Observations from the Legal Trenches
The thorny issue of discharging a patient from a practice
One the most common questions asked by physicians is how to properly discharge a patient from a practice. Sadly, there is little direct guidance regarding this issue.
AMA Ethics Opinion 1.1.5 states in part that when contemplating whether to terminate a physician-patient relationship a physician must:
- Notify the patient (or authorized decision maker) long enough in advance to permit the patient to secure another physician.
- Facilitate transfer of care when appropriate.
Similarly, NRS 630.304(7) states that a physician (MD) is subject to disciplinary action for “terminating the medical care of a patient without adequate notice or without making other arrangements for the continued care of the patient.” NRS 633.511(1)(n), applicable to DOs, reads almost identically.
These statements lack any definition of what defines “adequate notice.” There is a general notion that thirty days is appropriate, but this is not set forth in state law. Thirty days is typically considered adequate notice and is the notice period most practices follow. However, if you practice in an underserved specialty or care for patients in remote areas of the state, thirty days may not be sufficient; try to give as much notice as reasonably possible in these circumstances. In some cases you may be able to help the patient transfer to a new provider, if not, encourage them to contact their insurance carrier as quickly as possible for a referral. Regardless of the amount of notice, if the patient requires on-going medications, ensure that the patient has the necessary refills to last until they are able to see a new provider. In some cases, such as prescriptions for schedule II-controlled substances, this may not be feasible so early notice is crucial.
If you are discharging a patient for any reason other than you are leaving the practice, be sure to document in relative detail the patient’s chart as to why the patient is being terminated from the practice; this may protect you should the patient file a complaint with the state board or other entity regarding the discharge. Regardless of the reason you are discharging a patient, provide written notice to the patient, even if you have verbally informed the patient. In most circumstances you should notify the patient of the final day that you will be providing medical care for them but offer to provide interim care during the period between providing the notice and the final day of care.
Discharging a patient does not discharge your duties to retain the patient’s medical records. Also, the patient is entitled to a copy of the chart pursuant to NRS 629. 061; while it’s fairly standard to transfer the patient’s chart to a new provider, if the patient asks for their own copy of the chart, you may legally charge up to $.60 per page for the copy.
Finally, while it is recommended to provide as much notice as reasonably possible to a patient being discharged, neither you nor your staff should ever be placed in a situation which may result in physical harm or other danger; in those circumstances immediate termination is certainly justified. Under such circumstances be sure to document in detail the circumstances resulting in immediate termination; if appropriate, you may notify the patient that one refill has been made for their medications to avoid disruption of needed medications.
In unusual discharge situations, you may want to consult with counsel, however most physician-patient relationship termination should not require legal advice if proper notice is given and good documentation is made.
Ms. Beggs, principal of the Law Offices of Lyn E. Beggs, PLLC, focuses her practice primarily on assisting clients with administrative and professional licensing board matters in addition to representing healthcare providers on a variety of issues. Ms. Beggs may be reached at 775-432-1918 or at [email protected]. This article does not constitute legal advice and should not be considered a substitute for retaining counsel for advisement in legal matter.