Refusal and Non-Compliance

Refusal of Help

  • Screen for suicidal risk
    • Previous attempts
    • Current intention
  • Ethical obligations
    • Ensure patient and physician safety
    • Potential for involuntary commitment
  • Legal reporting requirements  

In the event that the physician refuses to cooperate with the committee, there are several options to consider.  Team members should always closely question the physician regarding suicidal ideation, previous attempts, and current suicidal intent or plan.  People are often reluctant to ask such questions, believing they will cause the person to begin thinking of this option.  However, this is not the case, and it is important to know what the person is thinking in this regard.  If the physician expresses suicidal ideation and is so deeply distressed as to consider the situation hopeless enough to refuse help, the committee may need to consider seeking legal means to get the physician into an emergent evaluation.  If committee members believe the physician is a danger to self (suicidal) or others (expressing homicidal ideation), or is unable to care for himself as in delirium, acute psychosis or mania and is refusing to participate in an evaluation, the committee can contact local law enforcement who can provide 24-hour emergency detention papers and facilitate transport to a local mental health facility.  

Finally, if the physician is not an imminent danger to self or others and is able to care for himself, but is refusing to cooperate with committee recommendations, and the committee believes the physician may have an impairment that puts patients at risk if he or she continues to practice medicine, a report to the health-care entity at which the physician has clinical privileges, if known, and to the Texas Medical Board is required. (Vernon’s Texas Codes Annotated, Occupations Code §160.004) 

Non-Compliance  

Lack of cooperation or repetitive occurrence of disruptive behavior may result in referral for disciplinary action or to appropriate agencies (i.e. hospital executive committee, TMB, National Practitioner Data Bank)  

Carefully review the alternatives that will be exercised if the physician refuses to comply with the recommendations.  Review state and federal requirements. Emphasize potential loss of privileges, liability insurance, or termination of employment or contract.  Outline precisely due process provisions that are operable through organization bylaws or policies.

This has become much more serious in light of JC regulations.

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Last Updated On

January 26, 2012

Originally Published On

March 23, 2010