What is the Proper Way for a Physician to Terminate a Patient?

How does a physician properly terminate a patient from their practice? There are several considerations for terminating patient relationships. There are generally three main things that the physician must do, so they can’t be accused of either patient abandonment or some other kind of ethical lapse. 

First, the physician needs to provide written notice. I would suggest sending a certified letter to the address on file of the patient. I would also send them an email as well. That way, the patient can’t state that they never received any notice. You also need to provide a reasonable amount of time for the patient to find a substitute provider. 

Now, this is obviously specialty-dependent. It’s easier for some patients to find a replacement than others. But unless there’s an egregious act on the part of the patient, you can’t just terminate the patient on a Monday and say, I’m done providing any care for you, move on. So, you need to find a reasonable amount of time to allow them to find a new provider. You could even assist in that, but I guess ultimately in that scenario, it would depend on why you’re terminating the patient. 

Usual Reasons to Terminate Physician-Patient Relationship

Now, there are several factors in terminating a physician-patient relationship, one, simply, maybe the physician is retiring and not transitioning to practice with someone else, maybe they’ve taken a new position out of town, and they’re moving. I mean, those are normal things that can happen. If it’s a behavioral concern on the patient’s side that complicates things a little bit, maybe they became verbally abusive to staff or the physician. Maybe they have mental health issues, and it’s just making the care impossible. Maybe like in pain management, they signed a pain contract with the physician and violated that contract. The physician obviously could then terminate them from the practice. 

The reason why you’re going to terminate the physician-patient relationship with the patient will also kind of dictate. I would think of the assistance that you provide to them. One, written notice, two, give them time to find a replacement, and then three, provide bridge scripts. Once again, depending upon specialty, if the patient is on psych meds or some life-saving medication, the physician needs to provide at least a reasonable bridge script, allowing them time to find a substitute physician. 

Patient Care Work Ethics: Providing Medical Records ASAP

And then lastly, you need to provide information on how the patient can retrieve the patient’s medical record. Every state board has kind of details as far as what a physician must do in providing the patient’s medical record. And then also what a patient must do to request it. I mean, for most states, the patient has to request it in writing, and then some states allow for a reasonable fee to get the copy of the med record, and then they have to state it has to be reasonably available within a short period. 

I have had plenty of clients who have gotten in trouble for not providing the patient’s medical records in a timely manner. Sometimes, the physician has no idea this is going on, and maybe an office manager had some clashes with the patient. They decide to terminate them, and then they mess around with quickly providing the record for whatever reason. Well, ultimately, that can fall on the shoulders of the physician. So, I want to ensure that the patient gets the medical record quickly. 

Summary

To summarize, it needs to be written. It would be best if you gave them time to find a new physician with services similar to your specialty or practice. You need to provide bridge scripts if possible or necessary. Then you need to give them access to the patient’s medical record. There are patients whom there is nothing you can do to satisfy, and no matter what, it will likely end up in a board complaint. If you’re covering what you’re required to do and acting ethically in terminating the patient, there should be no issues regarding a board complaint. Just sticking your head in the sand and not dealing with the patient is a bad idea.

There are some obligations when you’re providing medical care to someone. And even though you may want absolutely nothing to do with them just because of how they’re acting, or maybe they’re disruptive, you still must go through the steps to make certain that you’re giving a good transition to a new provider. Continuity of care is important, and that’s why these general guidelines are in place to ensure that even if someone is disruptive, they’re still going to get the care they need so that it doesn’t become a huge issue down the road.

Other Blogs of Interest

• What Should be in a Physician Leaving the Practice Letter
• Who Owns the Patient’s Medical Record as an Employed Physician?

Can You Sue Someone for Filing a False Complaint with the Arizona Medical Board?

