Removing a patient from your practice: A physician's legal and ethical responsibilities

A myriad of situations might bring about a doctor’s discharge of a patient and termination of the physician-patient relationship. The physician might move, leave the insurance network, or determine that the patient needs the care of a different specialist. The physician also might want to end the relationship due to inappropriate patient conduct such as disruptive or violent behavior; repeatedly missing appointments and/or nonadherence to treatment plans; or refusal to pay for medical services.

Avoid discrimination

Physicians must avoid discriminatory practices that are prohibited by law, including refusing to treat or discharge of a patient based upon the patient’s race, nationality, religion, age, sex or sexual orientation.

What defines patient abandonment?

Patient abandonment generally is defined as the unilateral severance by the physician of the physician-patient relationship, without giving the patient sufficient advance notice to obtain the services of another practitioner, and at a time when the patient still requires medical attention.

While individual states have their own definitions of patient abandonment, the concept of reasonable notice is common to most jurisdictions. In New York, for example, the following is considered professional misconduct: “Abandoning or neglecting a patient under and in need of immediate professional care, without making reasonable arrangements for the continuation of such care, or abandoning a professional employment by a group practice, hospital clinic or other healthcare facility, without reasonable notice and under circumstances which seriously impair the delivery of professional care to patients or clients.”

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Significant liability, fines and/or restrictions or loss of the physician’s professional license can result. In states such as California, Texas and Washington, D.C., patient abandonment is addressed in the medical malpractice laws, and significant liability may result if the physician abandons a patient without sufficient notice in advance of termination and injury results.

While some jurisdictions require a specific amount of time for providing notice to the patient, others simply allude to “reasonable” notice. In the absence of a specific legal notice period, 30 days generally is considered a reasonable amount of time to provide adequate notice to the patient in advance of termination.

The physician also should check his or her managed care contracts, which may include specific requirements concerning the termination of covered patients.

Most importantly, during the “notice” period, the physician must continue treating the patient and remain available for office visits.

NEXT: Practical tips to protect physicians from accusations of patient abandonment

Practical tips

The following strategies can help protect physicians from liability and accusations of patient abandonment:

• Provide written notice

The physician should issue a written termination letter to the patient prior to the effective date of termination. The letter should clearly state a termination date (we suggest 30 days in advance) and the reason for termination.

• Include a list of suitable alternative providers

We suggest that the letter also contain a list of alternative healthcare providers in the area and if appropriate, referral to the patient’s insurance network.

In addition, physicians can provide the patient with contact information from the local and state medical societies, which can be resources for finding a provider that fits their needs.

• Time the termination properly

Avoid withdrawing from treating the patient when the patient is in medical crisis, unless the patient requires the services of a different specialist and arrangements are made for transferring the patient's care to such specialist.

Continue providing effective treatment during the intermediate period following issuance of the termination letter and prior to the effective date of termination. Advise your office staff members that the patient is still welcome to schedule an office visit and/or arrange for services before the effective date of termination.

• Examine managed care contracts and communicate with health plans

If you are a participating provider in a managed care network in which the patient is covered, review the managed care agreement for specifications concerning termination of the physician-patient relationship. Some managed care contracts contain language requiring suitable justification for termination as well as specific notice requirements.

Related:Firing a patient: when it's needed and how physicians can handle it

The best strategy is to contact the payer, explain the situation, and ensure everything is done properly per the contract to prevent problems later.

• Provide access to medical records

Offer to send a copy of the discharged patient’s medical records to the patient’s new doctor. Numerous states have laws which require that records not be withheld solely because of a patient’s inability or refusal to pay.

• Communicate with everyone else in the practice

Be sure to apprise all physicians and office staff members of the termination to avoid inadvertent reestablishment of the physician-patient relationship.

For example, a receptionist or appointment scheduler who is unaware that a patient has been issued a withdrawal letter might schedule a new appointment for that patient following the termination date. In some jurisdictions, this has been construed as renewing the physician-patient relationship, regardless of whether such a result was intended.

Finally, the treating physician should always be the one who makes the determination to terminate the physician-patient relationship rather than another staff member. By remaining personally involved, the physician can ensure that all of the above concerns are addressed appropriately.

Eve Green Koopersmith, JD, is a partner, and Samantha N. Tomey, JD, is an associate with Garfunkel Wild, P.C., in Great Neck, New York. Send your legal questions to [email protected].