not do so. Some doctors like to have a wit- ness present when a patient refuses needed care. When an employee has been asked to witness the informed refusal process, he or she should sign the record and date the signature—whether the patient agrees to sign or not.

By refusing urgently needed care, a patient might increase his or her risk of injury and possibly increase the doctor’s liability risk. Under these circumstances, some doctors feel that they have no other choice but to for- mally acknowledge the patient’s withdrawal from care. Other doctors continue to see and treat such patients, with the hope that the patient may change his or her mind or that, if the patient’s condition deteriorates, emer- gent care still can be initiated.

If the doctor decides to withdraw from the patient’s care because of the refusal, a discus- sion should take place, if possible, before the formal discharge process. The patient should know the doctor feels strongly enough about the needed treatment that he or she may

withdraw rather than stand by as a witness to the deterioration of the patient’s condition.

Having decided to withdraw, the doctor should formalize the notification with a discharge letter, giving the patient adequate time (generally 30 days) to find another practitioner. The letter should be sent to the patient via certified mail with return receipt requested and an additional copy should be sent through standard mail. Copies of the letter should be kept in the patient’s file.

When a patient refuses care, the doctor needs to ensure that the patient understands the risks that may result from the decision and that this warning is thoroughly docu- mented. When in doubt about how to handle a patient’s refusal of treatment or withdraw from a treatment plan, the doctor should contact a risk management expert. f

This article was provided by the clinical risk management team at Medical Protective, the nation’s oldest professional liability insurance company dedicated to the healthcare pro- fessions and an Endorsed Company of the MDA. Copyright 2013 Medical Protective. For additional information, contact Laura Cascella at laura.cascella@medpro.com or visit www. medpro.com.

NEED AN INFORMED REFUSAL FORM? The Dental Record, an ADA/MDA Endorsed company, provides this and a variety of Informed Legal Consent Forms for purchase. Go to www.dentalrecord.com/ paperformscharts.php to explore the available options. To learn more about the MDA Endorsed Program visit www.modental.org/endorsements.

Save the Date

UMKC School of Dentistry Annual Scholarship Golf Tournament Friday, June 7, 2013

Shoal Creek Golf Course in Kansas City 11:30a Registration & Putting Contest

12p Lunch / 1p Shotgun Start & Scramble Awards & Prizes Following

For information contact Donna Weber weberd@umkc.edu or 816-235-2022

GRANT R. SMITH, DDS (UMKC 2002) has acquired the practice of ROBERT G. SMITH (UMKC 1971)

AFTCO is pleased to have represented all parties in these transactions.

ISSUE 2 | MAR/APR 2013 | focus 29