We reserve the right to refuse service.
These signs can be found in many restaurants and bars, but imagine seeing this sign in a doctor’s office. Restaurants and bars have a legal right to refuse service for legitimate business reasons, like preventing fights or acts of violence. Do doctors have a right to refuse services?
Some patients get denied an initial appointment and cannot even get a foot in the door. Some patients get in the door, but are refused certain prescriptions. This leaves the individual feeling rejected with raw emotions. If these refusals are not arbitrary or are not acts of discrimination based on race, creed, or sexual orientation, then a doctor absolutely has a right to refuse service. Here are some situations and scenarios encountered by doctors who treat chronic pain patients that might necessitate a denial of an appointment or prescriptions.
A cheater is caught by vigilant doctor who discovers that a patient is obtaining pain medication prescriptions from multiple doctors and multiple pharmacies. This type of behavior is consistent with “addiction” or “diversion.” As such, it is actually unlawful for a doctor to prescribe controlled substances to someone who has a harmful addiction to such substances or is diverting the medications to others. An exception would be the prescriptions written by a provider certified to treat addiction with medication like methadone and Suboxone. If a doctor is not treating addiction, then the doctor cannot perpetuate addiction. And the doctor is obligated to refuse prescriptions for controlled substances in this situation.
This same situation might also occur with a potential patient. Once someone calls a doctor’s office to establish care, that doctor has the legal right to obtain private health information from the patient including activity reports from pharmacies. If that doctor discovers that a potential patient has been seeing multiple doctors, obtaining multiple prescriptions for controlled substances, and using multiple pharmacies, that doctor may elect to deny an initial appointment. Keeping the door closed is easier than getting someone out the door.
But, sometimes trouble gets in the door. A patient arrives intoxicated. Speech is slurred. Gait is staggered. Questions are not answered appropriately. When a patient is chemically impaired, a doctor might decide to withhold a prescription for controlled substances, deeming that such medications have tremendous potential to harm the patient and/or others. At that point, the doctor will try to determine the source of intoxication and try to find a solution to minimize harm. At that point, a prescription might be denied.
Once a prescription is refused, a patient might get very vulgar and threaten the doctor. Threatening a doctor’s life is the quickest way to be discharged from the practice. Most pain management doctors have the police on speed dial. And many pain management doctors have other means of self protection at the ready. Safety is a very legitimate reason to refuse service.
Just like any service business, doctors have the right to refuse service if there is a legitimate business reason. Safety for the employees, the doctor, the patient, and the public are the primary reasons that prescriptions to pain medications will be denied. Avoiding a troubled, dishonest patient is the primary reason that an initial appointment will be refused. Ultimately, these decisions are difficult, but necessary to prevent harm.
Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.