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Termination of
Physician/Patient Relationship
Medical-Legal Guidelines
This
document has been prepared to assist LSMS members when they want to
terminate their relationship with a patient. The information
presented in this document should be considered to be in the form of
guidelines only. The document is presented with the express
understanding that neither the LSMS or its attorneys are providing
legal advice.
Under
most circumstances, the physician has the right to terminate the
physician/ patient relationship, so long as the patient is notified
in person and in writing and is given sufficient time to engage the
services of another physician. The legal theory of abandonment
of a patient by a physician is not very well developed or defined in
Louisiana, so we must look to the common law theory of abandonment
and medical ethics for guidance on this issue. The theory of
abandonment and medical ethics require that once a patient engages a
physician, that physician is under an obligation to provide the
patient with continuous care and attention until the relationship is
properly terminated. Neither the theory of abandonment nor
medical ethics require a physician to continue the relationship if,
for example: the patient is consistently non-compliant; the patient
refuses treatment that the physicians deems necessary; the
physician believes that there is nothing more he or she can do for
the patient; if the patient refuses to pay for services rendered; or
if the physician believes that the patient is diverting or abusing
controlled substances. There are numerous other reasons that a
physician may choose to take this action. A physician is not
required to offer or provide medically inappropriate treatment to a
demanding patient, or required to continue to treat a patient who
will not follow medical advice.
Once the physician/patient relationship is initiated, the physician
may terminate the relationship, either by acquiring the written
consent of the patient or by giving reasonable notice to the
patient. The physician must give the patient a reasonable
amount of time to establish a relationship with another physician
before the relationship is terminated.
If
the physician decides to terminate the physician/patient
relationship, he must carefully document the entire process in the
patient’s medical record. The first step is for the
physician to notify the patient or the patient’s legal guardian,
in person if possible, of his or her intent to terminate the
relationship and to explain the reasons for the decision. This
explanation should be very matter of fact and unemotional.
During this conversation, the physician should give the patient a
time limit of at least 60 days to find another physician and agree
to continue care and/or treatment for at least that time period.
You may need to extend the time period if the patient is unable to
procure the services of another competent physician. The
important thing to remember is that there should be no break in
medical attention between physicians. Be sure to let the
patient know that you will continue to see them on an emergency
basis until they are under the care of another physician.
During this initial termination conversation, the physician can
offer to refer the patient to other competent physicians who may
agree to continue the care and/or
treatment
of the patient. Offer to provide the new physician with a copy of the
patient medical records. It is probably a good idea to provide a
copy of the records free of charge to the patient or new physician.
The physician should confirm this initial conversation with the
patient or the patient’s legal guardian and in a letter detailing
the entire conversation. The letter should be sent to the
patient or the patient’s legal guardian by certified mail, return
receipt requested and by regular mail. A copy of this letter
should be placed in the patient’s medical record. This letter
should include the following information:
1)
That the physician intends to sever the physician/patient
relationship;
2)
The reasons for the termination (the tone of this explanation should
be matter of fact and cordial);
3)
The date upon which the physician/patient relationship will terminate
(see discussion below on how to determine what constitutes a
reasonable time period);
4)
That the patient should immediately find another competent physician
to provide continued medical care and/or treatment and that referrals
will be provided by the physician upon request;
5)
That the physician will make a copy of the patient’s medical records
available to the new physician and/or to the patient;
6)
The physician will continue to see and treat the patient until the
termination date given above; and,
7)
The physician will continue to provide emergency care until the
patient engages the services of another physician (the physician
should define “emergency care,” if possible).
One of the hardest decisions to make is how much time to give the
patient to find another physician. The physician should consider
the following factors when deciding what a reasonable time period
would be with a particular patient:
1) The seriousness of the patient’s condition or disease;
2)
The stage of the current course of treatment; and,
3)
The availability of comparable medical care or treatment.
4)
The patient’s mental health status and their ability to understand
the information they are given.
As a general rule, the physician should give the patient at least 45
days notice before he terminates the relationship and discontinues
non-emergency care and/or treatment. To avoid a claim of abandonment,
it is recommended that the physician continue to treat the patient on
an emergency basis until the patient finds a new physician, even if
the termination date has already passed.
Please
feel free to contact the LSMS Department of Legal Affairs if you need
further assistance.
Disclaimer
This information is
provided for informational purposes only and with the express
understanding that 1) no attorney-client relationship exists or is
created hereby, and (2) Neither the LSMS nor its attorneys are engaged
in providing legal advice.
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