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Healthcare professionals have a responsibility to patients with whom they have established a treatment relationship. However, there may be some instances when they will need to terminate their relationship with a patient. This FAQ article will review when premature termination of a patient can result in legal liability and how to avoid claims of patient abandonment throughout your practice. Though many of the statutes below apply to physicians alone, other healthcare professionals like chiropractors, dentists, APRNs, etc. have similar requirements under Ohio law. 

When does a physician-patient relationship exist?

Ohio Administrative Code (OAC) Section 4731-27-02 defines a physician-patient relationship for physicians in Ohio: “a physician-patient relationship is established when the physician provides service to a person to address medical needs, whether the service was provided by mutual consent or implied consent or was provided without consent pursuant to a court order. Once a physician-patient relationship is established, a person remains a patient until the relationship is terminated.” Other practitioners have a similar definition of practitioner-patient relationship.

What is patient abandonment?

Patient abandonment is a unilateral termination of the physician-patient relationship by the physician without reasonable notice for the patient to obtain alternative medical care. The elements of patient abandonment are:

• Health care treatment was unreasonably discontinued;
• The termination of health care was contrary to the patient’s will or without the patient’s knowledge;
• The health care provider failed to arrange comparable alternative care;
• The health care provider should have reasonably foreseen that harm to the patient would arise from the termination of the care;
• The patient actually suffered harm or loss as a result of the discontinuance of care.

Essentially, the establishment of a physician-patient relationship creates a duty for the physician to care for the patient. The physician then terminated that relationship prematurely and the patient suffered harm as a result.

What are the liabilities of patient abandonment?

Physicians who are found to have abandoned patients could be subject to:

• Medical board disciplinary action (including loss/suspension of licensure);
• Malpractice claims;
  1. But note that patient abandonment involves intentional or reckless act(s) that could result in punitive damages which are often not covered by malpractice insurance;
• Breach of payor contracts;
• Personal injury damages; and/or
• Elder abuse.

Termination of Patients – Notice Requirements

To avoid patient abandonment claims, physicians should properly terminate patients from their practice. OAC 4731-27-02(A) requires physicians to comply with the following requirements when terminating a patient:

• Send a notice to the patient that includes:
  1. A statement that the patient relationship is terminated and a rationale for termination when appropriate;
  2. A statement that the physician will provide emergency treatment for up to 30 days from the date that the notice was mailed to allow time for the patient to find alternative care; and
  3. An offer to transfer records to a new provider upon receipt of a signed authorization.
• The notice must be sent in one of the following ways:
  1. A letter sent via regular mail to the last address for the patient on record, with the date of mailing of the letter documented
  2. An electronic message sent via a HIPAA compliant EMR or EHR portal that provides a means of electronic communication and that can confirm the patient viewed the message.
     1. If the message is not viewed within 10 days, the physician must send a physical letter as detailed above.

The requirements of formal termination notice do not apply if: (1) the physician rendered services to the patient on an episodic basis or in an emergency setting where there is no reasonable expectation that related services will be rendered to the patient in the future; (2) the physician formally transferred the patient’s care to another health care provider in a different practice group; or (3) the patient terminated the relationship (either verbally or in writing) or has transferred care to another physician for the same condition and that these actions are recorded in the patient’s record. Also, always check any contracts with third-party payors prior to terminating any patients, since there may be additional notice or care requirements. There are also separate rules, found in OAC 4731-27-03(B) that govern the termination of a physician-patient relationship due to leaving, selling, or retiring from practice.

When to terminate a patient relationship?

In addition to leaving, selling, or retiring from practice, there are other reasons that terminating a physician-patient relationship is appropriate. These scenarios could include:

• Immediate termination if:
  1. Patient is violent or abusive;
  2. Patient makes sexual advances to provider or staff; or
  3. Patient lies about identity or is otherwise fraudulent.
• Termination with at least 30 days’ notice if:
  1. Repeated no-shows or non-compliance that jeopardizes patient safety;
  2. Breakdown of communication that makes it impossible to treat patient; or
  3. Consistent refusal to pay.

If immediate termination is required, consult with legal counsel immediately, call local law enforcement if necessary, and send the patient a formal termination notice as soon as possible. Except for the scenarios resulting in immediate termination, patients should always receive notice in advance of the termination of their physician-patient relationship.

Create a Patient Termination Policy

The best way to prevent patient abandonment is to have a comprehensive termination policy. The termination policy should include at a minimum:

• Specific circumstances that may require immediate termination of the patient or termination through a termination letter
• A procedure for whom the provider should speak prior to termination
• A procedure for what a physician needs to do prior to termination
• A requirement that no patient will be terminated during a critical point in the patient’s care and that the practice will comply with EMTALA (if applicable)
• An explanation of the legal notice requirements for termination
• A requirement that the physician or practice must seek consent for termination from the patient and must provide transitional care where termination is not immediate
• A statement that the practice has an interest in continuity of care for patients

This is only a short summary of the requirements applicable to the termination of the physician-patient relationship. For more information or questions about terminating a provider-patient relationship, please contact Ashley Watson at abwatson@bmdllc.com or your local BMD healthcare attorney.