What Happens When the Patient ‘Fires’ the Psychiatrist and Then Needs a Refill?

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Back to table of contents Previous article Next article Professional NewsFull AccessWhat Happens When the Patient ‘Fires’ the Psychiatrist and Then Needs a Refill?Moira Wertheimer,J.D., R.N., C.P.H.R.M.Moira Wertheimer,Search for more papers by this authorJ.D., R.N., C.P.H.R.M.Published Online:1 Mar 2018https://doi.org/10.1176/appi.pn.2018.3a3AbstractIf you prescribe a medication for a patient after a doctor-patient relationship ends, you may have to repeat the termination process.Moira Wertheimer, J.D., R.N., C.P.H.R.M., is aassistant vice president of the Healthcare and Psychiatry Group of AWAC Services Company, a member company of Allied World.In previous Psychiatric News articles, we shared with you best practices to consider when either the psychiatrist terminates the doctor-patient relationship with a patient or the patient terminates the doctor-patient relationship with the psychiatrist.As discussed, in either of these scenarios, the psychiatrist must take steps consistent with state law to avoid a claim for patient abandonment, including providing a “reasonable” period of time for emergent care and providing written notification of the termination. Moreover, when the psychiatrist prescribes medication, the termination correspondence should include the importance of continuing the medication as directed until the patient sees the new psychiatrist, any risks of abruptly discontinuing prescribed medication and, if relevant, instructions for tapering the medication to avoid harm. All too frequently in these situations, however, the patient runs out of his medication, needs a refill, and contacts you—the former psychiatrist—for assistance. These circumstances become particularly problematic in situations where it would be harmful to the patient to discontinue the medication abruptly. Do not assume that because you are “technically” no longer the patient’s physician of record that you do not have any remaining obligations to the patient. At the same time, however, keep in mind that if you refill a prescription for the patient after termination of the relationship, the clock for termination may reset and you may need to start the termination process again. So given this tension, what are your options in these circumstances?In these situations, it is important to consult with a local attorney or a risk management professional. Some options to discuss, depending on the specific circumstances, may include the following:Prescribing the needed medication and providing the patient with a tapering schedule. Note: this will likely re-establish the psychiatrist-patient relationship and require the termination period to begin anew, including sending the patient another letter containing the new termination effective date.Obtaining consent from the patient to speak with his primary care provider to discuss having that individual prescribe the medication in consultation with the psychiatrist until the patient establishes a relationship with a new psychiatrist.In circumstances in which threatening or abusive behavior toward the psychiatrist is a consideration, directing the patient to the emergency department to obtain the medication may be indicated. Keep in mind that if the patient or family member exhibits threatening, abusive behavior or there is a safety concern to you or your staff, simply because you prescribe medication does not mean you have to continue to see the patient. Safety is always the priority, and the patient can be referred to a local emergency department for treatment in these instances.Without a doubt, these complicated situations require careful consideration of the specific circumstances. Even in situations in which the patient “fires” you, your obligations to the patient may not end immediately or even upon the termination “effective date” when patient safety is an issue or when you are prescribing medications. Consult with attorneys experienced in medical malpractice liability or a risk management professional to assist you through the process and help limit your liability exposure and promote patient safety.This information is provided as a risk management resource and should not be construed as legal, technical, or clinical advice. This information may refer to specific local regulatory or legal issues that may not be relevant to you. Consult your professional advisors or legal counsel for guidance on issues specific to you. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings, GmbH, a Fairfax company (“Allied World”). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World. ■“What Happens When the Patient ‘Fires’ the Psychiatrist?” can be accessed here. “Risk Management Considerations When Terminating With Patients” is available here. ISSUES NewArchived