnose or treat a disease or condition."

More information is available at: http://pub.das.state.or.us/LEG_BILLS/PDFs/HB3294.pdf.

The issue also is addressed in the Medicare Conditions of Participation, Baxley notes, under the provision on patient rights (42 CFR 482.13 b), which includes the right of the patient to make informed decisions regarding care and to participate in the development and implementation of the plan of care.

In addition, standards of the Joint Commission for the Accreditation of Healthcare Organizations standards describe the right of patients to be involved in all aspects of their care (RI.1.2) and to give informed consent (RI.1.2.1), Baxley adds.

She also recommends reviewing a web site sponsored by the Louisiana State University Law Center: http://biotech.law.lsu.edu/books/aspen/Aspen-Chapter-9.html.

To avoid the potential legal tangle around the obtaining of consents, Baxley says, Adventist Health System has adopted a two-part consent form. The first part contains the medical consent and the second part is the financial consent. The two-part consent was instituted just before the Health Insurance Portability and Accountability Act privacy standard went into effect, she adds, as part of the system’s efforts to stay in compliance with Emergency Medical Treatment and Labor Act regulations and with state and federal consent laws. "The medical consent section is signed as soon as the patient presents — as long as it does not delay treatment — and the financial consent is signed as soon as the medical screening exam (MSE) has been completed," she explains.

Baxley suggests that Woodburn’s facility, which already is gathering the patient’s name and date of birth upon arrival, also get the medical consent signed at that time, as long it doesn’t delay treatment.

To facilitate the efficient collection of patient data, Baxley notes, Adventist registration departments are encouraged to work with ED physicians and clinical directors to develop MSE notification systems, whereby registrars are notified immediately when the MSE is completed. "This has enhanced our ability to sign forms, update accounts, and collect monies due from patients," she says. "Most of our facilities have been very responsive."

The key to gaining clinicians’ cooperation, Baxley adds, is to explain to them the financial importance to the health system of obtaining accurate, up-to-date patient information. At Adventist, she notes, that has included sharing with ED directors the number of denials and the amount of bad debt coming from the ED. "They care about customer satisfaction and the health of the patient, but if they also realize that it’s not just, I need to get this form signed,’ but, Here are the financial implications of this,’ it helps us work together as a team."

(Editor’s note: If you have feedback on this or another access issue, please contact editor Lila Moore at (520) 299-8730 or at lilamoore@mindspring.com. Susan Baxley can be reached at BaxleySF@ah.org.)