Hi, my name is Robert Chelle with Chelle Law, and my firm represents physicians before the Arizona medical board and the osteopathic board. We’ve been representing healthcare providers in Arizona for a long time, over a decade now. And one thing that comes up semi-frequently is the question, can you sue someone for filing a false board complaint in Arizona? Pretty simple question. The answer is yes, but there are some caveats we’re going to go over right now. Every board has a statute. They’re in the Arizona revised statutes, which lay the groundwork for what the board can and can’t do. In the statute for the Arizona medical board, there’s a section. I’m just going to read it that says any person or entity that reports or provides information to the board in good faith is not subject to an action for civil damages.

Arizona Medical Board

So breaking that down, anyone who files a board complaint in good faith can’t be sued for civil damages. The most important part of that section is good faith. What is good faith? What that means is if someone honestly believes that there was some kind of bad conduct on the part of a physician or that the physician did something that in some way was illegal or violated a statute, they’re kind of immune from civil damages. The only way that a physician could sue someone for filing a board complaint is if it was false and in bad faith. People can file a good faith complaint with bad intentions, right? You could have a patient who just wants to stick it to the doctor, a competitor physician who’s doing the same, an employer who is somehow upset about their relationship terminating, or something like that.

Licensing Board Complaint

If any of those people filed a good faith argument, meaning they believe that whatever the physician did could violate a statute, they’d be immune from a civil lawsuit. If you’re gonna sue the person, then you have to prove that they acted in bad faith, meaning they knew that what they were alleging is false or potentially they made up falsehoods and used that as a basis of a complaint.

There was a case in the mid-two thousand that kind of worked its way up to the court of appeals in Arizona. And basically, it was one physician who filed a board complaint against a competitor physician. They’re in the same specialty, fighting for patients in the same area, and alleged several things. And the physician who had the complaint filed against him filed a lawsuit against the other doctor stating that the complaint was not submitted in good faith.

Are There Any Mistakes Physicians Make?

And therefore, he suffered some damages, and I’m just gonna read what the counts of that lawsuit are. Right? One, the alleged defamation, false light invasion of privacy, wrongful institution, and maintenance of an administrative proceeding, intentional interference with prospective contractual to business relationships, and injurious falsehood. So, five counts. What the court held, though, was the first count. Was the complaint filed in good faith or not? And the court said, yes, it was. They’re saying even if, maybe some of the things that the person who filed the complaint alleged were untrue, they believed they were true. They made at least a minimum amount of verification of the facts. And therefore, the complaint was filed in good faith. And so, the physician who had the complaint filed against him couldn’t recover any damages.

We have a case currently with the Arizona medical board. We’re representing a client. Obviously, I won’t get into the details of it. However, I can give broad strokes. In this case, a patient alleged that our client gave them on a certain date, a specific procedure. And then, there was a negative outcome during the procedure. After a review of the patient’s medical records, our client never saw the patient on the date alleged and never even provided the procedure alleged by the patient. And then, obviously, the bad outcome didn’t occur either. So, did that person file a complaint in bad faith? Well, we believe, yes. As I stated before, when looking at whether a complaint is filed in good faith or bad faith, you need to look at, well, whether the person who filed the complaint made any attempt to verify any of the information.

Lawyer for Medical Board Complaints

In this case, obviously, no. What could someone do to verify the information? Well, they could call the office and verify when they saw the physician, they could request the patient’s medical records and review those, and talk to the people involved. A minimum base amount of effort needs to be given to verify allegations. And if the complainant, the person who files a complaint, doesn’t do any of that. Then that certainly allows whoever had the complaint filed against them to argue that it is filed in bad faith. 

This is a fairly nuanced topic, but in summary, can you sue someone for filing a false board complaint in Arizona? The answer is yes, you can, under certain circumstances. But it’s an interesting topic to kind of discuss. As I stated before, my firm Chelle Law represents physicians before the Arizona medical board and osteopath boards. If you have any questions, we’re certainly happy to answer them. Just give us a call, the number is listed below in the description, or you can visit us on our website, Chellelaw.com. Hopefully, this is informative. Please comment if you have any suggestions for other topics you want me to go over, and I’m happy to do that. So anyway, thanks for listening, and take care.

