Avoiding Abandonment Claim: How to Properly Terminate Patients From Your Practice

Most psychiatrists experience situations in which they consider terminating a patient from their practice. There are routine scenarios for terminating the relationship, but there are also other scenarios to consider.

Situations That May Lead to Termination

• Does the patient frequently cancel or miss appointments, leading to less effective treatment?

• Does the patient require a higher level of care outside your scope of practice?

• Are there payment concerns or outstanding balances?

• Is the patient exhibiting threatening, verbally abusive, harassing, or violent behavior toward you and/or your staff, creating safety concerns?

• Has the patient expressed a desire to no longer seek treatment or repeatedly failed to make follow-up appointments?

• When treating children of divorced parents, has the communication with the parents become disruptive to your practice, interfering with the child’s care? Did one or both parents revoke consent to treatment?

• Is the patient not following the treatment plan as prescribed?

• Has the patient recently been admitted or discharged from a higher level of care and requires care that exceeds the care you can provide?

Steps to Avoid Abandonment Claim

The following steps can be taken to decrease the likelihood of an abandonment claim and assist you with a successful defense.

• Understand your state laws for properly terminating the physician-patient relationship. Each state has its own requirements for ending the physician-patient relationship. It is important to follow your state’s requirements including knowing the timeframe by which notice must be given prior to terminating the relationship (typically at least 30 days’ notice).

• If possible, discuss the reason for termination with the patient. Except in circumstances requiring immediate termination, it is best practice to discuss with your patient the reason for termination. Remember, once the decision is made to terminate, avoid situations in which the patient attempts to negotiate a way back into the practice.

• If you are prescribing medications, ensure the patient has a sufficient supply of medication until the patient establishes care with a new provider, if appropriate. For example, a 30-day supply.

• Provide the patient with a termination letter. The letter should include the reason for termination, the date care will end, referrals, and authorization to release a copy of his or her medical record to the new provider. The termination letter should be handed to the patient and/or sent via both regular and certified mail.

• Offer to provide emergency care. The patient needs to be able to contact you in case of emergency for a reasonable period of time during the termination process, typically 30 days, unless there is a safety concern requiring immediate termination.

• Consult an attorney or risk management professional. Before discussing termination with your patient, consider discussing the situation with your attorney or risk management professional to ensure you are following the proper procedure.

• Documentation. It is very important to document the termination discussion with the patient including the thought process behind termination, along with retaining a copy of the termination letter in the patient’s medical record.

While the decision to terminate a patient from your practice is a difficult one, there are instances when termination may be appropriate. Once the decision to terminate has been made, follow the plan along with your state’s regulatory and medical board requirements for ending the physician-patient relationship. If necessary, seek assistance from your attorney or risk management professional for guidance. ■

^{This information is provided as a risk management resource for Allied World policyholders and should not be construed as legal or clinical advice. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings Ltd, a Fairfax company (“Allied World”). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World. © 2022 Allied World Assurance Company Holdings Ltd. All Rights Reserved.}

Allison Funicelli, M.P.A., C.C.L.A., A.R.M., is a risk management consultant in the Risk Management Group of AWAC Services Company, a member company of Allied World. Risk management services are provided as an exclusive benefit to insureds of the APA-endorsed American Professional Agency Inc. liability insurance program.