This final part of the ’Abandonment Issues” series will discuss three additional circumstances a physician may face that could lead to allegations of abandonment. Once a physician has provided care to a patient, they have a duty not to abandon the patient. A physician cannot unilaterally terminate the patient-physician relationship and/or refuse to continue treating the patient unless he or she arranges for care by another physician or gives the patient a reasonable time to find substitute care. It is important to take precautions if you choose to disengage your service (part I of this series) or when you are going to be out of the office (part II of this series). However, some other common changes in the life of your practice can expose you to abandonment allegations as well. The same general guidelines outlined in Part I and II of this series apply to the following situations that threaten to disturb a continuity of care. In each case,proper steps should be taken to communicate with patients and provide sufficient notice of the change.

Departing from a Managed Care Plan
If your practice is making changes in health care plan provisions or provider agreements, it is important to notify any patients affected by the departure from their plan. In order to help avoid any allegations of abandonment, provide adequate advance notice to allow affected patients to transfer their care, if necessary, without a break in the continuity of care where their wellbeing could be compromised. This is particularly important for those medial specialties where alternate physicians are limited, or where time frames in securing an initial appointment are challenging. You want to make sure to follow other timelines or guidelines dictated by the health care contracts themselves. Your attorney and insurance carrier’s risk manager can be good resources at this time.

Closing the Practice
Closing a medical practice requires thorough planning to ensure that there is no interruption in patient care or breach of contract obligations. Since closing a practice is a permanent change, a more formal process is necessary. A notice to your patients about closing your office should include at a minimum the following items in order to reduce your risk: the importance of continuing medical care, information about acquiring a copy of the medical record, the date of final closure, and method(s) for referrals (usually the local medical society). Closing a practice can be a stressful time, but it is important to talk to your agent or carrier to ensure that you are taking the necessary steps to protect yourself after your business stops providing care.

Selling the Practice
The sale of a medical practice may require many of the same notification requirements as closing a practice. Generally, the primary regulatory issue is access by patients to their medical records. However, from a liability standpoint, the primary issue is the risk of abandonment. Both areas can be avoided by providing appropriate notification. Prepare a list of all patients in the midst of diagnostic work-up and bring these to the attention of the buyer(s). Ensure that all outstanding labs and reports are brought to the attention of the buyer or physician to whom patient care has or will be transferred.

If your practice is going through one of these changes, or a similar change, it is always wise to seek legal and risk management guidance. Preparation, proper notification, and documentation work to alleviate the risks you face. Keep in mind that most of the changes made in your practice also involve a change on the part of one or more of your insurance policies, so it is important to contact your agent when considering or making a change.