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Abandoning Patients

Abandonment is the legal term for terminating the physician-patient relationship in such a manner that the patient is denied necessary medical care. This should always be avoided. The legal liability becomes significant when the patient is injured by the failure to receive medical care. Abandonment can be intentional or inadvertent. Intentional abandonment is legally riskier because a jury may choose to award punitive damages as punishment for intentionally putting a patient's health at risk.

The most common reason for intentional abandonment of a patient is failure to pay the physician's fees, either by the patient or by the patient's insurance company. This is also legally the least justifiable. Juries have little sympathy for physicians who deny a patient necessary care because the patient is unable to pay the bill. Perhaps the worst case occurs when the physician denies the patient care because the patient's insurance company has refused to pay. If the insurance company has mistakenly denied coverage, the jury may take its anger out on the physician for allegedly conspiring with the insurance company to deny the patient medical care. A physician who is considering refusing to treat a patient for any reason, including failure to pay, should make sure that he or she can ensure that the patient will not be injured by this action.

Inadvertent abandonment usually occurs through misunderstandings about backup coverage when the physician is unavailable. While a jury will be much more sympathetic if the physician was unavailable because of a medical emergency, as opposed to a social event, the reason makes little difference to the patient in need of care. Many physicians would never go to a party without arranging to receive their calls or providing someone else to cover emergencies, but they frequently become involved in lengthy hospital procedures that render them unavailable without arranging any coverage.

Failure of the system for backup coverage can result in constructive abandonment. A physician who is part of a group that shares call on a set schedule can get in trouble if the person on call does not show up. The physician's duty is to his or her patient. If the patient is injured because of a problem with the call schedule, it is the patient's original physician, not the on-call physician, who is ultimately liable. It is important to verify call arrangements each time rather than relying on habit or custom.

Patients may be abandoned through failures in the scheduling system. The appointment clerk may functionally abandon a patient by refusing to let a patient talk to the medical personnel, by scheduling an appointment too far in the future, or by filing away the chart of a patient who failed to keep an important follow-up appointment. (This is discussed more fully in Chapter 15.)


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