Not all relationships are meant to last forever. If you terminate a doctor-patient relationship, you shouldn’t do so in the middle of a treatment plan. And generally, you are required to continue care for 30 days or until the patient finds another provider, whichever comes first. And you should make records available to the new doctor. And provide general information on how to find a new doctor (for example, pointing them to County Medical Society website or their insurance network).
Most states do not require a specific method for transmitting this goodbye message. But three states do require certified return receipt.
Wyoming.
052-3 Wyo. Code R. §§ 3-5 –
- Any physician licensed by the board who desires to terminate a physician/patient relationship must notify the patient or the patient’s legally-designated agent in writing at least thirty (30) days prior to the date of the termination that the licensee will no longer treat the patient. The written notice of termination shall be sent via certified mail, return receipt requested, and notify the patient that the licensee’s care of the patient will continue for thirty days or until such date as the patient notifies the licensee of the name and address of the patient’s new physician, whichever occurs first. Such requirements do not apply to physicians treating patients in an emergency room or under other emergent circumstances.
New Jersey:
N.J. Admin. Code § 13:35-6.22 – Termination of licensee-patient relationship
(c) In order to terminate a licensee-patient relationship, a licensee shall:
- Notify the patient, in writing, that the licensee shall no longer provide care to the patient as of a date certain. The notification required by this paragraph shall be made no less than 30 days prior to the date on which care is to be terminated, and shall be made by certified mail, return receipt requested, or other proof of delivery, sent to the patient’s last known address;
- Provide all necessary emergency care or services, including the provision of necessary prescriptions, until the date on which services are terminated. The provision of any such emergency care or services shall not be deemed to manifest any intention to reestablish a licensee-patient relationship; and
- Comply with all requirements set forth in N.J.A.C. 13:35-6.5 for access to and transfer of patient records.
New Jersey allows some flexibility. Proof of delivery might be via tracking/signature required for delivery by UPS or Fed Ex, for example.
Ohio:
Ohio Administrative Code Rule 4731-27-02 | Dismissing a patient from the medical practice.
Once a physician-patient relationship is established, a person remains a patient until the relationship is terminated.
- Except as provided in paragraph (B) of this rule, a physician shall comply with the following requirements in order to dismiss a patient from the medical practice:
- Send notice to the patient that includes all of the following:
- A statement that the physician-patient relationship is terminated;
- Except where the patient, or patient’s representative, has displayed disruptive or threatening behavior toward the physician, office staff, or other patients, statement that the physician will continue to provide emergency treatment and access to services for up to thirty days from the date the letter was mailed, to allow the patient to secure care from another licensee; and
- An offer to transfer records to a new provider upon the patient’s signed authorization to do so.
- The notice shall be sent in one of the following ways:
- A letter sent via certified mail, return receipt requested, to the last address for the patient on record, with a copy of the letter, the certified mail receipt, and the mail delivery receipt maintained in the patient record;
- An electronic message sent via a HIPAA compliant electronic medical record system or HIPAA compliant electronic health record system that provides a means of electronic communication between the health care entity and the patient, is capable of sending the patient a notification that a message has been received and is in the patient’s portal, and is capable of notifying the sender that a message has not been viewed or has been viewed;
- If a notice sent via an electronic message as authorized in paragraph (A)(2)(b) of this rule is not viewed within ten days of having been sent, a letter sent in accordance with paragraph (A)(2)(a) of this rule.
In Ohio, certified mail is mandated, unless one can send a HIPAA compliant portal message and confirm that message has been received and viewed. 99.9% of the time, certified mail will be the correct path.
Washington state follows the Ohio method. Certified mail, unless a portal message sent and read. Again, 99.9% of the time, certified mail will be the correct path.
Do these details matter?
They did in Painter v. Hallingbye ex rel., Wyo. Brd. of Medicine, 2021 WY 78 (Wyo. 2021).
In that case, Dr. Painter’s Wyoming medical license was suspended for five years. The Board presented a laundry list of allegations. The contested case is summarized below:
The Patient inherited the family ranch outside of Gillette, Wyoming, to the exclusion of her two sisters. While the family understood the Patient was sole owner of the ranch, they continued to refer to it as the “family ranch.” The Patient never married or had children and intended to leave the ranch to her sisters or their heirs. In 1996, the Patient employed Frank Stevens to assist with her estate planning. She established a trust which held the ranch and all her property. The Patient was both trustee and trustor. She did not allow the family to see the estate plan and trust documents until September 2014, four months before she died.
