My general physician very sadly died unexpectedly a few weeks ago (he was a great person as well as doctor and we had an excellent relationship). I have some chronic health problems but my condition has been and remains very stable with the medications that he prescribed me, and there’s nothing challenging about my care or health needs. It’s all pretty routine.
There are five other internists in the office group he was in, and the people I spoke with assured me both verbally over the phone and in a letter that they would be happy to reassign me to another of their group and keep me as a patient. All I had to do was choose, and everything would be fine.
After reviewing my options and reading ratings of the doctors from patients, I sent in a fax asking to choose a particular doctor if he had room for me and was willing to continue my medications. That was a Thursday. On Saturday, I received a rude and icily abrupt certified letter from the group throwing me out of the practice! No consultation, no discussion, no explanations, just immediate termination with extreme prejudice. The letter said that I could be seen only in an emergency and only for 30 days from that date (which period has not yet expired).
Curiously, the letter was not signed! Not by anyone. An office manager told me over the phone that it wasn’t signed because it represented the entire group. However, I’ve learned online that an unsigned letter has no legal effect at all (see Is an unsigned letter legally binding? and A unsigned letter has legal binding no?)
So my first General Question is: Is it actually true in this case that, effectively, its as if the letter doesn’t even exist? Or is it binding all the same?
My main concern is about prescriptions. They’ve stopped refilling any of my medications, even those I need on a daily basis to deal with some chronic conditions (diabetes, for example)! They haven’t explicitly rejected the requests from the pharmacy; instead, the requests simply languish with no action taken.
Is that illegal, especially in light of the unsigned letter? Does it violate an AMA or other ethics code? They’re all MDs, by the way, and this is in Michigan if that makes a difference. I’ve read about laws against “patient abandonment”: does this qualify? What are my options? Does anyone have any recommendations on how best to proceed? I’m already seeking a new doctor, but that will take time…
I’m not going to comment on the legality or otherwise, mostly because I simply don’t know.
But in my experience, when nasty unsigned letters are received it’s normally from some relatively low level person who never had any place writing such a letter in the first place.
Can you go there in person and ask them about it? The fact that the letter was unsigned doesn’t sound like any doctor’s office I’ve ever heard of. I see lots of documents that go between the insurance company I work at and various medical providers (none terminating service as such, but still). What you’re describing sounds like a very unusual anomaly, so I’d recommend going in person today to clear up the issue. Unless they’re not accepting new patients, I can’t think of a reason for them to decline to assign you to another doc in the practice. So, go there in person and bring the letter they sent you, and ask them about it.
If they won’t compromise and write you a month of refills for now, go to your regular pharmacy and talk to the head pharmacist on duty. Explain the situation. Depending on your state, the pharmacist may be able to authorize one refill of each drug while you search for a new doctor.
Make an appointment to see the doctor of your choice, and take the letter. Ask him/her to their face if the letter is legit, and if it is, why they’re giving you the boot.
it could be legit, but also a mistake, or even a malicious prank. If it’s legit, then demand a release on the spot, and walk out with your records. Then find another doctor.
I’m thinking it’s an insurance issue, too, and what you were supposed to get was not what you got.
Even though it’s a group practice, not all individual doctors accept the same insurance plans. Often, it’s an individual choice; one doctor may not want to deal with the hassles of Joe’s HMO, so he won’t accept it even though others in the practice do. It’s possible that the doctor you want to see won’t accept your insurance plan, or may not be accepting new patients who have your insurance plan.
I’m also thinking you might have gotten the wrong form letter. Many clerical workers in doctor’s offices aren’t very well-trained or paid much more than minimum wage. The employee responsible for sending letters might have been told to send you letter x but sent letter y instead and whoever you spoke to didn’t bother to investigate any further before she talked to you. I don’t see this as a prank because the possible legal consequences are too great for the practice.
Ultimately, the decision to drop a patient as you were, at least according to the letter you got, is a serious matter that usually isn’t taken lightly. It’s usually reserved for deadbeats, people who refuse to comply with doctor’s instructions, and people who are abusive to the staff and/or doctors. Assuming none of these apply to you, it’s probably safe to assume incompetence rather than malice.
So what do you do? Despite what VunderBob said, don’t bother the doctor over this. He probably won’t know any more than you do because many group practices keep insurance and other financial information separate from patient records to maintain a firewall so that medical care can’t be colored by insurance considerations. (For example, a doctor might be tempted to order more tests if the patient has good insurance; these tests might not be indicated for that condition or not ordered for patients with insurance that isn’t as good.)
