In some cases, such as the one described above, it might be appropriate for the therapist to call or otherwise contact the terminated patient, or ask the patient to communicate with the therapist, for the purpose of assuring that the patient is following through on needed treatment.
Full Answer
What does it mean when a patient does not follow treatment?
· It’s a situation Amy Nicole Cowan, MD, explored in a JAMA Internal Medicine essay, “ Inappropriate Behavior by Patients and Their Families—Call It Out .” In her commentary, she described an end-of-life situation for an elderly patient whose family members very vocally found fault with apparently everything, including the treatment team.
What happens when a doctor stops treating you?
· The reasons a healthcare provider may dismiss a patient are: 1. Patient non-compliance ( non-adherence): When the patient fails to follow the treatment recommendations established by the healthcare provider. (Which is why it is so important that you and your healthcare provider make treatment decisions together .)
When can a physician terminate a patient for inappropriate behavior?
· The 1991 passage of the federal Patient Self-Determination Act (PSDA) guaranteed that Americans could choose to refuse life-sustaining treatment at the end of life. 8 The PSDA also mandated nursing homes, home health agencies, and HMOs to provide patients with information regarding advance directives, including: Do not resuscitate (DNR) orders
Is it legal for a doctor to refuse a patient treatment?
Once a patient-physician relationship has begun, a physician is said to "abandon" a patient who still needs medical attention when the physician refuses to continue treating the patient (i.e., severs the physician-patient relationship) without giving the patient proper notice and an adequate amount of time to find another physician who can take over the patient's care.
What do you say when a patient is dismissed?
When the situation for dismissing the patient is appropriate, provide a formal written notice stating that you are withdrawing care and requiring the patient to find another practitioner. Mail the written notice to the patient by both first-class and certified mail with a return receipt requested.
What is defined as patient abandonment?
Definition/Introduction 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.
What is it called when a doctor refuses to treat a patient?
If you need urgent medical attention, and a doctor refuses to treat you, you can pursue a medical malpractice suit against the physician and/or the establishment they work for. This is especially true for doctors in hospitals and emergency rooms.
What are the legal steps a physician must follow to terminate the care of a patient in Florida?
In general, the physician-patient relationship can be terminated in two ways without creating liability for abandonment: 1) the physician ends the relationship after giving the patient notice, a reasonable opportunity to find substitute care and the information necessary to obtain the patient's medical records, or 2) ...
What is the difference between abandonment and negligence?
Both cases involve patient harm and deviating from the standard of care. However, abandonment and negligence are still two different types of malpractice claims. Abandonment essentially is the cessation of treatment, while negligence still involves treatment, but incorrect or inappropriate therapies.
Which of the following is considered abandonment of care?
Abandonment of care happened swiftly and abruptly: To truly be considered patient abandonment, the physician must have left or abandoned the patient so quickly, there was no time to look for and establish new care and treatment with an alternative care provider.
What should a nurse do when a patient refuses treatment?
If your patient refuses treatment or medication, your first responsibility is to make sure that he's been informed about the possible consequences of his decision in terms he can understand. If he doesn't speak or understand English well, arrange for a translator.
Can doctors say no to patients?
Doctors have a legitimate right of refusing a patient or say, choosing a patient, as per Medical Council of India rules 2.1. 1 (Rules of ethics, 2002 and as amended in 2016), he said.
Can a doctor refuse to treat a non compliant patient?
All decisions should be made jointly, including when and why the patient should return. A patient of course has the right to refuse any investigation or treatment as long as they have the capacity to do so. The reasons for such refusal should be explored if possible and clearly documented.
What the physicians policies may be regarding the termination of the treatment with the patient?
According to CMA's California Physician Legal Handbook, physicians can terminate a patient-physician relationship without cause.
What is considered patient abandonment in Florida?
It may be termed patient abandonment when a doctor terminates their relationship with a patient without giving them enough time and continued care to allow them to find a new doctor. In order for patient abandonment to occur, a relationship between the medical care provider and the patient must have been established.
