Terminating Patient Relationships While Avoiding Patient Abandonment

The following article will be appearing in the California Physical Therapy Association’s August 2014 Newsletter, Physical Therapy Interventions. It was drafted by Simas & Associates, Ltd.’s own, Steven L. Simas.
Terminating the physical therapist-patient relationship is a necessary aspect of nearly all physical therapy practices. But there are pitfalls –some obvious and some not so obvious. This article addresses avoiding the pitfalls of patient abandonment.

What is Patient Abandonment?

When a patient sues for patient abandonment, it is usually negligence since it involves breach of a health care provider’s “duty” to the patient. California law defines it as when a health care provider: 1) withdraws from the care of a patient; and 2) Fails to provide sufficient notice for the patient to seek the care of another practitioner.[1]
California courts have stated:

  • As a general proposition, “a physician who abandons a patient may do so ‘only . . . after due notice, and an ample opportunity afforded to secure the presence of other medical attendance.’”[2]
  • “A physician cannot just walk away from a patient after accepting the patient for treatment… In the absence of the patient’s consent, the physician must notify the patient he is withdrawing and allow ample opportunity to secure the presence of another physician.”[3]
  • “When a competent, informed adult directs the withholding or withdrawal of medical treatment, even at the risk of hastening or causing death, medical professionals who respect that determination will not incur criminal or civil liability: the patient’s decision discharges the physician’s duty.”[4]

Patient abandonment can be the basis of a negligence lawsuit or can be grounds for license discipline.  In fact, the Physical Therapy Board of California (PTBC) has “Patient Abandonment” as one of the boxes that a complainant can check on its Consumer Complaint Form.[5] Further, the California Nursing Board has defined patient abandonment as when a nurse accepts the patient assignment and then severs the nurse-patient relationship without reasonable notice to allow for continuing care.[6] While the Physical Therapy Board does not have its own definition of patient abandonment, it has adopted the general definitions above in its licensing decisions.[7]

Reasons to Terminate the Physical Therapist Relationship

There are more reasons to terminate a patient relationship than might be addressed here. But some frequent ones are:

  • The physical therapist lacks the skills to provide adequate treatment to the patient
  • The treatment is or becomes outside the physical therapist’s scope of practice
  • Ethical or legal conflicts resulting from the treatment process
  • Patient non-compliance or violations of the physical therapist’s policies
  • Numerous cancelled or missed appointments
  • Inappropriate behavior of the patient

While all of these justify or even require the physical therapist to terminate the relationship, the existence of a good reason itself does not insulate the physical therapist from charges of client abandonment. The issue is how the physical therapist terminates the relationship.

Guidelines for Properly Terminating Physical Therapist-Patient Relationships

To professionally and ethically terminate the “agreement” to treat a patient established by the physical-therapist-patient relationship, the physical therapist should follow five steps to avoid patient abandonment:

  • Written NoticeProvide the patient with a written notice (preferably delivered by certified mail, return receipt requested); this addresses one of the major components of abandonment—lack of notice.
  • Brief Explanation – Explain why the treatment relationship is being terminated, such as failure to keep appointments, non-compliance, or other valid reason(s).
  • Continued TreatmentOffer continued treatment for a reasonable period of time to allow the patient to arrange for alternative care from an equally qualified provider.

[1] See California Civil Jury Instructions, 509.
[2] Payton v. Weaver (1982) 131 Cal.App.3d 38, 45.
[3] Hongsathavij v. Queen of Angels/Hollywood Presbyterian Medical Center (1998) 62 Cal.App.4th 1123, 1138.
[4] Thor v. Superior Court (1993) 5 Cal.4th 725, 743.