APMA News - April 2013 - (Page 56)
By William F. Munsey, DPM
When Is it Okay to ‘Fire’ a Patient?
At a meeting I attended recently, there was discussion about
detaching oneself from an undesirable patient. The term used
was “ﬁre a patient.” I am sure there are malpractice ramiﬁcations related to dismissing a patient and would like your thoughts
on the matter.
There are a number of circumstances that can motivate
you to terminate an undesirable patient from your practice. If
a particular circumstance occurs on a frequent basis, you
may want to evaluate the manner in which your staff relates
to patients and how staff responds to patient concerns.
When you reach the point that
terminating the doctor–patient
relationship is inevitable, careful
attention to detail is important to
avoid legal action in the future.
A few valid reasons for terminating your relationship with
a patient are: the patient’s failure to follow directions, discourteous treatment of you or your staff, failure to keep appointments, narcotic or alcohol addiction, gross neglect of
personal hygiene, and a variety of financial considerations.
Be aware that a patient may represent a malpractice case
waiting to happen. Be particularly cautious about severing
your relationship with a patient who is unhappy with his or
her medical results, or if there is an issue over fees. Patients
use the claim of malpractice to get even with a doctor when
they feel they have been mistreated. When you reach the
point that terminating the doctor–patient relationship is inevitable, careful attention to detail is important to avoid legal
action in the future. A certified letter to the patient with a
return receipt requested could state:
This letter will serve as a formal notice that I will no
longer be able to provide podiatric care for you because
there are important differences in our view of medical care
56 APMA News April 2013
I will continue to provide care for you until (specify
date, at least 30 days from the date of the letter). This
period of time should give you ample opportunity to select
a podiatrist of your choice from the many competent practitioners in this area. I will forward a copy of your medical
records to your new podiatrist. A medical record release
authorization form is enclosed for your convenience.
Consider referring the patient to one or more community
provider referral services to aid him or her in finding alternative care. Under most circumstances, it is best not to recommend a particular physician. Be sure to document in the letter
your specific recommendations and the possible consequences of not continuing with medical care.
Most important of all: Before you terminate care, take advantage of the experience and knowledge of your malpractice insurance carrier. Review the conclusions and proposed
action with the insurance professional to make sure your
planned action does not have hidden landmines.
What is a state insurance guarantee fund? How does it function?
State insurance guarantee funds are created by statute in
most states to guarantee claims payment by insolvent insurance companies domiciled in that state. These funds are created by assessments against financially sound insurance companies that write policies in that state. The Podiatry Insurance
Company of America (PICA) participates in the guarantee
fund of every state in which it writes policies. If you are insured by PICA, which has strong reserves, there is little
chance of needing this guarantee.
A word of caution: Don’t settle for a financially weak
company for your malpractice insurance and rely on the
state insurance fund to protect your interests in the event of
a malpractice action. Most guarantee funds only extend coverage with low limits, which leaves you under-protected for
any sizable judgment.
Contact Dr. Munsey at email@example.com.
Table of Contents for the Digital Edition of APMA News - April 2013
APMA News - April 2013
Beat Bunion Blues: APMA’s Spring PR Campaign
Matthew G. Garoufalis, DPM: Presidential Inaugural Speech to the APMA House of Delegates
Nuts and Bolts of the House of Delegates and Resoultions Outcomes
State Advocacy in Focus: Building Relationships
Medicare Advantage: Answering Questions about Coverage
2012 Podiatric Practice Survey: Corporation Type
Podiatric Medical Assistants’ Program at The National Promotes Team Learning
Annual Scientifi c Meeting Registration Forms
Annual Scientifi c Meeting Sponsors
Team APMA 5K Run/Walk
Seeking Award Nominations
Federal Advocacy Forum
APMAPAC Chair Report
Inside APMA’s Social Media
On the Road with APMA
Small Business 101
Worthy of Note
Classifi ed Advertising
Dates to Remember
APMA News - April 2013