Ethical/Legal question

[Sis123]

Hi,

Here's a hypothetical question:

Patient A comes in for elective surgery (TAH BSO) and is in pre-op. Anesthesiologist sees patient and does the normal pre-anesthesia talk. Patient refuses Versed, is willing to have anything else instead, but refuses Versed verbally as well as writing this refusal on the consent form. Anesthesiologist says ok, fine. Anesthesiologist comes back with the pre-op sedative and injects it into IV. Patient starts to calm down a bit, and then asks the Anesthesiologist (who is wheeling her off to the OR) What was the drug she was given, A-man answers Midazolam, very quickly, mumbling. Patient is heard saying, "But, but, but" then she's out.

Is this legal? Is this ethical? Is it a patient's right to refuse a particular drug? I always thought that it was.....

[Erin RN]

Sis..

If I was reviewing this file it would be a no brainer..The drugs are one in the same which of course the anesthesiologist knows ( sounds like the pt knew as well)..if it documented or even it was verbal , what the Anes. did was wrong..part of the patients rights and responsibilties addresses the fact that the pt has the right to refuse any care ..if the pt said no, the drug should not have been given!

[J. B.]

JB Legal Nurse Consultant

[Sis123]

What other drugs could have been given instead? And yes, she knew what midazolam was. Not a very nice (or professional) thing to do to a patient.

[jadednurse]

I completely agree it's wrong, but I'm just curious...what's the patient going to do, sue? For what? Psychological damages? I thought you don't have a malpractice case unless you can first demonstrate injury...?

Also out of curiosity...why did the pt object to Versed in the first place???

[Erin RN]

Sis

I am not anesthesia here so I may be way off base. Before I had a minor procedure I had valium. Also, when I was in nursing school we used IV Valium before scopes...there are probably others....well there would have to be since there is always someone who can't tolerate a drug?

Jaded

As far as the injury part..yes there needs to be damages with a med mal case and I would have to do some research to see what this would fall under...

The anes blatantly ignored the pts refusal..I have never had to look at a file like that.

The pt always has the right to refuse and if it went to court the pt would win..of course this would never go to court. If the refusal is documented and it was given anyway..it would be settled there would be no argument or defense..erin

[athomas91]

there are multiple drugs that could have been given instead....any benzo....a barb....even a narc........

[auroranae]

I worked as an anethesia tech for several years and helped the QA person review charts on occassion. This would have been a red flag incident for sure. Perhaps the patient is not allergic to Versed, but has a terrible reaction afterward-- severe n/v, severe migraines, hypotension, hypertension?

These are not things that woudl be considered as allergic rxn's but are very scary and not really desired effects either. If another drug- narcotic or barb or whatever can achieve the desired effect without upsetting the patient it is the patient's right to request that.

We have to remember- and I tell my patient's this everyday...

We- the healthcare professionals- are the employees of the patient. Whether we like to think that or not... they can choose to seek care from someone else-- in effect firing us- at any time.

Providing the care they ask for ( this was an elevtive procedure) in a way that they are satisfied with- as long as what they want is not illegal or harmful in any way- is what we are legally bound to provide.

The use of Versed in thsi case should have been explored a bit more-- why do you not want versed? would have been the first thing out of my mouth if doing the anesthesia interview.

Just my thoughts ... and here in MD would probably be cause for negligence lawsuit.

[deepz]

There have been cases where failure to follow the patient's wishes have resulted in criminal charges. Some years ago in Oklahoma an MDA suggested to the patient that he should have a spinal anesthetic, and the patient refused. The patient wanted general. The MDA gave a sleep dose of Pentothal, then turned the patient on his side and gave him a SPINAL.

Assault and Battery was the resulting charge.

deepz

[Erin RN]

Deepz

That makes sense!! I had a case one time where the pt was restrained and there was no good documentation as to why (although I am sure there probably was a good reason..if it not documeted.....well you know) In any case the pt sued for false imprisionment and won.

I have to call one of my adjustors today, I am going to run this scenario by her and she what she says about it....:) Erin

[javajunkie]

Who doesn't want Versed? Just kidding. I agree, another drug would have been appropriate.

While in nursing school, I once told a confused alcoholic patient his lactulose was whiskey and got my butt chewed. I learned a few valuable lessons though: A. Liver poo stinks and B. Be honest.

[jebain]

Refusal is refusal. Looks like an ego problem with the MD. It does not matter why the patient was refusing (outside of allergic rx). He violated the patients rights-PERIOD. He probably figures they won't remember later so what's the big deal. JERK!! Plus, there are many other meds he could have selected instead.