October 2000 Bulletin

Put patients in retirement planning

You need to give adequate notice, accessibility to records, recommendations or list of other specialists

By Susan G. Feibus and Lynn Gordon

Imagine packing up your office for the last time and looking forward to a well-earned retirement spent traveling, relaxing and escaping from the constant demands of an orthopaedic surgery practice. You close the practice and two weeks later you are hundreds of miles away floating on a lazy river or blissfully playing golf.

Meanwhile, one of your patients is trying frantically to get in touch with your practice to no avail. Crucial hours pass as his knee—which you operated on two months earlier—swells and circulation is slowly being cut off below the knee. Desperate, he drives to your office location to find a "for rent" sign. He collapses from the pain and ends up at the ER. Another two weeks of retirement bliss passes and you get a call from your lawyer—sorry, bad news.

Worst case scenario:

You will likely face a claim of patient abandonment and professional malpractice, and you may well lose. Start tallying up those retirement investment dollars—you are going to need them.

One of the first steps in closing a practice is to meet with your malpractice insurer and review your policy to determine whether you have appropriate coverage for claims related to acts or omissions during active practice. Then, as you move towards closing your orthopaedic practice, give your patients adequate notice and time to transition to other caregivers.

Courts have defined patient abandonment as the termination of the professional relationship between the physician and patient at an unreasonable time or without affording the patient the opportunity to procure an equally qualified replacement. To avoid a claim of patient abandonment, you should notify all active (seen within the past two years) patients of your impending retirement from practice. Also, to avoid forcing a transition at an inopportune time, do not schedule any complex surgeries within the last several weeks of your practice so that patients are not placed in the untenable position of needing close surgical follow-up from a physician who was not involved in the surgery. Make sure that you keep documentation of patient notification procedures.

At least 60 days from the intended date of practice closure, each patient should receive a letter clearly stating the following: when the practice will close; which physicians, if any, you would recommend the patient transfer to; and how the patient can transfer copies of his or her medical record to the new physician. In the event you are not specifically recommending other physicians for transfer, at least include a listing of qualified specialists in the area so that your patients have a starting point in finding a new physician.

At the same time, have your receptionist and other staff members remind patients of your retirement date and post a notice of retirement in your office. To facilitate a timely transfer, also include a medical records authorization form release to a physician the patient chooses.

Additionally, make sure patient records are in good order (complete with information supporting diagnosis, treatment and prognosis, including, especially, X-rays, MRI records, and lab reports, where applicable). Give all patients ample time and notice to receive copies of their records or to have copies sent to their new physician(s), and let patients know how they may request and receive copies of patient records in the future. Remember that, even once your practice closes, you will need to retain all medical records for a number of years in case of malpractice litigation and to allow patient access. Working with a document management company may be the most prudent option.

Susan G. Feibus is a partner in Ungaretti & Harris’ litigation department. Lynn Gordon is an associate in Ungaretti and


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