Head off problem patients with signed agreements, legal review: Expert

by Roy Edroso on Sep 1, 2023
Part B News recently reviewed the rights and responsibilities of practice managers who wish to remove or stop admitting troublesome patients. Here with further thoughts on the subject is Richard F. Cahill, Esq., vice-president and associate general counsel of The Doctors Company (TDC) in Napa, Calif.

Cahill: Based on inquiries TDC patient safety risk managers receive on a routine basis, practitioners are frequently confronted with competing, and often-conflicting situations, in the office setting. Deciding how best to proceed usually involves a balancing of the respective rights and obligations of the individuals involved consistent with federal and state law and the community standard of care. For example, disruptive and sometimes even violent behavior occurs, and providers must decide on the spot whether termination or contacting law enforcement is indicated.

Health care providers can mitigate and possibly avoid issues in advance by posting on their website their Conditions of Treatment as to the expectations of individuals accepted into the practice.

Having patients sign a Provider Service Agreement which memorializes those requirements helps to maintain proper office operations and decorum and enables clear communication with disruptive or violent individuals with understandable consequences for violations.

[A] common issue involves patients who bring animals to the office for a scheduled visit. State laws vary as to the rules defining and governing both service and emotional support animals. Practitioners are encouraged to know the law and administrative regulations in the jurisdiction where they practice. Violating a statute or directive may result in a complaint to a government oversight agency such as the medical board or the OCR.

With increasing frequency, disgruntled patents post adverse reviews on social media, often anonymously. The content can rarely be removed and is generally damaging to a professional’s reputation and may, depending on the allegations, impair their ability to attract new patients or third-party payers. Providers are cautioned not to specifically respond online as that might result in an alleged breach of federal and state privacy laws and a subsequent complaint to an administrative agency such as the OCR with an ensuing investigation.

It is recommended that you contact your assigned risk manager to provide support and guidance when you encounter difficult and complex clinical situations.
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