Right to Refuse Treatment
We understand that patients have the right to refuse treatment (standard I-05) and we always have them sign a refusal form when they do. Are we also required to have them sign a refusal form for refusing a single dose of medication?
No. A form does not need to be signed for every no-show at pill line or for every time a patient refuses a medication. However, if the patient is repeatedly refusing, the responsible health authority would do well to have a policy to address follow-up such as provider notification and patient counseling.
— From CorrectCare Volume 25, Issue 2, Spring 2011
I know that inmates have a right to refuse treatment (standard I-05), but what if they refuse a laboratory test for a communicable disease? Can we force them to take a PPD test [for tuberculosis] or an RPR blood test [for syphilis] against their will?
No, you cannot force an individual to have a test against his or her will (at least not without a court order). However, when an inmate’s refusal has possible public health consequences, you have to treat the situation differently. What staff in most facilities do is to tell inmates that if they refuse a screening test for a communicable disease, they will be segregated from the rest of the population. Until it can be determined whether the inmate is contagious or infectious, they cannot be allowed to mix with others. In our experience, when you provide this type of explanation, virtually everybody decides to comply.
— From CorrectCare Volume 23, Issue 3, Summer 2009
Our jail’s previous intake screening form had a line that gave “blanket” consent for medical treatment. Separately, consent would be obtained by the dentist for extractions and by the mental health department for medications. Now, medical has no signed consent, “blanket” or otherwise, since the new screening form has no place for this consent. Don’t we need signed consent for evaluation and treatment, and specific consent for invasive procedures? PPD placement, blood draws (RPR, CBC, etc.), I&D, and even Pap tests could all be considered invasive. I was told that only a refusal needs to be signed, which is like putting the cart before the horse.
Any procedure requiring written consent in the community also requires a signed consent from an inmate in a correctional setting. Generally, written consent is required for any treatment or procedure that is invasive and carries some risk of an adverse outcome. Note, though, that not all health encounters require written consent. If the treatment/procedure is neither risky nor invasive, consent may be implied when the patient shows up for the health encounter. That said, if your facility wants to obtain written consent for every health encounter, it may do so. Standard J-I-05 Informed Consent and Right to Refuse Treatment addresses these issues in more detail.
— From CorrectCare Volume 17, Issue 2, Spring 2003; updated February 2010
What is the Commission’s position on history and physicals when an inmate initially refuses? Do you have a time for when it should be offered again (e.g., every 90 days or at the time of the one-year annual)?
Inmates have a right to refuse health evaluations and diagnostic testing as well as health treatment. Thus, NCCHC does not require that health staff continue to offer an inmate a routine history and physical on an ongoing basis. Barring other health problems for the inmate who refuses the intake history and physical, it is OK to wait until the next routine health evaluation is scheduled. That said, the frequency of such refusals should be very low. It would be prudent to document that the individual who refused the intake history and physical was counseled against doing so.
— From CorrectCare Volume 15, Issue 3, Summer 2001