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Patient Abandonment - Home Medical

CGHS hospital

Elements of the Cause of Action for Abandonment

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

1. Healthcare treatment was unreasonably discontinued.

2. The termination of healthcare was contrary to the patient's will or devoid of the patient's knowledge.

3. The medical care provider did not arrange for care by another appropriate skilled doctor.

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

5. The person actually suffered harm or loss because of the discontinuance of care.

Physicians, nurses, and other health care professionals have an ethical, and a legal, duty to avoid abandonment of patients. The health care professional has a duty to give their patient all necessary attention as long as the case required it and should not leave the patient within a critical stage without giving reasonable notice or making suitable arrangements for that attendance of another.

Abandonment by the Physician

When a physician undertakes management of a patient, treatment must continue until the patient's circumstances will no longer warrant the treatment, the physician and the patient mutually accept to end the treatment by that physician, or the patient discharges problems. Moreover, the physician may unilaterally terminate the relationship and withdraw from treating that patient only if he or she provides the patient proper notice of her or his intent to withdraw and an opportunity to obtain proper substitute care.

In the home health setting, the physician-patient relationship does not terminate merely want . patient's care shifts rolling around in its location from the hospital to 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 certain that he or she was properly discharged his or her-duties on the patient. Virtually every situation 'in which home care is approved by Medicare, Medicaid, or perhaps insurer will be one inch which the patient's 'needs for care have continued. The physician-patient relationship that existed inside the hospital will continue unless many experts have formally terminated by notice on the patient and a reasonable try and refer the patient to another appropriate physician. Otherwise, health related conditions will retain his / her duty toward the individual when the patient is discharged through the hospital to the home. Failure to follow along with through on the part of problems will constitute the tort of abandonment if the patient is injured as a result. This abandonment may expose problems, the hospital, and the home health agency to liability to the tort of abandonment.

The attending physician from the hospital should make certain that a proper referral is built to a physician who will be responsible for the home health patient's care though it may be being delivered from the home health provider, unless problems intends to continue to supervise that homecare personally. Even more important, when the hospital-based physician arranges to have the patient's care assumed by another physician, the person must fully understand this transformation, and it should be carefully documented.

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

• premature turmoil the patient by the physician

• failure from the physician to provide proper instructions before discharging the patient

• the statement through the physician to the patient the physician will no longer treat the individual

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

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

Generally, abandonment does not occur if the physician accountable for the patient arranges for the 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 in the physician. As long as care by an appropriately trained physician, sufficiently knowledgeable with the patient's special conditions, if any, has been arranged, the courts will most likely not find that abandonment has occurred. Even when a patient refuses to pay for the care or is not able to pay for the care, health related conditions is not at liberty to terminate the partnership unilaterally. The physician must still take the appropriate steps to have the patient's care assumed by another or to give a sufficiently reasonable stretch of time to locate another ahead of ceasing to provide care.

Although a lot of the cases discussed concern the physician-patient relationship, as pointed out above previously, the same principles connect with all health care providers. Furthermore, as the care rendered by the home health agency is provided pursuant to a physician's plan of care, even if the patient sued health related conditions for abandonment due to the actions (or inactions of your home health agency's staff), problems may seek indemnification in the home health provider.


Similar principles to those that apply to physicians affect the home health professional and also the home health provider. A house health agency, since the direct provider of desire to the homebound patient, could be held to the same legal obligation and duty to offer care that addresses the patient's needs as is health related conditions. Furthermore, there may be both a legitimate and an ethical obligation to remain delivering care, when the patient has no alternatives. An ethical 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 a patient, the duty to remain providing care to the sufferer is a duty owed with the agency itself and never by the individual professional who seems to be the employee or the contractor in the agency. The home health provider does not have a duty to continue offering the same nurse, therapist, or aide for the patient throughout the procedure, so long as the provider will continue to 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 might be in the best interests of your home health provider to attempt to provide the same individual practitioner on the patient. The development of a private relationship with the provider's personnel may improve communications plus a greater degree of trust and compliance by the patient. It should assist to alleviate many of the conditions arise in the health care' setting.

If the patient requests replacement of a particular nurse, therapist, technician, or home health aide, your home health provider is still equipped with a duty to provide want to the patient, unless the individual also specifically states they no longer desires the provider's service. Home health agency supervisors should always follow up on such patient requests to look for the reasons regarding the dismissal, to identify "problem" employees, and to ensure no incident has gotten place that might produce 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 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. If the patient pose a physical danger to the individual, he / she should leave the premises immediately. The provider should document within the medical record the facts surrounding the inability to complete the therapy for that visit as objectively as is possible. Management personnel should inform supervisory personnel with the home health provider and will complete an internal incident report. Whether or not this appears that a criminal act has gotten place, such as a physical assault, attempted rape, or any other such act, this act should be reported immediately to local law enforcement agencies. The home care provider also need to immediately notify both the patient and the physician that this provider will terminate its relationship with all the patient and that an alternate provider for these services needs to be obtained.

Other less serious circumstances may, nevertheless, lead the home health provider to ascertain that it should terminate its relationship which has a particular patient. Examples might include particularly abusive patients, patients who solicit -the home health provider professional to destroy 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 methods are undertaken, however, the home health provider is normally obliged to continue providing services before the patient has had a reasonable opportunity to obtain a substitute provider. Exactly the same principles apply to failure of an patient to pay for the assistance or equipment provided.

As physicians, HHA personnel should have training on the way to handle the difficult patient responsibly. Arguments or emotional comments should be avoided. If it becomes clear 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 all 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. Instances should be documented from the patient's record.

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

3. The letter must be sent by certified mail, return receipt requested, or other measures to document patient delivery of the letter. A copy in the letter should be placed in the patient's record.

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

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

6. The person should be informed of the location of the nearest hospital emergency department. The person 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 needs to 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 the home health provider's risk manager, a lawyer, 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 due to termination of entitlement, lack of ability to pay, or other reasons, may also lead to liability for your tort of abandonment.

Nurses who passively uphold and observe negligence by the physician or anyone else will personally become accountable to the patient who is injured due to that negligence... [H]ealthcare facilities along with their nursing staff owe an unbiased duty to patients at night duty owed by physicians. Every time a physician's order to discharge is inappropriate, the nurses will likely be help liable for following an order that they knew or should know is below the standard of care.