Some (fortunately rare) patient actions, such as a patient’s threat to harm a physician, call for immediate termination with no intermediate treatment period. Other patient actions, such as non-payment of bills or noncompliance with care recommendations, are reasons for termination but do not eliminate a physician’s duty to give a patient sufficient notice to obtain alternative medical treatment. Consider the following case, in which the physician believed the patient’s initiation of legal action against his partner justified his immediate termination of the patient relationship.*
Case File
A patient with a history of miscarriage presented to OB 1 when she became pregnant. As in her earlier pregnancy, she was scheduled for a cerclage. After she was scheduled, OB 1 discovered she had filed a lawsuit against his partner, OB 2, but took no action to start a termination process. After the patient was admitted for surgery, OB 1 informed her that he would not perform the procedure because she was suing OB 2. The patient had OB 3 perform the cerclage four days later, but she miscarried. The patient sued OB 1, alleging the abandonment-related delay of the cerclage caused her miscarriage.
Discussion
OB 1’s duty to provide this patient with necessary medical treatment did not end when she filed a lawsuit against his partner, although the lawsuit did provide grounds for him to terminate the patient relationship with her. The court agreed with the patient in this case: OB 1 had a right to withdraw from the case, but he had a duty to give the patient reasonable notice to enable her to secure another physician to complete the cerclage in a timely manner. In other words, OB 1 needed to start the termination process much earlier and do so in a formalized manner.
Medical Liability Risk Management Recommendations
Consider the following recommendations:
- If you are considering immediate termination of treatment, ensure that you have valid grounds to do so. In all other situations, provide the patient with a reasonable period of time to obtain alternative treatment.
- Follow a formal protocol for terminating relationships with patients.
Immediate Termination of Violent Patients
In addition to duties that arise out of the patient-physician relationship, physicians have a duty to protect the safety of staff and other patients. If a patient or family member becomes violent or threatening, focus on safety. Preparation is the key to successfully addressing a potentially dangerous situation. Consider the following recommendations for immediate termination of dangerous patients:
- Create a policy that describes specific patient behaviors that trigger immediate involuntary termination.
- Train staff and clinicians to recognize behavior that triggers emergency response protocols, which include:
- Immediately calling 911 and following police instructions
- Alerting individuals in the “zone of danger” to the situation and providing direction
- Evacuating the office
- After everyone’s safety is addressed, plan a formal dismissal strategy with the assistance of a risk management specialist or your personal attorney.
Reference
* Case study derived from Tierney v University of Michigan. 257 Mich. App. 681; 669 N.W.2d 575 (2003).
