This three-part series—Part 1 in the June issue covered patient confidentiality—reviews a few topics giving physicians concern during the COVID-19 pandemic.

Maintaining Office Safety

PATIENTS l You retain the right to refuse a patient who will not cooperate with requirements to wear a facemask. If they refuse and can be safely seen later, they should be given an appointment past the expected isolation period. However, you cannot summarily deny care to someone under active treatment without adequate notice to permit them to set up care elsewhere.

You should also keep the issue of constructive abandonment in mind. Actual termination from your practice because of how a patient conducted themselves is something to deal with when the isolation regimen has ended.

EMPLOYEES l The EEOC has specifically said that nothing in the ADA should be taken to interfere with employers following public health recommendations. As an employer under OSHA obligations to maintain a safe workplace and a physician with a fiduciary duty to safeguard the health of your patients, you may therefore take steps that you would normally be more limited in.

Current employees can be denied access to your premises if they place others at a significant risk. You can require that employees self-report any exposure, answer questions about symptoms, and be tested with sufficient medical basis. You can require temperature checks, should counsel employees to be mindful of how they feel generally and to immediately report any changes, and remind all that hygiene and PPE precautions apply fully. All employees should be required to engage in proper hygienic procedures. If an at-will employee is not cooperating with hygienic conduct, you may fire them immediately.

If an employee was exposed or has tested positive, you will need to inform co-workers, but ask for permission to reveal their identity. If they refuse, tell other employees without naming the source. Since a sudden absence at this time can be revealing, firmly instruct in writing that the employees who remain not discuss a co-worker’s PHI. While an employee is on self-isolation, ask only the minimum information necessary to make a work-related determination of their safe return. You can also require that they provide a physician’s note saying that they are fit to return.

This article was written by Dr. Medlaw, a physician and medical malpractice attorney.