Bill Of Wrongs


We were having a quiet evening.  S.Q. Lapius had graciously permitted me the use of his recliner while he sat busily at his desk scribbling on his yellow foolscap.  I struggled to wade through the quarterly issue of the Archives, fighting sleep every inch of the way.  Finally, just to keep myself awake I called across, “What are you writing, Simon?  Another paper?”


“No, my boy,” he answered without looking up.  “Some amendments to the Bill of Rights.” 


“The Bill of Rights.  You’re 200 years too late.”


“Not that Bill of Rights.  The new one.  The Patients’ Bill of Rights issued by the American Hospital Association.”


“Ho hum,” I said, closing my eyes again.


“Don’t be derisive, Harry.  It’s very important.  The American Hospital Association has written a presumptuous document that would be ludicrous if it didn’t deal with so serious a subject.  Listen to some of this.  They have twelve items.  I’ll read some to you, if you’ll excuse my editorial comments.”


“Go on,” I said, eyes still closed trying to concentrate on the Bolero drifting in over the hi-fi.


“Harry, move over to the hardback chair while I read.  Then perhaps you will stay awake.”


“1.  ‘The patient has the right to consideration and respectful care’.”


“Sounds okay so far,” I said, while walking over to the hard-backed chair.


“No argument.  It goes without saying.  It seems the one principle that is implicit in patient care.  Why does the AHA have to discover it at this late date?  Then they go on to the patient’s right to informed consent from his doctor.  Again no argument, but certainly not a matter for hospital concern.  But they say ‘The patient has the right to receive from his physician information necessary to give informed consent prior to the start of any procedure and-or treatment.’


That is very broad, what?  Does it include all medications?  Will the doctor and his patient have to discuss the pros and cons before an enema is ordered?”  Lapius was warming to the task.


“Here, “4,” ‘The patient has the right to refuse treatment to the extent permitted by law – What law forbids a patient to refuse any treatment?”


I thought about that for a moment.  “I think they refer to guardianship.  A patient under guardianship probably couldn’t refuse treatment if the guardian approved.”


“Well, that’s a sticky wicket,” Lapius said.  I had never known him to retreat from an issue so readily, but he was anxious to get on.


“Forget that.  Let’s go on.  The following two emphasize the patient’s right to privileged communications ‘The patient has the right to expect that all communications and records pertaining to his care should be treated as confidential.’” “Agreed.”


“Of course agreed.  But then that would preclude review of the patient’s chart by utilization review committees without the express approval of the patient.  And since those committees are only trying to determine whether the third parties, the Blues, or government should continue paying the patients medical bills, why should the patient agree to that?


Yet hospitals all have these committees, and I doubt that the patient is ever consulted about whether his case should be reviewed by any other than his doctor.”


“That’s a point,” I said.


Lapius pursued the matter relentlessly.  “Look at “7,” ‘When medically permissible a patient may be transferred to another facility only after he has received the complete information and explanation concerning the needs for and alternatives to such a transfer.’”


“That’s a step in the right direction, isn’t it?”


“How?  It doesn’t protect the patient’s rights.  They will move him whether he or his doctor wants him moved.  They may explain why, but they’ll move him nevertheless.  Where does it say that the patient has any rights of appeal against this decision.  It states that after informed consent the hospital can do what it wants.  It’s the hospital’s rights that are being protected, not the patient’s.  Let’s look at No. 9, ‘The patient has the right to be advised if the hospital proposes to engage in or perform human experimentation affecting his care or treatment.”


“That’s good, I don’t see anything wrong with that.”


“Harry,” he seemed exasperated, “I think I know what they mean.  They want to say that the hospital will not allow members of its staff to perform experiments, etc. But they didn’t say that.  They said’—if the hospital proposes to perform.’  Hospitals don’t do experiments.  “A hospital is a building, a haven for the ill, a hospice.  It is made of brick and mortar.  It doesn’t treat, or do experiments or do any of the things that people do.  The AHA can no longer distinguish the inanimate.  Of course that’s their problem.  They think in impersonal terms.  Now look at “10.” ‘The patient has the right to expect reasonable continuity of care’?  This isn’t a bill of Rights, it’s a bill of Wrongs.”


“You take them too seriously, Simon.”  I said, hoping to get back to the recliner.  But that wasn’t the right thing to say. 


“Of course I take them seriously.  This is a manifesto by the American Hospital Association, a hodgepodge of loose thoughts, inexactly expressed, intruding into business other than their own.  It should really be a statement of intent.  For instance, here’s how I would put it.  ‘The Board of Trustees of the American Hospital Association that hospitalized patients have the following rights:


1.      To know that all members of the medical and nursing staff are duly accredited.


2.      The right to privileged communication with their doctor.  To know that their medical records will not be shown to any third party or representative thereof without the consent of the patient.


3.      The right to proper continuity of care; there will be adequate staff available day or night, weekends or holidays to properly carry out the doctor’s orders.


4.      The hospital administration will not evict a patient or transfer him to another facility without the consent of the patient in accordance with that of his doctor.


5.      The ecology of the hospital will be maintained at all times to the highest standards of cleanliness and comfort.


“Well,” Lapius said, preening a little, “How’s that for starters, Harry?”


“Great.  Can I go back to the recliner now?”