Can a doctor just drop you as a patient?
Even though physicians retain the legal right to dismiss patients in many situations, there are some circumstances when it's not only unadvisable but unethical and, depending on the state where it occurs, illegal and punishable both by law and by censure.
What is patient abandonment in nursing?
When a nurse deserts or neglects a patient with whom they have established a provider-patient relationship without making reasonable arrangements for the continuation of care and without reasonable notice, that nurse may stand accused of patient abandonment. 1.
Can a doctor just drop you as a patient?
Even though physicians retain the legal right to dismiss patients in many situations, there are some circumstances when it's not only unadvisable but unethical and, depending on the state where it occurs, illegal and punishable both by law and by censure.
What happens if a nurse is charged with abandonment?
Once the nurse has accepted responsibility for nursing care of a patient, severing of the nurse-patient relationship without reasonable notice may lead to discipline of a nurse's license.
Can a doctor discharge a patient without seeing them?
"From a malpractice and medical board standpoint, a physician can basically discharge a patient for any reason he wants, as long as it is nondiscriminatory and doesn't violate [the Emergency Medical Treatment and Labor Act] or other laws, or puts the patient's health, safety, and welfare at risk," says Kabler.
When A Doctor May Dismiss A Patient
We've reviewed previously many of the complaints doctors have about patients. They include everything from non-adherence to obnoxious behavior to m...
When A Doctor Cannot Legally Dismiss A Patient
There are reasons and times a doctor may not legally or ethically fire a patient, too — most of which are based on state or federal law. 1. Doctors...
How The Patient Dismissal Takes Place
Some states have laws that govern the process a doctor should use to fire his patient. However, in most cases, the dismissal protocol is based more...
What to Do If Your Doctor Has Dismissed You
If your doctor fires you, you have a few options: 1. If you want to go back to that doctor, you may want to attempt to repair the relationship with...
Case Objectives
Know that failure to properly act on abnormal test results is a significant patient safety issue.
The Case
A 21-year-old woman presented to the emergency department (ED) with heavy vaginal bleeding. She was admitted to the obstetrics and gynecology (OB/GYN) service for management. She received a blood transfusion and a Depo-Provera injection (a hormone to stop the bleeding), and was discharged home the next day.
The Commentary
The process of arriving at an accurate diagnosis often involves many steps in a complex system, and errors can occur at any step along the way.
Table
Table. Steps organizations can take to reduce the malpractice risk associated with following up test results.
What happens if a doctor's practice is closed?
If the doctor's practice is closing: Just like the rest of us, doctors close their practices. They may sell them, or retire from practice, they may die, or just close their doors. A relatively new reason for dismissal seems to be based on the type of insurance a patient has.
What does it mean when a patient doesn't show up for an appointment?
From the provider's perspective, that means a window of no income in addition to the fact that the patient isn't getting the help they need.
Can a doctor dismiss a patient?
Doctors may not dismiss a patient in the midst of ongoing medical care, called " continuity of care.". For example, a person who is pregnant cannot be dismissed by their doctor within a few weeks of delivery. A cancer patient cannot be fired before his chemo or radiation treatments are completed.
What to do if your doctor dismisses you?
If your doctor fires you, you have a few options: If you want to go back to that doctor, you may want to attempt to repair the relationship with your doctor. This will involve knowing what the reason was that you were dismissed (which may, or may not, be apparent).
What is non-adherence in medical terms?
Patient non-compliance ( non-adherence): When the patient fails to follow the treatment recommendations established by the doctor. (Which is why it is so important that you and your doctor make treatment decisions together .) Patient's failure to keep appointments: Patients make appointments, then cancel them at the last minute, ...
What are the rights of a patient who refuses treatment?
