As I cruise through online Facebook Pelvic Health Mentorship Groups - a weird bedtime passtime that brings me more satisfaction than doom scrolling on TikTok - I hear many providers worried about getting in trouble for patient abandonment. As rehab providers, we have worked hard to get our education, licensure, jobs, and clients that trust us, so it makes sense there would be a fear of losing any of all of those things.

When this concern comes up, I just want to reassure providers and also let them know that there are three continuing education classes in the Herman & Wallace curriculum tailor-made to address other ethical questions and concerns pelvic rehabilitation providers may have:

• Ethical Considerations from a Legal Lens - Scheduled for April 12th
• Ethical Considerations for Pediatric Pelvic Health - Scheduled for July 27th
• Ethical Concerns for Pelvic Health Professionals - Next date TBD

What is patient abandonment? Patient abandonment is a failure of the provider to fulfill their duty of care, leaving a patient without necessary medical support at a critical time. Unlike a patient voluntarily discontinuing care or being referred to another provider, abandonment involves a lack of appropriate communication or planning.

What are some myths surrounding patient abandonment? Some providers believe that any discontinuation of care constitutes abandonment. This is actually untrue if proper steps are followed to end the plan of care. It is also false to assume that providers are legally obligated to see a patient indefinitely. Patient abandonment does not only apply to doctors, it applies to all healthcare providers, including therapists and nurses.

How do I know something would be considered abandonment? For an act to qualify as patient abandonment, several factors must be present including a lack of adequate notice to the patient, no opportunity for the patient to secure alternative care, and abandonment occurring during an ongoing or critical phase of treatment. A provider’s failure to meet their duty of care without justified cause is central to this issue. There is a difference between ethical termination of care and actual abandonment.

How can a provider avoid being accused of abandonment? The provider can give the patient written notice, typically 30 days in advance, and includes referrals to other providers. If a patient consistently refuses to follow treatment recommendations or fails to attend appointments, the provider may have grounds to terminate care. The important take-home here is proper communication, documentation of this communication, and adherence to professional guidelines of your profession and state.

“I had this person call my clinic and I didn’t want to take their case, did I abandon them?” In order for it to even enter the possibility of abandonment, care has to be initiated. This means if someone calls your office, and you decline to treat them, as long as you give them a referral to someone else who might be able to help them, you should be safe.

“I started seeing someone and I want to stop. What do I do?” If you have seen them for a visit and started their care and choose to stop it, for any reason, you must follow some steps to cover yourself legally and ethically. First, consider why you are ending the plan of care. Are they not listening to you? Are their needs outside of your skill set? Are they being inappropriate? Are they not complying with their clinical contract - for example not paying outstanding balances, etc? Second, you must provide reasonable notice to give a patient adequate time to find another provider. Make sure to provide this in writing and verbally, and give a specific end date. Document the reason for termination - for example, non-compliance, missed appointments, not following appropriate clinical behavioral guidelines, etc. Explain the reason to the patient as appropriate while offering referrals, resources, and emergency assistance if it may be needed. When in doubt, a short consultation with a lawyer about the guidelines of your profession and state can save you money and worry in the long run.

“What if I don’t feel safe?” If a patient threatens you or your staff, stopping care is justified for safety reasons, but it must still be handled properly to avoid claims of abandonment. First, get to a safe space physically and emotionally. Document the incident and contact law enforcement and legal help as appropriate. Draft and deliver a formal termination notice where delivery can be confirmed and referrals for other providers should be included within this.

“I don’t want to pass off a dangerous person to someone else.” We must refer out as part of the termination process BUT it does not have to be a fellow therapist. We can send them back to their referring provider as one option. If you feel someone is predatory or engaging in criminal behavior, referral to mental health with the inclusion of law enforcement may be the next step. Having a lawyer to consult with can help you uphold your license, state, and HIPAA responsibilities.

As it goes with many ethical things, there may not be a perfect answer and there is room for nuance as well as “it depends.” But if you follow the principles of giving notice, providing referrals, and documentation of the scenario and actions, this should help you with taking care of your personal and professional safety.

AUTHOR BIO
Mora Pluchino, PT, DPT, PRPC

Mora Pluchino, PT, DPT, PRPC (she/her) is a graduate of Stockton University with a BS in Biology (2007) and a Doctorate of Physical Therapy (2009). She has experience in a variety of areas and settings, working with children and adults, including orthopedics, bracing, neuromuscular issues, vestibular issues, and robotics training. She began treating Pelvic Health patients in 2016 and now has experience treating pelvises and ages with a variety of Pelvic Health dysfunctions. There is not much she has not treated since beginning this journey and she is always happy to further her education to better help her patients meet their goals.

Dr. Pluchino strives to help all of her patients return to a quality of life and activity that they are happy with for the best bladder, bowel, and sexual functioning they are capable of at present. In 2020, She opened her own practice called Practically Perfect Physical Therapy to help meet the needs of more clients. She has been a guest lecturer for Rutgers University Blackwood Campus and Stockton University for their Pediatric and Pelvic Floor modules since 2016. She has also been a TA with Herman & Wallace since 2020 and has over 150 hours of lab instruction experience. Mora has also authored and instructs several courses for the Institute.