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

The law requires a physician to provide treatment to a patient until that patient can be
transferred to another physician safely or can be released from care. The physician is
not required to provide that treatment personally, but responsibility for after-hours care
and emergency care is always a vexing issue. This is easier to manage in urban settings
because of the availability of alternative medical care. Urban physicians usually have
arrangements with other physicians to share calls, reducing the burden of 24-hour
responsibility for patient care. The availability of emergency room facilities can relieve
the burden of after- hours care as well as provide care for patients who may need more
extensive services than are available in the office. The problem of urban practitioners
is educating patients about the use of these alternative sources of care.
The main problem with small town practice is the lack of backup coverage, either
through fellow practitioners or through easily accessible emergency room facilities.
Physicians in this situation will face the “super doc” dilemma: the “If I don’t treat
them, nobody will!” mind-set. Although there is great ego gratification in being
indispensable, this leads to burnout and the compromising of professional standards.
Physicians must take personal time for relaxation and education and arrange for
backup medical care for those times.
G. Terminating the Relationship
The initiation and termination of physician–patient relationships are legally risky
events. At both times, it is critical that the physician and the patient have the same
expectations and that the patient’s health not be compromised by the physician’s
actions. Terminations are becoming increasingly risky because market pressures are
making it more difficult for physicians to maintain long- term relationships with their
patients.
1. 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,
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