Patient Abandonment
WHAT DOES THE LAW REQUIRE TO AVOID “PATIENT ABANDONMENT”?
AM I PERMITTED TO DROP A PATIENT?
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HOW DO I AVOID ABANDONMENT PROBLEMS WHEN CLOSING MY PRACTICE?
THE MEDICAL PRACTICE ACT AND PATIENT ABANDONMENT
The Medical Practice Act simply states that “abandonment of a patient” is grounds for discipline of a license. Although it is well-settled that all physicians have a duty to continue care for their established patients and not to abandon them, the Act does not define “abandonment.” Therefore, professional standards of care will apply when dropping patients.
For physicians seeking general guidance about dropping patients, professional societies may provide useful standards in their codes of ethics. In individual cases where a patient complaint for abandonment leads to a hearing for monetary damages or license discipline, expert witnesses will be used to review the facts, establish the standard of care, and assess whether the physician’s conduct constituted abandonment in that particular case. No one rule fits all cases, and standards vary based on the nature and location of a physician’s practice, as well as the timing of a physician-patient termination. Physicians are expected to use good professional judgment and conduct themselves as would a “reasonably prudent” physician in similar circumstances.
WHEN IS IT ACCEPTABLE TO DROP A PATIENT?
Situations may arise in which the physician may no longer be able to serve the best interests of the patient or where the patient’s behavior warrants terminating the relationship. It is possible to ethically drop a patient.
Some circumstances that might warrant discharge include: repeated failure to follow advice, chronic missed appointments, inappropriate behavior, including physical advances or significant disruption of the office, and non-payment of fees (see caveat at end of paragraph). Discharge may be permitted if it is done with sufficient notice to the patient and does not interrupt care in a way that would cause immediate harm to the patient, thus avoiding abandonment. It may be necessary to delay discharging a non-paying patient who is under acute care to permit the patient to find another treater.
Case Law on Patient Termination and Abandonment
Illinois higher courts have considered only one case involving abandonment. In that case, the physician failed to timely attend to his patient who was in the emergency room. However, the state did not present an expert witness, so no breach of standard was established as Illinois precedent.
Court cases in other states have said that abandonment occurs when the relationship between physician and patient is terminated either at a time that negatively impacts the patient (during acute care) or without allowing the patient enough time to find a replacement. To avoid abandonment, a physician must notify the patient with adequate time to seek care elsewhere.
The Notice
Any discharge should be put in writing and sent by certified mail or other trackable carrier to the patient’s last known address. Under normal circumstances where the patient does not require immediate medical attention, the physician should allow at least 30 days for the termination to become effective and should include the reasons for discharge, as well as a statement that it is in the best interests of the patient to seek care from another provider. If the patient seeks the terminating physician’s care within the 30-day period, the physician needs to evaluate the urgency of the patient’s condition and other facts to determine whether to treat the patient or proactively arrange for alternative care. In all cases, it is good practice to provide the name of another practitioner or a referral service (such as a county health department), as well as a recommendation that the patient follow up on his or her care. The physician should also include an explanation of how the patient may request and obtain copies of records or have them transferred to a new physician.
CLOSING A PRACTICE
In the event of closure of a practice, the physician is required by law to provide the public with at least 30 days’ prior notice of the closure of the facility or the health care practitioner’s practice. The notice must include an explanation of how copies of the facility’s records may be accessed by patients. The notice may be given by publication in a newspaper of general circulation in the area in which the health care facility or health care practitioner is located.
