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January 02 2016


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 cause of action for the tort of abandonment:

1. Health care treatment was unreasonably discontinued.

CGHS card

2. The termination of healthcare was contrary to the patient's will or devoid of the patient's knowledge.

3. Medical care provider didn't arrange for care by another appropriate skilled health care provider.

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

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

Physicians, nurses, and other health care professionals have an ethical, as well as a legal, duty to avoid abandonment of patients. Medical care professional features a duty to give their patient all necessary attention as long as the case required it and should not leave the patient in a critical stage without giving reasonable notice or making suitable arrangements for your attendance of another.

Abandonment by the Physician

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

In the house health setting, the physician-patient relationship doesn't terminate merely just because a patient's care shifts in their location from the hospital for 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 for the patient. Virtually every situation 'in which home care is approved by Medicare, Medicaid, or perhaps 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 to the patient and a reasonable try and refer the patient to a new appropriate physician. Otherwise, health related conditions will retain her or his duty toward the person when the patient is discharged from your hospital to the home. Failure to adhere to through on the part of health related conditions will constitute the tort of abandonment when the patient is injured consequently. This abandonment may expose health related conditions, the hospital, and the home health agency to liability for the tort of abandonment.

The attending physician from the hospital should make sure that a proper referral is made to a physician who will be in charge of the home health patient's care though it may be being delivered with the home health provider, unless health related conditions intends to continue to supervise that homecare personally. Even more important, if your hospital-based physician arranges to have the patient's care assumed by another physician, the patient must fully understand this variation, and it should be carefully documented.

As sustained by case law, like actions that will result in liability for abandonment of a patient will include:

• premature turmoil the patient by the physician

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

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

• refusal of the physician to reply 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 does not occur if the physician in charge of the patient arranges for a substitute physician to adopt his or her place. This variation may occur because of vacations, relocation of the physician, illness, distance through the patient's home, or retirement from 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 will often not find that abandonment has occurred. Even when a patient refuses to spend the money for care or is unable to pay for the care, health related conditions 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 time frame to locate another prior to ceasing to provide care.

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


Similar principles to those who apply to physicians connect with the home health professional and also the home health provider. A house health agency, as the direct provider of care 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 the doctor. Furthermore, there may be both a legal and an ethical obligation to remain delivering care, if the patient has no alternatives. A moral obligation may still exist for 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 remain providing care to the person is a duty owed by the agency itself rather than by the individual professional who seems to be the employee or the contractor of the agency. The home health provider doesn't have a duty to continue offering the same nurse, therapist, or aide for the patient throughout the course of treatment, so long as the provider will continue to use appropriate, competent personnel to administer the course of treatment consistently with the plan of care. Through the perspective of patient satisfaction and continuity of care, it could be in the best interests of the property health provider to provide the same individual practitioner towards the patient. The development of an individual relationship with the provider's personnel may improve communications plus a greater degree of trust and compliance by the patient. It should help to alleviate many of the conditions that arise in the health care' setting.

If your patient requests replacement of a particular nurse, therapist, technician, or home health aide, the home health provider is still equipped with a duty to provide care 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 ascertain the reasons regarding the dismissal, to detect "problem" employees, and to ensure no incident has brought place that might bring about liability. The home health agency should continue providing desire to the patient until definitively told to refrain from giving 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 that the care is being provided. Personal safety of the person health care provider should be paramount. If your patient pose an actual physical danger to the individual, he or she should leave the premises immediately. The provider should document from the medical record the facts surrounding 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 should complete an internal incident report. Whether it appears that a criminal act has had place, such as a physical assault, attempted rape, and other such act, this act should be reported immediately to law enforcement agencies. The home care provider also needs to immediately notify both the patient and the physician how the provider will terminate its relationship together with the patient and that an alternate provider for these services should be obtained.

Other less serious circumstances may, nevertheless, lead the home health provider to ascertain that it should terminate its relationship using a particular patient. Examples might 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 another thing), or consistently noncompliant patients. Once therapy is undertaken, however, the property health provider is often obliged to continue providing services prior to the patient has had a good opportunity to obtain a substitute provider. The identical principles apply to failure of an patient to pay for the help or equipment provided.

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

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

2. Your home health provider should give or send instructions 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 receiving the letter. A copy with the letter should be placed 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. When the patient has a life-threatening condition or a medical condition that might deteriorate without continuing care, this condition should be clearly stated in the letter. Involve the patient's obtaining replacement home healthcare should be emphasized.

6. The individual should be informed of the location of the nearest hospital emergency department. The sufferer should be told with the idea to go to the nearest hospital emergency department in case there is a medical emergency in order to 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 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 relieve 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 uphold and observe negligence by the physician or someone else will personally become accountable towards the patient who is injured as a result of that negligence... [H]ealthcare facilities along with their nursing staff owe an unbiased duty to patients beyond the duty owed by physicians. Each time a physician's order to discharge is inappropriate, the nurses will likely be help liable for following an order that they knew or ought to know is below the standard of care.

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