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Patient Abandonment - Home Healthcare

CGHS hospital

Elements of the Cause of Action for Abandonment

Each of the following five elements should be present for a patient to have a proper civil reason behind action for the tort of abandonment:

1. Health care treatment was unreasonably discontinued.

2. The termination of healthcare was contrary to the patient's will or without the patient's knowledge.

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

4. The health care provider should have reasonably foreseen that problems for the patient would arise from your termination of the care (proximate cause).

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

Physicians, nurses, and other health care professionals have an ethical, in addition to a legal, duty in order to avoid abandonment of patients. The health 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 to the attendance of another.

Abandonment from the Physician

When a physician undertakes management of a patient, treatment must continue prior to the patient's circumstances no more warrant the treatment, health related conditions and the patient mutually consent to end the treatment with that physician, or the patient discharges the physician. Moreover, the physician may unilaterally terminate the relationship and withdraw from treating that patient provided that 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 home health setting, the physician-patient relationship won't terminate merely must be patient's care shifts in its location from the hospital on the home. If the patient is constantly on the need medical services, supervised healthcare, therapy, or other home health services, the attending physician should make sure that he or she was properly discharged his or her-duties towards the patient. Virtually every situation 'in which homecare is approved by Medicare, Medicaid, or even an insurer will be one in which the patient's 'needs for care have continued. The physician-patient relationship that existed inside the hospital will continue unless it is often formally terminated by notice towards the patient and a reasonable make an effort to refer the patient to an alternative appropriate physician. Otherwise, the physician will retain his / her duty toward the sufferer when the patient is discharged in the hospital to the home. Failure to check out through on the part of the physician will constitute the tort of abandonment if the patient is injured because of this. This abandonment may expose health related conditions, the hospital, and the home health agency to liability to the tort of abandonment.

The attending physician in the hospital should be sure that a proper referral was designed to a physician who will be responsible for the home health patient's care while it is being delivered by the home health provider, unless problems intends to continue to supervise that home care personally. Even more important, if your hospital-based physician arranges to achieve the patient's care assumed by another physician, the sufferer must fully understand this variation, and it should be carefully documented.

As based on case law, like actions that will cause liability for abandonment of the patient will include:

• premature turmoil the patient by the physician

• failure in the physician to provide proper instructions before discharging the individual

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

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

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

Generally, abandonment doesn't happen if the physician to blame for the patient arranges for the substitute physician to take his or her place. This variation may occur because of vacations, relocation of the physician, illness, distance through the patient's home, or retirement with the physician. As long as care by an appropriately trained physician, sufficiently knowledgeable with the patient's special conditions, or no, has been arranged, the courts will usually not find that abandonment has occurred. Even when a patient refuses to spend the money for care or is struggling to pay for the care, problems is not at liberty to terminate the partnership unilaterally. The physician must still take steps to have the patient's care assumed by another or give a sufficiently reasonable stretch of time to locate another just before ceasing to provide care.

Although most of the cases discussed concern the physician-patient relationship, as pointed out above previously, the same principles apply to all health care providers. Furthermore, because the care rendered through the home health agency is provided pursuant to a physician's plan of care, even if the patient sued the doctor for abandonment as a result of actions (or inactions of the property health agency's staff), the physician may seek indemnification through the home health provider.


Similar principles to people who apply to physicians affect the home health professional and the home health provider. A home health agency, because the direct provider of care to the homebound patient, could be held to the same legal obligation and duty to offer care that addresses a person's needs as is the physician. Furthermore, there may be both an authorized and an ethical obligation to remain delivering care, if your patient has no alternatives. A moral obligation may still exist on the patient even though the home health provider has fulfilled all legal obligations.

When a home health provider furnishes treatment to some patient, the duty to keep providing care to the sufferer is a duty owed by the agency itself and never by the individual professional who might be the employee or the contractor in the agency. The home health provider won't have a duty to continue giving the same nurse, therapist, or aide towards the patient throughout the course of treatment, so long as the provider is constantly use appropriate, competent personnel to give the course of treatment consistently with all the plan of care. Through the perspective of patient satisfaction and continuity of care, it could be in the best interests of the home health provider to try to provide the same individual practitioner for the patient. The development of an individual relationship with the provider's personnel may improve communications plus a greater degree of trust and compliance for the patient. It should assist to alleviate many of the conditions arise in the health care' setting.

If the patient requests replacing a particular nurse, therapist, technician, or home health aide, your home health provider retains a duty to provide care to the patient, unless the patient also specifically states he / she no longer desires the provider's service. Home health agency supervisors would be wise to follow up on such patient requests to discover the reasons regarding the dismissal, to identify "problem" employees, and to ensure no incident has brought place that might give rise to liability. The home health agency should continue providing care to the patient until definitively told to refrain from doing so by the patient.


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

Other less serious circumstances may, nevertheless, lead your home health provider to find out that it should terminate its relationship which has a particular patient. Examples can sometimes include particularly abusive patients, patients who solicit -the home health provider professional to get rid of the law (for example, by providing illegal drugs or providing non-covered services and equipment and billing them as something more important), or consistently noncompliant patients. Once therapy is undertaken, however, your home health provider is usually obliged to continue providing services before the patient has had a good opportunity to obtain a substitute provider. The same principles apply to failure of a patient to pay for the help or equipment provided.

As medical professionals, HHA personnel should have training concerning how to handle the difficult patient responsibly. Arguments or emotional comments ought to be avoided. If it becomes clear that a certain provider and patient are not likely to be compatible, a replacement provider should be tried. Should it appear that the problem lies with the patient and that it is essential for the HHA to terminate its relationship with the patient, the following seven steps needs to be taken:

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

2. Your home health provider should give or send a letter to the patient explaining conditions surrounding the termination of care.

3. The letter ought to be sent by certified mail, return receipt requested, and other measures to document patient receiving the letter. A copy from the letter should be used in the patient's record.

4. If at all possible, the patient should be given some period of time to obtain replacement care. Usually Four weeks is sufficient.

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

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

7. A reproduction of the letter must 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, a person's case should be thoroughly discussed with all the home health provider's risk manager, an attorney, medical director, as well as the patient's attending physician.

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

Nurses who passively uphold and observe negligence by way of a physician or anybody else will personally become accountable on the patient who is injured because of that negligence... [H]ealthcare facilities as well as their nursing staff owe an independent duty to patients beyond the duty owed by physicians. When a physician's order to discharge is inappropriate, the nurses will probably be help liable for following an investment that they knew or should know about is below the standard of care.