How your payment policy could foster a lawsuit

April 24, 2000

Q. My colleague and I have separate practices, but we share staff and expenses in the same office suite. Recently, a patient with no insurance called for an appointment with me. I overheard our scheduler tell her she'd have to bring payment for an old debt to my colleague before I could see her. I was horrified and talked to the scheduler, who told me that my colleague had given her these instructions. Isn't this policy unethical?and potentially dangerous? What if a patient I've seen in the emergency room fails to return to me for follow-up because she owes my colleague money? Shouldn't we avoid asking patients for each other's old debts until the patient checks out after a visit?

Q. My colleague and I have separate practices, but we share staff and expenses in the same office suite. Recently, a patient with no insurance called for an appointment with me. I overheard our scheduler tell her she'd have to bring payment for an old debt to my colleague before I could see her. I was horrified and talked to the scheduler, who told me that my colleague had given her these instructions.

Isn't this policy unethical—and potentially dangerous? What if a patient I've seen in the emergency room fails to return to me for follow-up because she owes my colleague money? Shouldn't we avoid asking patients for each other's old debts until the patient checks out after a visit?

A. You're right to be concerned. Once a doctor- patient relationship is established, either in the ER or in the office, refusing to see a patient could constitute abandonment. You cannot abandon a patient without giving adequate notice and continuing to treat ongoing conditions until the patient has found another physician. Imagine how a jury might react once they learned that an injured patient didn't receive needed care because she owed your colleague a few dollars.

Review your agreement with your colleague. Why should a debt to one doctor affect the practice of another? Even if you share expenses, you have an independent duty to your own patients. If your colleague wants to strong-arm patients, tell him to hire a collection agency and to butt out of your practice. Don't let his desire to recoup old debts compromise your patient care.

Another concern: If patients have the perception that your practice is a partnership, your colleague's collection policies could cause bad will or litigation against you. Make sure that you have separate letterheads and that the receptionist lets patients know that you have separate practices.