The article discusses the concept of patient abandonment, defined as the unilateral severance of the physician-patient relationship by the physician, without giving the patient sufficient advance notice to obtain the services of another practitioner. Patient abandonment can result in significant liability, fines, and/or restrictions or loss of the physician’s professional license.
What about the patient?
Pain Contracts are designed to allow doctors to abandon patients, a dangerous practice that is normally forbidden due to the potential devastating harm to patients.
The protection offered by these reasonable rules, followed by all others in the medical professions, is stripped away by the Pain Contracts patients are forced to sign in order to get treatment.
While doctors should not be forced to treat patients who are lying to get drugs, they should not be allowed to simply abandon patients who have come to them and clearly need some kind of help.
When a patient is suspected of lying to get drugs, there are two possibilities:
- The patient is lying, but since they’ve already been started on opioid therapy (even under false pretext), a physical dependency and probably addiction will have developed. These patients need a taper of opioids and additional care for their drug problem.
- The patient is telling the truth, and needs opioids to control their pain in addition to preventing withdrawals.
In either case, simply throwing the patient out into the street is denying them medically necessary treatments, either for pain or for phychological/addiction issues.
While a doctor may discharge a patient for any nondiscriminatory reason, termination is not without pitfalls. Physicians should follow a careful process so as to avoid claims of patient abandonment.
Unless they are treating pain patients, in which case their “Pain Contract” absolves them of all responsibility.
What defines patient abandonment?
In New York, for example, the following is considered professional misconduct: “Abandoning or neglecting a patient under and in need of immediate professional care, without making reasonable arrangements for the continuation of such care, or abandoning a professional employment by a group practice, hospital clinic or other healthcare facility, without reasonable notice and under circumstances which seriously impair the delivery of professional care to patients or clients.”
Significant liability, fines and/or restrictions or loss of the physician’s professional license can result. In states such as California, Texas and Washington, D.C., patient abandonment is addressed in the medical malpractice laws, and significant liability may result if the physician abandons a patient without sufficient notice in advance of termination and injury results.
While some jurisdictions require a specific amount of time for providing notice to the patient, others simply allude to “reasonable” notice.
Most importantly, during the “notice” period, the physician must continue treating the patient and remain available for office visits.
- Provide written notice – The physician should issue a written termination letter to the patient prior to the effective date of termination. The letter should clearly state a termination date (we suggest 30 days in advance) and the reason for termination.
- Include a list of suitable alternative providers
- Time the termination properly – Avoid withdrawing from treating the patient when the patient is in medical crisis, unless the patient requires the services of a different specialist and arrangements are made for transferring the patient’s care to such specialist.
- Examine managed care contracts and communicate with health plans
- Provide access to medical records
- Communicate with everyone else in the practice – Be sure to apprise all physicians and office staff members of the termination to avoid inadvertent reestablishment of the physician-patient relationship.