Question about story (pt refuse treatment)

[capribry]

Hi, in my A&P class today my teacher told us about a guy who cut his hand off b/c he had sinned. When he went to a local hospital he refused to get his hand placed back on b/c he had sinned with it. He even called his lawyer to come to the hospital b/c the doctors kept urging him to let them do their job. After the lawyer came, the doctors gave up on the surgery. 6 months later, the man sued the hospital for not replacing his arm, claiming that he wasn't in the right state of mind. I don't know who won the lawsuit(my teacher ended the conversation by saying that the man should have been shot) Anyways my question is what are the hospital suppose to do in a situation where a patient refuses treatment with a lawyer. Was the hospital wrong for not giving him treatment. And how can they be sued for doing what the patient wanted. Just a little curious.

[leslie :-D]

then why did he go to the hospital in the first place? wouldn't that be an implication of seeking treatment?

leslie

[capribry]

maybe he didn't want to bleed to death, i don't know

[leslie :-D]

i would think that the pt. left ama, offering some protection for the hospital and its' staff.

whenever i've encountered pts that have refused treatment, i document extensively and thoroughly.

leslie

[kukukajoo, LPN]

In ethics class they say document, document, document. get him to sign a statement saying he refuses treatment, etc.

In this case, a psych consult was most probably in order at time of visit. If not, it certainly should have been!

I would assume the hospital would win- heck the guy was of the right frame of mind to exercise his right to refusal and even sane enough to call his attorney to make darn sure, then he was most certainly aware enough to dictate his own treatment or refusal therof.

Hopefully the hospital won in a summary judgement.

[EricJRN, MSN, RN]

One of the keys would be whether the man was told of the consequences of refusing treatment and whether the man had the ability to understand those consequences. If both are yes, then the hospital should be fine, but it sounds like the pt in question was pretty wacked out.

For some reason, ER patients can behave in the strangest ways, but competent pts do have the right to withdraw consent to treat even after the arrive and begin asking for help.

They also have the right to refuse any part of the treatment. For example, the guy could have consented to direct pressure and bandaging, but not surgery. We run into this all the time in EMS, where we frequently respond to MVA's. The patient may want to be transported to an ER, but may refuse spinal immobilization.

[DusktilDawn]

I remember reading about this case years ago. If I recall this story correctly, the surgeon in the situation did everything he could LEGALLY do in order to do surgery on this person, the surgeon did not believe that the patient was competent at that time to make this decision. The patient was also threatening to cut the hand off again if it was reattached, he apparently was experiencing "voiced in his head" telling him to cut off his hand. Another factor, especially when it comes to surgically reattaching limbs is TIME. The surgeon followed what recourse he had in order to do surgery in the limited time he had available, believing the patient was actively psychotic at the time, surgeon called for psych evaluations, and basically went up the chain to have the patient declared incompetent to make a medical decision at that time, the problem was that NO ONE would deem this person/patient incompetent. Months later, after the patient's psychiatric disorder was under control (I believe he had schizophrenia), he sued, claiming that he was not competent to make that medical decision at that time and that no one should have listened to him in regards to his decision not to have surgery.

I don't recall the outcome of the case. I also don't recall the patient having called his lawyer at the time the decision was made about reattaching his hand. Despite having a psychiatric illness, a person still has rights, including the right to refuse treatment. In this situation, the laws protecting this person's rights were against him.

[PeachPie]

Why does this kind of remind me of the scene in The Incredibles in which a man sued Mr. Incredible for preventing him from jumping from a building because he wanted to die?

[NurseLatteDNP, MSN, DNP, RN]

Even if they did reattach the arm at the time the patient had refused it, I don't believe he would be compliant with a post op care. In that state he could have gotten a life threatening infection if he did something, he was advised not to do. I agree with the rest, document, document, document.

[Daytonite, BSN, RN]

There was just a story done about something similar to this on Primetime, I think it was, last week. They spotlighted two people who wanted to amputate their legs. They said they didn't feel normal with their legs. They gave the diagnosis for this which I can't recall and that it is rare. One man, an American, managed to freeze his legs using dry ice which damaged them so badly that both legs eventually had to be amputated. At first he was happy as a clam in his wheelchair. However, he now admits to the TV reporter that he's sorry he did it because there are a few subtle little things he was able to do and feel with his feet and toes that he misses now. No kidding? The other patient was a French lady who tried the same thing with dried ice and botched it. She's now crippled up in a wheelchair and still dreaming of how to get those legs amputated. Even showed the reporter exactly where the point of amputation for each leg should be.

Well, the point is that once damage is done, the doctor's hands are kind of tied (no joke intended). In the case of someone who comes in with an injury and refuses standard treatment all the doctor and staff can do is document that the patient was given informed consent and refused treatment. The doctor carries the burden of the informed consent part. He has to tell the patient (and in a case like this, document it very distinctly) why he needs the limb reattached, how it can be done, what other options for treatment are, and most importantly, what the patient's options are down the road if he was refusing the reattachment. If the doctor did that, there shouldn't be a problem, particularly if the nursing staff has coroborated the doc by charting statements made by the patient. I'm sure everyone in this case documented their butts off as it is quite bizarre and would have put everyone on alert.

The fact is that there are lawyers out there who will take a case and try to milk it for any kind of money they think they might be able to get out of it. That doesn't mean they will win or that the case will even get to trial. Also, the story isn't complete. I'm sure there are other circumstances to this interesting story that have been omitted that might clear up a few questions as to why a lawsuit was filed. One that came to my mind, especially if the patient was saying he didn't want the hand reattached because he had sinned, was if psychiatric evaluation was considered. Perhaps the patient refused that as well. Perhaps the patient didn't reveal the true circumstances surrounding the loss of his hand when he first went to the ER which would have impeded the doctor's diagnosis of a psychiatric problem. Who knows?

[MultipurposeRN]

Unfortunately there are lawyers who could take this case and win, simply because people would sympathize w/ the victim. It's not always what's right that wins cases.

[leslie :-D]

paradoxically, he would also sue if his hand was reattached....a no win situation.