If a patient states he or she can’t afford recommended care, the physician can try to work with the patient to develop a plan, advises Scott O’Halloran, JD, an attorney in the Tacoma, WA, office of Williams Kastner.
"In general, there is usually always a way to pay for needed care," he says.
If the patient still refuses recommended treatment due to cost, the physician needs to explain the risks of failing to follow through with the recommended therapy, says O’Halloran, and clearly document the patient’s decision in the chart.
Just as physicians’ offices have informed consent forms, they should have refusal-of-treatment forms, says Leilani Kicklighter, RN, ARM, MBA, CHSP, CPHRM, LHRM, principal of the Kicklighter Group in Tamarac, FL. Document the discussion with the patient that includes the reason why the patient is refusing, the attempts the physician and staff made to overcome obstacles, risks of refusal of care, and alternatives that were discussed, Kicklighter says. This information should be documented not only in the medical record, but also on the refusal form that the patient signs and is put in the medical record, she adds.
When patients cannot afford a test, treatment, or medication, she advises that the physician or his staff work with the patient to find an alternative, appropriate test, treatment, or medication. In addition, says Kicklighter, practices can refer the patient to an agency such as "2-1-1," a national program for help for food, housing, referrals for care or other support (For more information, go to http://211us.org).
"Every [physician practice] should be familiar with that phone number and the services available through that program," says Kicklighter, adding that physicians or their staff members also can refer patients to local resources available through community groups and religious organizations.
O’Halloran says that in his experience, "Juries expect that physicians, and especially hospitals, will find a way to provide needed medical therapies regardless of the patients’ finances."