What is Medical Malpractice Insurance Coverage?

Healthcare providers must protect against liabilities arising from medical negligence through medical malpractice insurance. 

Medical malpractice is a legal liability caused by a professional healthcare provider. In this case, the physician deviates from the expected healthcare standards, thereby causing injury to a patient. Medical malpractice (negligence) occurs through misdiagnosis, failure to treat, prescription drug errors, birth injuries, and surgical errors. 

In this article, we’ll cover:

• What is medical malpractice insurance?
• Who needs medical malpractice insurance?
• What does medical malpractice insurance cover? 
• What kinds of medical malpractice insurance are there?
• How much does medical malpractice insurance cost?
• Who pays for medical malpractice insurance coverage?
• Does your healthcare policy match your practice?
• How do you select medical malpractice insurance?
• What to look for in a liability insurance carrier?

What Is Medical Malpractice Insurance?

In Physician-Patient Relationship, Medical malpractice insurance is simply an insurance policy that covers healthcare workers against professional liability such as claims of injury and medical negligence while providing patient care. Usually, medical malpractice coverage is a necessity because claims in this field can be substantial to the physicians providing care to the patient. 

NSO malpractice insurance is essential for all nurses and other healthcare professionals who don’t want to cover professional liabilities out-of-pocket. Typically, Med Mal is provided by various carriers. 

Who Needs Medical Malpractice Insurance Coverage?

Everyone directly interacting with patients to provide healthcare services needs medical malpractice insurance. Importantly, fitness professionals also need to consider this policy to cover risks in their industry. Therefore, if you’re in any of the following practices or professions, it’s essential to consider this coverage. 

• Nurse Practitioners
• Physical Therapists
• Licensed Practical Nurses
• Personal Trainers
• Physician Assistants
• Nurse Anesthetists (CRNAs)
• Registered Nurses
• Optometrists
• Nursing students and more

What Does Medical Malpractice Insurance Cover and Not Cover?

As highlighted earlier, medical malpractice coverage covers physicians for negligent claims such as childbirth-related injuries, medication errors, surgical errors, misdiagnosis, wrong-site surgery, and other claims of wrongdoing of physicians. 

However, you need to understand that there are some aspects that a medical insurance policy will not cover. For example, medical malpractice policies will not cover illegal acts and claims of sexual misconduct and other acts unrelated to patient health care management. Also, the policy will be void if healthcare professionals misrepresent facts during policy application. 

What Kinds of Medical Malpractice Insurance Are There?

Medical malpractice insurance can either be claims-made or occurrence-based. Here’s the difference between the two types:

Claims-Made Medical Malpractice Policy

In this case, the insurance provider will cover a healthcare provider for medical malpractices which occurred when the policy was in place. The doctor must also report the claim when the policy is already in place. 

However, incidents reported outside the coverage period are not included. In such a case, a healthcare provider might consider tail coverage for claims reported when the policy is no longer in place. 

Occurrence-Based Medical Malpractice Policy

Occurrence-based plans cover malpractices during the coverage period. This type of insurance coverage also covers claims filed when the policy was no longer active. 

However, occurrence-based insurance policies are more expensive than claims-based due to their nature of coverage. Also, your employer might not be willing to provide such a policy due to cost challenges. 

How Much Does Medical Malpractice Insurance Cost?

The cost of medical malpractice policy is a sensitive aspect that you must analyze. Generally, there’s no defined amount that one has to pay. In most cases, your specialty and geographic location determine how much cost you’ll have to pay. Also, your personal claims history has a massive role in determining your insurance costs. 

Insurance carriers will estimate your annual premiums by breaking up the total coverage by the years covered. This will help determine the yearly premiums while spreading risks across the coverage period. 

