Physicians can fire patients, too
By Jeremy A. Wale, JD
The physician-patient relationship is created by mutual agreement between the physician and the patient. As such, the physician may terminate the relationship for any non-discriminatory reason. Valid reasons may include (but are not limited to) non-compliance with medical advice, combative or threatening behavior, or outstanding medical bills.
Patient non-compliance is one of the most common reasons for terminating the physician-patient relationship. Patients who routinely miss or cancel appointments or refuse to heed medical advice may be considered non-compliant.
Non-compliant patients might be your practice’s biggest liability risk. Patients are less likely to get better when they don’t comply with medical advice, placing them at higher risk for adverse outcomes. By properly terminating non-compliant patients, you may help reduce your risk of malpractice claims. It also is appropriate for practices to terminate hostile, aggressive, or verbally abusive patients.
Proper termination is important to help avoid a claim of patient abandonment. While the legal definition of abandonment varies from state to state, the following elements typically exist in a patient abandonment claim:
- Termination of a professional relationship between the physician and patient without good reason or at an unreasonable time;
- Termination occurred when the patient was in need of continuing medical care;
- The patient was not given reasonable notice sufficient to secure an alternate physician; and
- The patient was harmed as a result.[i]
The American Medical Association (AMA) summarizes your responsibility this way: once a physician-patient relationship exists, physicians are ethically obligated to place the patient’s welfare above all other considerations, including the physician’s own self-interest.[ii]
Once you've determined it’s prudent to terminate a patient from your practice, lower the risk of a patient’s claim of abandonment or malpractice by:
· Evaluating the patient’s condition and rendering stabilizing care, if needed. Avoid discharging a patient during treatment for an acute condition until the treatment is finished or the condition is resolved.
· When possible, discuss the termination and your reason(s) for termination with the patient. You may conduct the conversation via telephone or in person. We encourage the physician to have this conversation with the patient. Be sure to document this discussion in the patient’s medical record.
· Send a written letter to the patient confirming his or her termination from the practice. We suggest sending the letter by both regular mail and certified mail with return-receipt requested. If you choose to include the reason for termination in the letter, be sure you are objective and tactful in your choice of words. We suggest you include the following:
- A specified period of time during which you will continue to provide care. The AMA suggests at least 30 days’ notice; however, there is at least one state that requires at least 60 days’ notice. Review your state’s laws before you terminate a physician-patient relationship.
- A statement encouraging the patient to find another physician as quickly as possible.
- Referral services to aid the patient in finding another physician. These services may include the local medical society or the state board of medicine.
- Information on how the patient can get a copy of his or her medical record. You may want to consider including a release-of-records form to make this process easier.
- A signature. We encourage the terminating physician to personally sign the letter and retain a copy of the letter in the patient’s medical record.
We also encourage you to contact any third-party payer or managed care provider that may be involved in the patient’s care. Some third-party payers and managed care providers have specific contractual obligations you must follow prior to terminating one of their covered patients.
[i] American Medical Association. Ending the patient-physician relationship. 2013. Accessed August 25, 2014.
[ii] American Medical Association, Code of Medical Ethics Opinion 10.015.
Jeremy Wale is an attorney and Risk Resource Advisor with ProAssurance, a national provider of medical professional liability insurance and risk resource services.
Copyright © 2014 ProAssurance Corporation. Used by permission.