In addition, there are some patients who do not have the legal ability to say no to treatment. Most of these patients cannot refuse medical treatment, even if it is a non-life-threatening illness or injury: 1 Altered mental status: Patients may not have the right to refuse treatment if they have an altered mental status due to alcohol and drugs, brain injury, or psychiatric illness. 6 2 Children: A parent or guardian cannot refuse life-sustaining treatment or deny medical care from a child. This includes those with religious beliefs that discourage certain medical treatments. Parents cannot invoke their right to religious freedom to refuse treatment for a child. 7 3 A threat to the community: A patient's refusal of medical treatment cannot pose a threat to the community. Communicable diseases, for instance, would require treatment or isolation to prevent the spread to the general public. A mentally ill patient who poses a physical threat to himself or others is another example.
What is the meaning of refusing treatment at the end of life?
Choosing to refuse treatment at the end of life addresses life-extending or life-saving treatment. The 1991 passage of the federal Patient Self-Determination Act (PSDA) guaranteed that Americans could choose to refuse life-sustaining treatment at the end of life. 9
How can a patient's wishes be honored?
Another way for a patient's wishes to be honored is for the patient to have a medical power of attorney. This designates a person to make decisions on behalf of the patient in the event they are mentally incompetent or incapable of making the decision for themselves.
Can informed consent be bypassed?
In instances of an emergency situation, informed consent may be bypassed if immediate treatment is necessary for the patient's life or safety. 5 . In addition, there are some patients who do not have the legal ability to say no to treatment. Most of these patients cannot refuse medical treatment, even if it is a non-life-threatening illness ...
Can a parent refuse treatment?
Children: A parent or guardian cannot refuse life-sustaining treatment or deny medical care from a child. This includes those with religious beliefs that discourage certain medical treatments. Parents cannot invoke their right to religious freedom to refuse treatment for a child. 7 . A threat to the community: A patient's refusal ...
What is a threat to the community?
A threat to the community: A patient's refusal of medical treatment cannot pose a threat to the community. Communicable diseases, for instance, would require treatment or isolation to prevent the spread to the general public. A mentally ill patient who poses a physical threat to himself or others is another example.
Does palliative care extend life?
Palliative care focuses on relieving pain at the end of life but does not help extend life. Before you decide against receiving treatment at the end of your life, be sure you've followed steps to help you to make that informed decision. 10 .
How to terminate a physician-patient relationship?
The criteria for terminating a physician-patient relationship are numerous and varied and require careful documentation in the patient’s record. Although the following list is not exhaustive, it is generally appropriate to terminate a relationship under the following circumstances: 1 Treatment nonadherence—The patient does not or will not follow the treatment plan or the terms of a pain management contract, or discontinues medication or therapy regimens prior to completion. 2 Follow-up noncompliance—The patient repeatedly cancels follow-up visits, or is a frequent no-show for scheduled appointments with providers or consultants. 3 Office policy nonadherence—The patient fails to observe office policies, such as those implemented for payment, prescription refills, or appointment cancellations. Even more pressing are patient refusals to obey COVID-19 infection-control precautions that should mandate wearing masks, practicing social distancing, sanitizing hands frequently, and avoiding contact with anyone on the premises except as may be necessary for treatment purposes. 4 Verbal abuse—The patient, a family member, or a third-party caregiver is rude and uses improper language with 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. 5 Display of firearms or weapons—The patient, a family member, or a third-party caregiver wields a firearm or weapon on the premises. 6 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 on previously.
How long has a patient been in your practice?
A patient has been in your practice for about 10 years, has faithfully made regular visits, but has not been compliant with your medical regime for taking hypertension medications . You have repeatedly explained the risks of nonadherence, and you have rescued the patient on many occasions with emergent medications, usually in the local emergency department over a weekend. You are convinced that the patient understands but stubbornly refuses to comply.
Is it reasonable to screen incoming patients?
Just as it is an acceptable and reasonable practice to screen incoming patients, it is acceptable and reasonable to know when to end patient relationships that are no longer therapeutic or appropriate based on patient behaviors. It is critical, however, that the physician end the relationship in a manner that will not lead to claims of discrimination or abandonment.
What is verbal abuse?
