Terminating the Patient Relationship: Planning a Legally Compliant Breakup

Navigating a patient termination requires careful planning. Explore the essential considerations for complying with state and federal laws to minimize risk when ending a provider-patient relationship.

It’s never fun to break up with a friend or romantic partner. Terminating a relationship with a patient is even more complex because it introduces a variety of legal considerations.

Several circumstances might lead you to terminate a patient or client from your practice. Examples include:

• a patient is unwilling or unable to pay for services;
• a practitioner is moving to a new practice or new state and can no longer care for the patient;
• the patient fails to follow practice and patient policies or behaves in a way that requires termination; or
• the patient’s health needs fall outside the practitioner’s scope of practice or have otherwise evolved such that the practitioner’s services are no longer beneficial.

If you are in one of these situations, what should you consider, and how can you reduce liability for yourself and your practice in the process? The legal considerations for patient termination vary depending on the situation, but some basic guidelines apply. 

Check Your Internal Policies for Guidance. 

First things first — check your practice policies and patient intake forms so that you can remain consistent with internal procedures. Referencing your intake forms will allow you to consider the patient’s expectations for ending the relationship. If your intake forms or other internal policies are silent on termination procedures, consider adding language to ensure consistency within your practice and to establish guidelines with the patient. 

Communicate Clearly and Provide Adequate Notice.

Depending on the patient’s health and personal situation, consider the best way to communicate the end of the relationship. For some patients, it’s best to have a conversation before sending a written termination notice. For others, written communication alone may be sufficient. Typically, this communication should succinctly explain the reasons behind ending the provider-patient relationship.

The content of the communication is critical to avoiding claims of patient abandonment. For instance, Illinois courts consider abandonment to occur when the provider stops treating a patient who needs care without allowing enough time to find a new practitioner. Thus, before sending a termination notice, providers must determine whether the patient still needs treatment. If so, then the termination notice should afford a reasonable amount of time for the patient to find substitute care. Additionally, the notice should provide referrals or other information on how to receive the same or similar care. 

Maintain Records as Needed.

After the termination, keep proper patient records consistent with your practice policies. How long you need to keep the patient records varies, subject to state and federal law, and this information should be laid out in your written internal policies such as your HIPAA manual. If your internal policies do not set a timeline for maintaining records, you should update them accordingly. 

Respond to Any Patient Health Records Requests.

Various laws come into play when a patient requests their records following termination. 

HIPAA’s Right of Access

HIPAA’s Right of Access provisions include requirements for patients’ timely access to health records. For instance, healthcare practices must respond to a patient’s request for records within thirty days of receipt. We typically recommend you respond much sooner. If you anticipate a delay, be sure to notify the former patient in writing of the reasons for the delay. For more information, see the article, “HIPAA Right of Access: Six Reasons That Practices Get Busted.” 

Open Notes Rule 

The Cures Act Final Rule, informally known as the Open Notes Rule, applies broadly to practitioners, hospitals, and IT professionals. The rule prohibits information blocking, which is any activity by a healthcare practitioner that is likely to interfere with the access, exchange, or use of electronic health information. It requires providers to share with a patient virtually all notes that the patient might find relevant to their health. However, exceptions apply for certain records, such as psychotherapy notes. To learn more, see the article, “The OpenNotes Rule Against Information Blocking: What Healthcare Practices Need to Know.”

Unless an exception applies, we typically encourage practitioners to respond quickly to record requests from patients. A prompt response can help avoid right of access violations.

Get Legal Help. 

Do you need guidance on how to end a provider-patient relationship? Or have you recognized that your internal policies do not provide a blueprint for future terminations? If you are located in one of the states where we practice, set up a free consultation with one of our healthcare attorneys to learn how we can help. 

This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between our firm and the reader. It should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.