Successfully Terminate a Patient and Avoid Abandonment Lawsuit

While it may seem a little unfair, patients can switch providers—no questions asked—with nothing more than a call to your practice asking to have records transferred.

Unfortunately, when you’re the one making the split, terminating a patient-physician relationship isn’t so cut and dry—think abandonment lawsuit and medical malpractice.

Before You Terminate a Patient…

There are a number of legitimate reasons why you might need or want to terminate a patient. Unfortunately, this could lead to abandonment accusations which, in some states, can land you in a medical malpractice lawsuit! So before you call it quits, see if there is an alternative you can offer the patient, instead.

Here are some situations that might make you want to terminate the patient — and an alternative to consider:

Relocation: If your practice is closing or relocating or if you as a physician are leaving for another practice, logistics may make it difficult to continue the patient-physician relationship. Instead, offer your patient the option to see you at the new location, but express your trust and confidence in the physician to whom you’re referring patients.
Insurance Change: If you are leaving a particular payer or insurance network, it might make more sense for your patient to find an in-network provider. Consider extending your patient the option to continue on as self pay.
Difficult Patient: If your patient is rude or disruptive, abusive towards your staff, non-compliant in their treatment, aggressively seeks prescriptions, or flat out doesn’t show up to appointments, it would benefit your practice to not see this patient any longer. Communicate to the patient what they are doing is jeopardizing your patient-physician relationship and give them an opportunity to change their behavior.

Heed Caution When Terminating These Patients

Some patients will land you in legal hot water quicker than others just due to the nature of their medical status or the overall situation. These are the patients you should avoid terminating at all costs:

Urgent or Acute Treatment: Patients with mental health, substance abuse, trauma, pregnancy, post-op surgical patients
Limited Care: Patients who require highly specialized care that they can’t receive elsewhere, isolated rural areas where there aren’t other physicians nearby
Insurer Unavailability: Patients who have payer restrictions such as being on Medicare or Medicaid and you’re the only participating provider in your area, patient has an unpaid balance but is otherwise in good standing
Protected Class: Patients who have HIV/AIDS status, are disabled (unless the disability treatment is beyond your skill or expertise)

If you must terminate a patient in one of these categories:

Check State Rules: Make sure you know your state laws on patient records, patient termination, and patient abandonment
Engage Counsel: Contact your state medical association or board, malpractice insurer, and an attorney. You may not be able to avoid an abandonment claim, but you can do your best to minimize costs and fall-out.

3 Tips to Successfully Terminate a Patient

When you terminate a patient, there are a few simple things you can do to protect yourself from abandonment accusations and litigation that could follow.

Document Everything. Do what you can to salvage the relationship before terminating it, but document all interactions with your patient, including phone calls and emails. For example, if the patient is non-compliant, write a detailed letter explaining why non-compliance harms patient health, and ask the patient to be compliant. Then, keep a copy of the letter in the patient’s medical record so you will have it as proof that you did your due diligence. If you have a patient who isn’t following the treatment plan that you set up for them, counsel the patient with a witness present and document this in the patient’s chart. When you mail the termination letter, document that in the patient’s chart. This documentation will back you up if you ever face charges or fines.
Send Notification. Notify the patient with a simple, straightforward letter that you are ending the relationship, and give the patient at least 30-days notice. Use your practice letterhead, date the letter, and if your state medical board or association has a sample letter, use one of those. Keep it generic, don’t get into a lengthy explanation, but be sure to tell the patient how long they have to arrange for a new physician and when your contract with them officially expires. Send the letter certified mail and via email with a return receipt in the patient’s chart. You can also provide a referral to other physicians and offer your assistance in the transfer process.
Continue Care. Offer to copy and transfer records to a new physician, and follow up on this task promptly. In most states the patient data belongs to the patient, so be sure to include a release authorization with your termination letter. During the notice period, be sure to continue to provide care for the patient such as medication refills, helping them understand any diagnostic test reports, order labs or imaging as needed, and continue to provide referrals for further testing or treatment.

For more steps that you must employ to avoid being accused of abandonment when you end a patient relationship, sign up for the online training by healthcare attorney and educator, Heidi Kocher, BS, MBA, JD, CHC.