How to Appropriately Discharge a Patient

Are you a physician with a patient who no longer requires medical treatment? Do you have a patient you believe would be better served by another physician, specialist, or practice due to a developing condition? Do you want to terminate a patient relationship because it is costing more than it is worth to your practice?

Dealing with a burdensome or difficult physician–patient relationship can be frustrating and time consuming. But before you terminate the relationship and refuse to see a patient, you should review the essential guidelines below to ensure you are complying with law and to reduce exposure to medical malpractice or abandonment claims.

The Difficult Relationship

A difficult patient relationship can develop for a number of reasons. A patient may be unruly, uncooperative, disruptive or threatening. A patient may not be paying their bills in a timely manner. A patient may be taking up valuable time or resources from your team with unrealistic expectations or demands. A patient’s course of treatment may be complete. The first step in navigating how to end these types of relationships is to understand whether a physician–patient relationship exists.

If a physician–patient relationship exists, you cannot simply ignore the patient or tell them you will no longer treat them. You have a duty of care to the patient and must treat them or ensure the patient is being treated by another qualified physician. Therefore, it is important to determine whether a clear and direct relationship has been established with the patient.

Determining whether this type of relationship exists is often a question of fact. Courts look at many different factors, including the history of the interactions between the patient and physician, whether the patient has sought the physician’s medical advice in the past and whether the physician has offered treatment or care to the patient. If it appears that a patient has asked a physician for medical advice or treatment and the physician has offered that advice or treatment, a court will likely find that a relationship has been formed.

Act quickly and prudently after you decide to terminate a relationship with a patient to reduce the disruption to her and to protect yourself.

Appropriate and Ethical

If a relationship has been formed that you want to end, you must take the proper steps to eliminate any possible malpractice or abandonment claims. The first step is to notify the patient that you will no longer be treating him. Although laws vary by state, most statutes mandate a reasonable notification time period. To be safe, you should give the patient at least 30 days’ notice. This notice should be in writing and sent via certified mail so you can track whether the patient received the notification.

In the letter, don’t give too many details about why this relationship is ending. For example, the letter should not cite examples of when the patient was disruptive or state the patient has unrealistic expectations or demands. Instead, the letter should simply state that you will no longer be able to treat the individual and that the termination of the relationship will be effective 30 days from the date of the letter.

To reduce abandonment claims, if the patient requires further medical attention, you will want to stress the importance of selecting another physician as soon as possible. You may suggest the patient contact their insurance carrier or local medical society for recommendations. To ensure the patient does select another physician, we recommend including a release form in the certified letter for the patient to complete and return to your office so you know to whom the patient’s medical records should be forwarded. This will alleviate any doubt the patient has a new physician who can continue treatment.

Additional Considerations

It is important to act quickly and prudently after you decide to terminate a physician–patient relationship to reduce the disruption to the patient’s care and to protect yourself. Keep a file on the patient. Keep track of the dates you contacted them, including the dates the certified notification letter was mailed and when you receive the patient release. Make copies of all correspondence with the patient, and save them in the patient file.

Once directed to send medical records to the patient or another physician, send these records promptly. State statutes differ as to the specific amount of days a physician has to release requested medical records, so consult with an attorney or review the state statute as soon as you receive the request. If you are releasing the medical records to another physician, call the physician before you send the records and ask to whom the medical records should be addressed to avoid privacy concerns. Send records via certified mail so you can track that they are being sent properly and to whom they are delivered.

Train your receptionists, assistants and others who work in your office how to handle a call from a terminated patient. They should be polite and helpful, but not offer specific details about why the patient was terminated. Instead, they should simply refer the patient to the letter.

Although following these guidelines won’t eliminate the risk inherent in terminating a patient relationship, doing so will reduce the risk to you and your practice.

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Steven M. Harris, Esq., is a nationally recognized healthcare attorney and a member of the law firm McDonald Hopkins LLC. Contact him via email.