Our appreciation goes out to all healthcare professionals on the front line and our sincerest thoughts are with our community both locally and afar. During these unprecedented times, The Law Office of Nicole Irmer, as an essential business, remains open and available to help. If you need assistance maintaining or applying for a professional license, of if you have been contacted by a Board or DCA investigator, please do not hesitate to contact us at (619) 237-6130.

Terminating the Doctor-Patient Relationship / Patient Abandonment

Posted in Licensing Defense,News

doctor patient relationship

Over the course of your practice, there may come a time where you need to end a relationship with a patient. Perhaps the patient is non-compliant, has shown up to appointments while under the influence, or maybe they haven’t paid their bills for months. You may also be closing your practice, and need to terminate the doctor-patient relationship with everyone in your care.

Physicians are generally free to end a physician-patient relationship without the consent of the patient, as long as it is done for a non-discriminatory reason. However, once this relationship has been established, it cannot be terminated without taking specific steps. A failure to do so may lead to both a complaint of patient abandonment (unprofessional conduct) to the Medical Board of California. 

California has set forth guidelines for how to terminate the doctor-patient relationship. If a former patient alleges that you violated the law and abandoned them, a California physician license defense attorney can defend you against these charges — and protect your license.

What Is Patient Abandonment?

According to the Medical Board of California (MBC), patient abandonment is a form of unprofessional conduct. Under the California Business and Professions Code, “patient abandonment” is defined as terminating patient care (1) without written notice that treatment will be discontinued, and (2) before the patient has had a reasonable opportunity to obtain the services of another physician. 

California courts have interpreted this law to mean that a “…physician cannot just walk away from a patient after accepting the patient for treatment….In the absence of the patient’s consent, the physician must notify the patient he is withdrawing and allow ample opportunity to secure the presence of another physician.” Significantly, if a patient consents to the termination of treatment, or declines further medical care, they have not been “abandoned” under California law.

The MBC may impose discipline on a physician who they determine have abandoned a patient, including suspension or revocation of a license, or the imposition of probation. In addition, a doctor may face a medical malpractice lawsuit for patient abandonment that results in harm to the patient.

What Can Lead to an Allegation of Patient Abandonment?

In California, patients make the decision as to who provides their medical care. Although physicians are permitted to terminate the doctor-patient relationship for any non-discriminatory reason, they must do so in a way that avoids allegations of patient abandonment. 

Complaints about patient abandonment may arise in the following situations:

  1. Refusing to see a patient who has a large outstanding bill, without formally discharging the patient;
  2. Closing your practice without adequately informing your patients of the closure and providing them with information about how to get their records and secure a new provider;
  3. Refusing to see a difficult patient for a follow-up visit without taking steps officially terminate the relationship;
  4. Suggesting that a patient seek medical care elsewhere without following up with written notice; or 
  5. Ending the doctor-patient relationship where the patient is in active treatment, without giving a patient sufficient time to make other arrangements for necessary care.

For example, patient John Smith has been in your care for several years. Mr. Smith routinely ignores your medical advice, although you believe that he understands what you are asking him to do. At his last appointment, he became belligerent when you brought the issue up again. You tell him that he should find another doctor if he doesn’t like your medical advice.

In this situation, this may constitute patient abandonment if you refuse to book follow-up appointments with Mr. Smith and fail to provide him with written notice in accordance with the law. However, if Mr. Smith states that he doesn’t want to see you again, that may be considered consent to terminating treatment — which would not be considered patient abandonment. Out of an abundance of caution, you should choose to follow up with written notice pursuant with the MBC’s recommendations for severing/terminating patient relationships.

The MBC recommends that physicians take the following actions to avoid allegations of patient abandonment:

  1. Notify patient(s), in writing, of the last day that they will be available to render medical care, making sure that the patient has been given at least 15 days of emergency treatment and/or prescriptions before doing so;
  2. Informing patient(s), in writing, of alternative sources of medical care; and
  3. Notifying the patient(s) of the process by which they can obtain their medical records, including who to contact, how to contact them, and where to make such a request.

By taking these steps, a physician may protect themselves from a complaint to the MBC.

When Should a Physician Hire an Attorney?

A doctor may first learn that a patient has made an allegation of abandonment (unprofessional conduct) when an investigator with the MBC contacts them via phone or letter. If you receive this type of letter or a phone call from an investigator, you should contact an attorney immediately. Board investigations and requests for interviews are both formal processes that could impact your ability to practice medicine.

The investigation and interview are the first chance to litigate this issue. With the assistance of a skilled California physician license defense attorney, you may be able to resolve the matter without discipline. By thoroughly investigating the facts of the allegations and applying relevant case law, your lawyer can advocate for the complaint to be closed without discipline, or with an administrative citation.

The Law Office of Nicole Irmer represents physicians who are the subject of all types of MBC complaints — including patient abandonment. Our compassionate team will work collaboratively with you throughout the process, from the notice of investigation to the final resolution. With more than 20 years of experience, Ms. Irmer will utilize her knowledge to obtain the most favorable outcome for you.

Whether you have been accused of patient abandonment or another form of unprofessional conduct, we can help. We will put together a comprehensive strategy that addresses the allegations made against you, with the goal of protecting both your medical license and your livelihood. To schedule a confidential, no-risk consultation about a Board investigation, contact us at (619) 237-6310 or email us at any time.

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