# "Patient Abandonment", the law, and refusal to refill prescriptions **URL:** \ **Category:** In My Humble Opinion\ **Created:** [April 2, 2012, 8:52am UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557 "2012-04-02T08:52:06Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![ambushed](https://avatars.discourse-cdn.com/v4/letter/a/3bc359/32.png) [@ambushed](https://boards.straightdope.com/u/ambushed)\ **Post date:** [April 3, 2012, 8:16am UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557/21 "2012-04-03T08:16:51Z")
> [@MsRobyn](#): > > … > > … My assumptions, based on my experience as both a medical office worker and as a patient, are as follows: > > **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. I’m sorry, but that is a misreading of my OP. At no point did I _ever_ ask “why” the letter was unsigned. Instead — and this is extremely critical – **I asked if this unsigned letter has any legal standing whatsoever or whether, since it was unsigned, it’s as if I never received such a letter!** Why is the answer to that question so critical? Because if the letter is legally meaningless, **he is acting unequivocally illegally to refuse to care for me and refill my medically mandatory prescriptions, and thus I have an extremely strong legal case against him and his practice!** Therefore the signature or lack thereof is of extreme importance to me and my situation! It’s not some trivial consideration! I contend that the “Why did I get this letter?” question is of **far** less importance, since I have no desire to stay with that practice after I received such a letter anyway. Also, I was given an “explanation” over the phone, of “needing to see a specialist”, although that’s utterly bogus. Asking again and again is pointless, since they fabricated an “explanation” in order to get rid of me _without_ providing me any reason I might be able to sue them for. > [@MsRobyn](#): > > The “office manager” answered the question she was asked, which, since it’s apparently office policy, she didn’t have to research. To clarify, I was never told the official title of the manager I spoke with, and I was not aware that there was any difference between “office manager” and “practice manager”. Now that I’m aware of the distinction, there’s very good reason to believe that the woman I spoke to was indeed the “practice manager”. But verbal discussions don’t matter legally anyway, and no reason was given in the letter, which is just one more reason to pursue this as illegal. > [@MsRobyn](#): > > The answer the OP got wasn’t the answer he was looking for, but then, he got the answer to the question he asked. That’s plainly false on all counts, and I don’t understand your reasons for asserting that. The two questions that I actually asked in my OP have **not** yet been answered. > [@MsRobyn](#): > > 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. Again, incorrect on all counts. > [@MsRobyn](#): > > The OP didn’t follow up, he simply came here and posted. What’s _that_ supposed to mean? I came here and read the responses and replied as soon as I could work it out. In case you expected me to act otherwise, please be aware that I don’t use my employer’s computers to deal with personal matters. > [@MsRobyn](#): > > 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… Or, are issued by the most egregious and recklessly impulsive doctors, who in this case may well have falsely believed that I’d have no legal recourse because (as I discussed elsewhere) he and I had no history (even though another still-living doctor in the practice did). … > [@MsRobyn](#): > > …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. C’mon now! How far into your medical TMI zone would _you_ venture on a public message board? Please carefully read my post [here](http://boards.straightdope.com/sdmb/showpost.php?p=14929644&postcount=13) and let me know what you think. ---
**Author:** ![ambushed](https://avatars.discourse-cdn.com/v4/letter/a/3bc359/32.png) [@ambushed](https://boards.straightdope.com/u/ambushed)\ **Post date:** [April 3, 2012, 8:22am UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557/22 "2012-04-03T08:22:11Z")
> [@drdrizzy13](#): > > > [@drdrizzy13](#): > > > > Are you on a lot of pain meds? > > Just curious if this may have something to do with it? Hi, **drdrizzy13**. That’s a very reasonable question, but the answer is no. My previous doctors have prescribed occasional vicoprofen, but I use it so rarely that a thirty-day supply lasts 6-8 months. That’s one of the things my pharmacist made clear in the letter he wrote for me, and any doctor can confirm that readily. ---
