Considerations for Terminating the Therapist–Patient Relationship
How to mitigate the risk of an abandonment claim.
By Paul J. Welk, PT, JD*
Once a physical therapist establishes a therapist–patient relationship with an individual patient, there may be certain situations in which the therapist desires or is otherwise required to terminate the relationship.
While there is presumably no limit on the number of examples of such circumstances, common scenarios may include a patient who is repetitively abusive to other patients or staff, who is caught stealing from the practice, who repeatedly uses inappropriate language, or whom the therapist is no longer able to treat due to ethical considerations (e.g., a situation in which a patient is making inappropriate advances toward the treating physical therapist). Regardless of the reason for the termination of the therapist–patient relationship, the therapist should consider a number of issues in an effort to mitigate the risk of adverse consequences arising from the termination of the therapist–patient relationship. Many of the concerns in this area relate to the concept of “patient abandonment.” In the health care context, abandonment can be defined as the unilateral severance of the professional relationship between the health care provider and the patient without reasonable notice at a time when there is still a necessity for continuing medical care and attention.1
Initially, the therapist should consider whether there are alternative options to terminating the therapist–patient relationship. By way of example, if the therapist is no longer able to provide services to a particular patient based on an ethical concern, there may be an opportunity to transition care within the practice to another therapist who does not have the same ethical dilemma. In such a case, as in all cases of terminating or potentially terminating a patient relationship, communication with the patient is important. Continuing the example of the transition of care due to an ethical concern, the treating therapist should carefully consider how to discuss his or her concerns with the patient so as to avoid any appearance of patient abandonment.
Assuming it is ultimately determined that the therapist–patient relationship must be terminated, the therapist should clearly document in detail the reason or reasons behind the termination. From a process standpoint, the termination often involves a discussion between the patient and the treating provider, where appropriate under the circumstances, followed up with a certified letter to the patient. Depending on the nature of the circumstances leading to the patient termination, it may be appropriate to have the clinic manager or someone else in a leadership position participate in the discussion with the patient. This is important because it allows two representatives of the practice to participate in the process should there ever be a claim filed in connection with the termination. Also, in most cases, the reason for the termination of the therapist–patient relationship as to one therapist rises to the level of severity that the relationship with the patient is terminated as to the entire practice. The letter to the terminated patient often generally describes the reason for the termination, provides detail regarding alternative options where the patient can receive physical therapy services from another provider, offers to provide a copy of the patient’s record to subsequent treatment providers, and states on what date the relationship will terminate.
From a timing perspective, it is also important to consider when within the course of treatment the termination occurs. As noted earlier, the need for continuing medical care is generally considered as part of an abandonment analysis. By way of example, terminating the therapist–patient relationship for a patient with acute treatment concerns presumably raises greater risk for a claim of abandonment if care is not appropriately transitioned. In certain cases, it may also be appropriate to notify the referring physician when the patient–therapist relationship is terminated.
Once the termination process is complete, it is important to ensure that appropriate administrative staff are notified so that the patient is not inadvertently scheduled for a future appointment should he or she contact the practice. There may also be a mechanism for identifying terminated patients in the practice’s medical record or scheduling programs. Regardless of how a practice chooses to handle therapist–patient terminations, having a written policy that discusses the termination process is helpful, and in certain cases practices may even elect to make this policy available to patients at the start of care.
Failure to carefully consider issues related to the termination of the therapist–patient relationship can expose the therapist and the practice to the possibility of professional liability claims, allegations of violating applicable codes of ethics, including those of the American Physical Therapy Association, adverse action by state licensure boards, or potential claims by third-party payers. For example, in Texas, the Texas Board of Therapy Examiners includes within its rules that a licensee may be disciplined for practicing in a manner “detrimental to the public health and welfare,” which is defined to include abandoning or neglecting a patient under current care without making reasonable arrangements for the continuation of such care.2
While the facts and circumstances underlying the potential termination of a therapist–patient relationship can vary greatly, giving consideration to the issues described here as well as any applicable laws, rules, and regulations can help to mitigate the risk of a claim of patient abandonment in connection with termination of the therapist–patient relationship.
1 See Lee v. Dewbre, 362 S.W.2d 900 (Tex. App. 1962).
2 See Texas Board of Physical Therapy Examiners, Rules. August 2018.
Paul J. Welk, PT, JD, is a Private Practice Section member and an attorney with Tucker Arensberg, P.C. where he frequently advises physical therapy private practices in the areas of corporate and healthcare law. Questions and comments can be directed to firstname.lastname@example.org or (412) 594-5536.
*Please note that this article is not intended to, and does not, serve as legal advice to the reader but is for general information purposes only.