No matter how well a medical practice is ran, circumstances will eventually arise where you will need to terminate a relationship with a patient. Maybe it is the patient’s behavior, or maybe it is an innocent circumstance beyond anyone’s control, but sometimes the patient and the practice simply have to part ways. The problem is that if you end a patient relationship abruptly without proper cause and preparation, it can lead to claims of patient abandonment. Still, fear of accusations and litigation should not keep you from doing what is right for your practice and your patient.
For abandonment to be claimed, there must be a clearly established relationship between the patient and the practice to begin with. The American Medical Association (AMA) suggests that three other basic conditions must exist to create patient abandonment:
•The termination is not a mutual decision between patient and practice.
•The termination took place without reasonable notice (suggested by the AMA to be at least 30 days).
•The patient is still in need of care after the termination takes place.
Reasons for Dismissing a Patient
There are several legitimate reasons for ending a relationship with a patient. It is vitally important in preventing claims of patient abandonment to make sure that the reason for the termination is legitimate and non-discriminatory. Some legitimate reasons for termination include:
•Patient’s non-compliance with prescribed tests or treatments.
•Patient is abusive or threatening towards clinical staff.
•Patient makes unreasonable demands of clinical staff.
•Patient does not pay for services.
•Patient misses appointments without notification.
•Relocation of practice.
•Retirement or departure of primary care provider at practice.
Steps to Prevent Patient Abandonment
There are a few basic tactics that can be used to reduce the likelihood that a patient can make a claim of abandonment:
•Create a patient termination policy and share it with patients early in the relationship, preferably at first contact.
•Accurately document every patient interaction with meticulous detail.
•Make an effort to determine the cause of the problems in the patient’s interaction with the practice and make a reasonable effort to resolve it.
•Discuss the situation with the patient before making a final decision about terminating the relationship.
•Before termination takes place, send a letter that expresses your concerns in a productive, professional and gentle way to the patient.
•Consult a colleague, legal advisor or risk-management professional about the situation.
•Speak with the patient directly and inform them that they are being terminated from care. Give a detailed reason.
•Inform staff at the practice of the termination.
•Officially notify both the patient and their insurance carrier through a certified letter with return receipt of the termination. State clearly that care will be discontinued in thirty days.
•Offer interim care to the patient.
•If you are able to do so (depending on your own policy and local laws), suggest potential alternate care providers to the patient and provide the patient with names and contact information for them.
•Inform the patient that you will transfer records to the practice of their choice when they give you written permission to do so.
It’s never easy to end a relationship of any kind, and the relationship between a patient and a health care practice is no exception. In this litigious society, a claim of patient abandonment can easily blossom into a costly lawsuit, so health care providers need to do what they can to protect themselves. By making sure that there is proper cause for the termination of a relationship and following the basic steps to be sure that the termination is handled fairly and professionally, a practice can reduce the risk of lawsuits or other unpleasantness that can arise from patients who feel abandoned.
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