Public Health Law Map - Beta 5 - Medical and Public Health Law Site

state laws to gain access to medical care.
e) Continuing Care
Before referring a patient to a specialty institution, the physician and the patient
should decide to what extent the physician will provide continuing care to that
patient. Even physicians who no longer provide care after the referral should follow
up to make sure that the referral was received and that the patient is being cared
for. If the original physician will continue to provide some care for the patient or
take the patient back after the special care, he or she should keep abreast of the
patient’s care at the referral center. Too often, the patient is the only source of
information the community physician has. Checking with the patient or family
during the course of treatment helps maintain a good relationship and may allow
the physician to intervene if necessary.
The referring physician should make sure that complete records on the treatment
provided at the referral center accompany the returning patient. The referring
physician should insist on receiving copies of any operative reports, significant test
results, and discharge summaries. If it is difficult to get such information from the
referral center, the physician should consider getting a release from the patient and
formally requesting a copy of these sections of the record. The medical records
administrator of a large hospital is likely to be prompter and more thorough in
honoring such requests than a resident who has moved to another service.
f) Liability for Improperly Managed Referrals
Referring a patient to another physician generally relieves the original physician of
responsibility for the patient’s care and reduces his or her liability. However, if the
referral is not made correctly, the liability of the referring physician may increase.
The referral must be acceptable to all three parties involved: the referring
physician, the receiving physician, and the patient. (If the patient requires
emergency care or is in labor, the referring physician must comply with the federal
EMTALA law.)
Patients have the right to refuse referral without relieving their attending physician
of responsibility for their care. To refer patients against their wishes and then
withdraw from the patient’s care constitutes abandonment. Historically,
abandonment did not result in substantial tort losses because patients could usually
find substitute care. This is no longer true in many parts of the United States.
Abandoned patients, particularly pregnant women, may not be able to find care
until they can qualify for emergency care under the federal laws. Referrals must be
made so that the patient is ensured of the availability of ongoing care.
When a patient refuses to be referred to another physician, the attending physician
should find out why and attempt to correct any problem. If the patient is opposed to
the specific physician recommended, another physician should be sought. If the
patient’s insurance will not pay for the care, the attending physician should
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