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Patient Abandonment - Home Medical care

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Elements of the Cause of Action for Abandonment

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

1. Health care treatment was unreasonably discontinued.

2. The termination of medical was contrary to the patient's will or minus the patient's knowledge.

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

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

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

Physicians, nurses, along with other health care professionals have an ethical, in addition to a legal, duty to prevent abandonment of patients. The care professional features a duty to give her or his patient all necessary attention provided that the case required it and cannot leave the patient in a critical stage without giving reasonable notice or making suitable arrangements for the attendance of another.

Abandonment with the Physician

When a physician undertakes treating a patient, treatment must continue prior to the patient's circumstances no longer warrant the treatment, health related conditions 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 relationship and withdraw from treating that patient provided that 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 house health setting, the physician-patient relationship doesn't 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 medical, 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 home care 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 in the hospital will continue unless many experts have formally terminated by notice towards the patient and a reasonable try and refer the patient to a different appropriate physician. Otherwise, health related conditions will retain his or her duty toward the patient when the patient is discharged through the hospital to the home. Failure to check out through on the part of the physician 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 to the tort of abandonment.

The attending physician within the hospital should ensure that a proper referral was designed to a physician who will be in charge of the home health patient's care while it is being delivered by the home health provider, unless the physician intends to continue to supervise that homecare personally. Even more important, in the event the hospital-based physician arranges to have the patient's care assumed by another physician, the person must fully understand this modification, and it should be carefully documented.

As supported by case law, the sorts of actions that will bring about liability for abandonment of a patient will include:

• premature relieve the patient by the physician

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

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

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

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

Generally, abandonment doesn't occur if the physician accountable for the patient arranges for a substitute physician to adopt his or her place. This variation may occur because of vacations, relocation in the physician, illness, distance from your patient's home, or retirement with the physician. As long as care by an appropriately trained physician, sufficiently knowledgeable of the patient's special conditions, if any, has been arranged, the courts will often not find that abandonment has occurred. Even when a patient refuses to spend the money for care or is can not pay for the care, the physician is not at liberty to terminate their bond unilaterally. The physician must still take steps to have the patient's care assumed by another or give a sufficiently reasonable period of time to locate another just before ceasing to provide care.

Although the majority of the cases discussed concern the physician-patient relationship, as pointed out above previously, the same principles apply to all health care providers. Furthermore, as the care rendered with the home health agency is provided pursuant to a physician's plan of care, get the job done patient sued problems for abandonment because of the actions (or inactions of the property health agency's staff), the physician may seek indemnification from the home health provider.


Similar principles to people who apply to physicians connect with the home health professional and the home health provider. A property health agency, since the direct provider of want to the homebound patient, may be held to the same legal obligation and duty to provide care that addresses a person's needs as is the physician. Furthermore, there may be both a legal and an ethical obligation to carry on delivering care, if your patient has no alternatives. An ethical obligation may still exist towards the patient even though the home health provider has fulfilled all legal obligations.

Whenever a home health provider furnishes treatment with a patient, the duty to carry on providing care to the individual is a duty owed by the agency itself and not by the individual professional who might be the employee or the contractor of the agency. The home health provider does not have a duty to continue supplying the same nurse, therapist, or aide on the patient throughout the treatment course, so long as the provider continues to 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 can be in the best interests of the property health provider to provide the same individual practitioner for 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 from the patient. It should assistance to alleviate many of the issues 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 care to the patient, unless the sufferer also specifically states she or he no longer desires the provider's service. Home health agency supervisors should 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 care to the patient until definitively told not to do 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 that the care is being provided. Personal safety of the individual health care provider should be paramount. Should the 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 around the inability to complete the procedure for that visit as objectively as you possibly can. Management personnel should inform supervisory personnel at the home health provider and really should complete an internal incident report. If 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 the provider will terminate its relationship together with the patient and that an alternative provider for these services needs to 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 may 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 else), or consistently noncompliant patients. Once treatment methods are undertaken, however, the home health provider is usually obliged to continue providing services before the patient has had an acceptable opportunity to obtain a substitute provider. The same principles apply to failure of an patient to pay for the skills or equipment provided.

As medical researchers, HHA personnel should have training on the way to handle the difficult patient responsibly. Arguments or emotional comments must be avoided. If it becomes clear a certain provider and patient are not likely to be compatible, an alternative 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 the patient, the following seven steps ought to be taken:

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

2. The 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 another measures to document patient receiving the letter. A copy with the letter should be used in the patient's record.

4. If possible, the patient should be given a specific period of time to obtain replacement care. Usually 1 month is sufficient.

5. If the patient has a life-threatening condition or a medical condition that might deteriorate in the absence of continuing care, this condition should be clearly stated in the letter. Involve the patient's obtaining replacement home healthcare should be emphasized.

6. The person should be informed of the location of the nearest hospital emergency department. The sufferer 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 duplicate of the letter should 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, a lawyer, medical director, as well as the patient's attending physician.

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

Nurses who passively get ready and observe negligence by a physician or anybody else will personally become accountable to the patient who is injured because of that negligence... [H]ealthcare facilities and 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 be help liable for following a purchase that they knew or should be aware of is below the standard of care.