**Author:** ![ambushed](https://avatars.discourse-cdn.com/v4/letter/a/3bc359/32.png) [@ambushed](https://boards.straightdope.com/u/ambushed)\ **Post date:** [April 3, 2012, 8:29am UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557/23 "2012-04-03T08:29:17Z")
> [@Alice\_The\_Goon](#): > > 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. Thanks, Alice! Too bad I won’t be able to apply **VunderBob** ’s and **MsRobyn** ’s advice to demand the existing copy of my records (which are indeed on paper), but what you say makes sense to me. And thanks for the urgent care suggestion as well; there’s one quite near me and they are affiliated with the same hospital/health-care group that my old doctor was with, too, so that should help… ---
**Author:** ![ambushed](https://avatars.discourse-cdn.com/v4/letter/a/3bc359/32.png) [@ambushed](https://boards.straightdope.com/u/ambushed)\ **Post date:** [April 3, 2012, 8:34am UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557/24 "2012-04-03T08:34:17Z")
> [@psychobunny](#): > > FWIW the pracice is obligated to take care of you for that 30 days until you find a new doctor which includes filling your maintenance medications. That makes a great deal of sense to me, so thank you for at least an informal answer to one of my two question in my OP! But may I ask what leads you to that conclusion? I’d dearly like to cite such a rule in my communications with that practice as well as with the state medical board, if you can dig such a thing up. ---
**Author:** ![ambushed](https://avatars.discourse-cdn.com/v4/letter/a/3bc359/32.png) [@ambushed](https://boards.straightdope.com/u/ambushed)\ **Post date:** [April 3, 2012, 8:50am UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557/25 "2012-04-03T08:50:59Z")
> [@Ca3799](#): > > 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. Which is just what happened here (though without a signature which my research thus far tells me makes the letter meaningless), which is one of the reasons I’m so confident this was deliberately and intentionally done by the doctor in question. Otherwise, that routine legal advice would not have been followed at all. > [@Ca3799](#): > > 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… Agreed, and as I elaborated elsewhere, even though I specifically mentioned in my fax that I’d completely understand if the doctor in question didn’t have room for me, the practice didn’t use that reason, which would have let them completely off the hook. > [@Ca3799](#): > > … Have there been any ‘incidents’ you would care to relate? Nothing at all. I’ve occasionally “stumped” my doctors in the past with so-called “paradoxical” reactions and similar puzzlers, but nothing problematic or troubling. And I’ve never pursued legal actions against any doctor (or anyone else, for that matter), though I _am_ going to make a fuss over this unlawful patient abandonment! ---
**Author:** ![ambushed](https://avatars.discourse-cdn.com/v4/letter/a/3bc359/32.png) [@ambushed](https://boards.straightdope.com/u/ambushed)\ **Post date:** [April 3, 2012, 9:06am UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557/26 "2012-04-03T09:06:50Z")
Before I call it a night, it appears I need to emphasize a few things. First, contrary to what some replies seem to suggest, **I did not post here to whine or complain or to inquire about the reasons behind this!** Please note this! My purpose was to pose two General Questions, neither of which has yet been answered with any citation or legal authority that I can use and pass on. I shall once again repeat them: \*\*(1): Is an unsigned patient termination letter legally binding, or is it as if I’d never received it, thus making the refusal of continuing care quite illegal? If so, please provide a cite confirming this fact. (2): Does the legal obligation for continuing care officially include the continuing legal obligation to refill daily prescriptions, or not? If so, please provide a cite confirming this fact.\*\* Thank you! (For what it’s worth, I _ **still** _ think this belongs in General Questions!) ---
**Author:** ![BigT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bigt/32/12044_2.png) [@BigT](https://boards.straightdope.com/u/BigT)\ **Post date:** [April 3, 2012, 10:39am UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557/27 "2012-04-03T10:39:03Z")
> [@MsRobyn](#): > > 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. Why in the world would this accomplish anything? Terminating your relationship with the practice is what they already want. Shouldn’t you be giving them not what they want? Like, I don’t know, pointing out that patient abandonment is illegal and that if the situation is not resolved promptly the next conversation may be with a lawyer? I know **ambushed** isn’t planning on suing, but they don’t know that. Not