CAMLAW: Complementary and Alternative Medicine Law Blog

How Should Hospitals Handle Dietary Supplements?

How Should Hospitals Handle Dietary Supplements? This is a complex question, in part because it requires consideration of patient demands, administrative concerns, legal issues, ethical questions, and provider predilections. Often physicians find themselves in the middle of this complex equation, able to satisfy neither patients, nor their administrators, nor themselves.

Malpractice liability questions are probably foremost in the minds of the hospital executive, administrator, or physician, nurse, or other provider.

Certainly good clinical sense can help with risk management. For example, there is more and more literature about adverse herb-drug interactions; excellent articles by Piscitelli et al., Edzard Ernst, and others, provide valuable information. Even a product such as St. John's Wort, assumed by many patients to be safe, can be involved in such reactions. Also to note are potentially dangerous herb-herb interactions. As part of a thorough informed consent conversation, the notion that dietary supplements are inherently "natural" and therefore "safe" must be deconstructed.

A particular complexity involves continuance (or discontinuance) of dietary supplements when patient is about to undergo anesthesia. The American Society of Anesthesiologists has issued some recommendations about this; in general, the more professional societies can step in and offer guidelines to help advise their clinicians, the less each individual will have to go out and hire a lawyer. A lot of this work is societal and institutional, though some of it individual.

The notion of hospitals restocking common items such as gingko and echinacea can be even more controversial. Pharmacy directors as well as medical directors, administrators, and legal counsel need to be involved in this conversation.

The bottom line is this: due diligence about risks, including adverse reactions, is a must; so are clear conversations with patients about issues of safety and efficacy. Clear disclosure is a useful way to clear misperceptions and also reduce the risk of a lawsuit for failure of informed consent. If patients are insistent, however, such conversations may need be negotiated in a way that preserves the therapeutic relationship. You can find some information about this under the Negotiation topic, including an article on Negotiating Integrative Medicine.

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Michael H. Cohen, Esq.; 468 North Camden Dr. | Beverly Hills, California 90210 | 310-844-3173