The Patient established a close friendship with Dr. Painter, and in 2008, the Patient asked Dr. Painter to be the successor trustee and executor of her trust. Dr. Painter agreed. Eventually, Dr. Painter became co-trustee and helped the Patient manage her money. The Patient began paying Dr. Painter $60 per hour or $300 per month for the time spent managing the Patient’s finances. All told, excluding payments for medical care, Dr. Painter paid herself $42,725 from the Patient’s checking account.
Meanwhile, the Patient’s family became suspicious of Dr. Painter and relations between them grew contentious. Eventually, the Patient’s niece filed a complaint with the Board of Medicine because she was concerned about the relationship between her aunt and Dr. Painter and feared that the Patient might leave the ranch to Dr. Painter. As the Board initiated its investigation, the Patient’s health deteriorated and she moved to Pioneer Manor, a residential nursing facility in Gillette. When the Patient’s ranch managers quit on short notice, Dr. Painter suggested her son-in-law, and the Patient hired him to manage the ranch, paying him approximately $3,000 per month.
The Board prosecutor, Board investigator, and the Patient’s niece and nephew interviewed the Patient at Pioneer Manor about her relationship with Dr. Painter.1 The Patient remained steadfast in her support of Dr. Painter and her desire to compensate her for the financial management assistance. There is no dispute the Patient remained competent until her death. In response to the Board’s concerns, Dr. Painter had a member of her staff hand-deliver a letter terminating the physician-patient relationship, stating the Pioneer Manor physician had assumed care of the Patient. The Patient died in January 2015. Dr. Painter, in her role as trustee, worked to wrap up the estate and distribute its assets to the beneficiaries. Eventually, Dr. Painter and the Patient’s family reached an agreement which provided that the trust paid Dr. Painter $35,000 for the unpaid financial management services she provided before the Patient’s death, and the heirs inherited the “family ranch” free and clear.
In a 275-page order, the Board found Dr. Painter exploited the Patient and the Patient’s family, and improperly terminated the physician-patient relationship. Her license was suspended and she was fined. This went to court.
In court, the doctor was able to whittle the fine down.
“Finally, the Board cannot assess its hearing officer and attorney fees against Dr. Painter.”
The court spilled some ink on improper termination of the doctor-patient relationship.
Dr. Painter terminated the physician-patient relationship by instructing her employee to hand-deliver a letter to the Patient. (The Board cited testimony of the Patient’s niece casting doubt on whether the Patient ever received a termination letter but made no finding.) The letter informed the Patient that Dr. Painter could no longer treat her because of the growing complexity of her medical problems, and that the attending physician at Pioneer Manor would continue as her physician. There is no dispute that she did not follow the steps required by the Board rule to terminate the physician-patient relationship.
Dr. Painter next argues she substantially complied with the rule but offers no analysis to support that position. The Board rule requires doctors to send termination letters via certified mail, return receipt requested, with thirty days’ notice. Wyo. Bd. of Med. Rules & Regulations, ch. 3, § 5(a). The letter Dr. Painter claims she gave the Patient terminated the physician-patient relationship immediately and was hand-delivered by Dr. Painter’s employee. Dr. Painter’s termination letter did not meet any of the requirements of the Board rule. The Board’s conclusion is supported by substantial evidence.
While the Wyoming Board of Medicine interpreted the certified mail requirement strictly, there were other deficiencies in the termination of the relationship. The termination was immediate and did not provide 30 days or transfer to another doctor. And the harsh penalty of suspension was mostly related to her breach of professional boundaries. Dr. Painter was acting as both a treating physician and trustee of the patient’s trust/estate.
Ultimately, the doctor, as executor of the estate, did transfer the family ranch to the patient’s heirs. She didn’t keep it for herself as the family feared.
Back to the formality of terminating doctor-patient relationship, most states are silent on method of delivery of the message. But not all.
What do you think?