signing a letter is not going to get them out of refusing to set up an appointment and refusing medical treatment. (It wouldn’t surprise me if the letter was left unsigned so they can deny its existence later I would also recommend the OP pursue appointments with every doctor in the area. Not because he’s admitting to having seen the letter, but because he still can’t get the refills to the medicines he needs. I know of at least a couple doctors that will help out in situations like this in my area of the woods, so they may exist in the OP’s area as well. Whether illegal in her state or not, I still can’t get past how unethical this behavior is. Any ethical doctor would prescribe the medicines until the termination date. Even if the patient wouldn’t die, it does cause suffering and possible harm. I lament that there will likely be no punishment for this, as I don’t think that any doctor this unethical deserves to practice. And I’d feel the same if the OP were an actual drug seeker Sorry I can’t help you with your actual GQ questions, other than to suggest consulting a lawyer in your jurisdiction. (Since no lawyer has weighed in yet, I suspect they think it’s too sticky a situation to get involved in.) ---
**Author:** ![MsRobyn](https://avatars.discourse-cdn.com/v4/letter/m/90ced4/32.png) [@MsRobyn](https://boards.straightdope.com/u/MsRobyn)\ **Post date:** [April 3, 2012, 11:06am UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557/28 "2012-04-03T11:06:10Z")
I’m bowing out of this thread. I have nothing further to say, and apparently got so much wrong that I can’t defend anything I posted. ---
**Author:** ![Ferret\_Herder](https://avatars.discourse-cdn.com/v4/letter/f/e47774/32.png) [@Ferret\_Herder](https://boards.straightdope.com/u/Ferret_Herder)\ **Post date:** [April 3, 2012, 11:24am UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557/29 "2012-04-03T11:24:02Z")
> [@ambushed](#): > > Is that illegal, especially in light of the unsigned letter? Does it violate an AMA or other ethics code? FYI, the AMA (American Medical Association) is a voluntary-to-join, lobbying and professional association. IIRC, they have no legal or regulatory jurisdiction over their membership. They do have ethics codes and the like but these do not have power in terms of medical licensing; it only affects whether they kick the doctor out of their organization. I agree with **BigT** ’s statement that considering the situation, this may not be something that can be resolved over the Internet, and you may need to speak to someone in person about any legal issues. ---
**Author:** ![boytyperanma](https://avatars.discourse-cdn.com/v4/letter/b/4491bb/32.png) [@boytyperanma](https://boards.straightdope.com/u/boytyperanma)\ **Post date:** [April 3, 2012, 12:39pm UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557/30 "2012-04-03T12:39:05Z")
> [@ambushed](#): > > Before I call it a night, it appears I need to emphasize a few things. > > First, contrary to what some replies seem to suggest, **I did not post here to whine or complain or to inquire about the reasons behind this!** Please note this! My purpose was to pose two General Questions, neither of which has yet been answered with any citation or legal authority that I can use and pass on. I shall once again repeat them: > > \*\*(1): Is an unsigned patient termination letter legally binding, or is it as if I’d never received it, thus making the refusal of continuing care quite illegal? If so, please provide a cite confirming this fact. > > (2): Does the legal obligation for continuing care officially include the continuing legal obligation to refill daily prescriptions, or not? If so, please provide a cite confirming this fact.\*\* > > Thank you! > (For what it’s worth, I _ **still** _ think this belongs in General Questions!) Well your problem might be you can’t follow even the simplest instructions so that office has no interest in dealing with you. This isn’t the place to get legal advice and your questions were moved here because it is against the boards rules to ask for answers that are legal advice, you only get opinions. You can swear up and down that you never received that letter ‘because it wasn’t signed’ but it really doesn’t matter at this point because you acknowledge receipt and understanding of the letter. Claiming you never got the letter or that they didn’t inform you they were canceling your care isn’t getting you anywhere. They can prove you were informed. ---
