TERMINATION OF CARE: MINIMIZING RISKS TO THE PATIENT AND THE PROVIDER

The standard of care includes the legal duty to continue caring for your patients while they are in active treatment. In other words, care should never be terminated if it would leave the patient in a medically unstable condition. This is considered “abandonment.” Terminating patient care is a serious matter and should not be taken lightly. However, there are many situations that provide care givers both the legal and moral ability to release patients from their care:

1. Noncompliant patients. Patients who are non-compliant with their care are a big risk to you and to them. This includes patients who constantly miss their appointments and follow-up attempts, as well as to patients who do not seek medical tests that you prescribe, like chest x-rays, biopsies, colonoscopies, and other referrals you deem important. These people are putting themselves at risk - as well as you. Of course, you can continue to treat such patients; but if you do, make sure you document all your efforts to get patients rescheduled and to appropriate other care givers. Include what the patients say to you and your staff about why they choose not to comply. Should a lawsuit arise, you will want to show evidence that you did everything you could to make certain the patient knew of the risks of not complying with your suggested treatment.
2. Disruptive patients. There are some patients who are disruptive to those in your office. They might be loud, abusive, demanding, foul-mouthed, or disrespectful of you or your staff. When all attempts have been made to calm these patients and give them an opportunity to behave more appropriately, you can discharge them from your practice. Please let you staff know that such patients need to be brought to your attention and dealt with. Some patients who act appropriately with you, the physician, might be inappropriate with your staff. Please let your employees know that such behavior is unacceptable and that you will deal with these patients. Terminating care is never an easy decision, but sometimes a necessary one.
3. Patients with unrealistic expectations. Many patients feel that their medical treatment should be perfect and that you and your practice will cure all their ills. When patients profess these types of unrealistic expectations, you are at risk of never satisfying them, causing them to be disruptive, unhappy, and potentially litigious. It is sometimes endearing when patients put so much trust in their physicians, but this is dangerous and short-sighted.
4. Threatening patients. Patients who threaten lawsuits or other legal action against you or your practice can also be terminated from your care. Obviously, these people are not happy and use fear and intimidation to get their way. As stated above, if after attempts have been made to calm the patient and get to the root of the dissatisfaction, you still cannot get these patients to act appropriately, you should consider discharging them from your practice. You all work too hard to care for the myriad of patients in your practice to be made to feel fearful or threatened in any way.
5. Patients who are not paying their bills. It is very expensive to run a medical practice and all patients need to contribute what they owe. Patients who have not made their payments to you, after repeated attempts to contact them and make comfortable payment arrangements, are also patients you can consider terminating from your care.

HOW TO LEGALLY TERMINATE A PATIENT FROM YOUR CARE

Once you decide to terminate the care of a patient, you should contact the patient in writing that you and your office will no longer be providing care. Send two copies of the letter: one by certified mail, return receipt requested. If that letter is returned, put it unopened in the patient’s file. The second letter should be sent by standard first-class mail. Unless this one is returned, it is considered delivered.

Tell these patients that you will no longer be providing their care and that they have some appropriate time to find a new physician. Consider giving them 30-day’s notice, during which time you are available for emergencies only. Indicate a specific date. Tell them they can find a new physician of their choosing or contact the county medical society for a list of providers. Offer to forward copies of their records upon written request. Do not charge for these copies nor can you withhold records if patients owe you money. Let everyone in the practice know about this patient so staff can handle any calls and questions they may get. Establish a clear protocol for handling such calls, especially if these patients become angry or threatening.

Make sure your office documentation clearly indicates why the patient is being discharged from your practice and the steps you have taken. You do not need to give patients these reasons, however. Some practices do indicate in their letters that the patient is being discharged due to nonpayment or because they are noncompliant with important medical treatment. No other reasons should be given.

If you have any questions on who, when, or how to legally terminate a patient from your care, feel free to contact IND or your insurance broker for assistance.

IND offers three risk management programs per year, two in Las Vegas and one in Reno.  In addition, tailored programs are also held for nurses, administrators, and medical office staff.  Information regarding these programs can be found here:  http://www.ind-insurance.com/risk-management.  Please contact Idora Silver, IND Director of Risk Management, at (775) 829-0606 if you have any specific risk management questions or would like to consult with her on customizing a program specific to your needs.