Physicians must follow certain protocols should they wish to dismiss a patient in their practice.
Physicians can ask chronically disruptive or drug-seeking patients to leave their practice. They can do the same for patients who miss appointments or fail to pay bills, but generally they can’t fire patients for simple failure to follow their advice.
Recently, some pediatricians began refusing to care for the children of parents who don’t let them be vaccinated based on fears of a link between vaccines and autism.
The American Academy of Pediatrics frowns on this, Douglas Diekema, a former chairman of its bio-ethics committee told the Wall Street Journal, “because it gives you the opportunity to continue the discussion. Two years later, if the child gets whooping cough, the parents may change their mind.”
State laws on the subject are variable, but in general they require that doctors document the reason for withdrawing care, inform the patient about the problem, give him or her time to find a new physician and then send a certified letter ending the relationship.
The right of doctors to refuse to treat patients was reaffirmed by the Fifth Circuit Court of Appeals, in a case involving John Bower, the director of a kidney dialysis program in Jackson, Mississippi.
Bowers’ patient frequently missed appointments for dialysis, drank excessively and ended up needing emergency care all the time.
Bower eventually told the patient he was ending the relationship, but an advocacy group sued. Bower argued that forcing physicians to treat patients violated the 13th amendment, which outlawed slavery.
He won the case, but ended up treating the patient anyway because his hospital received funds under provisions requiring its physicians to treat anyone that needed care.
The patient died in a car accident 4 years later.