RIght to refuse

[harrry]

Yesterday at one of the private hospitals here in ED I had a slight problem.

I have severe COPD with an established COPD treatment and action plan. It is long standing as I has lungreduction surgery in 1999. I am also wheelchair bound because of an amputation.

I have had a chest infection which was not responding to basic antibiotics so attended the ED where I have previously been treated on 4 occasions.

My BP was tested immediately on entering the ed and although I had checked it at home at 158/81 was elevated as is normal with the effort of transport and transfers and the changes in temperature etc involved.

After 20 minutes the doctor came to me and said before examining me I had to be admitted. I refused and she said I had to be and got agressive saying she was a dctor and I had to stay. I pointed out that mynotes on the computer indicated that I had had similar treatments and that I required the assesment and treatment indicated for the infection and that if she wwas not prepared to treat me as an outpatient I would attend another hospital. She walked away saying i HAD TO stay.

My wife came in then and she explained the situation to the doctor and asked her to check with the previous doctor. She refused.

On my wife talking to the head nurse she (the nurse) telephoned the old doctor who confirmed that the treatment I had previously recieved was appropriate and staying home under the care conditions I have are satisfactory. The nurse handed the phone to the doctor and she apparently reluctently agreed to the IV antibiotics on a daily outpatient basis that I hadd wanted, I had to sign a form saying I refused to be admitted so I asked for and recieved a complaint form which I gave to the nurse.

The act does permit doctors to force treatment in an emergancy but does this apply to a fully concious patient following a treatment plan being forced to be an inpatient before any proper diagnose or treatment is given.

After treatmen with IV antibiotics my BP returned to normal and my shortness of breath decreased,

What is the correct procedure for furthering a complaint with the hospital which is the most convenient to me in the case of need and has some very good doctors and as shown by their actions lasst night excellent nursing staff.

What is the further step I can take in refering a complaint outside the hospital (though this would mainly be used to get the hospital to realise I am serious about the complaint.

Hope you can help me Sheryll as I respect your opinions and knowledge.

[Sheryl]

This is quite difficult and I am not sure how much a complaint will help, but for what it is worth, send a letter to the Hospital Director with cc to:

Dr Amphon Jindawattana

Secretary-General

National Health Commission

National Health Building, 3rd Floor,

88/39, Tiwanon 14 Rd., Mueang District,

Nonthaburi 11000 Thailand.

The Medical Council of Thailand
7^th Floor, Office of the Permanent Secretary, The Ministry of Public Health,
Tiwanond Rd., Nonthaburi 11000, Thailand.

and, if you have one, your lawyer.

In the letter stress that the doctor attempted to forcibly admit you against your will, contrary to Thai law and medical ethics which recognize a patient's right to refuse treatment. Ask for an assurance that this will nto occur again in the future. (Do nto go into the medical issues and who was right as to best treatment -- just stress the coercion aspect).

This may, however, all do little to prevent a recurrence.Neither the Medical council nor the Health Commission are set up to investigate such complaints.

In future, assuming this is a private hospital, best recourse is to flatly state you refuse to be admitted and wish to sign out against medical advice and request the form. And -- this is the most effective -- state loudly you will not pay for it, and do not sign any admission forms.

Laslty, if you can, arrange to use a hospital where you have a regular doctor familiar with your case on staff.

[harrry]

This is quite difficult and I am not sure how much a complaint will help, but for what it is worth, send a letter to the Hospital Director with cc to:

Dr Amphon Jindawattana

Secretary-General

National Health Commission

National Health Building, 3rd Floor,

88/39, Tiwanon 14 Rd., Mueang District,

Nonthaburi 11000 Thailand.

The Medical Council of Thailand

7^th Floor, Office of the Permanent Secretary, The Ministry of Public Health,

Tiwanond Rd., Nonthaburi 11000, Thailand.

and, if you have one, your lawyer.

In the letter stress that the doctor attempted to forcibly admit you against your will, contrary to Thai law and medical ethics which recognize a patient's right to refuse treatment. Ask for an assurance that this will nto occur again in the future. (Do nto go into the medical issues and who was right as to best treatment -- just stress the coercion aspect).

This may, however, all do little to prevent a recurrence.Neither the Medical council nor the Health Commission are set up to investigate such complaints.

In future, assuming this is a private hospital, best recourse is to flatly state you refuse to be admitted and wish to sign out against medical advice and request the form. And -- this is the most effective -- state loudly you will not pay for it, and do not sign any admission forms.

Laslty, if you can, arrange to use a hospital where you have a regular doctor familiar with your case on staff.

