Dismissing patients properly.(dismissing a patient without violating the laws)

Every so often, it becomes necessary to dismiss a patient from your practice.

I receive several questions a month about the "legalities" involved; the usual wording is something like, "How do I dismiss a patient without violating any laws?"

There are no statutory laws that I'm aware of that apply specifically to patient dismissal. Although there is a remote (and quite preventable) chance of running afoul of antidiscrimination laws, you should be concerned mostly with leaving yourself open to civil litigation--charges of abandonment and the like.

There are no rules that dictate specific reasons for dismissal, so reasons will vary from practice to practice. A common reason is failure to pay legitimate and reasonable charges. This can include technical requirements in the event that you drop out of a health plan.

Depending on the contractual rules of the plan, you may be forced to formally terminate treatment of participating patients if they have been given, and have refused, the option to pay out of pocket. Theft (including theft of insurance checks) also falls under this category.

Most patients, however, are dismissed because of interpersonal conflicts with the physician. Mostly that means persistent noncompliance with a reasonable treatment plan, but there are other valid reasons. These include unacceptable behavior, particularly in the presence of other patients, or a generally unruly or uncooperative demeanor.

And most experts agree you can refuse to treat a patient who insists on treatment outside your area of expertise, or at a location other than your private office.