Verbal abuse—The patient, a family member, or a third-party caregiver is rude and uses improper language with 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 .
Free Case Evaluation
Please answer a few questions to help us match you with attorneys in your area.
What Is a Physician-Patient Relationship?
A physician-patient relationship is the professional relationship that a doctor has with his/her patient. The relationship begins when the physician first diagnoses and treats the patient, or at least participates in the patient's diagnosis and treatment.
Terminating This Relationship
A physician-patient relationship can be properly terminated in the following ways:
What Can the Patient Recover?
If a physician improperly terminates the physician-patient relationship, the physician is liable for all damages that the patient incurs as a result of losing access to medical care. Let's take an example.
Why do doctors end their relationship?
Valid reasons to end a doctor-patient relationship include: the doctor has insufficient skills to provide adequate treatment to the patient. there are insufficient supplies or resources to provide adequate treatment to the patient. ethical or legal conflicts arise during the treatment process.
What are some examples of abandonment?
For example, if a doctor intentionally refuses to treat a patient who has failed to pay his or her medical bill, that is often considered unjustified.
What are ethical conflicts?
ethical or legal conflicts arise during the treatment process. the patient violates the physician's policies. the patient has numerous cancelled or missed appointments. the patient refuses to comply with the physician's recommendations, and.
Do you have to taper opioids?
Tapering should be done after consultation with the patient. There is no “one way” to taper a patient, yet generally, the longer the patient has been on opioids, the longer it will take for a successful taper.
Can you use multiple pharmacies?
Most patients do not use multiple pharmacies, most patients’ value continuity of care not just with their prescriber, yet also with the pharmacy. Pain agreements limit patients to one pharmacy for good reason; to avoid accidental interactions from other medications from other prescribers as well as over utilization.
Can you share opioids with a family member?
For a variety of reasons, patients may share opioids with a family member or friend. Sharing with a friend or family member is the most common form of drug diversion.9
Is addiction a chronic disease?
Addiction is a chronic disease and needs to be treated as such. Patients who are addicted may exhibit aberrant behavior such as poly-substance use and/or selling medications, while this can not be tolerated; efforts need to be made on the part of the prescriber to ensure the patient received appropriate treatment.
Take Advantage of Our Review Monitoring Service
We provide qualified applicants with free review monitoring for 6 week. Reports delivered bi-weekly.
Request a Consultation with Our Founder
Medical Justice Founder and CEO, Jeff Segal, MD, JD, provides consultations to doctors in need of guidance.
Meet the Experts Driving Medical Justice
Our Executive Team walks with our member doctors until their medico-legal obstacles are resolved.
Exceptions and Special Circumstances
- Know that failure to properly act on abnormal test results is a significant patient safety issue.
- Appreciate that failing to contact a patient about abnormal test results is a source of successful malpractice claims.
- Learn the legal standard that is applied to a failure to contact a patient about test results that require follow-up action.
- Know that failure to properly act on abnormal test results is a significant patient safety issue.
- Appreciate that failing to contact a patient about abnormal test results is a source of successful malpractice claims.
- Learn the legal standard that is applied to a failure to contact a patient about test results that require follow-up action.
- Describe some steps that might reduce the harm from failure to act on abnormal test results.
Steps For Withdrawing Care
Elements of The Written Notice
Case Examples
Case One
Should This Patient Relationship Be terminated?
Case Two
- When the situation with the patient is such that terminating the relationship is appropriate and none of the restrictions mentioned above are present, complete a formal termination of the patient relationship. Put the patient on written notice that you are withdrawing care as the treating physician and require that the patient find another healthca...
Options For The Practitioner
- The written notice terminating the relationship should include the following information: 1. Reason for termination—Although a specific reason for termination is not required, it is acceptable to use the catchall phrase “inability to achieve or maintain rapport,” to state that “the therapeutic practitioner-patient relationship no longer exists,” or to assert that “the trust necessary to suppor…
Assistance Is Available
- The following scenarios illustrate some of the issues involved in terminating a patient relationship.