According to a study published in the Journal of the American Medical Association, referrals to specialists by primary care doctors nearly doubled between 1999 and 2009. Physicians make specialist referrals to ensure the highest quality of patient care. A physician might refer a patient to a specialist when they are struggling to make a diagnosis or if they need a second opinion. They may also make a referral when a known diagnosis requires specialized care outside the scope of their practice or capabilities. Sometimes, a physician will make a referral to help the patient overcome barriers to health care access, such as location and language or when the patient wishes to seek a new doctor.
If a referral is negligent, however, a physician could be held liable for the reference, depending on the circumstances. If a physician is accused of making a negligent referral, they should contact a lawyer right away.
Why are Referrals Important?
Referrals allow a physician to remain involved in a patient’s care when they cannot provide specialized knowledge. Referrals are almost always good for everyone involved, such as the patient, the primary physician, and the specialist.
Physicians make referrals in good faith, but it is their responsibility to perform due diligence on the specialists in their referral network. They should know the specialist’s history, track record of patient outcomes, qualifications, practice capabilities, and disciplinary background.
If a primary physician refers a patient to a medical facility or clinic, they need to ensure the facility is accredited or licensed, properly staffed, and has not received negative reports by regulatory authorities. Physicians should also perform periodic checks of the specialists in their referral networks to ensure they have current information.
Why is it important to pay attention to referral providers? A physician could be held liable for negligent referrals. In such a case, a lawyer can defend a physician named in a lawsuit.
What is a Negligent Referral in Health Care?
A negligent referral is when a physician does not use appropriate care and due diligence in deciding to refer or in making a referral. A negligent referral also occurs when the referred medical professional or facility harms the patient or otherwise delivers substandard care.
If the patient sues the referred physician or facility for medical malpractice, the referring physician could also be held liable. For example, the patient could claim that the physician should have known that the referred provider could not deliver the standard or quality of care that was needed. A patient who is suing for malpractice might also claim that the referring physician did not follow up with them to see if they went to the specialist, and if they did go, they did not ask for a summary of the outcome.
In some lawsuits, patients have claimed that referring physicians never explained the severity of their conditions, why specialists were needed, or what would happen if they did not see the specialists. In other cases, physicians did not stress the urgency of seeing specialists quickly.
Medical malpractice lawsuits involving negligent referrals are often complex, which is why a lawyer is necessary. A lawyer knows how to effectively handle such cases.
How can a Physician Avoid Negligent Referrals?
There are many ways a physician can avoid negligent referrals, including:
- Refer patients to more than one specialist or facility. By giving a patient a few choices, a physician is not advocating for one specific referral.
- Refer patients to local medical professional associations or medical schools for sources and connections to specialists. This will lessen the chances for malpractice.
- Instead of referring to a specific medical provider, encourage patients to contact their insurance companies. Insurance companies can review their coverage and recommend an in-network specialist.
- Do not refer to an unknown physician or facility. Patients sometimes have their own preferences for providers. If the physician is not familiar with the provider the patient wants to use, they should explain that they cannot make a referral for this reason. Document this conversation in the patient chart.
- Do not refer a physician or facility that has a bad reputation. Explain to the patient that it is preferable for them to use a provider in the referral network.
- Stay firm on the decision. Some patients dislike the idea of seeing a specialist and prefer to be treated by their primary care doctor. If the diagnosis or treatment is outside the physician’s scope of practice, they should make a referral and be firm in their decision.
- Clearly explain the referral to the patient. Explain who the specialist is, what services to expect, and the timeframe in which the patient should see the referred provider. Answer their questions and make the conversation about the referral a part of their chart.
- Make an appointment with the specialist while the patient is in the office. When time is critical, it is a good idea to make the appointment before the patient leaves the office.
What Should be Documented?
Strong documentation is invaluable in negligent referral lawsuits. The following should be documented:
Patient Chart: In the patient chart, be sure to include detailed statements about the referral, when they should go, and why they were referred.
Initial Contact: Make the initial contact with the referral for the patient. Make it a policy to contact the referred specialist or facility to ask them to contact the patient for an appointment. This does not put the onus on the patient to make the initial call.
Prescriptions: Give the patient a prescription for specialist services. Include whom the patient should see, and list the specific services expected. Make the prescription valid for the timeframe in which the patient should see the referral, and keep a copy of it.
Check-ins: Document if the patient does not follow-up with the specialist. Although a physician is not required to ensure a patient has followed-up with a specialist, do document whether they have at their next appointment.
Why is Communication Important?
Ensure that there is strong communication with the referred specialist or facility. This communication should include the following:
- Reason the patient is being referred.
- Expectations from both of the providers.
- How the patient will be informed about their results or prognosis.
- Important dates and timeframes.
- How each party will provide information.
- Test results and other reports.
This communication is crucial to ensure that there are no gaps in patient care and that activities are documented.
It is also important to stay abreast of the specialists and facilities in the referral network. Once or twice a year, cull a list and note any changes in locations, retirements, and additions to the practice, such as equipment, services, and new physicians. It is important to note if services are no longer provided or of any disciplinary actions or issues. Do not hesitate to remove a provider from the referral network if it is needed.
What Should I Do if I am Involved in a Lawsuit?
If a physician is named in a lawsuit, it is crucial that they contact a lawyer as soon as possible. A lawyer will review the facts of the case and be able to defend their client’s rights. Negligent referral cases are complicated, and a lawyer familiar with health care law will be able to construct a strong defense.
Philadelphia Physician Lawyers at Sidney L. Gold & Associates, P.C. Provide Legal Counsel to Physicians Accused of Making Negligent Referrals
Our Philadelphia physician lawyers at Sidney L. Gold & Associates, P.C. understand the nuances of negligent referrals and malpractice. We offer a full spectrum of legal services for the specialized needs of medical professionals. Contact us online or call us at 215-569-1999 for a free consultation. Located in Philadelphia, we serve clients throughout Wilkes-Barre, Scranton, northeast Philadelphia, Bucks County, Chester County, Delaware County, and Montgomery County.