Q: I have a diabetic patient who is well-controlled but is generally cantankerous and veers to noncompliance unless I keep a close eye on him. I, therefore, like to get him into the office every 3 months. The last time he was in, he wore a mask as we require, but when he called for his next appointment, he said he would not wear a mask and that we had to respect that choice. I told the front desk to not schedule him, but the office manager said that would be abandonment and she convinced me to let him come in. The MA and I went full-on hazmat with PPE and, of course, the room was scrubbed down after he left, but the more that I think about it, the more I think that the office manager was wrong and that we could have refused to see him or even terminated him.

You are correct.

Abandonment is the second major issue that an office with a mask mandate must keep in mind.

Abandonment occurs when a medical practitioner or facility terminates a patient who is undergoing an active phase of needed care without giving the patient enough notice to find care elsewhere. It does not apply, however, to routine care.

A diabetic patient who was just discharged from the hospital after suffering an episode of diabetic ketoacidosis could, therefore, not be turned away without notice and would have to be dealt with by alternative methods, such as distancing from other patients, if they refused to wear a mask. This patient, however, was being seen at quarterly intervals not based on changes in his condition or as part of following up on a recent procedure or new treatment, but solely to keep tabs on him, and he would have time to seek another doctor’s care.

Of course, the threat of being cut loose from the practice could, itself, have gotten his compliance, but he could have been denied the appointment or even terminated from the practice if he remained intransigent on masking.

Before we leave this topic, there is another issue regarding abandonment that is particularly resonant during the pandemic: constructive abandonment. This occurs when a termination has been done facially properly as far as notice and an offer of emergency coverage, but the doctor knows that the patient really has no other option. Typically, this is because no one else locally takes the patient’s coverage or the patient needs care that is highly specialized. COVID-19 has worsened this situation, though, because practices are seeing their already-established patients on only a limited basis and are not taking on new patients, and ERs and clinics that could be fallbacks for a patient who is between doctors are now overwhelmed with priority cases. These issues should not apply in this case, because this patient really does not have to be seen at a specific interval based on his clinical status and will have time to get alternative care, but as a general matter, you should bear these limitations in mind.

This article was written by Dr. MedLaw, a physician and medical malpractice attorney. It originally appeared on SERMO, which retains all rights to it.