Eyeworld

111 OPHTHALMOLOGY BUSINESS October 2015 dictates that the patient's ability to pay should be a very distant consid- eration, regardless of the physician's Ms. Benitez to another physician in the group as well as give the group practice the option of discontin- uing the treatment altogether (so that no patient could receive it and hence no violation to all of the group's patients having "full and equal access" to care would occur). Importantly, the California Court's ruling was based on Ms. Benitez representing a protected class under the California Unruh Civil Rights Act, which specifically protects people from discrimination on the basis of "sex, race, color, religion, ancestry, national origin, disability or medical condition." Ms. Benitez's physicians at North Coast Women's Care Medical Group were ordered to provide care "even if the compliance pose[d] an incidental conflict with defendants' religious beliefs." Consequently, if Dr. Cassell practiced urology and hung his anti-Democrat sign in California rather than Florida, would he be vi- olating state law by refusing to treat Democrats? The answer is probably "no" because "political preference" isn't mentioned as a protected class under the California law. This is why refusing patients care on the basis of (the physician's) conscience can be tricky and may ultimately require a court's interpretation of relevant law. As the literature I read reports and as we've recently seen with the U.S. Supreme Court's gay marriage decision in Obergefell v. Hodges, courts take these civil rights pro- tections very seriously. A physician or medical practice that wants to invoke a conscience clause against treating a patient would do well to get formal legal advice before doing so. A third, complex situation is the inability to pay. In the abstract, ability to pay is not understood as a necessary prerequisite for receiving care. A patient can be a billionaire but his physician would be extreme- ly imprudent to treat him with a complex and risky procedure that the physician has no idea how to perform. Alternatively, many phy- sicians work in practices, such as emergency rooms or public health clinics, where they have a contrac- tual obligation to provide care to anyone who reasonably requires that care, regardless of that person's ability to pay. Otherwise, if refusing care to a walk-in patient, say, would place the patient in a situation of imminent danger that no reasonable physician would think acceptable, prudence EACH WEEK, OIS INTERVIEWS THE LEADERS OF OPHTHALMIC INNOVATION The conversations continue between the bi-annual OIS meetings. Subscribe for free, and listen in on weekly one-on-one candid conversations between Tom Salemi and the innovators changing the face of ophthalmology. VISIT OUR WEBSITE FOR OUR COMPLETE LINEUP OF PODCASTS WWW.OIS.NET/PODCASTS continued on page 112

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