A Slice Of Life Scarves

Patient Abandonment - Home Healthcare

CGHS hospital

Elements of the Cause of Action for Abandonment

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

1. Medical 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 still did not arrange for care by another appropriate skilled physician.

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, as well as other health care professionals have an ethical, in addition to a legal, duty to avoid abandonment of patients. The medical care professional carries a duty to give his or her patient all necessary attention providing the case required it and should not leave the patient within a critical stage without giving reasonable notice or making suitable arrangements to the attendance of another.

Abandonment by the Physician

When a physician undertakes treatments for a patient, treatment must continue prior to the patient's circumstances not warrant the treatment, the doctor and the patient mutually agree to end the treatment with that physician, or the patient discharges the physician. Moreover, the physician may unilaterally terminate their bond and withdraw from treating that patient as long as he or she provides the patient proper notice of his or her intent to withdraw and an opportunity to obtain proper substitute care.

In your house health setting, the physician-patient relationship won't terminate merely want . patient's care shifts in their location from the hospital to the home. If the patient is constantly need medical services, supervised medical, 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 insurer will be one inch which the patient's 'needs for care have continued. The physician-patient relationship that existed within the hospital will continue unless it's been formally terminated by notice on the patient and a reasonable make an effort to refer the patient to a new appropriate physician. Otherwise, the doctor will retain her or his duty toward the sufferer when the patient is discharged from the hospital to the home. Failure to check out through on the part of problems will constitute the tort of abandonment if the patient is injured consequently. This abandonment may expose the physician, the hospital, and the home health agency to liability for that tort of abandonment.

The attending physician in the hospital should make certain that a proper referral is built to a physician who will be to blame for the home health patient's care even though it is being delivered by the home health provider, unless the doctor intends to continue to supervise that homecare personally. Even more important, if your hospital-based physician arranges to achieve 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 types of actions that will bring about liability for abandonment of your patient will include:

• premature discharge of the patient by the physician

• failure in the physician to provide proper instructions before discharging the person

• the statement by the physician to the patient how the physician will no longer treat the sufferer

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

• the physician's leaving the sufferer after surgery or unable 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 take his or her place. This transformation may occur because of vacations, relocation in the physician, illness, distance in the patient's home, or retirement of the physician. As long as care by an appropriately trained physician, sufficiently knowledgeable in the patient's special conditions, if any, has been arranged, the courts will often not find that abandonment has occurred. Even the place where a patient refuses to pay for the care or is not able to pay for the care, problems 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 as well as to give a sufficiently reasonable stretch of time to locate another prior to ceasing to provide care.

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


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

Every time a home health provider furnishes treatment with a patient, the duty to continue providing care to the individual is a duty owed from the agency itself and not by the individual professional who may be the employee or the contractor from the agency. The home health provider doesn't need a duty to continue giving the same nurse, therapist, or aide for the patient throughout the treatment, so long as the provider will continue to use appropriate, competent personnel to provide the course of treatment consistently using the plan of care. From the perspective of patient satisfaction and continuity of care, it may be in the best interests of the house health provider to try and provide the same individual practitioner to 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 assistance to alleviate many of the issues that arise in the health care' setting.

If your patient requests replacing of a particular nurse, therapist, technician, or home health aide, the home health provider continues to have a duty to provide desire to the patient, unless the sufferer also specifically states he / she no longer desires the provider's service. Home health agency supervisors must always follow up on such patient requests to determine the reasons regarding the dismissal, to identify "problem" employees, and to ensure no incident has brought place that might give rise to liability. The home health agency should continue providing desire to the patient until definitively told to avoid 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. If your patient pose an actual physical danger to the individual, they should leave the premises immediately. The provider should document inside the medical record the facts all around the inability to complete the procedure for that visit as objectively as possible. Management personnel should inform supervisory personnel in the home health provider and should complete an internal incident report. When it appears that a criminal act has gotten place, such as a physical assault, attempted rape, or any other such act, this act needs to be reported immediately to local law enforcement agencies. The home care provider must also immediately notify the two patient and the physician how the provider will terminate its relationship with the patient and that an alternate provider for these services needs to be obtained.

Other less serious circumstances may, nevertheless, lead the property health provider to discover that it should terminate its relationship using a particular patient. Examples can sometimes include particularly abusive patients, patients who solicit -the home health provider professional to destroy 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 house health provider is generally obliged to continue providing services prior to the patient has had a reasonable opportunity to obtain a substitute provider. Exactly the same principles apply to failure of the patient to pay for the assistance or equipment provided.

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

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

2. The property health provider should give or send correspondence to the patient explaining instances surrounding the termination of care.

3. The letter needs to be sent by certified mail, return receipt requested, or 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. If your patient has a life-threatening condition or a medical condition that might deteriorate even without continuing care, this condition should be clearly produced in the letter. The need of the patient's obtaining replacement home health care should be emphasized.

6. The individual should be informed from the location of the nearest hospital emergency department. The sufferer should be told to either go to the nearest hospital emergency department in the case of a medical emergency or call the local emergency number for ambulance transportation.

7. A reproduction 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 with the home health provider's risk manager, a lawyer, medical director, as well as the patient's attending physician.

The inappropriate relieve a patient from healthcare coverage by the home health provider, whether as a result of termination of entitlement, inability to pay, or other reasons, might also lead to liability for your tort of abandonment.

Nurses who passively stand by and observe negligence by the physician or anybody else will personally become accountable on the patient who is injured as a result of that negligence... [H]ealthcare facilities in addition to their nursing staff owe an impartial duty to patients at night duty owed by physicians. Whenever a physician's order to discharge is inappropriate, the nurses will probably be help liable for following a purchase that they knew or should know about is below the standard of care.