How to Properly Disengage a Patient: Abandonment Issues for Physicians

PRESCRIPTION OF THE MONTH

Charles Malmquist,
CPCU, ARM, AAI

770.912.1201

Paul Tuggle, CPCU

770.913.1208

Ron Cuen
770.912.1204

John Lowden

770.913.1209

Kevin Chojnacki
770.913.1213

Is it Time?
At some point in your practice, you will be faced with a patient who creates issues for doctors, staff, or other patients. In some cases, you may be forced to consider terminating the physician-patient relationship. For example, a patient may fail to understand or accept your practice purpose or refuse to follow a recommended program of care. A patient may make sexual advances toward the staff or display other antagonistic or disruptive behavior. Perhaps more common, they may have numerous missed or cancelled appointments or non-payment of a bill and other billing disputes. If a patient, or a patient's family member, has threatened a claim or suit, this too may be a time you question disengaging your services.

What's the Risk?
While there may be moral and ethical considerations involved in disengaging a patient, it is the legal obligation to treat that is being addressed in this Prescription of the Month series of "Abandonment Issues." After establishing a relationship with a patient, a physician has an obligation to continue treating the patient until: 1. the patient's condition no longer warrants treatment;
2. the physician and the patient mutually agree to discontinue treatment by the physician; or 3. The patient discharges the physician. Otherwise, the doctor-patient relation may be presumed to continue, which can mean continued vulnerability long after a patient has stopped coming to your office.

In some cases, disengaging your service can help a situation; in others, it can make it worse. According to Medical Protective's VP of Clinical Risk Management, Theresa Essick,"the Clinical Risk Management team at Medical Protective gets numerous phone calls each month related to discharging a patient from the medical practice. When effective communication efforts have failed, the practice should clearly evaluate options for the patient and their organization. Hopefully at the very start of the physician- patient relationship the practice has informed the patient that non-compliance with their treatment plan can lead to discharging them from the practice. Lack of cooperation can increase risk, thus increasing the doctor's liability." Each situation is going to be different, so it is very important to carefully consider your options, and to consult your insurance carrier and their risk management/ claims department before making any decision.

What Should We Do?
However, a physician does have the absolute right to withdraw from providing care to a patient, provided that they have taken appropriate measures to fulfill all contractual agreements or statutory requirements. Failing to do so leaves a physician open to the malpractice liability exposure or for a board complaint of abandonment, occurring when a patient alleges that they have suffered injury because of terminated services without sufficient notice. A physician must be careful to take very specific steps to withdraw from treatment in order to protect themselves and the practice against claims of abandonment.

1. Establish practice policies regarding patient behavior. Clearly inform all patients, verbally and/or in writing, of your right to terminate the doctor-patient relationship if the patient fails to abide by the practice policies. Cover specific problem areas such as missing a set number of appointments in a row, canceling a certain number of appointments within a specified time frame, or failure to pay for services. If a patient violates the policies, first try to resolve the conflict amicably by discussing the situation, noting discussions verbatim in the patient files. Having written office policies will also help avoid any perception of discrimination against certain patients as well. It is important to remember that you cannot terminate a patient solely on the basis of disability, race, color, creed, ethnicity, gender or age: all patients must be treated in the same manner, and the criteria for terminating a patient applies equally to all patients.

2. Consider the patient's medical condition before severing the physician-patient
relationship. Are they in the midst of a medical crises? Will a severance in the
relationship result in a break in the continuity of care, which in and of itself, could
unfavorably impact the patient's condition? If either answer is 'yes,' severing the
relationship at this time causes a risk not only to the patient, ... PAGE 2

How to Properly Disengage a Patient:
Abandonment Issues, Part I of III

May 2010

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The information contained above is intended to be illustrative and discusses general insurance issues. It is not designed to give any specific legal advice pertaining to any specific circumstance. It is not intended as a policy of insurance, binder, or state of coverage or as an amendment, modification or waiver of the terms and conditions of any policy of insurance. In every instance, a policy is the only accepted statement of coverage, and it is important to read and understand your policy. Contact your agent if you have questions regarding your coverage.

All original content 2010 Potter-Holden & Company. No content may be copied, reproduced, published, and/or distributed without the express permission of Potter-Holden & Company.