Podcast

Mar 12, 2026

Roetzel HealthLaw HotSpot: Terminating Patients: Legal Guidance for Physicians and Medical Practices

Host Ericka Adler is joined by Roetzel shareholder Christina Kuta to discuss when and why physicians may need to terminate a patient from their practice. The conversation highlights common situations that can lead to patient termination, including abusive behavior toward staff, repeated cancellations or missed appointments, failure to follow medical advice, and unpaid bills. They also address the growing use of patient behavior agreements, which establish expectations for conduct in the practice and may address issues such as harassment and false statements on social media.

Ericka and Christina also explain the key steps physicians and medical practices should take when ending a patient relationship, including documenting concerns, providing written notice, offering to transfer medical records, and allowing time for the patient to find a new provider to help avoid patient abandonment claims.

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Transcript

Ericka Adler:
Hi, everyone. Welcome to the HealthLaw HotSpot. I'm Erica Adler, shareholder leader of health care practice at Roetzel & Andress. I'm joined by shareholder Christina Kuta, also part of our health care group. Welcome, Christina.

Christina Kuta:
Thank you.

Ericka Adler:
Today, we're going to be talking about getting rid of patients from your practice. And Christina and I deal with this question repeatedly, but what we want to focus on today is why you would consider getting rid of patients, when you should consider getting rid of patients, and how you get rid of patients. I really want to start, first of all, by talking about some of the things that Christina and I witness in our practice clients, where it becomes imperative and necessary to terminate a patient. So, Christina, tell me some of the examples that you've come across.

Christina Kuta:
2026 is kind of coming in with a bang for this issue. We've had a number of clients reach out to us with patient concerns. I can tell you that a lot of times we see this happen when there's been sort of a pattern of poor behavior with patients, patients that are routinely abusive to staff, that are rude, disrespectable, they cause behavior problems in the office.

A lot of times, it's also patients that will claim they're unhappy for a reason, and it's not something that's rising to the level of a malpractice claim or anything like that, but they're wanting the practice to give them services for free, or they're wanting the practice to refund money for certain procedures or services they've received. But it's usually in sort of an ongoing pattern where the patient is not behaving in a respectful way, or in a way that you would anticipate a person would behave in a business setting. And usually, it's going on for some time before we hear about it.

Ericka Adler:
Right, and I'm hearing the same things, and I also want to mention, of course, that separate from behavior patterns, you have patients who don't show up for appointments, regularly cancel, don't follow the advice, contradict the advice that's given to them.

Christina Kuta:
Pay their bills.

Ericka Adler:
Right. So, there's lots of different reasons to terminate, and those are the very obvious ones. And usually when a client calls us with those kinds of reasons, they're ready. You know, they haven't paid the bill, they've done everything they can do to collect, the patient won't follow advice, etc., and those become clear.

I think you and I struggle more where somebody allows a patient to come in and verbally abuse the doctor, the staff, leave harassing messages, and this sometimes incredibly goes on for a period of months or years. and the doctor allows the patient to remain as part of the practice. So, as you can see, there are many different reasons why you might consider getting rid of a patient.

If you're not sure if you have a right to get rid of a patient, if you're not sure you follow the right steps before you get rid of a patient, you can certainly contact us. We're just trying to give you some ideas of what we have seen happen when it might lead you to really feel that you need to get rid of someone.

Now, before we talk about the actual steps, I also want to talk about a growing trend, which is to have a contract between the practice and a patient about what the practice expects of the patient within the practice. We have drafted these before, and we've certainly reviewed them before. What are some of the points that you're seeing in these kinds of contracts?

Christina Kuta:
We do see these contracts from time to time, and they are becoming more popular as time goes on, but generally they're things like expectations set up for the patient: that you're not going to be disrespectful, you're not going to verbally abuse staff, you're not going to call continuously with harassing phone calls, you're not going to cause a scene in our lobby, you're going to appropriately handle complaints through the complaint process the practice has set up.

It basically is sort of navigating their behavior and setting up expectations in advance for what the practice intends that relationship to be like. Also, they often have terms in that about social media: that you are not going to put untrue information on social media about the practice. Look, if somebody didn't have a good experience with a provider, and they want to share that, they're certainly allowed to do that. But what they shouldn't be doing is actually going on social media and lying about interactions, lying about a practice, lying about a provider. Unfortunately, you and I have seen that many times over the last year or so, where patients are putting up information on social media that's not just an opinion of their experience, but actually totally false information.

Ericka Adler:
Right now, whether or not these contracts can be enforced in the court of law remains to be seen, but I think it does definitely serve as a deterrent to patients when they're reminded of what they agreed to, and many practices will have this sign on an annual basis, so it serves as a reminder.

The other thing you and I have kind of talked about, and I expect to see this somewhat as a growing trend, is whether you can have patients sign something that if they do choose to go and post something false on social media, whether they are giving permission, in the form of an authorization for HIPAA purposes, for a physician or a practice to be able to respond to that false statement.

And as many of you listening may be aware, typically physicians cannot respond to a statement made online, which puts them at an unfair disadvantage because a false statement can be made, but because you cannot identify someone as being your patient, you often cannot respond. And one of the trends we're seeing is that you can have the patient sign something that is a specific authorization for HIPAA purposes, that if a post is made, and perhaps this is, you know, signed on an annual basis to make sure that it remains relevant, to Google, Yelp, Instagram, Facebook, whatever it is, that sets forth a false statement about the practice or a provider that the patient is specifically giving authorization for the physician to be able to respond to that. And this is something that I think the concept is growing in popularity. What are your thoughts on that?