**Author:** ![Little\_Nemo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/little_nemo/32/3120_2.png) [@Little\_Nemo](https://boards.straightdope.com/u/Little_Nemo)\ **Post date:** [April 3, 2012, 1:03pm UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557/31 "2012-04-03T13:03:53Z")
Haven’t read all the posts so my apologies if this point’s already been raised. But one possibility is that the practice doesn’t have room for the OP. They lost one doctor which means the remaining doctors are presumably all handling more patients. And I’ve been told there are legal limits on how many patients a doctor can carry. As for the OP’s specific question, I’m not a lawyer or a physician but I don’t think there’s any legal requirement that a doctor has to continue treating a patient except in emergency situations. If the doctor decides he doesn’t want a patient, I’d assume all he has to do is give sufficient notice to the patient that they should find another doctor. ---
**Author:** ![ShelliBean](https://avatars.discourse-cdn.com/v4/letter/s/f9ae1b/32.png) [@ShelliBean](https://boards.straightdope.com/u/ShelliBean)\ **Post date:** [April 3, 2012, 1:37pm UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557/32 "2012-04-03T13:37:36Z")
Is your goal to be treated by this doctor’s group? Or is this simply a mental exercise in what is wrong vs. what is right or legal? Because I can tell you what I think, but I can’t tell you what the legality of any of it is simply because I don’t know. ---
**Author:** ![Foxy40](https://avatars.discourse-cdn.com/v4/letter/f/a9a28c/32.png) [@Foxy40](https://boards.straightdope.com/u/Foxy40)\ **Post date:** [April 3, 2012, 4:07pm UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557/33 "2012-04-03T16:07:46Z")
Since I send out these types of letters on a regular basis I will try to help you. 1. As far as the legality of the letter. The point of the letter is to advise you to find another physician as they are no longer willing to treat you. If you happen to drop dead on the 31st day because you refused to accept the letter and didn’t attempt to find care elsewhere, perhaps you would have a case of abandonment. Otherwise, that shouldn’t even be an issue to you. You can not go back and demand to be seen. 2. They are obligated to refill your medication for those 30 days. You were a little vague regarding whether or not they did so. Usually I will send a prescription with the letter for the next 30 days if there weren’t refills left. (Unless they are narcotic pain relievers). 3. I feel like you want reasons and it is likely you won’t get them so simply find another doctor. I discharge patients because we are a specialty practice and we don’t do long term care but refer people back to their primary. I discharge them when they are on long term pain medications because we aren’t a pain clinic. I discharge them when they fail drug tests. I discharge them when they are rude to my staff. I discharge them for non payment of fees. I discharge them when they fail to keep appointments. Sometimes we discharge them simply because they have personalities that conflict with their provider for whatever reason. If it is a private office, they have no obligation to keep you whether or not your regular doctor was still alive. They are obligated to give you enough time to find someone else and treat you for a reasonable time until you do. Saying to yourself that the letter isn’t valid might make you feel better but in the end, it makes no difference. You have been discharged, request a records transfer and move on. And no, you aren’t entitled to the original records. They belong to the practice but you ARE entitled to a copy of all your medical information at a reasonable copy and mailing price. ---
**Author:** ![IvoryTowerDenizen](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ivorytowerdenizen/32/17937_2.png) [@IvoryTowerDenizen](https://boards.straightdope.com/u/IvoryTowerDenizen)\ **Post date:** [April 3, 2012, 4:12pm UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557/34 "2012-04-03T16:12:40Z")
> [@boytyperanma](#): > > You can swear up and down that you never received that letter ‘because it wasn’t signed’ but it really doesn’t matter at this point because you acknowledge receipt and understanding of the letter. Claiming you never got the letter or that they didn’t inform you they were canceling your care isn’t getting you anywhere. They can prove you were informed. He’s not saying he’s going to claim he never received it. He’s asking if the net effect of the letter, unsigned, is AS IF, he was never sent such a letter. It has no effect unsigned, so it’s AS IF the practice just dropped him. I don’t know the answer, but I can imagine the question: Is an unsigned letter enforceable? having a concrete answer. I don’t know what the answer is, though. ---