The person to talk to here is the practice manager. This person is the ultimate authority for the business end of the practice. Make an in-person appointment and show this person the letter, have her pull your records, and ask for specific reasons why you got this letter. Don’t allow him/her to give you off-the-top-of-their-head answers; make sure his/her responses come from your records. In fact, you are within your rights to see the actual records, so don’t be afraid to invoke this right. If this person can’t or won’t give you answers to your satisfaction, demand a records release and walk out of the building with your records right then and there. Follow this up with a signed letter, sent return-receipt, that says that you are leaving the practice, and why. This is something they need to know, and something you need to document to cover your ass.
Finally, ask yourself if this is a practice you really want to do business with. If their administrative staff is so sloppy that you got a patient termination letter by mistake, can you trust them to keep your other paperwork straight? A good bit of the doctor-patient relationship is really the relationship between the patient and the business office, and if that’s not working, find a new practice.
My point was colored by the practice manager being the driving force behind this, and going over their head. The House of Vunder has been bitten twice in the past by corrupt practice managers pulling crap like this. One lost her job when we fought back by going over her head to the doc, who was clueless to the multiple situations she was orchestrating.
I will absolutely stand by my statement that should you decide to walk away, do it with your records in your hands.
[ul]
[li]ambushed’s doctor dies suddenly.[/li][li]ambushed is told verbally and in writing that the practice is able and willing to assign him to a new doctor within the practice.[/li][li]ambushed, after doing some research, sends a fax to request a specific doctor. This is on Thursday.[/li][li]ambushed receives a letter on Saturday, two days after making his request, terminating his relationship with the practice. The letter is unsigned, which is what prompted the OP’s initial question.[/li][li]ambushed called the office to inquire about the letter’s legal validity, and was told by “an office manager” that the letter isn’t signed because it reflects the position of the entire group.[/li][li]The OP focuses on the lack of signature. There are no further details about why he might have gotten the letter in the first place.[/ul][/li]
My assumptions, based on my experience as both a medical office worker and as a patient, are as follows:
[ul]
[li]ambushed is really asking the wrong question. The first question should have been “Why did I get this letter?” not “Why is the letter not signed?” If he’d asked the former question, whoever he spoke to would have had to pull his records to be able to give him an answer. At that point, the problem would have been found and the situation remedied.[/li][li]The “office manager” answered the question she was asked, which, since it’s apparently office policy, she didn’t have to research.[/li][li]The answer the OP got wasn’t the answer he was looking for, but then, he got the answer to the question he asked. He didn’t give the “office manager” a reason to look into it further, so she didn’t. She assumed that ambushed was supposed to get the letter.[/li][li]The OP didn’t follow up, he simply came here and posted.[/li][li]Finally, these kinds of termination letters can have serious legal consequences for the practice, which is why they’re generally saved for the most egregious offenders. They also have to be documented in the record.[/li][li]Given the facts as they were presented in the OP, malice isn’t really at the top of the list. Assuming it is a prank or some malicious act isn’t really helpful here.[/ul][/li]
The reason why I suggested starting with an in-person meeting with the practice manager (who is probably a different person from the “office manager” the OP spoke to by phone; the practice manager is the “office manager”'s boss.) is because it’s very clear that the real issue is the lack of communication. Making sure that the practice manager has the actual records in front of him/her, and making sure that this person addresses ambushed’s questions based on information from those records will address the entire problem, which is why he got a termination letter, and whether he should have gotten it in the first place. At this point, the practice manager can either correct the mistake, or ambushed can walk out with his records, followed by the letter I suggested upthread. The reason you start with the practice manager is because this person is the guy in charge of the administrative side of the practice. He (usually) reports directly to the doctors. It’s Chain of Command 101. Even if you have to go back and talk to the same “office manager”, it’s OK, just do so in person under the same terms I’ve already described. Give her a chance to make things right or at least explain why you got this letter with actual information that is specific to you, not an off-the-cuff answer given over the telephone.
If, on the other hand, the practice manager turns out to be a dildo, then take it to the doctors by sending a return-receipt letter addressed to each of them that lays out the entire situation, what you’ve already done to resolve it, and that you intend to terminate your relationship with their practice effective immediately because of your dissatisfaction with the way their practice is managed. Making an appointment to talk to one doctor doesn’t accomplish anything, but sending a letter will get their attention, especially when it’s a letter that has to be signed for, and one all of the doctors get. (Make sure you cc all of them, as well as the practice manager, if you send this.) You will get action, I can guarantee it.
What the OP also has to be made aware of is that being “fired” from a medical practice is a serious thing for him, too. Having that letter in your medical records (and you can bet there’s a copy in there) sends a red flag to a new doctor (and his staff) that you are going to be difficult, either because you don’t pay your bills or you’re an asshole whose behavior is so egregious that you’re not worth the trouble.
