Written by Dr. MedLaw

 

I have a patient to whom I was prescribing Prozac on a monthly basis.  I last saw him three months ago, when I gave him a one month prescription as usual. After I did so, he became uncooperative and then said that he did not want another appointment and I have not heard from him since. The pharmacy he listed with my office says that he has not filled a prescription since the last one that I gave him. He has not contacted my office about wanting a prescription. To close matters off I will be sending him a formal termination letter. Do I have to include a prescription to avoid being charged with abandonment by this difficult patient?

No.

Let’s start with the fact that you are actually not terminating him, which does carry the duty of avoiding abandonment. You will actually be memorializing the fact that he terminated you. In that setting there is no carryover obligation because you are not the one ending the care.

However, even if you were the one doing the termination based on his non-compliance you not only would not be obligated to provide a prescription, you should not do so.

To avoid a claim of abandonment in the termination setting the doctor is responsible to tide the patient over the transition period to another practice.  This includes being available for emergency care during that time and prescribing enough of current medications to cover the interval specified in the termination letter.

However, this patient has already stopped the drug for two months.  If you prescribe for him now you would actually be starting a new course of treatment.  This would be the opposite of verifying his removal from your practice and could actually be held to vitiate the ending of the physician-patient relationship because a patient who gets a new prescription could then reasonably conclude that you were now treating them anew.

There is also a professional conduct issue to consider since you would now be giving a psychoactive medication to someone you have had no clinical contact with for longer than your previous evaluation interval.  This is different from a bridging prescription given to a terminated patient leaving active care.

Just send a letter verifying that, as per his statement that he no longer wishes to seek care with your office, that you are closing his file.