What Happens When the Patient ‘Fires’ the Psychiatrist and Then Needs a Refill?

In previous Psychiatric News articles, we shared with you best practices to consider when either the psychiatrist terminates the doctor-patient relationship with a patient or the patient terminates the doctor-patient relationship with the psychiatrist.

As discussed, in either of these scenarios, the psychiatrist must take steps consistent with state law to avoid a claim for patient abandonment, including providing a “reasonable” period of time for emergent care and providing written notification of the termination. Moreover, when the psychiatrist prescribes medication, the termination correspondence should include the importance of continuing the medication as directed until the patient sees the new psychiatrist, any risks of abruptly discontinuing prescribed medication and, if relevant, instructions for tapering the medication to avoid harm.

All too frequently in these situations, however, the patient runs out of his medication, needs a refill, and contacts you—the former psychiatrist—for assistance. These circumstances become particularly problematic in situations where it would be harmful to the patient to discontinue the medication abruptly. Do not assume that because you are “technically” no longer the patient’s physician of record that you do not have any remaining obligations to the patient. At the same time, however, keep in mind that if you refill a prescription for the patient after termination of the relationship, the clock for termination may reset and you may need to start the termination process again. So given this tension, what are your options in these circumstances?

In these situations, it is important to consult with a local attorney or a risk management professional. Some options to discuss, depending on the specific circumstances, may include the following:

Without a doubt, these complicated situations require careful consideration of the specific circumstances. Even in situations in which the patient “fires” you, your obligations to the patient may not end immediately or even upon the termination “effective date” when patient safety is an issue or when you are prescribing medications. Consult with attorneys experienced in medical malpractice liability or a risk management professional to assist you through the process and help limit your liability exposure and promote patient safety.

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, GmbH, a Fairfax company (“Allied World”). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World. ■

“What Happens When the Patient ‘Fires’ the Psychiatrist?” can be accessed here. “Risk Management Considerations When Terminating With Patients” is available here.