It’s important to address why you got the letter in the first place. I cannot overemphasize this point. Fuck the lack of signature. Focus on why you got the letter in the first place.
Or there’s a lot more information than what the OP is sharing.
I have only seen a termination of relationship notice like that a few times in my nursing career and it was always instituted by the doctor who no longer wanted to see the patient, usually for serious non-compliance to the point the Doc would be worried about legal problems, or for having the feeling that the patient was argumentative, hostile or threatening and would no longer be welcome in the office.
Also, whenever a notice was sent terminating the relationship, it was usually sent certified mail, return receipt, so that there was proof the letter was received.
I have never seen a case where the relationship with a whole group was terminated because one Doc died and the other docs could not or did not want to absorb that Doc’s patient load, and I suppose that is possible, but it seems unlikely to me. They spend a lot of time ‘building their practices’ and generally try to keep their customer/patients.
So, perhaps it is as simple as that- the other Doc’s are already overly full. Have you had problems getting appointments there?
Have there been any ‘incidents’ you would care to relate?
The only time I’ve seen people kicked out of a practice is if they are a complete asshole to the MD or staff, or they’re busted violating their pain contract in some way, either by getting more narcotics on the side or failing a drug test.
Assuming you’re not an asshole or a drug addict, you should physically go down there and very nicely ask them to 'splain. It sounds like a mistake to me.
Get your records while you’re at it. You’ll probably have to pay for copying, though.
First, thank you all most kindly for your welcome replies! This thread is another fine example of The Dope at work.
Gird your grid for another typically lengthy ambushed post (sorry!).
In reply to bengangmo, rachelellogram, VunderBob and others who suspect the letter may have been inadvertent or unauthorized by a doctor, let me assure you that it was indeed entirely intentionally authorized by a specific doctor that I’ve just today learned has a reputation for general misanthropy and for making snap, knee-jerk decisions. Had I known that, I certainly would not have chosen him for my doctor, but alas, here I am.
I received two copies of the same unsigned letter, one via conventional mail and the other via certified mail with return receipt, precisely as my readings about patient termination laws from professional web sites (like the AMA) repeatedly advise doctors to do when terminating a patient. Also, the day after my fax (on Friday), I received a voice-mail message asking me to call the group’s office manager. I could not call until the following Monday (after receiving the letters on Saturday), and when I did she confirmed the termination by the doctor I mentioned in my fax. After explaining why the letters were unsigned – “it came from the entire group” (total BS in my view) – she went on and on in empty, blame-denying officespeak, during the course of which she “explained” that the doctor in question said I “needed to see a specialist”, which is utterly ludicrous BS given the fact that my condition was and continues to be stable and that I was merely in what I’d call routine medical maintenance. All I needed was my regular prescriptions to continue to be refilled and nothing more. Certainly no “specialist” was needed! But that “explanation”, of course, was obviously just a bogus cover for whatever snap judgment he made. He didn’t even tell her what kind of “specialist” I allegedly needed!
Now, I don’t know how to convince you I’m not some kind of “problem patient”, such as being non-compliant or abusive or drug-seeking or drug-abusing or unwilling or unable to pay or rude or psychologically unstable or whatever. If the doctor had bothered to review my medical records (something he almost certainly did not do, considering the extremely tight timing), he would have seen no such thing; not a single word of criticism or other negative remark from my previous doctor who was right there in the same office! But I do have a suspicion about what might well have prompted his knee-jerk reaction: One of my daily, routine medications that I’ve been taking for years and has been prescribed by several past physicians is a scheduled drug (which by the way is not a pain medication). And that’s the only potential for such an immediate, unthinking rejection I can possibly imagine. But I’ll wager that’s just what set him off.
It’s definitely not an insurance issue, either; I know that he accepts my insurance. And if it were simply that he had too many patients (something which is certainly plausible considering that the practice had to absorb any number of other patients of my deceased doctor), why not just say that? I’d even specifically mentioned in my fax that I’d understand if he had no room for me!
There was no mention in the letters of any reason for discharging me. Here is the content of the letter (the letterhead lists all the doctors in the practice, including my doctor who has passed):
I have not sent in the form, because to do so would legally represent my tacit acceptance of my receipt of a legally binding letter – even though it was unsigned and thus technically doesn’t legally even exist (or so those links in my OP claim). I wish to make a point about his unconscionable behavior and leave its mark in his record. I have no desire to sue him, since attorney friends in the past have taught me well that no one ever wins a lawsuit. Furthermore, I doubt I can prove sufficient harm. However, I plan to report him to the state’s medical board and see to it that he’s chastised in some meaningful way. But if I act as if the letter was legally binding, I lose all such courses of action.