Thanks Sheryl.

The hospital concerned is private but convenient and has some good doctors at least two in ED are aware of my condition and treat well.

As they showed last night the nursing staff is excellent.

My concern is making sure it does not happen again as this need comes up a few times a year whenever I have an infection.

[Sheryl]

The best way to do that would be to get under the care of a physician on staff there who understands you and is responsive to your wishes. In that case, all you'd need to do is insist they call your primary doctor (or if possible, call him yourself before going to the hospital).

[harrry]

The best way to do that would be to get under the care of a physician on staff there who understands you and is responsive to your wishes. In that case, all you'd need to do is insist they call your primary doctor (or if possible, call him yourself before going to the hospital).

That is what she would not do but the nurse did. Yesterday Doctor in duty was very different and I had a full examination and proper treatment and he was quite critical of the level of care and medicine reluctantly given then. Fortunately this is one more exacerbation it now looks as if I am going to get through so people will have to put up with me for longer.

I treat my condition seriouly and have sucessful managed it with the help of medical staff on occasion since the Lung Reduction Surgery in 1999 and for many years of last century. One day things will not work but I do not want that to be sooner than it has too. My family need me and I enjoy life too much.

Thanks for help Sheryl. It is good to know there is someone who understands both sides to help.

[richardjm65]

I, similarly, have to deal with COPD - though my condition is deemed 'moderate'. I would expect that the doctor dealing with my case and the regular tests involved, should be a pulmonologist and who, therefore, should be familiar with my symptoms and previous treatments and who should be consulted in the event of an exacerbation, especially if that involves a repetitive infection which you, (as the patient), recognise, even if the pulmonologist himself is not immediately available to see you.

COPD patients, (especially after LVRS), are well aware of their condition, the potential for repetitive infection, and the treatment that previously alleviated the situation, and should be listened to, even by the available doctors who are not (themselves) pulmonologists and not familiar with your particular case.

Stick to your guns, Harrry. And good luck and better breathing.

[Sheryl]

Yes, do stick to your guns.

If possible, call your doctor prior to going to the hospital so that even if he is not able to come in and treat you himself, he can leave orders for you management and instruct the ER doctor. (This will of course require that you have the doctor's home number, for which you will have to make a special request).

Thai doctors are not accustomed to dealing with informed or assertive patients and many do not react well to a patient trying to give input but they will usually understand and respond to a patient insisting that they want to be cared for only by their usual doctor. "I am a patient of Dr X and will only accept treatment ordered by him" may work better than trying to explain you know what you need, even though of course you do.

I might add that in my experience there is a direct inverse correllation between a doctor's genuine expertise and his/her discomfort with patient input. Really competent doctors aren't threatened by a knowledgeable patient.

[harrry]

Yes, do stick to your guns.

If possible, call your doctor prior to going to the hospital so that even if he is not able to come in and treat you himself, he can leave orders for you management and instruct the ER doctor. (This will of course require that you have the doctor's home number, for which you will have to make a special request).

Thai doctors are not accustomed to dealing with informed or assertive patients and many do not react well to a patient trying to give input but they will usually understand and respond to a patient insisting that they want to be cared for only by their usual doctor. "I am a patient of Dr X and will only accept treatment ordered by him" may work better than trying to explain you know what you need, even though of course you do.

I might add that in my experience there is a direct inverse correllation between a doctor's genuine expertise and his/her discomfort with patient input. Really competent doctors aren't threatened by a knowledgeable patient.

I would have to disagree slightly with your third paragraph. I have been very impressed by the competance and patient oriented care I have received at both public and private hospitals here. That is what surprised me most. I have sinced learned that the doctor is newl graduated and works mainly with children. It seems she should never have been places as the sole ED doctor in an otherwise fair hospital.

With my admissions I do not explain what I need as the protoclols for COPD exaacerbations of my type are fairly standard.

I explain I have COPD have been having increased problems for 2 day have taken xxx for 2 days. I have taken 25 mg predisone on onset of the severe exacerbation 1 hour ago.

I then expect depending on the severity to be given an xray followed by a steroid inection and antibiotic IV together with nebulisers as needed. I then like to know what I have had if I get discharged.

I do not expect to be abused as to where I got the predisolone and that I should not take it then told I had to be admitted before I got treated all without any examination. I have since found that she wanted me admitted as she apparently did not know what to do with COPD patients and wanted to pass the job on.

I will follow up but I think the letter to the hospital director stating I wish to be assured that forced admission will not be attempted again with the mention that if I did not get that a complaint would be forwarded to the Ministry.

