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Patient Abandonment - Home Health Care

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Elements of the Cause of Action for Abandonment

All the following five elements must be present for a patient to possess a proper civil source of action for the tort of abandonment:

1. Medical treatment was unreasonably discontinued.

2. The termination of health care was contrary to the patient's will or with no patient's knowledge.

3. Medical care provider did not arrange for care by another appropriate skilled health care provider.

4. The health care provider really should have reasonably foreseen that injury to the patient would arise in the termination of the care (proximate cause).

5. The individual actually suffered harm or loss as a result of the discontinuance of care.

Physicians, nurses, and also other health care professionals have an ethical, and a legal, duty to prevent abandonment of patients. The medical care professional has a duty to give his / her patient all necessary attention providing the case required it and cannot leave the patient in a critical stage without giving reasonable notice or making suitable arrangements for your attendance of another.

Abandonment from the Physician

When a physician undertakes treatment of a patient, treatment must continue before the patient's circumstances no longer warrant the treatment, health related conditions and the patient mutually consent to end the treatment with that physician, or the patient discharges the doctor. Moreover, the physician may unilaterally terminate the partnership and withdraw from treating that patient as long as he or she provides the patient proper notice of her or his intent to withdraw with an opportunity to obtain proper substitute care.

In your house health setting, the physician-patient relationship doesn't terminate merely want . patient's care shifts in its location from the hospital on the home. If the patient will continue to need medical services, supervised health care, therapy, or other home health services, the attending physician should make certain that he or she was properly discharged his or her-duties for the patient. Virtually every situation 'in which home care is approved by Medicare, Medicaid, or even an insurer will be one inch which the patient's 'needs for care have continued. The physician-patient relationship that existed within the hospital will continue unless it has been formally terminated by notice on the patient and a reasonable try to refer the patient to an alternative appropriate physician. Otherwise, the doctor will retain her or his duty toward the sufferer when the patient is discharged from the hospital to the home. Failure to adhere to through on the part of the doctor will constitute the tort of abandonment in the event the patient is injured therefore. This abandonment may expose the doctor, the hospital, and the home health agency to liability for your tort of abandonment.

The attending physician in the hospital should be sure that a proper referral is built to a physician who will be to blame for the home health patient's care while it is being delivered with the home health provider, unless the doctor intends to continue to supervise that homecare personally. Even more important, when the hospital-based physician arranges to achieve the patient's care assumed by another physician, the person must fully understand this transformation, and it should be carefully documented.

As supported by case law, the sorts of actions that will cause liability for abandonment of an patient will include:

• premature turmoil the patient by the physician

• failure of the physician to provide proper instructions before discharging the person

• the statement from the physician to the patient that this physician will no longer treat the person

• refusal of the physician to respond to calls or to further attend the person

• the physician's leaving the patient after surgery or failing to follow up on postsurgical care.

Generally, abandonment doesn't occur if the physician to blame for the patient arranges for a substitute physician to take his or her place. This change may occur because of vacations, relocation with the physician, illness, distance from the patient's home, or retirement with the physician. As long as care by an appropriately trained physician, sufficiently knowledgeable in the patient's special conditions, or no, has been arranged, the courts in most cases not find that abandonment has occurred. Even the place where a patient refuses to pay for the care or is not able to pay for the care, the doctor is not at liberty to terminate their bond unilaterally. The physician must still take the appropriate steps to have the patient's care assumed by another or to give a sufficiently reasonable period of time to locate another just before ceasing to provide care.

Although almost all of the cases discussed concern the physician-patient relationship, as pointed out previously, the same principles apply to all health care providers. Furthermore, because the care rendered with the home health agency is supplied pursuant to a physician's plan of care, get the job done patient sued health related conditions for abandonment due to actions (or inactions of the home health agency's staff), health related conditions may seek indemnification from the home health provider.


Similar principles to those who apply to physicians sign up for the home health professional and also the home health provider. A home health agency, because direct provider of desire to the homebound patient, might be held to the same legal obligation and duty to provide care that addresses the patient's needs as is the doctor. Furthermore, there may be both an authorized and an ethical obligation to keep delivering care, when the patient has no alternatives. An ethical obligation may still exist to the patient even though the home health provider has fulfilled all legal obligations.

