Question:

We have patients who want to tell us where to draw their blood from, and insist the vein they pick is the only place they'll let us draw them from. Is there any legal document we can have them sign releasing us from liability should anything happen? My staff tells me the patient will go so far as to get up and leave if they don't have their way. What should we do?

Our response:  

It?��s nice to be able to honor a patient?��s wishes, but ultimately it?��s not the patient?��s choice.

According to CLSI, you must survey both arms, if accessible, for the presence of a vein in the center of the antecubital area before selecting the basilic vein since veins in the center are least likely to be near vulnerable nerves or the brachial artery. The standards make no mention of giving patient preference a priority. Even getting permission from the patient in writing to draw from a high-risk area when a safer vein is accessible won't release you from liability should an injury occur. The patient?��s attorney can successfully argue that the patient wasn?��t knowledgeable enough about the risks involved to be given the authority to select a specific site or vein. They'll claim, rightly so, the phlebotomist has the expertise to make a better judgment of the venipuncture site.

If the patient becomes insistent, your staff should be told to contact a supervisor before taking it upon themselves to operate beneath the standard of care. Some diplomacy will be required, for sure, but at the end of the day it's best for the patient to find another facility willing to violate the standards than for you to consider it a customer-service issue.

Here's something else to consider: all an addict has to do to fund his/her addiction is to study the standards and get someone to deviate from them. If the phlebotomist takes the bait, the addict feigns an injury and you have no defense. Stranger things have happened.