Termination of relationship between Physician

and Patient
abstract

This paper assesses the termination of relationship between physician and patient. In
Allison v. Patel (1993), the defendant abandoned the plaintiff in a critical situation and
provided less competent physician, which lead to plaintiff's death. In Maltempo v.
Cuthbert (1974), in which physician abandon a patient just by thinking that another
physician is handling the case; such case should be considered under implied way of
abandonment. These are just a few examples of cases that provide the understanding
and supportive ideas for patient abandonment or termination of relationship between
physician and patient. This paper seeks to: (1) provide basic idea of patient 'physician
relationship existence, (2) discuss the rules of law, (3) discuss legal cases involving
abandonment of patient and action taken by patients, (4) propose recommendation and
conclusion for brief understanding of termination of relationship between physician and
patient.

introduction

The relationship between physician and patient exists when a physician decided to fulfill
a patient's medical needs; in general a relationship is voluntary and created by either an
expressed or implied agreement. Mostly, a physician agrees to accept responsibility for
a patient's care in response to an overt or implied request in return of payment. There
will be no duty of care by physician to patient if the contract between physician and
patient is absent. The agreement between physician and patient is a prerequisite to a
physician-patient relationship. According to the American Medical Association (AMA)
Code of Medical Ethics (1994), a physician is free to select whom to treat (in
nonemergency situations), but once a patient-physician relationship has been
established, the physician is obligated to provide the patient with consistent, constant
care as needed (AMA, 1994).

The termination of relationship is considered to be the final stage in physician and

patient relationship. Termination may be originated by patient or physician. Patient
originated termination comes about as a result of absolute physician's inadequacy,
change in physician's competency, or comparison with other physician's competency.
Physician originated termination is due to the patient's unwillingness to obey with the
physician's regimen, or due to the physician's self-recognized inability to handle an
episode. 'The relation of physician and patient, once initiated, continues until it is ended
by the consent of the parties or revoked by the dismissal of the physician, or until his
services are no longer needed, and until then the physician is under a duty to continue
to provide necessary medical care to the patient" (61 Am. Jur. 2d, Physicians, Surgeons,
etc., '234).

The situation in which a physician withdraws before a patient is cured often results in a
claim of abandonment by the patient. A physician, who leaves a patient at a critical
stage of treatment, without giving the patient adequate notice and time to choose
another physician, has abandoned the patient. Abandonment of a patient by physician is
a tort, and a physician who does it is legally responsible for damages.

rules of law

To prove abandonment, the patient must present following four essentials:

1. An established physician-patient relationship;

2. The termination or negligence by the physician;

3. Absence of adequate notice to allow the patient to choose another physician; and

4. The patient must have been injured as a result (Showalter, 2008).

A physician may terminate a relationship with a patient only when:

1. The medical condition that has given rise to the physician patient relationship ends

2. Discharge of physician by the patient

3. Physician give adequate notice to the patient that he/she is withdrawing from the
case and providing the patient enough time to secure other medical treatment (Furrow,
2009).

Legal cases

In Stohlman v. Davis (1928), the case involved abandonment of patient by physician in a

serious condition of disease without reason or sufficient notice. The patient developed
complication as a result of surgery. When the patient was in a critical situation, the
physician became ill and went for treatment in another state. In this case the physician
left the patient in the care of the physician with far less experience than the doctor had.
This case represents medical malpractice and abandonment against the doctor. The trial
court decided in favor of the patient. The court found that the patient employed the
doctor as a specialist or an expert in surgery in return of payment; and by looking at
condition of patient and circumstances that for the doctor to substitute himself with
another physician of less experience without any notice or agreement with the patient
would not result in violation of duty but will clearly represents abandonment in this
case.

In Norton v. Hamilton (1955), the physician accepted the mother as a patient while she
was pregnant and agreed to give the mother required care and treatment as might be
needed to deliver the child. While the mother was in labor through the delivery, the
physician refused to see the mother, after initially treating her. The physician abandoned
the mother while she was still in labor, which forced her to undergo a painful trip to a
hospital which caused complications. The physician left his patient at a critical stage of
treatment without reason or sufficient notice or providing a competent physician shows
patient abandonment, breach of warranty, and breach of contract. The court found the
physician guilty of his dereliction of duty and requested damages were proper.

In Allison v. Patel (1993), the defendant was a vascular surgeon whose patient required
an arteriogram. The radiologist would only perform it in the presence of a vascular
surgeon because of possible complications which might result. Immediately after the
arteriogram, the defendant received a telephone call about defendant's mother-in-law
that she had slurred speech, was nonresponsive, and was dying. The defendant left
immediately to assist his mother-in-law, leaving his patients to be covered by another
doctor who was qualified to handle 90-95% of the complications arising from an
arteriogram. The complication was uncommon which required the services of a vascular
surgeon. Since the defendant was out of town and unreachable, the substitute doctor
arranged for the plaintiff to be transferred to another facility where a vascular surgeon
was available. The patient suffered from thrombectomies for a month but later suffered
from cardiac failure while he was in intensive care. The patient's widow sued the original
vascular surgeon on failure to provide standard of care and abandonment.

Maltempo v. Cuthbert case (1974), is a case which explains that a physician may not
abandon a patient simply because he thinks another physician is handling the case; the
plaintiff's diabetic son was in county jail awaiting transportation to a state prison to
serve a punishment for a drug violation. In jail the son's health worsened, and his
mother called her family physician for assistance but could only reach the defendant
physician, who was taking the family physician's calls. This physician told the mother
that he would investigate and call back if there were any problems. He then called the
jail, and got to know that the son was being treated by the jail physician, and did
nothing further. The young man died while being transported to the state prison. The
appellate court affirmed a jury verdict in favor of the plaintiff. Even if it were unethical
for the defendant physician to treat the young man without the jail physician's consent,
the jury could find negligence in the doctor's failure to ask the other doctor about the
man's condition or at least to inform the parents that he was proceeding no further.

Recommendation

Abandonment of a patient is considered as a tortious act. Physician should provide

sufficient notice or provide a proficient physician in replacement before withdrawing
from the case. A physician who leaves a patient in a serious condition of the disease,
without any reason, or sufficient amount of notice to enable the patient to obtain
another medical attendant, is guilty of a responsible negligence of duty. Physicians are
liable for "unwarranted" abandonment of the patient or for abandoning the patient
"without reason."

Furthermore, the recommendation to decrease probable liability for a claim of patient

abandonment; it is important to terminate relationship with a patient by providing letter
notifying the termination of the physician patient relationship. There are certain
guidelines for a termination letter as follow:

' Provide sufficient time at least 30 days period for the patient to find competent
physician;

' Propose Short term emergency care;

' Provide resources of competent physician in his place;

' Physician should provide duplicate of the patient's medical record to the new care
provider with appropriate authorization.

Conclusion

To conclude, once the physician-patient relationship has been established by mean of

contract or agreement, a physician must provide treatment to the patient. A patient has
more flexibility to terminate the relationship, should act in a professional and prudent
manner. Once the relationship is established, the physician is limited in the ways and
reasons that he or she can terminate the relationship with a patient. If physician wants
to terminate relationship due to certain reason than he should follow certain steps. If he
fails to do so then he should be consider under abandonment.