Health Care Providers and Health Professionals are Expected to Follow Certain Guidelines When Ending the Relationship with Patients

Often, health professionals consider whether (or when) it is appropriate for them to end their professional relationship with their patient.

In Thellend v Hana[1], the Health Professions Appeal and Review Board (the “Board”) answered these  questions and provided direction to health professionals – particularly physicians – about when and how to end the professional relationship, if necessary.

Summary of Events

M.H. is a physician (the “Respondent”) who provided care to M.T. (the “Applicant”), her patient of several years. The Respondent terminated the physician-patient relationship in 2019.

The Applicant complained to the College of Physicians and Surgeons of Ontario (the CPSO) about the Respondent’s conduct and actions. The Applicant alleged the Respondent inappropriately terminated the relationship when the Applicant moved out of the catchment area and that he was abandoned without proper notice or adequate time to find another physician. He was advised by way of telephone message that he was no longer a patient of the Respondent.

In responding to these allegations, the Respondent advised that the Applicant missed appointments and eventually stopped attending appointments in 2016. In December 2019, the Applicant advised the Respondent (through her office) that the Applicant moved to another catchment area and was finding another health care provider.

The Inquiries, Complaints and Review Committee (the “Committee”) of the CPSO investigated the complaint and issued advice to the Respondent to ensure she complies with the CPSO’s policy, Ending the Physician-Patient Relationship (the “Policy”). The Applicant requested that the Board review the Committee’s decision.

The Board’s Review

Adequacy of the Committee’s Investigation

Before the Board, the Applicant argued that the Committee’s investigation was inadequate because it did not obtain online ratings of the Respondent and that these reviews would disclose numerous complaints similar to the Applicant’s complaint. He also argued that the Committee should have interviewed nurses involved in his care.

The Respondent argued that the Committee’s investigation was adequate and that it obtained sufficient information to make an informed decision about the Applicant’s complaint.

The Board found that if the Committee had obtained the Respondent’s online ratings, it would not have provided the Committee with information relevant to the complaint, nor would it have changed the Committee’s decision. With respect to interviewing nurses, the Board found that the Committee reviewed the nurses notes and it was not necessary to interview the nurses as well.

On the whole, the Board found that the Committee obtained and reviewed relevant information to make an informed decision about the complaint. The Committee’s investigation was adequate.

Reasonableness of the Committee’s Decision

The Applicant argued that the Respondent inappropriately terminated their relationship because the Applicant moved out of the catchment area. He stated that the Respondent failed to consider the effects that ending the relationship would have on him and that it resulted in significant difficulty in obtaining medical treatment. He further argued that the Respondent failed to work with him to resolve his concerns.

The Respondent argued that the Committee’s decision to advise the Respondent to comply with the Policy was reasonable because it was education that corrected a concern raised by the Applicant about the Respondent’s conduct, which protects the public interest.

The Committee provided the following information regarding ending the physician-patient relationship:

• moving to a new town does not remove a patient from a “catchment area” and seeking care outside of a Family Health Organization (FHO) does not immediately or automatically constitute a termination of the relationship;

• leaving a message on a patient’s answering machine is not a reasonable way to inform a patient that the physician-patient relationship has been terminated;

• the Policy requires physicians to provide notice of termination, in writing, to patients along with an explanation for the termination; and

• the Policy also requires physicians to ensure the provision of necessary medical services while the patient seeks a new physician and that this may include renewing prescriptions where medically appropriate for a reasonable length of time and ensuring appropriate follow up on all laboratory and test results that have been ordered.

The Committee noted that the details of the termination of the relationship did not comply with the Policy. As a result, the Committee found that it was appropriate to issue advice to the Respondent to ensure she understands her obligations and complies with the Policy.  

The Board noted that the Policy addresses two main issues: (1) the appropriateness of ending the relationship; and (2) proper notice requirements.

The Board found that the Committee focused on the manner in which termination occurred (e.g. the notice requirements) and did not make a determination as to whether the Respondent had a basis for ending the relationship with the patient that was consistent with the Policy. The Board found that the Respondent’s termination of the physician-patient relationship was inappropriate. Because the Committee failed to determine whether or not the physician-patient relationship was appropriately terminated, the Board found this aspect of the Committee’s decision to be unreasonable.

The Board’s Decision

The Board returned part of the Committee’s decision (to issue advice to the physician to ensure compliance with the Policy) back to the Committee and required it to issue a revised decision in accordance with the Board’s reasons. The Board confirmed the balance of the Committee’s decision (not discussed here).  

Conclusion

The Board’s decision highlights the important considerations that should be weighed when health professional or health organizations make decisions about ending their relationships with patients. Health professionals should ensure that they are aware of any regulatory policies, guidance, or protocols that speak to when and how the relationship can be terminated. For example, the CPSO provides the Policy discussed here as well as a companion piece, Advice to the Profession. Other colleges and /or regulatory bodies have similar policies or guidance with respect to ending relationships with patients.

The Board provided insight into how physicians should conduct themselves prior to ending the relationship with patients, including that physicians should:

• apply good clinical judgment and compassion to determine the best course of action;

• keep in mind that ending the relationship may have significant consequences for the patient; and

• make reasonable efforts to resolve the situation in the best interest of the patient.

These tips can also be applied to all health professionals. They serve as a reminder to consider the knowledge imbalance and best interests of the patient when deciding whether to end the relationship.  

[1] Thellend v Hana, 2021 CanLII 122304 (ON HPARB).