Practice Closure, Record Fees, and Continuity of Care
Dr. C has decided to retire and close her solo chiropractic practice in 30 days. She has 450 active patients, including 60 with open personal-injury claims and 12 who are currently in active treatment for acute lumbar disc herniation. She plans to post a sign on the door on the last day and leave a voicemail greeting. She will transfer records only if patients pay a $75 per-record fee within 10 days; otherwise, she will shred the records after 30 days. One patient, a 42-year-old injured worker, needs his records sent to a neurosurgeon within 5 business days for a scheduled surgical consult. He has an unpaid balance of $220. Dr. C's office manager tells him, 'No records until the balance is paid.' Dr. C also has not arranged coverage for the 12 acute patients. The state Board has a rule requiring patient notification and record retention.
1. What notice and continuity obligations does Dr. C have when closing her practice?
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Closing a practice is not a defense to abandonment. Dr. C must give patients reasonable advance notice, not a sign on the last day. She should notify all 450 active patients in writing, provide a way to obtain records or transfer care, and arrange coverage or referral for patients in active treatment, especially the 12 with acute disc herniation. The Board's patient-notification and record-retention rule reinforces that she cannot simply disappear. She should also notify the Board if required, maintain malpractice tail coverage, and keep records for the required retention period. The office manager's 'no records until paid' statement is inconsistent with continuity obligations. Dr. C should prepare a closure plan, document it, and ensure a licensed successor or covering doctor is available.
2. May Dr. C withhold the injured worker's records for the $220 balance, or charge $75 per record?
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She should not withhold records needed for the patient's surgical consult. Even if Oklahoma allows a reasonable, cost-based copy fee, a $75 per-record charge may exceed actual cost and cannot be used as a debt-collection lever when the records are needed for continuity or urgent care. The safer course is to send the records to the neurosurgeon within the 5-business-day deadline, bill the $220 separately, and document the request and release. If a fee is allowed, it should be disclosed in advance, uniform, and tied to copying costs. Withholding records in an urgent situation risks abandonment, harm to the patient, and Board discipline. Dr. C should also check the Board's record-fee rule before charging anything.
3. What must she do with the 12 acute patients and the records?
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For the 12 acute patients, Dr. C must either continue care until transfer is safe or arrange a licensed covering chiropractor and give each patient a specific referral. She should contact them individually, document the plan, and confirm the receiving provider accepts them. For records, she cannot shred after 30 days; she must retain them for the Board-required period and provide copies on proper request. She should notify patients where records will be stored, how to request them, and any fee. If she sells the practice, the buyer must agree to maintain records and honor transfer requests. The reasoning is that patients' continuity and access to records survive the doctor's retirement.