Medicine and the Law – Part 5: Abandonment

Continuing on in our series we will now talk about abandonment and terminating the physician-patient relationship. We’ve previously talked about the contract and consent. Then we moved on to medical malpractice and causation. Finally we discussed informed consent. Now we move on to abandonment.

Abandonment is the concept whereby a physician terminates the physician-patient relationship without reasonable notice at a time when the patient still has need of medical attention. This typically is prevented by giving the patient adequate time to find a replacement physician, planning for adequate post-procedure follow up, and giving the patient adequate instruction for care when the patient is not in the presence of the physician.

Abandonment typically only comes up when a physician is treating an undesirable patient or a patient that he or she simply no longer wishes to take care of. This may be for financial reasons or simply because the patient has disease that is too complicated for the physician to take care of. It may also occur because the patient is not adherent to the doctor’s recommendations and thus the doctor notifies the patient that he plans on terminating the relationship if the patient will not follow instructions. Most often, the physician will write a formal letter to the patient so there is record of the severance. The main concept is that there must be a chain of continuous medical care that cannot be broken.

If a doctor prematurely discharges a patient or discharges a patient from the hospital without adequate follow up instructions he could be found to have abandoned the patient. If the doctor notifies a patient that he is closing his practice or moving to another location, he must allow adequate time for the patient to find another doctor. He may even refer all of his patients to another doctor to prevent any claims of abandonment.

When a patient is abandoned, lawyers typically only get involved if there were damages caused by the abandonment. However, if the physician shows that good faith efforts were made to treat the patient and the patient was simply lost to follow up, he is not liable.

I will address the ethics of severing the physician-patient relationship in another article.