Who Pays for Medical Malpractice Coverage?

Medical malpractice insurance can either be paid by individual providers or by employers. Depending on the type of insurance plan you’ll have, it’s always important to know that you’ll get some pros and cons. 

Individual Coverage

Outside the employer-provided plans, doctors can choose to get their coverage. Individual providers offer some flexibility that employer coverage might not provide. They work directly with insurance advisors to obtain coverage that meets their needs. In addition, physicians who get individual coverage can overcome the disadvantages of group plans by working in multiple locations and can easily switch providers when renewing their plans. 

Employer Coverage

The majority of the employers in the country provide medical malpractice insurance policies. Employees are easily added or removed from the group plan based on their employment status. Most importantly, employer coverage is a claims-made policy, meaning only claims reported when the policy was active are covered. Therefore, physicians need to consider tail insurance to mitigate the disadvantages of this policy. 

Does Your Healthcare Policy Match Your Practice?

Generally, the majority of insurance policies have limits. For example, a standard medical malpractice insurance policy may range from $10,000 to $30,000. The policy provider will pay the lowest amount ($10,000) per claim during the policy period. The second ($30,000) is the maximum amount your insurance provider will pay during the policy period. 

You’ll be personally liable for any amount exceeding your policy limits. Therefore, you should pay attention to your policy limits and ensure they align with your geographical location and specialty. In addition, you need to work with an experienced physician contract lawyer when discussing insurance limits with your insurance provider for maximum protection. 

How Do You Select Medical Malpractice Insurance?

It’s not always easy to choose the best medical malpractice insurance policy. For example, in some states, claims are very high. So, you must select the right insurance with the proper policy limits. 

Your medical insurance limits must be sufficient to cover the possible settlement and rigorous defense where necessary. Again, working with a medical physician contract attorney is advisable to get advice on the best insurance policy. 

What to Look for in a Liability Insurance Carrier?

There are multiple medical malpractice insurance companies in the industry today. However, your objective is to work with the best provider to access quality policies and good customer services. 

The carrier’s sensitivity to policyholders, claims procedures, and fiscal soundness is critical when choosing your provider. It’s always necessary to seek advice from a physician who has worked with a carrier before making final decisions. 

You need to know whether the insurance provider has risk management programs that provide emotional support for defendants. It’s also essential to seek discounts and participation in risk management. Contact Chelle Law today if you need a medical contract lawyer or want to hear more about contract benefits or medical malpractice insurance.

What Are Types of Medical Malpractice Insurance?

What are the different types of medical malpractice insurance for physicians? This is a frequent topic that comes up when I’m reviewing a contract. I would say, during med school or training, most physicians are not given a breakdown of the different types of malpractice insurance. 

When talking to a relatively new physician who doesn’t understand the difference, it’s always a good idea to give a brief breakdown of each one. And maybe the pros and cons of each. There are three main types of professional liability insurance for physicians. You have self-insurance programs from big hospital networks, and then most private practices will utilize one of two, either occurrence-based coverage or claims-made insurance. Let’s just kind of talk about three of them. 

Self Insurance

First is self-insurance. Large hospital networks will usually have their own policy in the simplest way: they’ll set aside a pot of money and pay claims out of that. In that circumstance, generally, the physician doesn’t have to worry about purchasing malpractice tail insurance coverage. The employer’s self-insurance program covers that. This is great. I mean, it’s great insurance when a physician never has to worry about tail insurance and doesn’t have to worry about paying for the underlying premium. That is kind of a nice, secure feeling. That’s what most large hospital networks utilize. 

Occurrence Based Coverage

The next type is occurrence-based coverage. And that means a policy has to be in effect when the event occurs. Any malpractice event will occur while you’re employed with the employer. So, you are covered in perpetuity if an occurrence-based policy is in place and then something happens. The benefit of occurrence-based insurance is that you don’t need to purchase tail insurance. The downside is it costs more than a claims-made policy. 

