Author: Janet Thoman Green

Despite a provider’s best efforts, there are times when a relationship with a patient becomes too problematic to continue to provide care. The patient may consistently ignore the provider’s recommendations, demand care or services that are unnecessary or inappropriate or may be generally disruptive to the clinic or other patients. Discontinuing care of a patient is permissible in most circumstances, but certain guidelines should be followed to avoid liability or a licensing board complaint.

Duty to Treat:

The treatment relationship is generally a contract between a provider and a patient. It requires agreement by both parties to enter into the relationship. Generally, health care providers are free to refuse to treat a patient for any non-discriminatory reason or no reason at all. However, there are exceptions for emergency situations and in some managed care settings.

The treatment relationship does not extend indefinitely. It can be ended when there is no longer a need for care. When this happens, the treatment relationship starts over if the patient returns for additional care for a new condition. Therefore, if a former patient returns for a new problem, the provider may refuse to treat the patient as if there had been no prior relationship. However, there may be a gray area between the provider’s and the patient’s perception. If a provider has a concern that a patient may return and demand care against the provider’s wishes, the relationship should be formally terminated as below.

Though care can be refused for no reason at all, any health care provider who receives federal funds, such as payment from Medicare or Medicaid, cannot refuse to treat a patient because of the patient’s race, sex or HIV status. This is dictated by several federal anti-discrimination statutes.

Formation of the Provider-Patient Relationship:

When a patient makes an appointment and is seen, a clear relationship has been formed and certain duties arise for the provider. However, even when contact is short of an actual examination, it may be enough to trigger the provider’s duty. If a patient relies on a provider’s recommendations during a telephone conversation, this may be enough to trigger the duty to treat the patient. Once the relationship is established, there are constraints on a provider’s ability to end the relationship abruptly later on.

The provider may limit the care that is rendered to a patient by making an agreement at the time the relationship is formed.

Termination of the Relationship:

A long-standing rule on the appropriate manner of a provider to withdraw patient care was established by the Washington Supreme Court in 1942:

It is the general rule that when a physician undertakes to treat a patient, it is his duty to continue to devote his best attention to the case until either medical attention is no longer needed, he is discharged by the patient, or he has given the patient reasonable notice of his intention to cease to treat the patient, so that another physician may be obtained.

Gray v. Davidson, 15 Wash.2d 257, 266-67 (1942).

This means that the provider must continue to provide care to a patient unless:

1. The Patient’s condition no longer requires care;
2. The patient terminates the relationship (this can be oral or written);
3. The provider gives written notice of withdrawal and allows sufficient time for the patient to employ another provider. Sufficient time for the patient to secure another provider is judged by the specific circumstances and must be reasonable. If a similar provider is easily located, the time period may be relatively short. If, however, the treatment is very specialized and there are few options for the patient, the provider must allow sufficient time for such a specialist to be located. Thirty days appears to be the norm.
4. The provider agreed to only treat a specific condition or at a certain time or place.

Finally, it is recommended that termination of a patient’s care should be done in writing with a copy placed in the patient’s file. The provider may choose to set out the reasons for termination in the letter, but is not required to do so.

If you have a patient whose care you are considering terminating, a call to the patient’s attorney is appropriate. If Adler Giersch represents the patient, we can assist you in problem-solving with the patient before withdrawal of care becomes necessary. We believe the medical and legal aspects of a personal injury claim are intertwined and the patient, health care providers and the patient’s attorney must work as a team and support the work of each to ensure the highest level of medical care and legal representation to the victims of traumatic injury.