The Text-Message Discharge
A patient is 5 weeks post total knee arthroplasty and attends outpatient physical therapy twice weekly. She misses two appointments because her transportation falls through. The PT sends a text message: 'We are discharging you. Do not come back.' The message does not offer another appointment, a referral, or a transition plan. The patient still has difficulty with knee extension and stair negotiation, and her surgeon's protocol calls for continued therapy. She calls the clinic and is told the PT is 'too busy' and that she should 'find somewhere else.' The clinic has not provided her records, and the PT has not documented the discharge in the chart. The patient asks whether the clinic can simply stop treating her and whether she can get her records.
1. Was the text-message discharge patient abandonment? Explain.
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It has the hallmarks of abandonment: the PT unilaterally ended the relationship without meaningful notice, without offering a transition, and without considering the patient's continuing need for care. Missing two appointments can justify discharge, but only after the clinic communicates, gives the patient a chance to resume or explain, and documents the decision. A text saying 'do not come back' is not adequate notice. The patient remains symptomatic and has a protocol that calls for continued therapy, which increases the risk of harm. Abandonment is fact-specific, but this conduct is very risky and could support a licensing complaint. The clinic should immediately correct course rather than defend the text.
2. What steps should the PT have taken to end the relationship properly?
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The PT should first discuss the attendance problem with the patient, document the discussion, and offer reasonable accommodations or a chance to reschedule. If discharge is still appropriate, the clinic should give written notice that explains the reason, the effective date, and how to obtain records. It should offer a referral or list of alternative providers and allow a reasonable transition period, especially because the patient is postoperative. The PT should document the patient's status, the risks of stopping therapy, and the patient's response. The clinic should not simply stop; it should ensure the patient is not left without needed care. If the patient is discharged for cause, the record should show that notice and transition were provided.
3. What are the patient's record rights and the PT's documentation duties?
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The patient is entitled to access her physical therapy records under Nebraska law and the clinic's policies, subject to the applicable procedures and any permitted fees. The PT must document the discharge, the reasons, the notice given, and the transition plan. The record should also include the missed appointments, the clinic's outreach, and the patient's current functional status. The clinic should not withhold records to pressure the patient or punish her for complaining. A complete record protects the patient and demonstrates whether the discharge was handled properly. If the record is incomplete, the PT should add a late entry that is clearly dated and factual, not rewrite history.