A good rule of thumb is that occurrence is about a third more expensive than claims-made policies annual your premium. So just to give an example, let’s say you have a claims-made policy, and it’s 6,000, then your occurrence-based coverage would be around 8,000 per year. There is a math equation that needs to be considered to determine what is the best policy for a physician. And I’ll get into that at the end. But honestly, most of the time, physicians don’t have a choice between occurrence insurance or claims made policy. It’s whatever the employer chooses to provide. That’s what the physician must go for. 

Claims Made Insurance

The last one is claims made. What that means is a policy must be in effect when the claim is made. When someone terminates a medical employment contract and no longer works for the employer, there is a gap between their last day of practice with that employer and the last day somebody can sue. That’s called the statute of limitations for malpractice claims. In most states, it’s two years. If there is no policy in effect if a claim is made, then the physician is in trouble. Nearly every employer will require one of the parties to purchase tail insurance. 

Tail Insurance Policy

Tail insurance simply covers that gap between the last day a physician works for the employer and the last day somebody can sue them. Now, it’s two years from when the patient either knows or should have known of a malpractice incident. It’s possible that it could go past two years if there were no way for the patient to know until a few years later. I’d say most of the time, if a physician is working for private practice, a small physician-owned group, or something like that, they’re going to have to be the one that purchases the tail policy. Some employers will pay for it, but I’d say the physician is responsible for their tail insurance more often than not. 

Tail costs about two times what the annual is. So, if a physician has a $10,000 annual premium, you just multiply that times two, and then that’s about how much they’ll have to pay for tail insurance. It’s a one-time cost, so you don’t have to pay it yearly until the statute of limitations runs. It’s just a one-time cost. You’re covered for that amount as soon as you finish with the employer. There can be different lengths as far as the tail policy goes, but most of the time, the tail policy will simply cover a reasonable amount of time until the statute of limitations is over—somewhere two to five years. 

Claims Made vs. Occurrence Based Insurance

As I mentioned before, regarding the math equation, if a physician has their choice of claims-made vs. occurrence, you need to think about how long you will be with the employer. If you’re paying a third more for occurrence coverage per year, but you don’t have to pay tail insurance, then it might make sense to utilize that if you’re going to be there on a short-term basis. 

Let’s say you’re there for two years, you’ll pay a third more for two years, but then you don’t have this significant one-time cost at the end. If you’re in a claims-made policy and you’re going to be somewhere long-term, then it might make sense to use claims-made. Therefore, your annual premium is cheaper, but you’ll still have that hit on end with the tail insurance coverage. Which one is better? It honestly just depends upon the situation. And then certainly, it depends upon specialty.

A Different Math for a Different Specialty

The annual premium can vary wildly. Like primary care, peds, or something that could be 6,000 a year whereas OB-GYN, one of the higher-level surgeons, cardiac surgeon, or something like that, could be between 20,000 to 50,000 a year, and then just do the math on that tail insurance cost. It could be forty to a hundred thousand for their tail insurance. It’s specialty-dependent as well. This certainly is something that we negotiate. When we’re looking at a physician contract, you always must consider, okay, what’s most important to the physician. And then what areas can we work on more comp, more time off, better bonuses, whatever? But who pays for tail insurance is essential for most physicians, especially those in higher-end specialties.

In the physician-patient relationship, some physicians will commit errors and be prone to negligent claims. Hence, a physician in practice or providing health care services to patients needs malpractice insurance coverage. 

What Is Considered Patient Solicitation? | Soliciting Patients

Stop Soliciting Patients | What Is Considered Patient Solicitation banner

What is considered patient solicitation? First, why does this matter? Suppose a healthcare provider has signed an employment contract. In that case, there’s likely going to be a section that’s called restrictive covenants. And then, in that section, there will be several things the provider can’t do after the contract terminates. The most common restrictive covenants would be a non-compete, non-disparagement clause, and confidentiality. And then what we’re going to talk about today is non-solicitation agreement, and any non-solicitation agreement will essentially say the provider can’t actively solicit. Usually, elicit patients or employees of the employer for a period. 

