This is the first in series of articles about changing or terminating a practice. This article focuses on notifications to patients when a doctor retires or goes to another practice.
Physicians who retire or leave a medical practice are
duty-bound to notify patients of the change.
Even if the physician is employed by a group or other corporate model,
the physician and the entity should work together to notify patients that the
physician is changing practices and how the patient will obtain continued
care. The patient must have the right
to change physicians, even follow the departing physician, if the departing
physician is still providing care.
Consider this scenario: A doctor leaves a practice, fully expecting the practice to follow-up on her patients. A chronically ill patient is unable to get an appointment with “her doctor,” and fails to come in for a regular visit. The patient dies fromt the chronic disease, a death that arguably wouldn’t have occurred if she had visited her phsyician’s office. The claim agasint the physician: Abondonement of Patient. The scope of this article is preventing such claims.
The California Medical Board recommends that “due
care be exercised when closing or departing” a medical practice to ensure
against “patient abandonment.”
This includes notification of the move.
As stated by the Medical Board:
“It is the patient’s decision from whom to receive
medical care. Therefore, it is the responsibility of all physicians and other
parties who may be involved to ensure that:
- Patients are notified of changes in the medical practice.
This is best done by letter to patients by the physician explaining the change,
including the final date of practice. (The California Medical Association (CMA)
recommends, if possible, that letters be sent by certified mail, return receipt
requested, and that a copy of the letter with the return receipt be kept. To
inform inactive patients or those who have moved away, the CMA also recommends
placing an advertisement in a local newspaper.)
- Patients be advised as to where
their medical records will be stored including how they may access them.
- To
facilitate the transfer of medical records to the new treating physician, an
authorization form should be included in the letter.
- That patients secure another health care provider. If the
practice is being taken over by another physician or another can be
recommended, the patients can be referred to that physician.”
Retiring or Leaving Physicians.
When physicians retire or leave a practice, patients have
the right to decide who will provide them care.
They may stay with the current practice, continue their care with the
departing physician, or go to some other physician all together.
Physician’s Agreement.
The original practice agreement should address the
process to be used when a physician leaves the practice. Such agreement should not interfere with the
patient’s right to choose their physician.
All parties should cooperate to send appropriate notice to patients.
Avoid Patient Abandonment.
Before the departing physician terminates any
physician-patient relationship, that patient must be given sufficient advance
notice to enable him or her to secure the services of another physician. Failure
to provide sufficient notice may leave the departing physician and/or the
practice vulnerable to charges of patient abandonment, which is when a
physician fails to provide for necessary medical care to a current patient
without adequate justification. In general, once a physician-patient
relationship is established, the physician and the practice have an ongoing
responsibility to the patient until it is terminated.
Patient Notification.
The exact nature of the notification depends on the
patient. Patients with more severe
conditions require more immediate notification, and consideration should be
given to sending letters by certified mail, with return receipt requested. Such
patients are those who are more likely to experience adverse outcomes and allege
abandonment if their physician is unavailable for ongoing care. You should use
your professional judgment when deciding who falls within this category.
Examples would include post operative patients and those currently being
followed for serious or chronic conditions.
The parties should keep a copy of the notification letter and
certification material in the patient’s record.
Active patients who aren’t high risk should be sent a letter by regular
post. Examples of active patients include those seen within the last 12 to 18
months. Keep a copy of the notification letter in the patient’s record. Notify other patients who won’t be receiving
a letter by placing a notice in the local newspaper with the largest circulation,
putting a sign up in the lobby and preparing a patient handout.
The practice should also provide a script for
receptionists on what to say. This should include information on how to contact
the departing physician.
What should the patient notification say?
If the departing physician will be available for ongoing
care, explain to patients that the physician is leaving the practice but is
available in the area. Tell patients that they have the choice of staying with
the practice or continuing to see the same physician in his or her new
location. Instruct patients who choose to follow the physician that, upon their
written authorization, a copy of their medical record will be forwarded to the
physician at his or her new location.
To expedite the transfer of records, you should consider
including an authorization form with the letter of notification. If your
practice is going to charge the patient for the photocopying costs, you should
inform the patient what the fee will be. Any material that is related to
patient care should be considered part of the medical record and should be
provided to the new physician. Both the practice and the new physician should
keep a copy of the medical records.
The best practice for both the group and the doctor is to work together to send notices to the patients in order to prevent claims in the future for patient abandonment.