- 2005 Volume 2 Number 1 January - March
- Saying “Goodbye” To A Patient Without Saying “Hello” To A Lawsuit: A Primer On Patient Dismissal
Saying “Goodbye” To A Patient Without Saying “Hello” To A Lawsuit: A Primer On Patient Dismissal
Susan B. Collingwood, Esq. UF Associate General Counsel
Although infrequent, there can come a point in a physician-patient relationship when the physician, due to any number of good and sufficient reasons, no longer wishes to continue treating a patient. When done appropriately, ending the physician-patient relationship poses no liability risks; however, the practitioner must take care to ensure that he or she has not “abandoned” the patient. Be aware – poorly done patient dismissals lead to lawsuits!
The first thing to know is that when you wish to discharge a patient, you don’t have to go it alone – help is available! University of Florida Physicians has developed a Dismissal Policy that addresses the most common reasons for dismissing a patient. Clinic managers have access to the policy, which provides a standard letter template and sample language for the most common reasons for dismissal.1 The policy also details the steps that must be taken by clinic and Family Group Practice personnel for a patient dismissal. In addition, other template letters are available for situations where the patient has completed his or her course of treatment with the physician and the physician has nothing more to offer the patient. For circumstances where the need to dismiss is urgent (i.e., there are threats of violence against physicians or staff) or where the patient’s medical condition is serious or other factors make the physician or clinic manager concerned about the dismissal, help and guidance are always available from Kelly Kerr (Director, Faculty Practice Clinics, 265-7989) and from the Medical School Office of the General Counsel (392-3705). That said, the rest of this article explores in more detail some of the practical issues surrounding patient dismissal.
Patient dismissal can be risky, not only for litigation, but for public relations. Poor public relations can sometimes hurt us more than a lawsuit in terms of real dollars! In most cases, the clinic’s or physician’s first approach to the problem should be to try to talk things over and work things out with the patient. If that fails, then the process of dismissing the patient can begin. Patient dismissals should always be in writing.
Although the law does not require a physician to provide care to all patients under all circumstances, once a physician has undertaken care of a patient the physician generally must ensure that the manner of the termination of the relationship does not put the patient at greater risk of harm. Generally, this means giving the patient an adequate period to secure other care for their condition. While there is no hard and fast rule about what constitutes a reasonable time to find care, the AMA has recommended that patients be provided with 30 days of access to emergency care before dismissal is final. As a result, “30-days’ notice” has become the standard in the industry for most cases. Be aware that there may be some circumstances where a longer period is needed, while a shorter period (or none at all) may be justified if there is a concern that the patient may become violent and injure physicians, staff, or other patients.
Even when the 30-day provision of care has been met, if the patient has been unnecessarily confronted by angry staff or physicians, the patient may feel abused by the process – and those hurt feelings can prompt litigation. Patients’ memories or understanding of what is told to them can be incomplete. Thus, it is important that the dismissal be handled professionally, without undue emotion, and in a way that the patient cannot misunderstand. This generally means notifying the patient of the dismissal in writing, not in person.
Dismissal letters generally should simply stick to the facts that make the dismissal necessary and avoid emotionally laden language about those facts. In some cases, the letter will need to be “customized” from the forms – in those cases, legal review is appropriate before the letter is sent. Finally, to ensure that the patient receives the notice, it should be sent both by regular mail (which is presumed received) and by certified mail, return receipt requested which gives proof of receipt as long as the patient will sign for it.
In some cases, after a patient has received a letter dismissing them from the clinic or from the entire Faculty Group Practice, the patient will call wanting to discuss the dismissal. If the patient does not provide new information that makes the physician or clinic want to reconsider the dismissal, then the response should be short and nonargumentative, referring the patient to the letter and encouraging them to find other care for their condition (our standard form letter refers patients to the county medical society for assistance in locating a new physician). In rare cases, the dismissed patient may make repeated or abusive calls. There is no requirement to take these calls and, if they persist for a long period or constitute a serious disruption, you should consult with the legal office to determine if court action is appropriate to stop the harassment.
This article has discussed the broad concepts related to dismissing a patient from a physician’s care, but it is the specific, factual circumstances of the patient’s case and behavior that govern how we should approach the dismissal. The Faculty Practice Group and Office of the General Counsel are happy to assist in making the dismissal decision and process as risk-free as possible – call us!
1 excessive no-shows, failure to meet financial responsibilities, disruptive behavior, duplicate care from another physician that contradicts/harms our care, failure to comply after warning with the physician’s recommendations, breakdown in physician-patient relationship.