Can You Turn Away a Bed Bug Ridden-Patient?

I was asked by a physician practice whether it could turn away a patient with bed bugs and refuse to treat the patient any longer.   The practice had already lost the use of its waiting room and treatment rooms numerous times due to this patient (in order for furniture and carpets to be fumigated). This was not as easy a question to answer as you might think and there are few helpful guidelines on how to handle a patient with bed bugs! 

Generally, physicians need to be careful not to discriminate against a person for ethnic, racial, or religious reasons or because of their sex (unless it has to do with the physician's specialty).  Physicians also should not refuse to see patients who are part of a protected class.  Physicians can also be forced to see patients they do not otherwise prefer to see if required by payer contract. For example, if you are required to see a certain population of HMO patients, the payer may not allow you to turn a patient away with bed bugs (although you would try to work this out with the insurer).

Although it may seem unethical to turn away a patient, this does not make it illegal.  Of course a patient who requires urgent care and who will be harmed should he or she not be seen imminently, should never be turned away until the patient is stable and can make other arrangements.  I also recommend, when possible, completing the patient's current course of care.  With significant safeguards in place, treatment can continue for patients with bed bugs, even though it may be taxing on a practice and its staff.

There is a lot of literature about how to handle patients who bring bed bugs into the office setting - how their clothes should be removed, how they need to be cleaned, and how the patient should not be allowed to sit in the waiting room with other patients.  Certainly all of these steps will assist in preventing the spread of the bed bugs and avoid an infestation among practice staff and patients. Unfortunately, these same steps can cause a patient with bed bugs to feel mistreated, angry, and humiliated.  

So what is a practice to do?  What I have recommended is the following (assuming the practice is not one specializing in the treatment of bed bugs):

1. Work with patients to refer them for appropriate assistance to address their bed bug problem.  This might be social services or a referral to an agency that can help treat the bed bug infestation. Patients should be treated kindly and respectfully, and the steps being taken should be explained fully in case patients are not aware of how the bugs spread and the impact they may have on the health of the patient and others. 

2. If the patient has an urgent healthcare issue, the patient should be seen immediately.  Appropriate steps to minimize contamination should be made and every state has guidelines (as does the CDC) on how this can best be accomplished.

3. The patient should be allowed to return to the practice once the issue is addressed.  If the patient is unable or unwilling to address the issue, or if it reoccurs, the practice may decide to terminate the patient relationship.  I recommend talking to counsel if termination is elected.

Contrary to popular belief, bed bugs are not a sign of being dirty and can be contracted during travel or coming into contact with infested carpeting, furniture, etc. It is anticipated that the nation's bed bug problem will continue to grow in the future, and thus having protocols in place is essential. A practice should be prepared with the knowledge of how to properly clean its facilities and protect its staff and patients from bed bugs and other infestations.  All medical facilities should also have protocols in place regarding how to handle patients suffering from such afflictions in a humane and compassionate manner.