When a patient refuses to take a test

August 26, 2008

I have a patient who's been prescribed Warfarin. She has been asked repeatedly to go for PT-INR testing but refuses. The last testing several months ago required us to change her dose and I'm sure it will need adjusting again, but there is no way of knowing until I get results from the refused tests. I would think that I'd be held liable if I refill the medication and it causes bleeding or if it's ineffective, but I would think that I could be held liable for not refilling the medication, too! What do I do?

Q: I have a patient who’s been prescribed Warfarin. She has been asked repeatedly to go for PT-INR testing but refuses. The last testing several months ago required us to change her dose and I'm sure it will need adjusting again, but there is no way of knowing until I get results from the refused tests. I would think that I'd be held liable if I refill the medication and it causes bleeding or if it's ineffective, but I would think that I could be held liable for not refilling the medication, too!  What do I do?  

A: So long as you have carefully documented both your record and your communication with the patient concerning the risk of not following your advice, you should not be liable for the patient’s failure to follow your directions. The documentation and communication should both be clear, easily understood and specify the risks of noncompliance. If the patient has not been discharged, your decision as to whether to provide a short period of continued Warfarin pending lab results should be based upon sound clinical judgment, weighing the risks of short-term continued use without lab data against holding off pending receipt of the data. Since INR results can generally be obtained quickly, the best option may well be to insist on a stat INR.

The author is a health law attorney with Kern Augustine Conroy & Schoppman in Bridgewater, New Jersey, Lake Success, New York, and Philadelphia. He can be reached by e-mail atkern@drlaw.com.

The answers to these queries are general opinions and are not intended as substitutes for legal advice. You should not rely on these replies in making decisions involving questions of law, but should instead consult with competent legal counsel.