Medical Futility and Maryland Law II

I am on the way back home from spending the day in Baltimore with some 200 healthcare professionals, hospital lawyers, and risk managers, talking about whether there should be changes to the unilateral refusal provisions in the Maryland Health Care Decisions Act.  The general consensus was that changes are needed.  Among other things:

• Maryland is a treat until transfer state.  Even if the hospital determines inappropriateness, it must continue to provide the disputed treatment until the patient is transferred.  


• The definition of "medically ineffective" is extremely narrow, effectively encompassing only physiological futility.  

MY attention was drawn to a few things I had not sufficiently grasped before.  For example, Charlie Sabatino pointed out that once a medical inappropriateness determination is made, the transfer could be impaired because that determination could itself affect reimbursement at the potential transferee facility.  In other words, the refusal of transfer may not be due to an agreement of medical inappropriateness but to a concern about taking an expensive patient.  While the patient may be insured at the time of the transfer, she may be imminently uninsured either because of inpatient days, total cap, or because of the dispute resolution process itself.