Each time a home health provider furnishes treatment with a patient, the duty to continue providing care to the sufferer is a duty owed through the agency itself rather than by the individual professional who seems to be the employee or the contractor of the agency. The home health provider doesn't need a duty to continue supplying the same nurse, therapist, or aide towards the patient throughout the procedure, so long as the provider is constantly on the use appropriate, competent personnel to give the course of treatment consistently using the plan of care. From the perspective of patient satisfaction and continuity of care, it may be in the best interests of the house health provider to try to provide the same individual practitioner towards the patient. The development of a private relationship with the provider's personnel may improve communications and a greater degree of trust and compliance by the patient. It should assistance to alleviate many of the problems that arise in the health care' setting.

If the patient requests replacing a particular nurse, therapist, technician, or home health aide, the house health provider continues to have a duty to provide desire to the patient, unless the individual also specifically states she or he no longer desires the provider's service. Home health agency supervisors must always follow up on such patient requests to ascertain the reasons regarding the dismissal, to identify "problem" employees, and to ensure no incident has gotten place that might help with liability. The home health agency should continue providing care to the patient until definitively told to refrain from giving so by the patient.


Home health provider personnel may occasionally encounter an abusive patient. This abuse mayor is probably not a result of the medical condition which is why the care is being provided. Personal safety of the baby health care provider should be paramount. When the patient pose an actual danger to the individual, they should leave the premises immediately. The company should document within the medical record the facts all around the inability to complete the therapy for that visit as objectively as you possibly can. Management personnel should inform supervisory personnel in the home health provider and will complete an internal incident report. Whether or not this appears that a criminal act has brought place, such as a physical assault, attempted rape, or another such act, this act needs to be reported immediately to law enforcement agencies. The home care provider also needs to immediately notify the patient and the physician that the provider will terminate its relationship with the patient and that an alternate provider for these services ought to be obtained.

Other less serious circumstances may, nevertheless, lead the house health provider to ascertain that it should terminate its relationship using a particular patient. Examples can include particularly abusive patients, patients who solicit -the home health provider professional to get rid of the law (for example, by offering illegal drugs or providing non-covered services and equipment and billing them as something more important), or consistently noncompliant patients. Once treatment solutions are undertaken, however, the house health provider is normally obliged to continue providing services before the patient has had an acceptable opportunity to obtain a substitute provider. Exactly the same principles apply to failure of an patient to pay for the services or equipment provided.

As physicians, HHA personnel should have training regarding how to handle the difficult patient responsibly. Arguments or emotional comments must be avoided. If it becomes clear a certain provider and patient will not be compatible, a substitute provider should be tried. Should it appear the problem lies with the patient and that it is critical for the HHA to terminate its relationship with the patient, the following seven steps must be taken:

1. Conditions should be documented within the patient's record.

2. The property health provider should give or send instructions to the patient explaining the circumstances surrounding the termination of care.

3. The letter needs to be sent by certified mail, return receipt requested, or another measures to document patient receiving the letter. A copy in the letter should be placed in the patient's record.

4. If at all possible, the patient should be given a particular period of time to obtain replacement care. Usually Thirty days is sufficient.

5. In the event the patient has a life-threatening condition or even a medical condition that might deteriorate even without continuing care, this problem should be clearly stated in the letter. Require the patient's obtaining replacement home medical should be emphasized.

6. The patient should be informed of the location of the nearest hospital emergency department. The person should be told to either go to the nearest hospital emergency department in case of a medical emergency or to call the local emergency number for ambulance transportation.

7. A duplicate of the letter should be sent to the patient's attending physician via certified mail, return receipt requested.

These steps should not be undertaken lightly. Before such steps are taken, the patient's case should be thoroughly discussed using the home health provider's risk manager, an attorney, medical director, and the patient's attending physician.

The inappropriate discharge of a patient from medical care coverage by the home health provider, whether because of termination of entitlement, being unable to pay, or other reasons, might also lead to liability for the tort of abandonment.

Nurses who passively get ready and observe negligence with a physician or someone else will personally become accountable to the patient who is injured because of that negligence... [H]ealthcare facilities in addition to their nursing staff owe an independent duty to patients past the duty owed by physicians. Every time a physician's order to discharge is inappropriate, the nurses will probably be help liable for following a purchase that they knew or ought to know is below the standard of care.