Christina Kuta:
Yeah, as you indicated, doctors are kind of hamstrung in that they cannot provide information in response to social media posts, without really violating HIPAA. So, having that authorization in advance that specifically says, “you are allowing me to disclose X information in response to social media posts during this particular window period,” like you said, annually, and have that renewed is a concept a lot of practices have explored. Now, there are some potential legal considerations. I'm not aware of any type of review of this by the bodies that enforce HIPAA. Would they see that to be valid authorization? Also, you generally can't condition treatment based on signing an authorization that is to the advantage of the provider. So, there are some legal considerations that need to be further explored, but because this is becoming more common, I do foresee that regulators at some point in the future are probably going to address this specific issue.

Ericka Adler:
Okay, great. Alright, so we've decided there's a bad patient in the practice, making the doctor unhappy, making the people who work in the practice unhappy, and it's time to terminate them. So, let's talk about what the proper steps are that should be followed, okay? What is step one?

Christina Kuta:
The biggest concern when we're talking about the steps to take for termination is to not have a claim of patient abandonment. Generally, you are not restricted from terminating a patient as long as you're not terminating for an illegal reason, and that would be a discriminatory reason, like, based on someone's race or religion. But if it's someone's disruptive, not a good fit, not paying their bills, things like that, you can terminate that patient.

The first step, I think, goes even before you decide to terminate, which is documenting everything. If you have a disruptive patient, if you have someone that's not paying their bills, or someone that's really causing problems in the office, you should make sure that that's been documented, so you have a history and support for that.

The next step is providing written notice to the patient, offering to forward their records to a new provider in compliance with HIPAA, and making sure that you leave a period of time where you're still available to the patient to prevent claims of abandonment.

We generally recommend refilling prescriptions for 30 days. If a patient's undergoing treatment that must continue for a period of time, it's ongoing frequent treatment, continuing to care for that patient for at least 30 days, depending on their illness or, you know, what type of treatment that patient has, that may need to be longer. Also, depending where you live. If you live in a more rural area where it would be more difficult for someone to find an alternate provider, you may need to require more time or be available for more time to a patient in order for them to receive care from someone else.

But the main issue is you want to prevent claims of abandonment. So just saying, I'm terminating you today, and I'm going to have nothing to do with you after today, is likely problematic, unless it's somebody who isn't on medications that you're prescribing for them. It's not somebody that has any ongoing mental health issues or physical health issues.

Ericka Adler:
Okay, perfect. Getting rid of the patient, technically, is easy, and of course, I just want to kind of make it clear that if somebody is posing a threat to your safety, or to safety of someone in your practice you certainly can review whether you have to continue to interact with that person. So, the 30 days is not a hard and fast rule if you feel your safety is at risk.

When you terminate someone, even if you follow all these appropriate steps, that does not necessarily mean the harassment is going end. They may continue to show up at the practice, they may continue to send letters, they may have their lawyer send a letter, they may threaten you in other ways. You will need to do what you need to do.

Certainly, again, if somebody's showing up and they're not authorized to be there, you can always call the police and make a report and document that. If you're continuing to be harassed in other ways, we always invite you to provide our name and contact information. Usually, the minute a lawyer's involved, somehow, they disappear or they quiet down. If you're doing things legally, you're properly terminating them, and it's a proper reason, they can make a lot of noise, but it should not have any bite at all. But I just want to let people know that it's not necessarily the end of the road once you get that letter out. You agree?

Christina Kuta:
Absolutely. You know, I would say 90% of the time it is, and people will go away, and they'll find a new provider, and nothing else happens. But there is that 10% of patients that will continue to make a lot of noise, and whether that's going on social media, whether that's filing complaints, whether that's continuing to contact the office by letter or phone, that does happen. So, you should always be prepared and sort of have a process for handling that.

I also want to note that state medical boards may have different rules or recommendations regarding terminating patients, so you always, if you're not familiar with them, you always want to take a look at what your state medical board says about terminating patients to see if there's any additional things you need to include in a letter, or things that you need to consider when doing that.

Ericka Adler:
Right, I agree. And then finally, don't hesitate and wait too long to terminate a patient. If you're seeing all the red flags, you don't need to give them chance after chance after chance. If they've already extorted you, and you've refunded money, and you've redone it, and you've already dealt with them and their lawyer, you don't have to keep someone as part of your practice who's making you miserable.

One of the most shocking things to me is how long doctors will allow a patient to be abusive and to behave badly before they're willing to terminate. I know it's that sense of wanting to take care of people and not wanting to abandon patients, but I do think more often than not, doctors need to act sooner than they do.

Christina Kuta:
Absolutely, and I think sometimes there's also a concern that if I let this patient go, they're going to speak badly about me, they're going to tell lies about me on social media, I'm going to get a bad reputation, and I'm really sensitive to that, but I'll tell you, if a patient is the type of patient that would do that, whether you terminate them the third time they do something versus the 20th time they do something. they're going to do it anyway. So, save yourself the heartache, and don't continue to take abuse, or have your staff continue to take abuse. Terminate the relationship, and then there are ways to deal with patients that may cause trouble after that relationship's terminated.

Ericka Adler:
Great. Well, great advice, and this has been the HealthLaw HotSpot. Thanks, Christina. We hope you'll join us next time, and you can check out more of our podcasts at ralaw.com. Thanks for joining us.