Doctors reserve right to refuse service

Patients who don’t follow physician’s advice may have to seek medical care elsewhere

GOLDEN VALLEY - Patients who refuse to follow a prescribed course of treatment under a doctor's care run the risk of being banned from Cerbat Medical Center in Kingman. But, that's a drastic last resort.

M.D. McAfee, 60, of Golden Valley, is a strong proponent of holistic and naturopathic medical care. When his beliefs clashed with his physician's orders, the doctor told him to follow the care plan he had outlined or find another health-care provider.

"I retired from the Marines after 30 years, so I have no problem telling people how I feel," McAfee said. "Military people are a different breed. We've had to be strong and self-sufficient. That doesn't stop when you retire."

McAfee's primary care physician prescribed medication aimed at controlling his cholesterol and stress levels, but the patient had other ideas. As a result, the doctor told him to either comply with orders or find another doctor.

"I contacted my military and supplemental health insurance carriers and they said the clinic is a private practice, and they can do whatever they want to do," McAfee said.

The problem arose when McAfee's stress levels rose after his father died, and he learned his "bad" cholesterol was bordering on being too high. His doctor at Cerbat Medical Center prescribed medications to control both issues.

"I made the mistake of opening up to my doctor about some of the troubling things that were going on in my life," he said. "I lost my 82-year-old father. He was killed by a tree falling on him, so I traveled out to Ohio to help my mom get her life back together. It was very stressful."

His doctor prescribed a mild sedative and cholesterol-lowering medication. Last month, McAfee stopped taking the medications and asked for natural alternatives.

"There's a difference between medicine and drugs. Medicines are for healing. Drugs mask the symptoms and keep real healing from happening. I told the doctor I don't like to take drugs if there's a natural way of taking care of things," McAfee said. "I told him I didn't want to go through the blood tests again and I asked him about diet and exercise, lifestyle changes, instead. He didn't offer me any dietary or nutritional information. Instead, he told me that if I refuse to take the medications, he would send me a letter divorcing me from the clinic. If I refuse to follow his orders, I can no longer be his patient."

McAfee said he told the doctor he would just switch to another physician in the center. That's when he learned the center has a policy that precludes patients who have a problem with one doctor in the Cerbat team from moving across the hall to get the care they want.

"I talked to the administrators and asked them what I should do if I need medical care, and I've sent them a letter requesting a copy of their policy and procedures for patients who refuse to take specific medications," McAfee said.

Ron DeVries, Cerbat Medical Center's practice administrator, said the center has a policy that allows for "separation of care for non-compliance with the care plan" prescribed by any of its physicians.

"If a patient refuses medications or testing and insists on going against medical advice, it's the doctor's prerogative to dismiss that patient," DeVries said.

He said the center's board of directors is in the process now of revamping the policy book, so a copy of that particular policy isn't available at this time.

But before the center tells a patient to look elsewhere for care, the staff offers other choices, he said.

"We haven't dismissed Mr. McAfee," DeVries said. "We gave him other options and we're very willing to work with him."

One of the options was for McAfee to return to the care of another physician in the Cerbat team, but who works at the Golden Valley branch offices.

"Mr. McAfee had been under that doctor's care in the past and seemed to have a good relationship with him. We suggested he switch to that office and that physician, and I believe he is willing to work with that.

"If we can re-establish a relationship with an unhappy patient, we will certainly do so," he said. "But if one doctor in our care system separates from a patient, it applies to all of the doctors in our system."

DeVries said the policy is set up that way to avoid confrontations and possible litigation in the event the disgruntled patient's primary physician isn't available and the doctor with whom the patient had the disagreement is the one on call.

"We have to know the patient isn't going to have a problem if their doctor is out of town or absent for any other reason," DeVries said. "The physicians cover for each other and could end up having to provide care for someone they dismissed for one reason or another. The policy is designed to avoid those situations."

It also aims to relieve the clinic from any liability in the event a patient refuses a course of care and later is hospitalized or dies as a possible result of that decision.

"We know it was the patient's decision not to follow the doctor's prescribed treatment. But that doesn't mean the family won't try to come back with a lawsuit against the clinic if that patient becomes very ill or dies as a result of refusal to follow the doctor's advice," DeVries said.

He said patients like McAfee, who prefer to manage their health under a naturopathic physician, might want to see a provider with those credentials. Those who trust traditional allopathic medicine also have that option within the center system.

"Some of our doctors are more willing than others to work with non-allopathic medicine. Dr. Joe, for example, is an excellent physician whose practice relies strongly on allopathic care," he said. "At the opposite end of the spectrum, so to speak, is Dr. Barbara Harris, who is a licensed naturopathic physician and M.D. Our patients can make those choices."

The center has a brochure that reveals each doctor's background and specialized training to make those choices easier.

"The brochure is a little outdated, but we'll have a new one available soon," DeVries said.

Jamie Taylor, center public relations, said patients naturally have to take responsibility for their own health.

"That's critical," she said. "You have choices if you decide not to follow the doctor's advice. There are other physicians in town, or you can even switch doctors within the clinic system if it's just a matter of preference and not a full disagreement."

She used herself as an example.

"My doctor was gone and another doctor from the clinic covered my care," she said. "They use a team approach. Patients need to be aware the doctors support each other's decisions."

McAfee still is working to monitor and maintain his own health.

Through personal research, he has discovered a device that allows him to stay aware of his cholesterol levels.

"It's called Cardiocheck and I found it online," he said. "I looked around here and it's not available at any of the local drugstores."

He said it's his opinion that the piece of equipment is superior to the tests he underwent when he was following his doctor's orders.

"When the doctor wanted to do a full blood profile, they took nine vials of blood. That's an awful lot. This is a hand-held device that allows me to just prick my finger and it gives me the results, so I can monitor my own cholesterol levels. It's kind of like the glucose monitoring machine diabetics use. It's one small device, one drop of blood. And it performs four other tests. I'll just check my own blood from now on."

Still, he is waiting for his doctor to begin practice in January at the Golden Valley branch of Cerbat Medical Center.

"He's used to dealing with us military people," McAfee said. "I'll talk to him and decide if he's the one I'll see from that point on."