Occasionally, a doctor will receive a call from a pharmacist who has detected a fraudulent prescription order from a person who has forged a prescription on the doctor’s prescription pad or who has fraudulently called in a prescription.

If the offender is an employee, you should take appropriate disciplinary measures which will likely involve termination. If the offender is a patient, you should discuss the incident with the patient and make a determination regarding whether or not you will continue your relationship with the patient. If you choose to discontinue your relationship, you will need to follow formal termination procedures. (See the section on Termination of the Physician-Patient Relationship.)

Prescription fraud is a felony and should be reported to local police. Usually, the pharmacist who discovered the fraudulent prescription reports the incident, so check with the pharmacist before making a report to police.

The owners of the office practice have a duty to provide adequate and reasonable security for the safety of their staff, patients and others. Violence of any type (physical assault, verbal or written threats or harassment) should not be tolerated. You and your office staff should be trained to recognize patient risk factors, including a history of violent behavior, associated medical and psychiatric diagnoses, behavioral cues and substance abuse. Employees who frequently deal with people on the telephone and those who handle angry or dissatisfied patients should receive specific training in managing angry or difficult patients. Skills in de-escalating the angry caller or complainant can go a long way in preventing a future act of violence.

For patients or persons accompanying patients who are disruptive, but are not really violent, try to determine the reason for their disruptive behavior. Maybe the patient is frustrated with long wait times or is confused about the care and treatment being rendered or is upset over a billing matter. You may be able to eliminate the disruptive behavior by addressing the patient’s concerns. If the patient or other person continues with the disruptive behavior, you should discuss with him/her that his/her behavior is not acceptable and that if the behavior continues, you will have no choice but to terminate the relationship if the abuser is a patient, or ask the person not to return if the abuser is someone other than a patient.

While normally you should follow a formal termination process (see the section on “Termination of the Physician-Patient Relationship”) in which you continue to provide care to the patient being terminated for a period of time until he/she can obtain a new doctor, you may be justified in immediately terminating a patient if the patient is violent or presents a threat of violence to you or your staff. The patient’s behavior should be documented objectively in the patient’s medical record.

Any serious threats of violence should be reported to law enforcement officials.

Yes. Employers can be vicariously liable for the actions of their employees. Under the cause of action respondeat superior (“let the master answer”), the master or employer is liable for the negligence of its servants or employees that occurs in the course of employment. Thus, an employer can be held vicariously liable for the negligent acts of nurses, employed doctors, and other employees.

Employers may also be at risk for allegations of negligent credentialing if they fail to properly evaluate and reevaluate provider credentials and performance. Office practices must ensure not only the clinical competency of their doctors, but also that of midlevel providers and any licensed and unlicensed personnel with patient care responsibilities.

Employers may also be held liable for failure to supervise or direct the activities of midlevel providers and other licensed and unlicensed staff. For licensed and allied health staff, any gaps should be identified between actual job responsibilities and the scope of work permitted under state licensing laws (e.g., nursing and medical practice acts, doctor-assistant licensing acts, nurse practitioner licensing acts).

Current patients (any patient seen/treated by you on one or more occasions in the past 12 to 24 months) should receive written notification of practice closure approximately 90 days before the last date of active practice. The letter should be sent via certified mail, “return receipt requested,” and regular U.S. mail. The certified receipt should be attached to the file copy of the letter and placed in the patient’s patient record.

The letter should include the following:

• The date the practice will close.
• The importance of seeking continued care.
• Information about where the patient’s medical records will be located (for example, another doctor’s office).
• Notification that a copy of the patient’s records will be sent to another doctor of the patient’s choice upon receipt of the patient’s written authorization.
• A medical record release authorization form.
• A statement of how long the patient’s records will be retained.
• A permanent mailing address (or P.O. Box) for all future record requests, if the records will not be maintained at the current location.

Patients receiving ongoing care and treatment should also receive verbal notification with a discussion of their plan of treatment and coordination of follow-up care, all of which should be documented. Other patient notification efforts may include:

• Placing an ad in the local newspaper notifying the public of the office closure.
• Placing signs in the office notifying patients of the pending office closure.
• Placing a message on the office phone system.

If you do not want patients or others taking pictures or filming in your office, you may develop an office policy stating that the use of cameras or electronic devices are prohibited in the office. You could post a sign notifying patients and others of your policy in waiting and treatment rooms.

If a patient or his/her family member, etc. begins to take pictures or videos, politely remind him/her of your office policy. If he/she insists on continuing, you may opt to discontinue treatment (unless doing so would put the patient in jeopardy) and formally terminating your relationship with the patient.