Dismissing a Patient in Labor Leads to Physician Removal from Hospital Call Panel

Timing must be a primary consideration when contemplating termination of treatment. To avoid abandonment, a physician must give a patient a reasonable opportunity to safely continue care with another healthcare provider. Patients with acute conditions may find it next to impossible to safely locate a new provider. For various other patients — the indigent, rural dwellers, individuals with rare conditions or combinations of conditions — it could take longer than average. Safely dismissing patients in these circumstances may take additional effort, planning and documentation.¹

Patients in Need of Immediate Care

Acute conditions that warrant immediate treatment must first be resolved or stabilized before termination actions can commence.²

Pregnancy and Labor

A patient in active labor cannot be given a reasonable notice period to find an alternative physician; therefore, terminating a patient relationship during this time is not recommended. Terminating a patient late in her pregnancy or early in the postpartum period may also increase risk because it may be too difficult for the patient to find a new obstetrician in a timely manner. Considering the finite nature of pregnancy and the seriousness of potential injuries to the patient and fetus, continuing the relationship through the postpartum period may be the safest choice, even when there are grounds for terminating the relationship.

Case File

A patient in labor presented to the Emergency Department (ED). The physician admitted the patient to the labor and delivery department. Shortly thereafter, the physician discovered the patient was uninsured and indigent. He then refused to provide medical treatment. The hospital removed the physician from the call panel based on his abandonment of the patient, and he appealed.

Discussion

The appellate court agreed with the hospital, stating, “[A] physician cannot just walk away from a patient after accepting the patient for treatment. A physician cannot withdraw treatment from a patient without due notice and an ample opportunity afforded to secure the presence of another medical attendant. In the absence of the patient’s consent, the physician must notify the patient he is withdrawing and allow ample opportunity to secure the presence of another physician.”¹ Similar descriptions of patient abandonment can be found in appellate opinions in various other states, medical journal articles, medical ethical statements and state statutes.

Caveat: Discussing the EMTALA issues associated with terminating a patient relationship with a patient in labor are beyond the scope of this article. The foregoing case is presented to highlight the abandonment issue. The EMTALA issues were addressed separately by the appellate court.

Risk Management Recommendations

Consider the following recommendations:

• Do not dismiss patients in active labor.
  • In limited situations a termination may be possible if you have arranged for and coordinated an appropriate hand-off to an appropriate physician and both the patient and the physician willingly accept the hand-off.
    • Obtain documented proof that the patient has been seen and that care has been established with the new physician.
  • Carefully consider dismissing a patient late in her pregnancy or early in the postpartum period. It may be too difficult for the patient to find an obstetrician willing to accept her.

References

1. Case study derived from Hongsathavij v. Queen of Angels Etc. Medical Ctr., 62 Cal App 4th 1123, 1138 (1998).

2. Harris S. Take care when firing a patient. American Medical News 2008 Feb 4.