Guideline - A Physician's Responsibilities When Permanently Closing a Medical Practice (Replaced by new policy effective 30 Apr 12)

Notice 

The Personal Health Information Act (PHIA) came fully into force on April 1, 2011. PHIA governs the collection, use and disclosure of personal health information within the health care system. The intention of PHIA is to ensure that personal health information, including personal health information in the medical records in physicians’ offices, is held confidential and kept secure.

In order to meet PHIA requirements, the College has amended the existing By-Law No. 6 – Records and the four related guidelines, as described below.

The amendments to By-Law No. 6, renamed By-Law No. 6 - Medical Records, represent an evolution of the existing By-Law regarding both the information a physician should record in a patient’s medical record (Paragraphs 10 and 12 of the new By-Law) and the obligation a physician has to retain medical records (Paragraphs 13 to 29 of the new By-Law).

The amended By-Law No. 6 incorporates the amended versions of two of the College’s four existing guidelines regarding medical records:

• Guideline – The Patient Medical Record; and
• Guideline – Retention and Storage of Medical Records.

Incorporation of these guidelines into the By-Law will give the intent of the guidelines greater force and authority, consistent with the requirements of the Personal Health Information Act. After April 30, 2012, they will no longer exist as stand-alone documents.

The existing guideline titled “A Physician’s Responsibility when Permanently Closing a Medical Practice” has been amended to meet PHIA requirements. It becomes a policy (with the same title) in order to give it greater force and authority.

The College also amended the existing guideline titled “Patient Access to Office Medical Records.” It has been renamed “Patient Access to Office Medical Records and the Personal Health Information Act”. It will remain as a guideline.

The amended By-Law, Policy and Guideline, listed below, will come into force on April 30, 2012.

• By-Law No. 6 - Medical Records
• Policy - A Physician’s Responsibility when Permanently Closing a Medical Practice
• Guideline - Patient Access to Office Medical Records and the Personal Health Information Act

The College’s Guideline – A Physician’s responsibility when Closing a Medical Practice for an Extended Period is also related to PHIA and the By-law, Policy and Guideline listed above. It has not changed and will remain in force after April 30, 2012.

Physicians are responsible to comply with PHIA and with the College's related By-Law, Policy, and Guidelines. Failure to do so may result in a complaint by a patient to the Office of the Information and Privacy Commissioner for an alleged violation of PHIA and/or to the College for alleged violations of PHIA-related By-Law, Policy, and Guidelines.

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This guideline expresses the views of the College of Physicians and Surgeons of Newfoundland and Labrador with regards to a physician’s responsibilities when permanently closing his/her medical practice.

A physician may permanently close his/her medical practice for a number of reasons including retirement, illness, or relocation.

When permanently closing a medical practice, a physician should consider:

• arrangements for the continuing medical care of patients in his/her medical practice; and
• patient access to their medical records.

Except in the case of illness, a physician should not abruptly close his/her medical practice. Patients should receive adequate notice of their physician’s intention to close his/her medical practice. This notice should be sufficient to permit patients to obtain a copy of their medical records and to transfer their care to another similarly qualified physician.

Notification of patients may be made by one or more of the following:

• By a letter;
• Directly at the time of an office visit;
• By a notice in the newspaper;
• By a notice in the physician’s office; and
• By a telephone answering service

Notices should inform patients of the name of the physician, if there is one, who will assume responsibility for the medical practice or who will accept responsibility for the custodial care of patients’ medical records. Patients have the option to continue with the physician assuming responsibility for the medical practice or to transfer their medical care to another physician of their choice.

In instances where another physician will not be assuming responsibility for the medical practice and where patients’ medical records will not have been transferred to another physician by the time the practice has closed, the physician’s medical records should be appropriately stored and kept readily available to patients, should they require copies. Physicians are referred to the College’s guideline regarding the retention and storage of medical records following closure of a medical practice.

For greater clarity and to assure continuity of care following the closure of a physician’s medical practice, it is recommended that a physician should, prior to closing his/her medical practice, take reasonable steps to:

• assure that patients are notified of the physician’s intention to close his/her medical practice;
• assure that patients are advised that copies of their medical records will be available and provided upon request. This access to their medical records includes access not only before, but also after, the medical practice is closed. Costs of copying the medical records should be reasonable and physicians are referred to the Newfoundland and Labrador Medical Association guidelines;
• assure that the College, the hospitals where the physician practiced, as well as colleagues are informed of the physician’s new contact information e.g. new mailing address, telephone number, fax number and e-mail address;
• assure that the College, the hospitals where the physician practiced, as well as colleagues, are informed of where the physician’s medical records are stored, and as well, the name and the contact information of the designated person who should be contacted if a copy of patients’ medical records are required;
• assure that all laboratory, imaging and other reports, received at the physician’s office following the closure of his/her medical practice are reviewed by a physician and patients are notified of the results;
• assist patients in making arrangements for another physician to assume their continuing care;
• make arrangements to assure the transfer of patients, who remain in hospital, to the care of another physician;
• cancel elective surgeries, which are scheduled in the immediate period prior to the closure of the physician’s medical practice, if it is anticipated that the patients will not have recovered from the surgery by the time the physician’s medical practice is closed. Assure that patients who remain in hospital, or who require postoperative follow-up, are transferred to another physician who has similar specialist qualifications;
• assure that patients who have received an appointment and are scheduled to be seen in the physician’s office or clinic are notified by written correspondence of the closure of his/her medical practice and cancellation of the scheduled appointment; and
• assure that patients who have been scheduled for procedures are informed by written correspondence of the physician’s closing of his/her medical practice and cancellation of the scheduled procedure.