Managing risk from uncooperative parents

Parents who decline or are non-compliant with medical recommendations are not only putting their child at risk, but also the pediatrician, said James P Scibilia, MD, a private practitioner in Beaver, Pennsylvania, and member of the American Academy of Pediatrics Committee on Medical Liability and Risk Management.

In a session on Saturday, October 24, titled “When Parents Refuse Care”, Dr Scibilia reviewed the ramifications of these scenarios and tips to deal with them.

He suggested most pediatricians probably do not realize that when a parent refuses care or does not follow advice for evaluation or treatment and harm comes to the patient, the physician may be liable for the harm.

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“It is important to understand the concept of what creates a physician-patient relationship from a legal perspective and the liability consequences of not fulfilling the contract created with the patient,” said Dr Scibilia.

“In fact, failure to diagnose a condition, illness, or problem, which can occur when parents refuse testing, is one of the highest risk actions in medical liability for all practitioners.”

Depending on the specifics of the case, it may be tenable to remain in the patient-provider relationship. However, pediatricians should document in the child’s record the advice given and the refusal, and Dr Scibilia advised having the child’s parents/caretakers sign an informed refusal form. Such a document, which is available from the AAP for vaccine refusal and can be created for other situations, outlines the information given to the family and obtains their acknowledgment of having received the information, understanding the risks and benefits of their refusal, and being willing to accept the consequences.

In situations in which it appears best to disengage from a relationship when parents are not following advice, pediatricians need to know how to do so without creating abandonment or other liability issues. Since legal requirements vary by state and may also depend on contractual obligations with insurers or other third parties, practitioners may need to check with several parties to be secure in their actions.

In addition to offering some practical strategies for achieving parental cooperation, Dr Scibilia made pediatricians aware that incidentally providing care or health advice to parents in the course of a child’s visit may result in creation of a patient relationship with the adult, and corresponding with that, liability.