How to Protect Your License When Terminating Doctor/Patient Relationship

Steps to Terminate the Relationship Ethically and Legally

The delicate process of terminating a patient-physician relationship requires both ethical consideration and strict adherence to legal protocols. At Unlock Legal, we’re committed to guiding professionals like you through these complexities. Here are the essential steps to ensure that the termination of your relationship with a patient is both ethical and legal:

  • Evaluate the Justification for Termination: Before taking any action, it’s vital to determine the reason for termination. Whether it’s due to repeated missed appointments, refusal of recommended care, or disruptive behavior, ensure that your rationale is clear and justified.
  • Continue Providing Care in the Interim: Until the termination process is formally completed, it’s your duty to ensure continuity of care. This includes addressing emergencies and providing necessary prescriptions.
  • Formal Written Notification: The termination process must be formally initiated through a written notification. This letter should clearly state:
    • The specific end date of care, ideally offering a notice period between 15 to 30 days.
    • Availability for emergency treatments until the specified end date.
    • Risks associated with discontinuing care or treatment.
    • The need for the patient to find another physician for continued care.
  • Use the Proper Channels for Communication: Send the letter via certified mail with a return receipt requested, and also by regular mail. If it’s returned unopened, retain it in the patient’s medical record. If the patient verbally indicates their desire to end the relationship, follow up in writing for clear documentation.
  •  Provide Assistance for Continuity of Care: Offer guidance to help the patient find a new healthcare provider. This could be a referral to another physician or providing contact information for a local physician referral service or insurance carrier.
  •  Include a Medical Record Release Form: Ease the transition for the patient by including a form that allows them to transfer their medical records to a new physician.
  •  Thorough Documentation: Every detail of the termination process, including the mode of communication and reasons for termination, should be meticulously documented in the patient’s medical record.
  • Be Mindful of Special Circumstances: If a patient is undergoing complex care or is in the midst of an acute illness episode, extra caution is needed. Only under rare circumstances should you consider termination during such critical periods.
  • Review Contractual Guidelines: Especially for patients part of health plans or HMOs, review any related contractual guidelines to ensure you’re not breaching any terms.

By following these steps with precision and empathy, you’ll ensure that the process is handled with the utmost professionalism and care. If you’re uncertain about any aspect or need expert guidance, Unlock Legal stands ready to assist. Our primary aim is to ensure that professionals navigate such critical junctures with clarity and confidence.

Voluntary or Involuntary Termination

Voluntary Grounds

These are situations where the choice is mutual or unrelated to the patient’s behavior. Common examples include:

  • Doctor’s Retirement: A physician may choose to retire, requiring patients to seek care elsewhere.
  • Relocation: The doctor might be moving to another city, state, or even country.
  • Change in Services: A physician or clinic may decide to specialize in different services or treatments and thus no longer offer the current care the patient requires.

Involuntary Grounds

Often more sensitive, these reasons stem from specific challenges or issues within the relationship:

  • Non-compliance: When a patient consistently fails to follow medical advice, treatment plans, or prescribed medications, endangering their health.
  • Missed Appointments: Frequent no-shows or last-minute cancellations can disrupt the doctor’s schedule and impede proper care.
  • Financial Reasons: Patients who repeatedly fail to pay for services rendered may face termination after multiple notifications.
  • Inappropriate Behavior: This can encompass a range of actions from aggressive behavior, verbal abuse, harassment, or any conduct that makes the healthcare environment unsafe or uncomfortable for staff and other patients.
  • Ethical or Personal Conflicts: Sometimes, differences in values, beliefs, or personal biases can strain the doctor/patient relationship. While medical professionals strive to maintain objectivity, there can be instances where it’s believed that a patient might receive better care elsewhere due to these differences.

Each ground for termination, whether voluntary or involuntary, requires a different approach, ensuring the doctor acts within legal and ethical boundaries. Moreover, understanding these reasons can provide clarity and a solid foundation when communicating the decision to the patient, reducing potential misunderstandings or conflicts.

Potential Pitfalls and How to Avoid Them When Terminating the Patient-Physician Relationship

Terminating a patient-physician relationship is a delicate process and, if not managed correctly, can lead to various complications. Both legal and ethical concerns arise. Here are some potential pitfalls that physicians might face, and guidance on how to sidestep them:

  • Accusations of Patient Abandonment: Always ensure the termination is done with ample notice. Typically, a notice period of 15-30 days is recommended. Provide emergency treatment and necessary prescriptions during this window. Moreover, don’t terminate during acute illness episodes unless in rare circumstances.
  • Inadequate Communication: Open communication is essential. Utilize certified mail for termination letters to ensure the patient receives the notice. If the patient verbally expresses their desire to terminate, follow up in writing to have a clear record.
  • Not Offering Referrals or Alternatives: It’s not just a courtesy but also an ethical practice to guide patients toward finding another care provider. Offer information like physician referral lines or direct them to their insurance carrier. Ensure patients understand the risks of discontinuing treatment.
  • Failure to Document the Termination Process: Document everything. From the initial reason for termination to the method of communication used, everything should be recorded. In cases where letters return unopened, they should be kept in the patient’s file as evidence of the attempt to communicate.
  • Breach of Contract: Especially relevant for patients under specific health plans or HMOs, always review contractual obligations before terminating a relationship to ensure there isn’t a breach.
  • Not Considering the Complexity of Care: If a patient has a complex medical history, offer a more extended notice period. This ensures they have enough time to find another physician who understands their unique needs.
  • Not Providing a Means to Transfer Medical Records: Patients have a right to their medical records. Always include a medical record release form when notifying of termination. This ensures a smooth transition to a new healthcare provider.

Take Care to Avoid Patient Abandonment

Patient abandonment is a form of medical malpractice that occurs when a healthcare provider severs the provider-patient relationship without reasonable notice or a reasonable excuse and fails to provide the patient with an opportunity to find a qualified replacement care provider. The essential elements often involve the unexcused termination of the relationship between the physician and the patient, a situation where ongoing care is still needed, and the patient is left without resources for continued care.

The Medical Board of California considers patient abandonment as unprofessional conduct. Physicians are obligated to inform patients in writing about the terms of discontinuing care and to provide reasonable time for patients to find alternative medical care. Failure to do so can result in legal ramifications, including disciplinary action by the Medical Board and potential civil liability.

The medical license defense attorneys at Unlock Legal, recognize that the decision to end a doctor/patient relationship isn’t taken lightly. The reasons for such terminations can be multifaceted, and understanding them is pivotal to ensuring both the physician’s and the patient’s rights are upheld.

Have You Been Accused of Patient Abandonment?

We at Unlock Legal have expertise to successfully negotiate settlements, and help fight penalties. We are always here to assist and guide you through any concerns or accusations that may arise. Contact us today to schedule a free consultation.

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