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You're Fired! A Guide to Dismissing Patients

"You're fired!" will have a paper trail sonable discontinuation of healthcare give patients a reasonable time frame
According to a new of documentation to treatment. of at least 30 days to find another
study published this support your decision. As much as you would like to dis- provider.
May in JAMA Internal Legal and common miss a problematic patient, do not cast Make sure that your staff is notified
Medicine, this phrase of reasons for dismissing good judgment aside. For example, as well, lest they continue to call the
dismissal is more than a patient include dismissing an existing patient who is patient to schedule routine follow-up
just Donald Trump’s repeatedly missing now in the last trimester of a high-risk care. If you are a member of a group
reality show trademark. appointments, violat- pregnancy, when another doctor is practice, discuss the patient's dismissal
The study found that ing bill payment poli- unlikely to accept her as a patient, with your colleagues and decide if the
nine out of 10 medical cies, disregarding med- likely would be deemed unreasonable patient should be dismissed from the
practices have fired a ical recommendations, even if she has repeatedly missed practice altogether.
patient for reasons rang- and disruptive or inap- appointments and is behind in paying Finally, it is wise to review any
ing from missed propriate behavior her bills. Apply the same judgment to patient dismissal policies that the
appointments to not BY MITCHELL GREEN towards doctors and patients undergoing chemotherapy or patient's insurance carrier may have in
paying bills and disre- staff. post-operative care, even if you wish place, especially if the patient is cov-
garding medical direc- A murky area that you could fire them now. ered by a government payor, which
tives. may cast you in an unethical light and If your patient is in stable condition may have strict procedures you need to
It is not surprising that most physi- raise questions among payors is “cher- and transfer of care would not adverse- follow.
cians during the course of their med- ry picking” your patients and dismiss- ly impact their health, then you can Firing anyone is one of the most
ical careers are tempted to dismiss ing those with complex or chronic reasonably proceed with a dismissal, unpleasant parts of managing any sort
problematic patients and that many conditions to ensure better outcomes, but if your patient is ill or in the mid- of business and brings with it particu-
have followed through and done so. especially as insurers shift from fee- dle of a course of treatment, you may larly sensitive issues when the busi-
Before banishing a patient from your for-service reimbursement to value- need to delay the termination. ness is a medical practice. When it is
care, however, you should heed the based payments. While this may be necessary to do so, however, you can
following considerations and avoid technically legal, it is not advisable. Follow the Appropriate legally and ethically dismiss a trouble-
potential legal issues down the line. Be aware that it is illegal to terminate Termination Process some patient from your care by follow-
a patient for discriminatory reasons, Notifying your patient in writing via ing the necessary steps.
Justify the Termination such as age, race, disability, gender, a certified letter is the best practice.
Be sure to keep a written record of religion and sexual orientation. Clearly stating your reason will help
missed appointments, failure to follow avoid the appearance of discrimina- Mitchell Green is a partner in the law
your medical directives, payment Do Not Abandon a Patient tion. Additionally, including a list of firm of Kramer, Green, Zuckerman,
issues and other problematic behavior Dismissing a patient in critical need other providers and even taking steps Greene & Buchsbaum, P.A. He can be
for all patients. If the patient chal- of care exposes you to liability for to confirm that care has been trans- reached at (954) 966-2112 or
lenges your eventual decision to no patient abandonment, a form of med- ferred will help avoid issues of patient MGreen@KramerGreen.com.
longer provide their medical care, you ical malpractice defined as the unrea- abandonment. It is also important to

Leading FAU Neuroscientist

Receives $1 Million Grant for New Approach Coming

to Preventing Dementia next month in
South Florida
Is it possible to prevent dementia from
happening in the first place? That is what Hospital News
a leading neuroscientist at Florida
Atlantic University hopes to prove and Healthcare
through an innovative approach that
defies the notion that “one-size-fits-all” Report...
when it comes to battling Alzheimer’s
disease (AD), Lewy Body Dementia
(LBD), Parkinson’s disease (PD) and • Profiles in
other related disorders. Leadership &
FAU’s Charles E. Schmidt College of
Medicine has received a $1 million grant Administration
from The Harry T. Mangurian, Jr.
Foundation for a Dementia Prevention • Healthcare
Initiative that uses the latest advances in Professionals
genetics, biology and the molecular bases
of disease. This grant will launch the Associations
Comprehensive Center for Brain Health
(CCBH) at FAU, which will focus on • Education Update –
using a personalized approach and preci- New Programs in
sion medicine to reduce risk.
Catherine Robson, a nurse practitioner at FAU’s CCBH, observes as Dr. James Galvin
Developed by James E. Galvin, M.D., Healthcare Education
administers a test using a videonystagmography (VNG), which measures eye movements
M.P .H., a world-renowned neuroscientist,
and is used as an early biomarker sign of Parkinson’s disease and neurodegeneration. • Outsourcing Update
a leading international expert on AD and
LBD, and associate dean for clinical • Revenue Cycle
research in FAU’s College of Medicine, this program will deliver a personalized prevention plan, tailored to each individual’s risk
profile based on their genetic traits, biomarkers (blood, imaging, and electrophysiology), socio-demographics, lifestyle choices, Software Trends
and co-existent medical conditions. The CCBH is one of only a handful of centers in the world focusing on dementia prevention,
and the only one that uses Galvin’s novel protocol based on personalized evaluation and prevention plans. For more information
“It is time to abandon generalized approaches to how we address Alzheimer’s disease and other forms of dementia and to usher on advertising and
in a paradigm shift in which we begin to consider neurodegenerative disorders as diseases of a lifetime with opportunities for editorial opportunities, call
individualized strategies to build a better brain as we age,” said Phillip Boiselle, M.D., dean of FAU’s College of Medicine. “We
(561) 368-6950 today!
are extremely grateful to The Harry T. Mangurian, Jr. Foundation for supporting Dr. Galvin’s highly innovative work, which we
believe will alter the cascade of pathologic events occurring in at-risk individuals, thereby reducing the risk or even preventing
dementia from developing.”

South Florida Hospital News southfloridahospitalnews.com July 2017 29