Establish a Jehovah's Witness liaison committee
April 1, 1996 5 minutes read
Establish a Jehovah's Witness liaison committee
Learn what you need to know: Ask a Witness
Observing the health care preferences of different religions can be fraught with medical and legal risk for hospitals. Patients who could otherwise be treated with conventional techniques may die by observing religious beliefs, and obtaining court intervention can be a costly and protracted legal process.
One Florida hospital has established a liaison program with the Jehovah's Witnesses to learn how to treat patients of the faith while maintaining necessary risk management protections.
The program has helped the hospital avoid litigation over medical treatment, hospital officials say, and has had the unintended effect of attracting a larger patient base because of the hospital's willingness to work with people with restrictions and concerns about medical care.
"Our goal was a collaborative approach to the care," says Cory Meyers, RN, MN, risk manager at Baptist Medical Center/Wolfson Children's Hospital in Jacksonville, FL. "We wanted to work with the families, the doctors, and the Jehovah's Witness [faith] to provide care. We are not on opposite ends. We are here to provide medical care. This is a population that wants medical care and believes in it, and we wanted to do what we could to try to provide that."
Beliefs may conflict with state laws
Members of the Jehovah's Witness faith will not accept blood transfusions, blood products, blood cells, or platelets. Observing this restriction can present numerous risks, particularly with surgeries, if a blood refusal is honored, Meyers says.
While most doctors and hospitals will observe a blood refusal from an adult, the situation is more complicated when it comes to children. Most state laws require hospitals to provide appropriate care for children, even if that means overriding the religious preferences of parents. But enforcing a state law also could subject the hospital to a civil lawsuit from the parents.
This medical and legal quandary makes many hospitals weary of treating Jehovah's Witnesses. Baptist Medical did not want to use its standard blood refusal form for members of the Jehovah's Witness faith because of the possibility that it might not be honored in an emergency. "We didn't want patients coming in and signing a blood refusal and then in an emergency having to give them blood," she says.
Instead, Baptist Medical Center began working with the Jehovah's Witness church to enhance the staff's understanding of the faith and how the hospital can treat these patients while still honoring their religious beliefs. As a result of this program, the hospital has begun conducting alternative procedures to treat Jehovah's Witnesses, including "bloodless" surgeries, where procedures are staged first to reduce the likelihood of needing blood. That is, the patients and caregivers actually rehearse the procedure prior to actual surgery to ensure that no blood will be needed, or to reduce the likelihood of unforeseen blood needs.
"What I learned from working with the Jehovah's Witness national organization is that blood refusals are not a fixed rule," Meyers says. "You need to address each patient individually as to what treatments they might accept. They do not want fresh frozen plasma, they do not want blood. Some may allow cell-saver blood. We've done different things by working through the national organization."
Hospital liaison committee program
The church's national headquarters in Brooklyn, NY, has assembled 120 hospital liaison committees across the country, says Angus Maitland, chairman of the hospital liaison committee for the Jehovah's Witnesses in northeast Florida. Within the church organization, its hospital information services department tracks developments in bloodless surgeries and procedures. It also keeps a list of surgeons throughout the country who have expressed a willingness to conduct "bloodless" surgeries.
Members of these committees are educated about bloodless surgeries and medical procedures. When the liaisons work with hospitals, they can provide the doctors and administrators with information on medical procedures and the names of doctors who observe blood prohibitions.
"If there is something that we cannot handle ourselves, then we call our New York office," Maitland says. "But the training that they give us and the information that they send us pretty much covers most situations. If a doctor is not willing to work with us, the hospital can call us for referrals to doctors who are."
The Jehovah's Witness liaison program has been beneficial for hospitals. "They have gained a lot of expertise from the information provided," Maitland says. "It's not just Jehovah's Witnesses who have used it, but patients from other faiths," he says. Also, given the heightened awareness about blood contamination, this process is proving more useful.
To start a program like the one at Baptist Medical Center, it is imperative to get a liaison for your hospital, she advises.
Address children and adults
Risk managers must address the issue of blood transfusions in adult and pediatric patients separately, Meyers advises. After working with Maitland, Baptist Medical Center revised its blood consent policies. Adult patients can sign a blood transfusion refusal form for elective treatments in which the doctor deems the transfusion unnecessary. But she cautions risk managers from accepting a blanket blood refusal form for pediatric patients because of state laws requiring medical action.
The hospital has created a new form to use for its pediatric patients who are members of the Jehovah's Witness faith. Meyers, her hospital's legal counsel and the Jehovah's Witness church worked together to create the document. Other risk managers are advised to get the input of their legal counsel on such a form because of the nuances of state laws, Meyers adds.
While the hospital was unable to release the form to Healthcare Risk Management other risk managers should include a provision in their forms that acknowledges the blood transfusion refusal and states that the hospital has the right to get a court order to treat a child with blood in the event of a medical emergency, she recommends.
Don't forget ethical concerns
Forms may help from a legal standpoint, but they do not always alleviate doctors' ethical concerns. Before Meyers revised her hospital's policy on blood transfusion refusals, she met with many doctors to discuss their concerns.
Other risk managers should meet with their hospitals' doctors before implementing any policies on blood transfusion refusals, she says. It is particularly important to meet with anesthesiologists, because they typically are in charge of blood transfusions during surgeries. After initiating these discussions, Meyers encouraged the anesthesiology department to determine internally how to provide their services to adult Jehovah's Witnesses patients.
"It's an area that risk managers need to be aware of," Meyers adds.
Educate the hospital and medical staff about the services that the Jehovah's Witness hospital liaison committee can provide.
"From my standpoint, it is very helpful to have a liaison," Meyers says. "They are very familiar with techniques across the country to stage surgeries or avoid blood transfusions. They are excellent resources. If you are committed to caring for children, and parents don't want blood transfusions for them, they are a reference we can use and the physicians can use to provide that care."
[Editor's note: To find the Jehovah's Witness hospital liaison for your area, call the hospital information services division of the Jehovah's Witness national headquarters. The address is 124 Columbia Heights, Brooklyn, NY 11201. Telephone: (718) 625-3600.] *
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