Firing Patients

January 1, 2007

What to do if a patient refuses to sign for receipt of dismissal letter?

Question: If I have to fire a patient - say, someone I suspect of narcotics abuse - I follow the advice I’ve been given and send the patient a letter of dismissal by registered mail. But sometimes when I use registered mail and require the recipient’s signature so I have proof that the patient received the letter, the patient refuses to sign it and claims never to have received my correspondence. What should I do to make sure patients do not have a way to claim they did not get my letter?

Answer: With both certified and registered mail, you should be able to confirm delivery even if you don’t get a signature.

In addition to sending a certified letter, send a letter by “regular” mail. Sometimes patients will not open or sign for a certified letter, but they will get a letter through regular mail. If the letter sent via regular mail is not returned, you can assume it was delivered.

Of course, if the patient does show up at the practice, the manager should bring him into her office and tell him he is being terminated.

Either way, document what you have done and why. You can do only so much. You should also contact the risk management folks at your malpractice carrier for their advice.