I might add that I was well treated last night by another doctor when I had to return and today received my 750 mg Cravit IV from a nurse from the hospital at my home a service which the hospital only charged me the Iv cost of about 1400 baht 250 baht nursing fee and 450 baht ambulance fee for the ambulance that came with the nurse. That is first class care.

Edited September 8, 2013 by harrry

[richardjm65]

I think it's clear from your post #8 that you were unfortunate enough to be attended to by an inexperienced doctor whose field of expertise and experience does not include pulmonology. It's not a particularly common calling, you'll agree, and certainly she would probably not have been prepared for a LVRS patient going through an exacerbation. You've spoken kindly of the treatment you receive, (and have received), from the other staff at the hospital. If this particular, inexperienced doctor has been advised by her fellows that there was a better way to handle the situation, (and also by the hospital admin), perhaps she may learn from the experience and will be better prepared for the next patient with a condition like yours.

We all have to learn - and perhaps some good will come of this. Easy breathing.

[harrry]

I think it's clear from your post #8 that you were unfortunate enough to be attended to by an inexperienced doctor whose field of expertise and experience does not include pulmonology. It's not a particularly common calling, you'll agree, and certainly she would probably not have been prepared for a LVRS patient going through an exacerbation. You've spoken kindly of the treatment you receive, (and have received), from the other staff at the hospital. If this particular, inexperienced doctor has been advised by her fellows that there was a better way to handle the situation, (and also by the hospital admin), perhaps she may learn from the experience and will be better prepared for the next patient with a condition like yours.

We all have to learn - and perhaps some good will come of this. Easy breathing.

Sadly in Northern Thailand particularly the doctors get too much experience of copd. Environmental conditions and practices need to changel. Generally they treat it well with standard protocols and even under the free scheme people get good care but although the medicine they get given is good and correct and would be quite expensive in the West access to some more medicine my be of benifit but given their resources I fully repect the Public Hospital system here.

[Sceptict11]

Yes complain ! You will be rejected and rightly so .

Acute exacerbations of COPD commonly result in a rapid onset of respiratory failure and a need for heroic attempts to provide respiratory support. ( Do not just believe me ! Look it up!)

The Dr was probably right in saying you needed admission !

However, you have the right to refuse any and all recommended medical treatments.

You do not have a right to insist that a Dr. provides what you "want"!

So "stick to your guns" and accept the possible consequences !

If you can arrange for your "specialist" to be available 24/7 , 52 weeks a year then good !

Contact the "specialist" and order the "treatment "

[harrry]

Yes complain ! You will be rejected and rightly so .

Acute exacerbations of COPD commonly result in a rapid onset of respiratory failure and a need for heroic attempts to provide respiratory support. ( Do not just believe me ! Look it up!)

The Dr was probably right in saying you needed admission !

However, you have the right to refuse any and all recommended medical treatments.

You do not have a right to insist that a Dr. provides what you "want"!

So "stick to your guns" and accept the possible consequences !

If you can arrange for your "specialist" to be available 24/7 , 52 weeks a year then good !

Contact the "specialist" and order the "treatment "

Thank you proffessor Doctor. In declining admission but expecting apropriate medical acute care in ED I am expecting complience with the law. I am also following the strong suggestions of the Lung specialist who has an extremely high reputation in Perth Australia, who treated me for 15 years. The suggestion backed up by a pulmonary specialist in Chiangmai at SriPat who while fairly young had his training at one of the hospitals that pioneered LVRS and my current main Pulmonary specialist at ChiangRai hospital. All are concerned at the risk of increased infection risk through being admitted to hospital.

I am well aware of the risks and when admission is likely to be needed as most LVRS patients who have undergone extended periods of Respitory Rehabilitation sessions at hospitals that specialise in helping people to live successfully and participate in the Community.

Any talk of admission is to be considered after Acute treatment is started and investigations made.

As far as rights to ask for what I want it is not what I want it is what they are required to do both by law and standard protocols.

I do not have to look up about acute respitory failure, hypercapnia, and the need to maintain adequate but not excessive O2 levels and the need to respond rapidly. I can be in Hospital in 15 minutes. I have full facilities in home for a filtered air environment with nebuliser (and a portable battery one for power failures, 2 oxygen concentrators. Plus one portable one for travelling. 30 hours of bottled O2 in case of power failure and the training to recognise when it is time to go to ED. My wife has the knowledge to be able to handle a minor exacerbation and get me to help.

I have a formal structured medically designed Action Plan to follow in determining my own treatment and when to get help.

If you are a medical person speaking i suggest you do a refresher on Patient Rights and Medical Personel Responsibilities.