**Author:** ![Foxy40](https://avatars.discourse-cdn.com/v4/letter/f/a9a28c/32.png) [@Foxy40](https://boards.straightdope.com/u/Foxy40)\ **Post date:** [April 3, 2012, 4:16pm UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557/35 "2012-04-03T16:16:33Z")
As I look up, it appears they are ignoring your pharmacists phone calls. If the medication is life and death, it is the office’s best interest to refill it due to liability concerns if something should happen to you. When I said obligated I meant in reference to acceptable standards of care. In my state, there is no LEGAL obligation. It is the CYA protocol that most follow. If you are on medications like allergy pills or migraine medication or other “improve the quality of life” medications, they probably don’t have to refill them but there may be different laws in your state. ---
**Author:** ![Foxy40](https://avatars.discourse-cdn.com/v4/letter/f/a9a28c/32.png) [@Foxy40](https://boards.straightdope.com/u/Foxy40)\ **Post date:** [April 3, 2012, 4:20pm UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557/36 "2012-04-03T16:20:53Z")
> [@IvoryTowerDenizen](#): > > He’s not saying he’s going to claim he never received it. > > He’s asking if the net effect of the letter, unsigned, is AS IF, he was never sent such a letter. It has no effect unsigned, so it’s AS IF the practice just dropped him. > > I don’t know the answer, but I can imagine the question: Is an unsigned letter enforceable? having a concrete answer. I don’t know what the answer is, though. This would only be an issue if he is injured in some way before finding a new doctor. If the letter was sent certified mail as is the custom, there is record of receipt so I doubt the office would have much of a liability, signed or not, if he refuses to seek medical care elsewhere as soon as possible. ---
**Author:** ![LurkerInNJ](https://avatars.discourse-cdn.com/v4/letter/l/ed655f/32.png) [@LurkerInNJ](https://boards.straightdope.com/u/LurkerInNJ)\ **Post date:** [April 3, 2012, 4:21pm UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557/37 "2012-04-03T16:21:46Z")
Shouldn’t you be spending your time and energy finding another doctor asap rather than wasting time splitting hairs about your old doctor’s office? ---
**Author:** ![IvoryTowerDenizen](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ivorytowerdenizen/32/17937_2.png) [@IvoryTowerDenizen](https://boards.straightdope.com/u/IvoryTowerDenizen)\ **Post date:** [April 3, 2012, 4:44pm UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557/39 "2012-04-03T16:44:25Z")
> [@Foxy40](#): > > This would only be an issue if he is injured in some way before finding a new doctor. If the letter was sent certified mail as is the custom, there is record of receipt so I doubt the office would have much of a liability, signed or not, if he refuses to seek medical care elsewhere as soon as possible. I agree. I was simply clarifying that I didn’t think he was going to claim he never received it, just asking if it being unsigned was the equivalent of it never existing. I don’t think he was planning to lie, in other words. ---
**Author:** ![Ferret\_Herder](https://avatars.discourse-cdn.com/v4/letter/f/e47774/32.png) [@Ferret\_Herder](https://boards.straightdope.com/u/Ferret_Herder)\ **Post date:** [April 3, 2012, 6:07pm UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557/40 "2012-04-03T18:07:10Z")
> [@IvoryTowerDenizen](#): > > He’s asking if the net effect of the letter, unsigned, is AS IF, he was never sent such a letter. It has no effect unsigned, so it’s AS IF the practice just dropped him. > > I don’t know the answer, but I can imagine the question: Is an unsigned letter enforceable? having a concrete answer. I don’t know what the answer is, though. Considering his only references for that argument came from a site with questionable veracity, I would suggest that there may well be little support for that possibility. However, IANAL, so I don’t know. ---
**Author:** ![Taomist](https://avatars.discourse-cdn.com/v4/letter/t/53a042/32.png) [@Taomist](https://boards.straightdope.com/u/Taomist)\ **Post date:** [April 3, 2012, 7:00pm UTC](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557/41 "2012-04-03T19:00:08Z")
What I’m getting from this so far is that -It’s not illegal for a doctor to drop a patient without reason, with a 30 day notice. So, signed or not, the letter doesn’t even matter. -The office is required to continue care until the 30 days are up, including meds. If it were me, I’d concentrate on getting those meds, make the office DO ITS JOB until time runs out, and give up on the office. Get copies of your files and walk away. [Previous page](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557.md?page=1) [Next page](https://boards.straightdope.com/t/patient-abandonment-the-law-and-refusal-to-refill-prescriptions/617557.md?page=3)