The Voicemail Discharge
Dr. E has treated a 72-year-old man for six weeks for lumbar radiculopathy. The patient has progressive weakness in dorsiflexion, has fallen twice, and now needs a cane. Dr. E’s last note says “continue plan; no change.” The patient has missed two appointments and owes $340. Dr. E decides to end care by voicemail: “You’re discharged; find another doctor.” He does not send a written notice, offer records, or refer. The patient calls asking for a copy of his records; the front desk says the office will release them only after the balance is paid and only if the patient comes in person. The office uses paper records and has no written records-release policy. A chiropractic assistant sometimes signs Dr. E’s name to progress notes when he is running late. The patient’s daughter, who holds a durable power of attorney for health care, calls and asks for the records to be sent to a neurosurgeon.
1. Was the voicemail discharge appropriate? What must a chiropractor do to terminate care without abandonment?
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The voicemail discharge is not adequate termination and creates an abandonment risk. The patient has progressive dorsiflexion weakness and falls, which are neurologic red flags requiring urgent medical evaluation, not simply discharge. A chiropractor ending care should give written notice, explain the reason, provide a reasonable transition period, offer to transfer records, identify emergency contacts, and refer to an appropriate physician or neurosurgeon. The notice should not be a surprise voicemail with no follow-up. The unpaid $340 balance does not justify abandoning a patient with active neurologic deficits. Dr. E should contact the patient promptly, arrange urgent referral, document the conversation, and send written notice. If the patient cannot be reached, he should document attempts and send the notice to the last known address. The assistant's practice of signing Dr. E's name compounds the record problem.
2. Must the office release records to the patient and daughter? Explain the payment and in-person conditions.
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The office should not withhold records solely because of an unpaid balance, and it should not require in-person pickup if a valid written request and authorization are provided. Michigan patient-access rules generally allow the provider to charge a permitted fee and to require proper identification, but they do not make payment of the treatment bill a condition of access. The daughter holds a durable power of attorney for health care, which may authorize her to act for the patient; the office should verify the document and obtain a proper authorization for release to the neurosurgeon. The records should be sent promptly by a secure method. If any exception or legal restriction applies, the office should cite it in writing. The lack of a written release policy is itself a compliance problem; the office should adopt one and train staff.
3. What administrative-rule and recordkeeping problems are shown by the assistant signing Dr. E’s name?
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The assistant signing Dr. E's name is a serious recordkeeping violation. Progress notes must accurately identify who rendered and documented the service; an assistant may enter administrative data or a late entry only under a lawful policy, but cannot sign the chiropractor's name as though he performed or reviewed the service. The practice should correct the policy, audit affected records, and add dated addenda where appropriate. It should not delete the improper entries. The office also needs a written records-release policy, a retention schedule, and secure storage. These are administrative-rule and professional-responsibility issues, not just office convenience. Dr. E should consult counsel and his malpractice carrier because the records may be evidence in a board complaint or malpractice claim. He should ensure that future notes are authenticated by the treating chiropractor.