Andrew Harvan, JD, PAMED’s Legal & Regulatory Analyst
The Pennsylvania Medical Society (PAMED) has recently received several questions from member physicians regarding how to correctly withdraw from physician-patient relationships.
Physicians are generally free to unilaterally end a physician-patient relationship. However, physicians cannot abruptly dismiss a patient without first giving the patient notice and an opportunity to make alternative arrangements for care. When discontinuing care to a patient, physicians must be cautious not to abandon the patient.
What is Patient Abandonment? And How Can You Avoid It?
Patient abandonment occurs when a physician ends a physician-patient relationship and fails to provide the patient with adequate notice, of their intention to withdraw, in sufficient time to allow the patient to find another qualified physician.
Failure to properly end a physician-patient relationship exposes both physician and patient to significant risk. Patients can be left stranded without necessary medical care, while physicians can face both professional discipline and legal liability. Under the Medical Practice Act, at 49 Pa. Code §16.61(a)(17), physicians who abandon patients are subject to disciplinary action by the State Board of Medicine.
A physician who abandons a patient is also vulnerable to a medical liability suit. If the patient suffers any injuries from their physician's abandonment, the physician could be held liable.
To avoid a claim of patient abandonment, physicians must timely notify a patient of their intention to end the physician-patient relationship. This notice should clearly state a termination date and must afford the patient ample time to find replacement care. There is no set rule specifying the number of days in advance that notice must be provided. However, thirty (30) days is generally acceptable. The exact number of days is often dependent upon the specific circumstances and facts of a particular case. Shorter notice may suffice in situations where the patient can easily transition to a new physician, whereas longer notice might be required if it will be difficult for the patient to locate and secure an appointment with a new physician. It is usually best to provide longer notice than is legally necessary. Physicians must remain available to provide care to the patient through the end of the notice period.
When ending physician-patient relationships, physicians should be cognizant of contractual obligations and applicable laws. Provider and managed care contracts might stipulate certain procedures and steps that the physician must follow when dismissing patients. For example, a physician who serves as the primary care physician for an HMO patient may need to arrange for the patient's transfer to another participating primary care physician. Also, note that federal and state civil rights laws bar physicians from engaging in certain discriminatory practices. Under these laws, physicians cannot dismiss patients because of the patient's race, gender, ethnicity, religion, disability, or age.
Tips on Providing Notice of Termination to Patients
- Physicians must provide notice of their intention to end a professional relationship with a patient or the patient's personal representative.
- This notice should state a termination date. Termination date should be at least thirty (30) days from date of notice. Adequate time period for notice may vary depending on the circumstances of the case.
- It is recommended that notice be in writing and provided to the patient or their personal representative either face-to-face or via certified mail with return receipt requested.
- Document all discussions and correspondence with the patient regarding notice in the patient's record.
- Physician must remain available to provide care to the patient through the end of the notice period.
Where Can I Find More Information?
PAMED's Quick Consult called "Starting and Ending the Patient Relationship" includes a detailed discussion on how to provide notice when ending a physician-patient relationship and an example letter for terminating an individual patient relationship.
For information on this topic and much more, visit PAMED’s Legal Resource Center at
www.pamedsoc.org/LegalResourceCenter. PAMED's Legal Resource Center provides quality, timely legal advocacy and resources for member physicians.