BRN Definition of Patient Abandonment Doesn't Cover All That NPs May Face

By Melanie Balestra, NP, Esq.

Patient abandonment is becoming a more frequent complaint against nurse practitioners.  The Board of Registered Nursing only defines abandonment of patients generally, stating that for patient abandonment to occur, the nurse must:
a) Have first accepted the patient assignment, thus establishing a nurse-practice relationship, and then b) Severed that nurse-patient relationship without giving reasonable notice to the appropriate person (e.g., supervisor, patient) so that arrangements can be made for continuation of nursing care by others.

This definition by the BRN was written with the RN in mind but not the nurse practitioner who is required to have a collaborating physician and treat patients whose visit to a health care provider may be governed by his/her insurance companies.    A current case in point involves a nurse practitioner who was working with a physician who abruptly decided to close the office.  The nurse practitioner was brought before the BRN for abandoning patients.  The patient had a government insurance that only covered certain providers.  The nurse practitioner informed her patients that she could not continue to see them because the office closed and she did not have a collaborating physician.  She told the patients to call their insurance company to find out what other providers would accept their insurance.  She called in prescription refills to carry over the patients until they established a relationship with another health care provider.

One patient became upset and complained against the nurse practitioner for abandonment.  The patient was seen by another health care provider within a month.  However, the BRN believes it was the nurse practitioner’s responsibility to inform the patient and find the patient another provider.  The problem is that only the government insurance company knows what health care providers they are contracted with.  The nurse practitioner would have no way of knowing these health care providers.  The government insurance company will only discuss health care providers with the insured patient.   Many times the patients do not understand how government insurance works.  The nurse practitioner started working for another physician but that physician was not contracted with the insurance company.

Don’t let this situation happen to you.  Document that you informed the patient’s insurance company, specifically the person you spoke to, and that your collaborating physician is no longer contracting with the insurance company.  Document that you informed the patient that he/she needs to contact the insurance company as soon as possible to retain another health care provider.  Offer to see the patient for a cost to the patient if you have a collaborating physician.  If your collaborating physician terminates your relationship, document this in the patient’s medical record and any specific counseling you gave the patient on contacting his/her insurance company to find another health care provider or in an emergency situation, advise the patient to go to the emergency room.   Document any medical advice or prescriptions that you provided the patient for the next thirty days.  Give the patient written notice of the termination and file a copy in the medical record.

Abandonment issues also arise with non-compliant patients and physician unavailability.  If you have a non-compliant patient, you are placing yourself at risk.  These patients will frequently report you to the BRN because they are unhappy.  However, you have to very carefully release them as your patients.  You can politely tell them that they might be a better match in another practice and tell them to contact their insurance company for names of other providers in your area.  You need to give them at least thirty days’ written notice before you discharge the patient from your practice.

Another situation that has happened, particularly with newly licensed nurse practitioners, was a physician who gave instructions to the new graduate nurse practitioner to care for his patients in home settings, but he was never available for any questions or consultation.   The nurse practitioner believed the patients were being put at risk and resigned from the practice.  The physician then reported the nurse practitioner for abandonment of patients.  It was the physician who was abandoning both the patients and the nurse practitioner.

If you do not believe you have adequate contact with your physician, it is not abandonment to leave the practice.  However, write a resignation letter explaining the reason you are leaving the practice.  This particular physician had a pattern of hiring recent nurse practitioner graduates and then abandoning the nurse practitioners.

I cannot stress enough the importance of documenting your dates and conversations with patients and insurance providers.  Documentation is still your best defense.