By the way, a doctor can much more easily reject a patient with whom he has no history, and I’ve never met the man. However, I have been seen by another doctor in that practice when the now-deceased doctor was unavailable (only later to learn at his funeral service that this unavailability was due to his stage-four cancer). And it is this second doctor who was sent my refill requests and who has still refused to act on them. Thus, the laws against patient abandonment are in full force and definitely apply in my case.
I’m already out of two daily medications. In two or three days, I will have run completely out of a total of 5 daily meds. I have spoken about this several times with my usual pharmacist, who over time became good friends with me and would certainly do all he legally could to help me. He has truly praiseworthy principles and a very strong ethical code, yet has agreed to very small refills of the most important daily meds twice now, but that’s all I will ask. His hands are tied, and my own principles are just as rigorous as his: Friends must NEVER push, and I totally refuse to do so. He has, however, kindly offered to write up my medication history and his professional judgment about them and myself, which he writes demonstrates I am an exemplary patient.
I’ll now go on to reply to individual posts and questions that were not addressed in this post. However, please note that my two main questions remain (about which I don’t quite agree with moving this out of General Questions):
**(1): Does the fact that the termination letter(s) were unsigned definitely mean they effectively don’t exist, or not?
(2): Does the legal requirement for continuing care even from doctors who dismiss their patients definitely include refilling daily medications, or not?**
(psychobunny’s reply strikes me as extremely likely, but I can’t find anything online that specifically covers continuing prescription rules.)
Well, as I explain in my second post, here, the letter(s) conform to what my online readings about how to terminate a patient recommend, with the possible exception of a complete lack of explanation (though some lawyers recommend deliberately leaving that out for legal reasons). I’m highly confident that this was exactly what the misanthropic doctor in question wanted done…
Thanks, rachelellogram, for your good suggestions. I’m very reluctant to go to the office in person until I learn more about the legalities involved to learn if I have some legal cause of action (although as I explained in my second post, I have no desire to sue, the threat of legal action can often get someone’s attention!). I’m also a bit worried I might lose my cool when challenged by this misanthrope and make matters worse.
As for the pharmacy, I also explained here that I won’t push them any farther, but I will very probably see if the county medical society will agree to refill them temporarily until I’m set up with a new doctor. I’m not so stupid as to jeopardize my health just to make a point – no face-spiting for me!
Hi, Bob! I’m not on Medicaid, and as I explained elsewhere, I’m highly confident the letter was deliberately sent by the doctor in question. And as I wrote to rachelellogram above, I’m not ready yet to visit the office in person.
But I am extremely grateful for your advice to simply take my current file as is rather than request copies! For one thing, they’ve already kicked me out of the practice, so there’s no reason to keep a copy of them. But also, I don’t want this jerk to know who my new doctor is in case he feels vindictive enough to interfere with my new patient-doctor relationship.
Before responding further, I wish to thank you enormously, MsRobyn, for your wise and insightful comments!
Please see my second post, MsRobyn, which responds to these matters, and can be found here. There were no insurance or capacity issues stated, which could have been easily done with no consequences. The termination was clearly intended by the doctor in question, though it is my strong suspicion that it was very far from cautiously considered – the timing was far too tight for that.
Another option – the explanation I favor – is a hasty, knee-jerk decision that was reached in an instant by an impatient and/or overly busy doctor who failed to understand or consider the legal consequences of his actions (or just didn’t care about them at the time).
This is just who I spoke to over the phone…
This is wonderful advice! And it seconds the fine records advice that VunderBob gave me, too. Thank you!
Oh, I entirely agree, and I’m in the process of doing exactly that. But as I elaborated elsewhere, I nevertheless want to see a letter of castigation from the state medical board in his records, if not more. I also want the public to know about this unconscionable act and the refusal to refill my necessary daily meds, but I might well face a threat of lawsuits myself if I say anything in public about this without ensuring that all the legal ducks are in order. Thus, I’m not going to just forget about this, even though as I said above I’m not going to put my health at risk in the process…
I don’t know the answer to all of your questions, but I do know that in no way are you going to be able to go in there and demand your actual file. For one thing, most records are electronic these days, and even if there is a paper file, it’s not your property, it’s theirs. They are legally obligated to keep your records for several years after you were last seen. They do have to give you copies of most of your file, but not immediately on request. They legally have 30 days in my state in which to do so- I’m not sure if the time varies from state to state.
As for maintenance meds, urgent care? They should be able to give you Rxs at least once, and you should be able to get in with a new doctor by the time you need more.