Every practice experiences situations from time to time when they must terminate the physician-patient relationship. However, you can’t cut ties with even the most difficult patients until you first evaluate your legal obligations. In some cases, termination of the relationship is not a possibility due to medical credentialing or legal guidelines that require the provider to continue caring for the patient. And if you want to avoid a costly patient abandonment lawsuit, you must know the rules.
Check out these four instances when you cannot fire a patient if you want to avoid a patient abandonment lawsuit or a malpractice claim.
1. The Patient Won’t Find Adequate Care
If the patient won’t be able to find the same or adequate medical care within your specialty in a reasonable geographic area, it’s your responsibility to keep treating them. Instead of terminating the relationship, you should keep providing care for the patient until you’re sure there will be a proper transition to a qualified specialist who can offer them the same level of care that your practice does.
In some cases, this may require some detective work on your end. You might have to call other providers who say they have patient waiting lists and ask if they’d be willing to forego the wait list and allow your patient to transfer there. But whatever happens, you need to keep treating the patient until they find another option.
2. Termination Would Violate EMTALA
The Emergency Medical Treatment & Labor Act (EMTALA) laws require providers to provide a medical screening examination and stabilize/treat patients with an emergency medical condition, regardless of their ability to pay for care.
EMTALA violations can result in the loss of Medicare participation for the hospital and civil monetary penalties of up to $50,000 per violation (on top of patient abandonment lawsuit issues), so you must pay careful attention to these rules.
3. The Provider Doesn’t Have Proper Paperwork
Your practice must have appropriate records to support a properly executed termination. Before terminating, you must document your efforts to get the patient to comply with your practice requirements. So if that means they’ve been abusive to your staff or they haven’t been paying their bills, you have sent them warning letters, you’ve talked with family members, or you’ve had them sign documents demonstrating that they understand what they must do to stay with your practice.
If you haven’t given the patient any warnings in writing or you don’t think they understand the ramifications at hand, it’s likely not the right time to terminate the relationship.
4. The Provider Is Treating an Acute/Urgent Condition
If the provider is currently in the midst of treating an urgent or acute medical condition that requires uninterrupted care, you must continue the relationship until the patient is stabilized. This is also true for patients who are pregnant, are about to go into surgery, and who are in the middle of a multi-step treatment program (such as chemotherapy or prosthetic fitting). You should see the treatment through before releasing them from your practice.
If the Patient Has Filed a Complaint About You, They Aren’t Automatically Gone
If a patient has filed a complaint against your practice with the medical board, or even a malpractice action against you, that does not automatically terminate your relationship with them. You must still go through the standard termination process, issuing warnings that fit into the legal guidelines that your counsel has approved. And until you formally terminate the relationship, you must continue seeing the patient, or they can file a patient abandonment lawsuit on top of their current actions.
Consider These Alternatives
If you’re in one of the above situations and you’re unable to terminate a patient, you can send them a warning letter, a behavior modification agreement, or other document outlining the issues you have with them and asking them to change if they want to stay with your practice. You can also ask one of your partners or colleagues to see the patient, or recommend they pursue telehealth visits instead of in-person visits.
If needed, you can engage a social worker, patient family member or other support person to help explain the situation to the patient and witness the patient signing an agreement to change their behaviors if they want to stay with your practice.
At that point, it may be a good idea to engage legal counsel to navigate the potential next steps so you ensure that if you do eventually need to terminate a patient who’s in a delicate situation, you are legally dotting your I’s and crossing your T’s.
To learn more about terminating physician-patient relationships without running afoul of legal requirements, check out the 60-minute online training session, “Fire Your Patients Without a Costly Abandonment Lawsuit.” During the training session, attorneys Daphne Kackloudis and Ashley Watson will explain the steps you must pursue to fire patients without having to deal with legal accusations.
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