Policy AD-720 Dismissal of Patients from Clinical Care and Behavioral Contracts 2019-01-10

Purpose: The purpose of this policy is to ensure a therapeutic patient relationship and to ensure safety for all staff member and patients.

Policy: Westside Family Healthcare (WFH) seeks to provide high quality clinical care and a therapeutic relationship with patients, through good customer service and mutual respect, while also ensuring the safety of all staff members and other patients.  When a patient’s behavior compromises the ability of WFH to provide high quality clinical care and a therapeutic patient relationship, it is the policy of WFH that the patient may be dismissed from the practice. Westside Family Healthcare will adhere to state law regarding patient dismissal. Dismissals will not be discriminatory (based on race, ethnicity, color, national orientation, gender, sexual orientation, religion, or age).

Scope: All WFH locations and patients.

Definitions: None

Procedure:

1. The following infractions that may be committed by a patient are considered behaviors that compromise the therapeutic patient relationship, and are cause for consideration of dismissal or a behavioral contract:
   • Verbal abuse towards a staff member or another patient
   • Physically threatening behavior
   • Altering or falsifying a prescription, record, or medical/legal document
   • Threatening legal action for malpractice
   • Other behavior that directly impacts the provider-to-patient or staff member-to-patient relationship in a negative way, and is deemed high-risk by the Chief Medical Officer
2. If a patient commits an infraction, a manager or clinician will inform the patient that his/her behavior is not tolerated in the practice.
3. If a patient has interacted with a clinical staff member and an infraction has occurred, the incident is to be documented thoroughly in the patient’s medical or dental record at the time of occurrence.
4. An Incident Report should also be completed by any staff member when an infraction incident occurs.
5. A Director will investigate the incident with the appropriate Office Manager and a Clinical Site Lead. As part of the investigation, an evaluation of the infraction will be made. When applicable and when supported by the patient’s primary care provider, the Office Manager will submit a request, via WFH’s Incident Reporting system, to the Chief Medical Officer (CMO) for a behavior contract with the patient or for the dismissal of the patient. After the request has been made, the Director of Site Operations will schedule a meeting with the Chief Medical Officer for review.
6. Determination of dismissal will be based on repetitive nature, degree of infraction, and risk to staff.  
   1. A behavioral warning letter will be sent to the patient with limited infraction occurrences or in low-risk situations.
   2. An additional behavioral contract (“Notice of Unacceptable Behavior”) may be put into place for a patient with limited infraction occurrences or in low-risk situations. The contract requires the patient to sign and acknowledge the behavior and also states that continued repetition of the behavior, or other infractions, may lead to dismissal.
   3. In other instances, Westside Family Healthcare may immediately dismiss a patient when there is a threat or perceived threat of violence.
7. The decision to dismiss a patient from the practice will follow a consistent process. The CMO will make the final determination, with input from relevant Directors, Managers, and Clinical Site Leads, and with consideration of Delaware state laws on terminating the physician-patient relationship.
8. If the patient is being dismissed for altering a prescription, record, or legal document, the copy of the altered document will be retained in a file that is separate from the patient’s medical record.
9. Patients dismissed from the practice will receive certified letters with the date of dismissal.  They will also be provided a list of other low cost medical and dental providers in the community.
10. The patient will be listed as “dismissed” in the Practice Management (which is used for medical and dental office scheduling) and the Electronic Medical Records systems by the Director of Site Operations and also in the Electronic Dental Records system by the Director of Dental Operations. No further appointments will be scheduled at WFH sites after the date of dismissal.
11. In some instances, WFH will allow 30 days for a dismissed patient to establish a relationship with another provider, and limit care during this time to acute needs only.

References: None