If not I suggest you do a lot more reading and less writing.

Edited September 8, 2013 by harrry

[Sceptict11]

"In declining admission but expecting apropriate(sic) medical acute care in ED I am expecting complience(sic) with the law"

What "law" as a matter of interest would that be ?

Point me to this "law" as clearly I need to inform myself !

Doctors have "rights" and they can , legally, decline to treat someone whose condition is not, immediately , life threatening.

​The only "legal" obligation Dr's have in such a situation is to direct a patient to an alternative source of advice.

Edited September 8, 2013 by Sceptict11

[harrry]

"In declining admission but expecting apropriate(sic) medical acute care in ED I am expecting complience(sic) with the law"

What "law" as a matter of interest would that be ?

http://www.medicine.cmu.ac.th/research/ethics/patient_right_eng.htm

http://whothailand.healthrepository.org/bitstream/123456789/590/1/National%20Health%20Act_2007.pdf Edited September 8, 2013 by harrry

[Sceptict11]

1. http://www.medicine....t_right_eng.htm

Interesting but not "law"

2.http://whothailand.h...th Act_2007.pdf

Again interesting but show me the section which directs Drs to do as patients want/instruct

Just one informative extract for consideration

"In case he or she refuses to receive service, no person shall provide service to him or her."

​I look forward to learning about your successful "legal action" against the Dr/Hospital you are complaining about !

Edited September 8, 2013 by Sceptict11

[harrry]

1. http://www.medicine....t_right_eng.htm

Interesting but not "law"

2.http://whothailand.h...th Act_2007.pdf

Again interesting but show me the section which instructs Drs to do as patients want/instruct

​I look forward to learning about your successful "legal action" against the Dr/Hospital you are complaining about !

Actually I said nothing about legal action. My concern is with the hospital and from what I have heard today my initial comment complaint form to them is being well recieved.

Anywa Sheryl has answed the question I asked competently and well as usual and I do not want to continue fighting people on here about rights or wrongs. The only reason I posted about my medical condition here was it is a forum and to answer it some knowledge of it was needed. As Sheryl does so much to help this forum I did not think it would be fair to just PM her and anyway the answer is relevent to other people too.

I will discuss my condition anytime as there is nothing to be ashamed of and sometimes to to indicate that things that are coonsidered life changing do not mean stopping living.

[Sceptict11]

Nothing at all to be ashamed of .

But please do not invoke the "law" when the "law" will not provide support.

You may have disliked your Drs attitude but she was within her rights !

As I suggested previously make sure your "specialist" is available 24/7 , 52 weeks a year . You will then be able to make direct contact and ensure you receive the treatment you want .

[Sheryl]

A Doctor is not within their rights if confining a mentally competent patient to the hospital against their will.

[Sceptict11]

A Doctor is not within their rights if confining a mentally competent patient to the hospital against their will.

Absolutely agree

.If someone attempted to "detain" me against my will I would be making a very serious complaint to the police !

[harrry]

I have recieved a pleasant surprise over the last couple of days. I was told by the some people I know at the hospital on Monday that there had been a big meeting and the Doctor had been told in no uncertain terms what was expected. That evening when the nurse arrived to give me my injection she had a phone number which is htat of their Service Manager. I have not yet rang it but have been told that the Dr sends me her appologies and from what I hear everyone in the hospital knows what happened. At this stage I had only put in a brief complaint form to go with my refusal to stay in the hospital form.

A couple of things stand out:

The nurse on duty at the time had the courage and apparently the right to do the correct thing and overule the Doctor by phoning the Doctor and giving the phone to the Duty Doctor.

The staff on my next visit were their usual friendly selves and were quite free in discussing what had happened and saying it was wrong and why.

I am sure in Australia a formal complaint would be acted on but behind closed doors.

I sadly know few Australian nurses (who I greatly respect) or Doctors who would criticicise another Doctors treatment in such an open manner.

Maybe there is something in the way it is more left to informal methods rather than legal type procedings.

I will be phoning the Service Manager but will leave it at that as I think they have the message.

[Sheryl]

Excellent.

You have not only helped yourself but other patients.

I suspect that this doctor is both very junior and also incompetent in more than the management of COPD and that fact was well known to the nurses hence their willingness to call your other doctor.

It is BTW very common for nurses to step in like this in the US. But not in Thailand, so you were lucky.

[richardjm65]

Yes, a good result, and perhaps the young doctor has gained both knowledge and experience. As you've said, I also think that there's no need to take it further unless, of course, it is repeated. Which is unlikely.