Sometimes, although it may be uncomfortable, you just have to dismiss a patient. Dismissals don't happen frequently however, there are some considerations to be given when the need for dismissing a patient arises.

Posted in Malpractice Insurance on Monday, May 22, 2017

Sometimes, although it may be uncomfortable, you just have to dismiss a patient. Dismissals don’t happen frequently however, there are some considerations to be given when the need for dismissing a patient arises. Therefore it is good to be prepared ahead of time with two documents:

• A “new to our practice” policy, establishing expectations from the patient
• A policy which outlines the steps to take in the event of a dismissal 

While the reasons for dismissal may vary, the dismissal should always be handled in the best interest of the patient. It is helpful to have, as part of your “welcome to our office packet” an explanation of your expectations of the patient and, in particular, how your office handles various situations such prescription refills, no shows, cancellations, after hours calls, etc. By bringing a document such as this to their attention when the need for dismissal seems evident, you can open the discussion about the difficulties in the relationship and if pertinent, how they are not adhering to your office policies. If you don’t have this document, consider the fact that you may be expecting the patient to adhere to a policy to which they were unaware. While the dismissal may still be necessary, a discussion is also still necessary. A discussion with the patient will give you the opportunity to explore why the situation has arisen and what can be done to alter the impending decision.

When dismissing a patient, to reduce the allegation of abandonment, it is important that you comply with the policy and procedures you have established. The policy should clearly state the goal for dismissal is in the best interest of the patient so they can seek care from another healthcare professional who can better meet their healthcare needs on their terms.

Before dismissal, review your documentation to make sure it provides objective data supporting your decision for dismissal. Then:

• Discuss with the patient your consideration of dismissal
  • Document this discussion in their records, including any witnesses which might be present (family members, staff)
• Send a letter regarding the dismissal to the patient both by certified mail (with a return receipt) and regular mail marked “personal and confidential”
  • If the certified mail is not claimed and/or the regular mail is returned unclaimed or undeliverable, mail them again
    • If they are received back a second time, maintain them (with the envelopes with the markings) in the records as evidence of your attempts
  • If your letter includes who witnessed the discussion in your office
    • Reference their presence at the discussion in the letter (such as with your wife, your son, etc.)
    • Do not include the surnames of your staff, be generic using their title instead (my nurse)
  • You can reiterate the reason for the dismissal, keeping the statement professional and objective
    • Describe any urgent conditions of which the patient should be aware being sure to finish any procedures that you have started before the dismissal
    • Include the necessity of continuing care,
  • Include a copy of the letter in the patient’s records along with the certified mail receipt
  • Agree to continue treating the patient for 30 days while the patient is making arrangements for continued care with another healthcare professional
  • State that medication and refills will not extend beyond the 30 day transition period
  • Clearly include the date care with your office is terminated
  • Recommend the patient to the local medical society or a physician referral service to seek further treatment
  • Offer to transfer the records to another provider with the appropriate release
  • Agree to see the patient on an emergency basis only during the 30 day transition period
• Document the patient’s medical condition and stability prior to the termination
• Inform the staff of the dismissal from the practice
  • Make sure they know how to address the situation if the patient contacts the office
    • No future appointments should be scheduled
    • No medication refilled
• Confirm dismissal is in compliance with any third party payers’ guidelines
• In a multi-provider group, consider dismissing the patient from the entire group not just the current healthcare professional
• Be aware of possible Americans with Disabilities Act (ADA) accusations which might arise – discuss concerns with your practice attorney
• Be aware that the patient may take to social media to express their frustration

Because state regulations may vary, always be sure to check with your attorney when establishing policies to confirm you are adhering appropriately to those local mandates.