The short answer is “yes,” a doctor may terminate a patient-physician relationship. The American Medical Association has addressed the proper patient-physician termination process in its Code of Medical Ethics:
AMA Code of Medical Ethics
1.1.5 Terminating a Patient-Physician Relationship
Physicians’ fiduciary responsibility to patients entails an obligation to support continuity of care for their patients. At the beginning of patient-physician relationship, the physician should alert the patient to any foreseeable impediments to continuity of care.
When considering withdrawing from a case, physicians must:
(a) Notify the patient (or authorized decision maker) long enough in advance to permit the patient to secure another physician.
(b) Facilitate transfer of care when appropriate.
The American Medical Association, Office of the General Counsel, offers the following suggestions when terminating a patient-physician relationship:
- Provide the patient with written notice, preferably by certified mail, return receipt requested;
- Provide the patient with a brief but valid explanation for terminating the relationship (for example, non-compliance, over-demanding or threatening);
- Agree to continue care or emergency care for at least 30 days, to allow a patient the opportunity to secure another physician. In some instances, it may be necessary to slowly reduce a particular medication to avoid withdrawal or negative medical consequences;
- Provide resources and/or specific recommendations to help a patient locate another physician of a like specialty;
- Offer to transfer records to a newly designated physician upon signed authorization to do so.
The Doctors Company offers the following advice to its doctor-insureds regarding termination of the patient-physician relationship:
If efforts to rehabilitate the relationship are not appropriate or are unsuccessful, it is generally appropriate to end a relationship under the following circumstances:
Treatment nonadherence: The patient does not follow the treatment plan or the terms of a pain management contract or discontinues medication or therapy regimens before completion.
Follow-up noncompliance: The patient repeatedly cancels follow-up visits or fails to keep scheduled appointments with practitioners or consultants.
Office policy noncompliance: The patient fails to observe office policies, such as those implemented for prescription refills or appointment cancellations, or refuses to adhere to mandated infection-control precautions.
Verbal abuse or violence: The patient, a family member, or a third-party caregiver is rude, uses disparaging or demeaning language, or sexually harasses office personnel or other patients, visitors, or vendors; exhibits violent or irrational behavior; makes threats of physical harm; or uses anger to jeopardize the safety and well-being of anyone present in the office.
Display of firearms or weapons: The patient, a family member, or a third-party caregiver threatens practice operations by wielding a firearm or weapon on the premises. Office staff may need to contact law enforcement promptly for support to help ensure that the situation does not escalate.
Inappropriate or criminal conduct: The patient exhibits inappropriate sexual behavior toward practitioners or staff or participates in drug diversion, theft, or other criminal conduct involving the practice.
Nonpayment: The patient owes a backlog of bills and has declined to work with the office to establish a payment plan or has discontinued making payments that had been agreed previously.
Exceptions and Special Circumstances
A number of circumstances may require additional steps or a delay before ending the patient relationship. Examples include the following situations:
- If the patient is in an acute phase of treatment, delay ending the relationship until the acute phase has passed. For example, if the patient is in the immediate postoperative stage or is in the process of a diagnostic workup, it is not advisable to terminate the relationship.
- If the practitioner is the only source of medical or dental care within a reasonable driving distance, care may need to continue until other arrangements can be made.
- When the practitioner is the only source of specialized medical or dental care, treatment may need to continue until the patient can be safely transferred to another practitioner who is able to provide appropriate care and follow-up.
- If the patient is a member of a prepaid health plan, the practitioner must communicate with the third-party payer to request the patient’s transfer to another practitioner or otherwise comply with the specific terms of the payer-practitioner agreement.
- If a patient is pregnant. During the first trimester: End the relationship only if it is an uncomplicated pregnancy and the patient has time to find another practitioner. During the second trimester: only for uncomplicated pregnancies and only if the patient transfers to another practitioner prior to cessation of services. During the third trimester: only under extreme circumstances, such as illness of the practitioner. Effect a safe transition by working with the risk manager of the facility where delivery is scheduled. Provide timely and accurate documentation in the medical record of the situation.
Certain situations prohibit patient dismissal:
- Patients may not be dismissed or discriminated against based on limited English proficiency or status within a protected category under federal or state legislation, including race, color, national origin, sex, disability, and age. Examples of laws prohibiting discrimination—which carry significant civil and administrative penalties for violations—include the Americans with Disabilities Act (ADA), the Civil Rights Act, and the Affordable Care Act. (The Department of Health and Human Services outlines requirements for practitioners regarding nondiscrimination policies and notices.)
- A patient’s disability cannot be the reason for terminating the relationship unless the patient requires care or treatment for the particular disability that is outside the expertise of the practitioner. Transferring care to a specialist who provides the particular care is a better and safer approach.
Patient Abandonment
Patient abandonment is considered a breach of duty and is defined as unilateral termination of the physician-patient relationship without providing adequate notice for the patient to obtain substitute medical care. The patient-physician relationship must have been established for abandonment to occur. This patient-physician relationship becomes established when a physician affirmatively acts in a patient’s care through the patient’s diagnosis or treatment. This relationship is also established if the physician agrees to diagnose or treat the patient.
In general, in order to prove patient abandonment, the patient must show the existence of the patient-physician relationship, that the patient-physician relationship was terminated, that the relationship was terminated without the patient’s consent or desire or without the patient’s knowledge, that the termination was unreasonable, that the physician did not refer the patient to another health care provider or arrange for other appropriate care, that the physician ended the relationship at a critical stage in the patient’s treatment without good reason or sufficient notice to allow a patient to find another physician, and that the patient was injured (harmed) as a result.
If you or a family member may have been wrongfully abandoned by a health care provider and harm (injuries) was suffered as a result, you should promptly find a medical malpractice attorney in your state who may investigate your patient abandonment claim for you and represent you or your family member in a patient abandonment lawsuit, if appropriate.
Visit our website or telephone us toll-free in the United States at 800-295-3959 to be connected with medical malpractice lawyers in your state who may assist you with your patient abandonment medical malpractice claim.
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