An Example of Patient Solicitation in Medical Practice

Let’s say you are a primary care physician and you have decided to leave the employer, and they have, let’s say, a 10-mile non-compete. You decide to establish a practice outside the non-compete, so you’re not violating that. Are you allowed to blast an email or send direct marketing to your patients from the old employer? The answer is no. That’s what the non-solicitation agreement would stop. It stops the act of solicitation of your current patients. Now, the practice can’t stop patients from coming with you, meaning a non-solicitation agreement can’t dictate someone’s healthcare provider. But they can dictate that the physician, in this instance, isn’t the one initiating contact.

Some of the questions I usually get are, alright, well, let’s say I’ve given notice. It’s widely known that I’m leaving and seeing a patient, and they ask me, hey. I hear you’re leaving. Where are you going? Is that considered solicitation? In my opinion, no, that wouldn’t be an active solicitation. The doctor’s not initiating it. They’re simply providing information already known, and the patient requested it. So, in that circumstance, yes, you can say to the patient, yes, I’m leaving. And here’s where I’m going.

Now, where people get in trouble is they would go into the EMR and download a list of patients they currently have. And then, as I said before, send out a direct email to all of them saying, hey, I’m leaving. Here’s my new practice. Please come with me. That’s what this would prohibit.

General Marketing Is Not an Example of Patient Solicitation

Some other issues are, alright, let’s say I go to my new job and do general marketing. So, I put up a billboard or send direct mail to a specific zip code. Is that considered solicitation? And for the most part, no, it’s not. If you’re not actively targeting your patients and just doing general marketing, that’s not considered a solicitation. They can’t stop you from doing those types of activities.

Asking Co-employees to Join Your New Practice

Next, employees. One of the biggest fears, and this is in private practice specifically, is bringing in a new provider. They establish relationships with the staff, so the MAs, the RNs, the front office, the office manager, and maybe the other providers. Then, when they leave, they take all the staff with them. A non-solicitation agreement can also stop a provider from actively soliciting employees.

And if they’re a savvy employer, they’ll stick in there “you just simply can’t hire them for the restrictive period.” A normal restriction for a non-solicit is about one year. So, you can’t solicit these people one year from when the contract terminates. 

If it states you cannot hire them, which would be considered enforceable for the most part, you can’t hire them. There’s nothing you can do about it. If it says you can’t actively solicit them, then once again, you can’t be the one to initiate contact. So, no emails, voice messages, text messages, or direct messages through social media. You can’t do any of that. 

Now, if someone approaches, let’s say that front office staff says, hey, I hear you’re leaving. I’d be interested in coming with you. If they’re the ones to initiate the contact, you are not the one actively soliciting them. Over time, more and more contracts have inserted you “cannot hire them” into the language. And it’s smart for the business to do that. Once again, you can’t initiate contact with the employees.

Non-Solicitation Agreements Are Enforceable

Overall, yes, non-solicitation agreements are enforceable. They’re there for a reason. As I stated before, they don’t want someone coming in and then yanking their entire staff or a patient base. Is there any kind of negotiation as far as a non-solicitation agreement? Not really. Maybe you could negotiate some types of activities that would make it beyond the edge of solicitation. Still, for the most part, this is kind of like an all-or-nothing clause. 

Like with the non-compete, you can usually play around with the time, meaning how long it lasts or the geographic restriction. So, five miles instead of 10 applies to one office instead of two, and the specialty is listed. What you can’t do, like maybe you’re internal med. You could do urgent care, hospitalists, ED, primary care, and focusing the specialty. Whereas with the non-solicitation agreements, you can’t solicit your patients. That’s about it.