Risk Management Considerations When Terminating With Patients
We frequently receive calls through our psychiatry risk management line concerning how to terminate a professional relationship with a patient, particularly “challenging” patients. There is a variety of reasons for terminating a patient from your practice or for patients’ deciding to terminate the relationship. Regardless of the situation, the process of terminating the relationship should be handled carefully with all patients, through a standardized process, in compliance with applicable state laws, and well documented. Should you provide improper termination, you could potentially expose yourself to a board of medicine complaint or lawsuit.
In general, you can employ a number of risk mitigation strategies when terminating with a patient:
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Know your state’s laws/regulations regarding terminating the relationship. Many states have specific requirements that must be followed, and they vary by state.
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Discuss the termination with the patient and document it in the medical record. When possible, consider having termination sessions with the patient when transitioning care and avoid negotiation about whether treatment should continue.
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Patients receiving prescription medications need additional consideration prior to termination as there may be issues if you continued prescribing. For example, you check your state’s Prescription Drug Monitoring Program and learn that the patient is filling the same prescription written by several other providers.
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When terminating with a patient for whom you prescribe, keep in mind that if you refill a prescription for the patient after you have terminated the relationship, the clock for the time period for termination may need to be reset, and you may need to start the termination process again.
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If you have a patient for whom immediate termination should be considered, it is important to seek advice from your risk management professional or attorney to determine whether you are able to do so without exposing yourself to potential liability risks. For example, a patient is being discharged from inpatient treatment for whom you are not comfortable or able to assume ongoing care.
Termination should be communicated in writing and include the following information:
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The date of termination of care, in accordance with your state requirements.
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Names of alternative providers, if required by state law.
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Information stating that you will provide emergency care for a certain period if required by state law, as well as noting the option of receiving emergency care through the nearest emergency department.
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There are often state requirements regarding mailing the letter. Often the best practice is to send the letter first class by certified mail, return receipt requested, to the patient’s last known address. Be sure to check the requirements in your state. It is also important to keep a copy of the letter in the patient’s record as well as a copy of the return receipt.
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Should you have questions, consult your risk management professional or attorney.
For other risk management topics, please see the online risk management courses, available on APA’s Learning Center Risk Management page. ■
This information is provided as a risk management resource and should not be construed as legal, technical, or clinical advice. This information may refer to specific local regulatory or legal issues that may not be relevant to you. Consult your professional advisors or legal counsel for guidance on issues specific to you. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings, AG (“Allied World”). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World.
Biographies
Kristen Lambert, J.D., M.S.W., L.I.C.S.W., is vice president of the Psychiatric and Professional Liability Risk Management Group, and Moira Wertheimer, J.D., R.N., is assistant vice president of the Psychiatric Risk Management Group at AWAC Services Company, a member company of Allied World.
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Published online: 7 April 2016
Published in print: April 2, 2016 – April 15, 2016
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