1/3/2016 - Patient Abandonment - Home Health Care
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Elements of the Cause of Action for Abandonment

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

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1. Medical treatment was unreasonably discontinued.

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

3. The health care provider failed to arrange for care by another appropriate skilled health care provider.

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

5. The sufferer actually suffered harm or loss due to the discontinuance of care.

Physicians, nurses, and other health care professionals have an ethical, and a legal, duty to stop abandonment of patients. The health care professional includes a duty to give their patient all necessary attention provided that the case required it and cannot leave the patient inside a critical stage without giving reasonable notice or making suitable arrangements for that attendance of another.

Abandonment by the Physician

When a physician undertakes treatment of a patient, treatment must continue until the patient's circumstances no more warrant the treatment, problems and the patient mutually accept to end the treatment by that physician, or the patient discharges health related conditions. 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 plus an opportunity to obtain proper substitute care.

In the house health setting, the physician-patient relationship doesn't terminate merely because a patient's care shifts in the location from the hospital to the home. If the patient continues to need medical services, supervised health care, therapy, or other home health services, the attending physician should ensure that he or she was properly discharged his or her-duties on the patient. Virtually every situation 'in which homecare is approved by Medicare, Medicaid, or an 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 it is often formally terminated by notice towards the patient and a reasonable try and refer the patient to a different appropriate physician. Otherwise, problems will retain their duty toward the individual when the patient is discharged from the hospital to the home. Failure to follow through on the part of problems will constitute the tort of abandonment if your patient is injured as a result. This abandonment may expose health related conditions, the hospital, and the home health agency to liability for your tort of abandonment.

The attending physician from the hospital should ensure that a proper referral is made to a physician who will be in charge of 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, in the event the hospital-based physician arranges to get the patient's care assumed by another physician, the person must fully understand this change, and it should be carefully documented.

As based on case law, the sorts of actions that will result in liability for abandonment of the patient will include:

• premature relieve the patient by the physician

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

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

• refusal of the physician to respond to 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 doesn't happen if the physician in charge of the patient arranges to get a substitute physician to adopt his or her place. This transformation may occur because of vacations, relocation of 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, if any, has been arranged, the courts in most cases not find that abandonment has occurred. Even where a patient refuses to pay for the care or is can not pay for the care, the physician 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 time period to locate another ahead of ceasing to provide care.

Although most of the cases discussed concern the physician-patient relationship, as pointed out above previously, the same principles sign up for all health care providers. Furthermore, for the reason that care rendered by the home health agency emerges pursuant to a physician's plan of care, get the job done patient sued health related conditions for abandonment as a result of actions (or inactions of the property health agency's staff), the physician may seek indemnification in the home health provider.


Similar principles to people who apply to physicians apply to the home health professional along with the home health provider. A house health agency, because direct provider of want to the homebound patient, could possibly be held to the same legal obligation and duty to offer care that addresses a person's needs as is the doctor. 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.

Each time a home health provider furnishes treatment to some patient, the duty to carry on providing care to the person is a duty owed through the agency itself and never by the individual professional who may be the employee or the contractor of the agency. The home health provider doesn't need a duty to continue offering the same nurse, therapist, or aide towards the patient throughout the treatment course, so long as the provider is constantly on the use appropriate, competent personnel to manage the course of treatment consistently together with the plan of care. Through the perspective of patient satisfaction and continuity of care, it can be in the best interests of the property health provider to try to provide the same individual practitioner to the patient. The development of a private relationship with the provider's personnel may improve communications along with a greater degree of trust and compliance on the part of the patient. It should help alleviate many of the conditions that arise in the health care' setting.

When the patient requests replacing of a particular nurse, therapist, technician, or home health aide, the home health provider continues to have a duty to provide want to the patient, unless the individual also specifically states he / she no longer desires the provider's service. Home health agency supervisors should follow up on such patient requests to look for the reasons regarding the dismissal, to detect "problem" employees, and to ensure no incident has had 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 for which 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, he / she should leave the premises immediately. The provider should document within the medical record the facts regarding 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 should 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 any other such act, this act should be reported immediately to local law enforcement agencies. The home care provider also needs to immediately notify the two patient and the physician how the provider will terminate its relationship together with the patient and that an alternative solution provider for these services must be obtained.

Other less serious circumstances may, nevertheless, lead the house health provider to ascertain that it should terminate its relationship with a particular patient. Examples may include particularly abusive patients, patients who solicit -the home health provider professional to break 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, the property health provider is often obliged to continue providing services before the patient has had a fair opportunity to obtain a substitute provider. The same principles apply to failure of the patient to pay for the assistance or equipment provided.

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

1. The circumstances should be documented from the patient's record.

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

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

4. Whenever possible, the patient should be given a certain period of time to obtain replacement care. Usually 30 days is sufficient.

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

6. The patient should be informed with the location of the nearest hospital emergency department. The person should be told with the idea 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 replica of the letter must 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 together with the home health provider's risk manager, legal counsel, medical director, and also the patient's attending physician.

The inappropriate discharge of a patient from medical care coverage by the home health provider, whether as a result of termination of entitlement, inability to pay, or other reasons, can also lead to liability for the tort of abandonment.

Nurses who passively the stand by position and observe negligence with a physician or anybody 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 impartial duty to patients past the 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 be aware of is below the standard of care.

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