Parting Ways: Curi’s Guide to Patient Termination

Whether to terminate a doctor-patient relationship is a difficult, yet sometimes necessary decision for physicians and practices. If this is something you’ve considered—you’re not alone. Questions around patient termination are among the most common inquiries brought to Curi’s Risk Solutions experts.

Determining how and when it’s appropriate to terminate a patient is a nuanced situation that must be handled with care to avoid potential liability. In this article, we’ll explore how to effectively discontinue doctor-patient relationships, as well as when this decision is not appropriate.

Termination Best Practices

It’s natural for physicians to want to help all patients regardless of circumstances, but there are certain situations where it is appropriate or necessary to discharge a patient from the practice. Some common acceptable reasons include non-compliance with recommended treatment plans; multiple no-show appointments; significant debt to the practice; and abusive or threatening behavior toward physicians, staff members, or other patients. If your patient has exhibited one or more of these behaviors, you are within your rights to terminate the relationship. Key information that should be included in the termination letter includes:

• Assurance that the practice will provide emergency medical care for no less than 30 days (except in cases of violent or threatening behavior that may put staff at risk)
• Assurance that a copy of the patient’s medical record will be provided to the patient and/or sent to the practice of the patient’s choice with proper authorization
• Resources to assist the patient in finding alternative care
• Prescription for a 30-day supply of maintenance medications

Termination letters must be handled with care and follow this specific format to avoid the potential for future malpractice claims of abandonment or discrimination. By taking a standardized approach to developing comprehensive termination letters, physicians can limit their vulnerability to future liability.

This letter should be signed by all physicians in the practice who have seen or treated the patient directly, or by the president of the medical group. Keep in mind, we do not recommend terminating a patient from one physician and allowing him or her to continue seeing other physicians in the practice, as there is always a chance that the patient will have to see the original physician in the event of an emergency.

When Not to Terminate

Patient termination may not always be the most effective course of action, and there are specific circumstances when physicians should avoid severing the relationship. The following four scenarios are among the most common reasons that physicians should avoid patient termination:

1. Active Episode of Care
   The patient should be seen until care is concluded or until the patient has reached a point of maintenance for their condition. Put simply, we suggest taking a “finish what you started” approach and continue to provide care if there is an acute medical need for follow-up.
2. Existing Scheduled Appointment
   If the patient has scheduled an appointment for an active problem, that appointment shouldn’t be cancelled. After the appointment, the termination process may begin, assuming a new active problem has not been identified. However, if the appointment is for a known issue or a routine maintenance exam, the physician may cancel the appointment and proceed with termination.
3. Outstanding Diagnostic Study
   In all cases, physicians should avoid terminating a patient if they are scheduled or awaiting diagnostic testing, such as laboratory or radiology studies.
4. Pregnancy
   When the patient is in the first trimester of pregnancy, physicians should only end the relationship during an uncomplicated pregnancy, leaving the patient adequate time to find another practitioner. If the patient is in the second trimester, physicians should only discontinue care during an uncomplicated pregnancy and when care has been transferred to another practitioner. Finally, care termination for third-trimester patients should only be considered under extreme circumstances in which the doctor is unable to provide necessary care.

Patient termination is a complex and nuanced issue that requires careful examination and consideration. If you have any questions about patient termination, call 800-328-5532 to speak with one of Curi Advisory’s Risk Solutions experts for individual consultation.