By Robin Webster, MHA, BSN, RN, CPHRM

As the COVID-19 pandemic persists, a segment of the population remains unvaccinated by choice. Practitioners may wonder if they should discharge vaccine-refusing patients from their practices. While patients have the right to decline the vaccine, practitioners may view discharging unvaccinated patients as the only way to protect their remaining patients and staff from COVID-19. 

The American Medical Association advises that:

A physician should not refuse a patient simply because the individual is not vaccinated or declines to be vaccinated…Nor may a physician ethically turn a patient away based solely on the individual’s infectious disease status, or for any reason that would constitute discrimination against a class or category of patients.

When deciding to discharge any patient from your practice, it’s important to understand the associated risks. These include:

1. Abandonment allegations. 
2. Complaints to:
  • State medical boards.
  • Third-party payers. 
  • Federal and state regulatory bodies that protect the rights of individuals from unlawful discrimination. 
3. Negative social media posts or publicity.

To avoid these risks, approach the complex decision to discharge a patient from your practice on a case-by-case basis. When deciding, consider the following risk management recommendations:

Know the law. State and local laws vary regarding vaccination requirements, and these laws may not always be consistent with federal mandates and directives. As these conflicts work their way through state and federal courts, it may be difficult to determine a clear course of action. Before implementing any policy regarding the discharge of patients who refuse the COVID-19 vaccine, seek the advice of an attorney. 

Educate your patients. While patients have the right to refuse any medical intervention or treatment, including a vaccine, their refusal often stems from a lack of education. It is important to educate patients about vaccines and answer any questions they may have on the subject. Try to understand the patient’s perspective and reason for vaccine refusal or hesitancy and strive to dispel myths, if possible. Continue to educate patients who decline vaccination on every visit. Document the counselling and education provided to the patient along with the patient’s response. Consider providing vaccine information developed by the Centers for Disease Control and Prevention, including:  Consider your practice. While it is important to respect a patient’s right to refuse a vaccine, that right must be weighed against the risks that unvaccinated patients present to the rest of your patients. For example, the risk an unvaccinated patient poses to a sports medicine clinic is very different from the risk an unvaccinated patient poses to an oncology clinic. Consider whether there are ways to mitigate the risk to other patients by altering the environment, such as implementing telehealth visits, alternative office hours, or separate waiting rooms. 

Check health plan contracts. Check the provisions of any contract you have signed with the patient’s managed care organization or health plan to ensure compliance, as third-party payers may have their own policies and procedures that must be followed prior to the termination of a professional relationship.

Recognize limitations to discharge. Evaluate each relationship on a case-by-case basis to determine whether discharge is appropriate. Consider the patient’s underlying state of health, severity of disease process, prognosis, and course of treatment in addition to the availability of comparable medical care. Some conditions, like pregnancy, require ongoing medical care and resolve over time. Some relationships must be terminated with extreme caution or not at all. 
  • Do NOT terminate a relationship with a patient because of gender, race, religion, or sexual orientation.
  • Do NOT terminate a relationship with a patient who is in physical, emotional, or psychiatric crisis. For example, a psychiatrist may not terminate a patient who is in a suicidal state or a state of extreme agitation or depression. 
  • Do NOT terminate a relationship with a patient who is past 20 weeks gestation until after resolution of the pregnancy and completion of any requisite postpartum care.
  • Use extreme caution when discharging a patient with acute conditions. Resolve acute conditions prior to discharging a patient from your practice. 
Discharge the patient correctly. In the event you decide to discharge a patient from your practice, you must take certain steps in order to avoid an allegation of abandonment. These steps include:  
  • Notify the patient in writing. 
  • Allow the patient sufficient time to find another practitioner.
  • Continue to treat the patient during the notice period.
  • Maintain good documentation practices.
  • Avoid reestablishing the relationship.  

Copyrighted. No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances.