Refusing Care to Uninsured Patients

Question: Say a surgeon is on call and the ER physician refers a patient to him. The patient needs a gallbladder removed but has no insurance and cannot pay up front for the procedure. Can the surgeon refer the patient to another practice after seeing the patient in the office for initial evaluation?

Answer: I can’t give you a yes or no answer. Let’s just say, “Be careful.”

You don’t want to be accused of patient abandonment. It is also not clear to me how urgent the situation is, where you saw the patient, or whether the Emergency Medical Treatment and Active Labor Act applies.

A physician-patient relationship is expressly established when the physician actually sees the patient. But it can be implied in other ways: For example, when the patient schedules an appointment with the physician, or when a primary-care physician refers the patient to a specialist and the specialist’s office gives the patient an appointment at a designated time and place.

Once a physician-patient relationship is established, the physician has a duty to continue to provide care to the patient until that relationship is terminated by mutual consent, the patient dismisses the physician, the services of the physician are no longer needed, or the physician properly withdraws from the physician-patient relationship.

Assuming the relationship exists, you have a duty to treat and cannot simply deny care to a patient without exposure to liability for abandonment of the patient, potential risk of malpractice suits, and possible licensure revocation, suspension, or other disciplinary action, based on specific state laws. However, under common law, there is a “no-duty rule” that says a physician has the right to refuse treatment to a patient in need of emergency care if there is no prior physician-patient relationship. Ideally, you skirt the issue by having a policy in place that allows the patient to set up an alternative payment plan of some sort.

If the patient is not in immediate need of medical care (which I don’t think is the case here), then you can dismiss the patient with a certified letter. But even then, you must provide care for 30 days while the patient looks for another doctor.

This case is worth running by your malpractice carrier for advice. Contact its risk management office.