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Patient Abandonment - Home Healthcare

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Elements of the Cause of Action for Abandonment

Each one of the following five elements has to be present for a patient to get a proper civil source 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. Medical care provider did not arrange for care by another appropriate skilled physician.

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

5. The sufferer 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 care professional includes a duty to give his / her patient all necessary attention so long as the case required it and cannot leave the patient inside a critical stage without giving reasonable notice or making suitable arrangements to the attendance of another.

Abandonment through the Physician

When a physician undertakes treatments for a patient, treatment must continue prior to the patient's circumstances no more warrant the treatment, health related conditions and the patient mutually accept to end the treatment with that physician, or the patient discharges health related conditions. 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 his / her intent to withdraw as well as an opportunity to obtain proper substitute care.

In your home health setting, the physician-patient relationship doesn't terminate merely must be patient's care shifts in their 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 ensure that he or she was properly discharged his or her-duties to the patient. Virtually every situation 'in which homecare is approved by Medicare, Medicaid, or even an insurer will be one out of which the patient's 'needs for care have continued. The physician-patient relationship that existed in the hospital will continue unless it has been formally terminated by notice towards the patient and a reasonable try and refer the patient to a different appropriate physician. Otherwise, the doctor 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 health related conditions will constitute the tort of abandonment when the patient is injured consequently. This abandonment may expose the physician, the hospital, and the home health agency to liability for 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 while it's being delivered from the home health provider, unless health related conditions 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 individual must fully understand this variation, and it should be carefully documented.

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

• premature turmoil the patient by the physician

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

• the statement with the physician to the patient the physician will no longer treat the sufferer

• refusal of the physician to answer calls or to further attend the sufferer

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

Generally, abandonment does not occur if the physician in charge of the patient arranges for a substitute physician to consider his or her place. This variation may occur because of vacations, relocation from 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 in the patient's special conditions, or no, has been arranged, the courts in most cases not find that abandonment has occurred. Even when a patient refuses to spend the money for care or is not able to pay for the care, problems is not at liberty to terminate the relationship unilaterally. The physician must still do something to have the patient's care assumed by another as well as to give a sufficiently reasonable period of time to locate another prior to ceasing to provide care.

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


Similar principles to those who apply to physicians apply to the home health professional and the home health provider. A property health agency, because the direct provider of choose to the homebound patient, might be held to the same legal obligation and duty to supply care that addresses the patient's needs as is the physician. Furthermore, there may be both a legal and an ethical obligation to carry on delivering care, when the patient has no alternatives. An ethical obligation may still exist towards the patient even though the home health provider has fulfilled all legal obligations.

Every time a home health provider furnishes treatment into a patient, the duty to remain providing care to the individual is a duty owed through the agency itself and never by the individual professional who might be the employee or the contractor from the agency. The home health provider won't have a duty to continue giving the same nurse, therapist, or aide for the patient throughout the procedure, so long as the provider is constantly use appropriate, competent personnel to manage the course of treatment consistently with all the plan of care. From the perspective of patient satisfaction and continuity of care, it might be in the best interests of the house health provider to try and provide the same individual practitioner towards the patient. The development of an individual relationship with the provider's personnel may improve communications as well as a greater degree of trust and compliance by the patient. It should help to alleviate many of the problems that arise in the health care' setting.

In the event the patient requests replacing a particular nurse, therapist, technician, or home health aide, your home health provider is still equipped with a duty to provide desire to the patient, unless the patient also specifically states he or she no longer desires the provider's service. Home health agency supervisors should follow up on such patient requests to discover the reasons regarding the dismissal, to identify "problem" employees, and to ensure no incident has taken place that might give rise to liability. The home health agency should continue providing desire 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 in which the care is being provided. Personal safety of the people 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 inside the medical record the facts all around the inability to complete the therapy for that visit as objectively as possible. Management personnel should inform supervisory personnel with the home health provider and may complete an internal incident report. When it appears that a criminal act has gotten place, such as a physical assault, attempted rape, or another such act, this act must be reported immediately to local law enforcement agencies. The home care provider also need to immediately notify both patient and the physician the provider will terminate its relationship together 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 ascertain that it should terminate its relationship having 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, through providing illegal drugs or providing non-covered services and equipment and billing them as something different), or consistently noncompliant patients. Once therapy is undertaken, however, your home health provider is often obliged to continue providing services before patient has had an acceptable opportunity to obtain a substitute provider. The same principles apply to failure of an patient to pay for the help or equipment provided.

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

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

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

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

4. If at all possible, the patient should be given some period of time to obtain replacement care. Usually 30 days is sufficient.

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

6. The individual should be informed in the location of the nearest hospital emergency department. The individual should be told either to go to the nearest hospital emergency department in the case of a medical emergency or to 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 really 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, legal services, medical director, along with the patient's attending physician.

The inappropriate turmoil a patient from health care coverage by the home health provider, whether as a result of termination of entitlement, wherewithal to pay, or other reasons, could also lead to liability for that tort of abandonment.

Nurses who passively the stand by position and observe negligence by way of a physician or other people will personally become accountable to the patient who is injured because of that negligence... [H]ealthcare facilities along with their nursing staff owe an independent duty to patients after dark duty owed by physicians. Whenever 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 is below the standard of care.