Overview
In America, a person is supposed to be able to access a certain level of medical treatment. However, there is a possibility that a doctor or a hospital may deny such care. This is particularly relevant for the attorneys working on medical malpractice cases. In this article, we will discuss: under what reasons can medical treatment be denied, the legal context related to these issues, and how the review of medical files aids in forming the allegation in a precise manner.
What is the Meaning of Denial of Medical Treatment
Dissatisfaction with medical care or medical treatment denial can occur at the level of a hospital, private practice, or even an urgent care clinic. Understanding the context and ramifications of such denials, is of utmost importance.
• Additional Denial Types:
• Denial of emergency treatment
• Refusal of elective procedures
• Based on coverage denial
Citing the Practice: The American Association of Hospital reports that roughly 130 million US citizens are registered to use the emergency department services every year. This highlights the relevance of treatment availability.
Legal Considerations Relevant to Medical Treatment
The denial of medical treatment is an intersection of multiple laws that differ from state to state and are rather intricate. Important statutes include:
• Emergency Medical Treatment and Labour Act (EMTALA). This law was passed in 1986. EMTALA requires the admission of emergency treatment regardless of whether or not a patient has the financial means to pay for the treatment.
• State Laws: The laws governing patient autonomy and healthcare provider obligations differ for each state.
• Medical Malpractice Criteria: Patients claiming medical malpractice must show that in the context of treatment denial, notice of treatment being provided was given without recourse.
Importance of Medical Records Review
For attorneys dealing with medical malpractice cases, medical records review is a basic but critical service. It comprises of:
• Reviewing Patient History: Review of medical records is often more complicated by the presence of numerous prior patterns of care and therapies performed, along with the reasoning for the treatment performed.
• Legal Documentation: Legally correct documents can support claims concerning denial of proper treatment and allegations of carelessness.
• Clinical Record Review: Medical records could expose the unexplained treatment inconsistencies that would psychologically lessen the impact of the other side’s argument regarding malpractice claim.
Overlooked Reasons For Denial of Treatment
Within the legal realm, understanding the foundations of treatment denials can go a long way in building a robust case. As a rule of thumb, the common reasons include the following:
• Inability to afford: Some providers may refuse to treat a patient based purely on their financial capability.
• Payor Restrictions: Some insurance will not reimburse for certain treatments or procedures and therefore denials may arise.
• Behavioral Issues: Patients are sometimes turned away for exhibiting problematic and drug seeking behavior.
• Claimed Health Necessity: A patient may be refused treatment by a provider if the physician deems such a treatment not necessary.
Patient’s Options As Wrap-Up Overview
A patient who feels that they have been denied treatment in an inappropriate manner has a range of legal recourse to address such claims:
• Reporting a Medical Malpractice: Should denial of treatment cause some form of harm to the patient, then it is within the right of the patient to take legal action against the provider.
• Getting a Lawyer: A medical malpractice lawyer can assist the patient in understanding what actions can be taken with regard to the issue at hand.
• Reporting Contraventions: Breaches of EMTALA or any other violations can be reported directly by the patient to other relevant authorities.
Case Study
Case Study 1
- Overview of Denial Of Emergency Treatment: Analysis A 45-year-old male presented with chest pain to an EMERGENCY ROOM but did not receive any treatment because his insurance card was not available.
- Challenges: This patient’s condition worsened significantly after experiencing a heart attack post-discharge.
- Solutions: A review of the patient’s medical records indicated the hospital had not complied with EMTALA provisions.
Case Study 2
- History of substance addiction was noted not to have received attention for her severe abdominal pain.
- Challenges: The diagnosis led to appendicitis, advanced intra-abdominal inflammation, and the need for emergency surgery.
- Solutions: An extensive evaluation of the patient’s medical documents concluded that the hospital lacked a proper evaluation of the treatment’s medical necessity.
Conclusion
For attorneys involved in medical malpractice litigation, understanding the legal ramifications of denying treatment is critical. With access to medical records, attorneys who track developments in the law have the means to construct an accurate case for their clients who are unjustly denied care. This document should be useful to those dealing with legal aspects of denying patients needed medical procedures.