Patient Abandonment - Home Healthcare


Elements of the Cause of Action for Abandonment

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

CGHS hospital

1. Medical 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 care provider failed to arrange for care by another appropriate skilled medical doctor.

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

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

Physicians, nurses, and other health care professionals have an ethical, and also a legal, duty to prevent 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 inside a critical stage without giving reasonable notice or making suitable arrangements for your attendance of another.

Abandonment from the Physician

When a physician undertakes treatments for a patient, treatment must continue before the patient's circumstances will no longer warrant the treatment, the doctor and the patient mutually agree to end the treatment by that physician, or the patient discharges the physician. Moreover, the physician may unilaterally terminate the connection and withdraw from treating that patient only when he or she provides the patient proper notice of her or his intent to withdraw as well as an opportunity to obtain proper substitute care.

In your house health setting, the physician-patient relationship does not terminate merely just because a 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 to the patient. Virtually every situation 'in which homecare is approved by Medicare, Medicaid, or perhaps 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 for the patient and a reasonable attempt to refer the patient to another appropriate physician. Otherwise, problems will retain their duty toward the individual when the patient is discharged in the hospital to the home. Failure to follow along with through on the part of the doctor will constitute the tort of abandonment in the event the patient is injured consequently. This abandonment may expose problems, the hospital, and the home health agency to liability for your tort of abandonment.

The attending physician from the hospital should make certain that a proper referral was designed 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 home care personally. Even more important, if the hospital-based physician arranges to offer the patient's care assumed by another physician, the individual must fully understand this modification, and it should be carefully documented.

As based on case law, the kinds of actions that will bring about liability for abandonment of your patient will include:

• premature turmoil the patient by the physician

• failure with 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 patient

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

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

Generally, abandonment doesn't happen if the physician responsible for the patient arranges to get a substitute physician to look at his or her place. This variation may occur because of vacations, relocation from the physician, illness, distance in the patient's home, or retirement with the physician. As long as care by an appropriately trained physician, sufficiently knowledgeable from the patient's special conditions, or no, has been arranged, the courts will usually not find that abandonment has occurred. Even the place where a patient refuses to spend the money for care or is can not 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 in order to give a sufficiently reasonable stretch of time to locate another prior to ceasing to provide care.

Although most of the cases discussed concern the physician-patient relationship, as outlined above previously, the same principles connect with all health care providers. Furthermore, for the reason that care rendered from the home health agency is given pursuant to a physician's plan of care, whether or not the patient sued the physician for abandonment due to the actions (or inactions of the property health agency's staff), the doctor may seek indemnification through the home health provider.


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

Every time a home health provider furnishes treatment to a patient, the duty to remain providing care to the person is a duty owed by the agency itself rather than by the individual professional who may be the employee or the contractor with the agency. The home health provider doesn't have a duty to continue offering the same nurse, therapist, or aide towards the patient throughout the procedure, so long as the provider continues to use appropriate, competent personnel to manage the course of treatment consistently with the plan of care. From your 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 towards the patient. The development of a private 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 alleviate many of the conditions that arise in the health care' setting.

If your patient requests replacing of a particular nurse, therapist, technician, or home health aide, the house health provider is still equipped with a duty to provide want to the patient, unless the individual also specifically states she or he no longer desires the provider's service. Home health agency supervisors should always follow up on such patient requests to determine the reasons regarding the dismissal, to detect "problem" employees, and to ensure no incident has taken place that might help with liability. The home health agency should continue providing choose 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 might not be a result of the medical condition for which the care is being provided. Personal safety of the individual health care provider should be paramount. If your patient pose a physical danger to the individual, he / she should leave the premises immediately. The company should document from 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 at the home health provider and will complete an internal incident report. When it appears that a criminal act has taken place, such as a physical assault, attempted rape, or other such act, this act needs to be reported immediately to law enforcement agencies. The home care provider also needs to immediately notify both patient and the physician that this provider will terminate its relationship with all the patient and that a different provider for these services must be obtained.

Other less serious circumstances may, nevertheless, lead the house health provider to discover 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 break 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 treatment methods are undertaken, however, the house health provider is normally obliged to continue providing services prior to the patient has had a fair opportunity to obtain a substitute provider. The identical principles apply to failure of an patient to pay for the skills 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 which a certain provider and patient will not be compatible, an alternative provider should be tried. Should it appear the problem lies with all the patient and that it is important for the HHA to terminate its relationship with the patient, the following seven steps should be taken:

1. Instances should be documented from the patient's record.

2. The home 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 any other measures to document patient delivery of the letter. A copy from the letter should be placed in the patient's record.

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

5. When the patient has a life-threatening condition or perhaps a medical condition that might deteriorate even without continuing care, this issue should be clearly produced in the letter. The need of the patient's obtaining replacement home healthcare should be emphasized.

6. The individual 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 the event of a medical emergency or call the local emergency number for ambulance transportation.

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

These steps shouldn't be undertaken lightly. Before such steps are taken, a person's case should be thoroughly discussed using the home health provider's risk manager, a lawyer, medical director, along with the patient's attending physician.

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

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

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