July 31, 2012
I have a patient involved in an assault. He is an older man "accused" of choking a teen age girl. She was not permanently harmed. He has not been to trial yet. He is on a monthly narcotic regimen. Is my ethical obligation to treat and not abandon this patient? Can I discharge him for being a bad person I don't want to see? Can I justify cutting off his narcotic supply based on this behavior? I have no reason to believe narcotics were involved in this incident.
Dr. R, you have highlighted a serious concern. To answer your first question, whether you may terminate the patient for being a "bad person", the answer is you are entitled to terminate a patient from your practice so long as you do not "abandon" your patient. Abandonment constitutes misconduct under the New York State Education law, section 6530(30).
To effectively terminate a patient appropriately: (1) you must provide proper and adequate notice to the patient (make sure to document this!); and (2) the patient must be able to secure another doctor to replace you (the latter requirement may be difficult to fulfill if your practice is located in a rural area or your specialty is unique to an area, in which case you may be forced to continue treatment). In addition the AMA recommends other steps be taken when necessary in order to ensure continuity of care, such as: providing the patient with a brief explanation for the termination, agreeing to provide treatment for a reasonable period of time to allow the patient to secure care from an alternate physician, and helping the patient find an alternate physician. For more guidance on this topic see the AMA article, ending the patient-physician relationship.
The second question asked above, whether you can justify cutting off his narcotic supply based on his behavior, where you have no reason to believe narcotics were involved in the stated incident, is a tougher question, one that I would like to relay is in your discretion. However, we are living moreso in a reality where a physician's professional judgement is increasingly questioned. The standard for malpractice is whether a reasonable physician in your shoes would terminate the narcotic supply? Again, I defer to you (and/or your peers), however, will state that terminating care may be your best bet.