Patient Abandonment - Home Healthcare

Elements of the Cause of Action for Abandonment

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

1. Healthcare treatment was unreasonably discontinued.

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

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

4. The health care provider must 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 also other health care professionals have an ethical, in addition to a legal, duty in order to avoid abandonment of patients. The care professional includes a duty to give his or her patient all necessary attention as long as 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 through the Physician

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

In your home health setting, the physician-patient relationship won't terminate merely must be patient's care shifts in the 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 sure 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 an insurer will be one out of which the patient's 'needs for care have continued. The physician-patient relationship that existed from the hospital will continue unless it has been formally terminated by notice on the patient and a reasonable make an effort to refer the patient to another appropriate physician. Otherwise, the physician will retain her or his duty toward the sufferer when the patient is discharged through the hospital to the home. Failure to follow through on the part of the physician will constitute the tort of abandonment when the patient is injured because of this. This abandonment may expose the physician, the hospital, and the home health agency to liability for the tort of abandonment.

The attending physician within the hospital should make sure that a proper referral was created 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 problems intends to continue to supervise that home care personally. Even more important, if your hospital-based physician arranges to offer the patient's care assumed by another physician, the patient must fully understand this variation, and it should be carefully documented.

As backed up by case law, the sorts of actions that will lead to liability for abandonment of your patient will include:

• premature discharge of the patient by the physician

• failure with 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 reply to calls or to further attend the individual

• the physician's leaving the sufferer after surgery or neglecting 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 look at his or her place. This transformation may occur because of vacations, relocation in the physician, illness, distance through the patient's home, or retirement of the physician. As long as care by an appropriately trained physician, sufficiently knowledgeable of the patient's special conditions, or no, has been arranged, the courts will usually not find that abandonment has occurred. Even in which a patient refuses to spend the money for care or is struggling to pay for the care, the physician is not at liberty to terminate the relationship unilaterally. The physician must still take steps to have the patient's care assumed by another or 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, since the care rendered with 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 your home health agency's staff), health related conditions may seek indemnification from the home health provider.


Similar principles to people who apply to physicians sign up for the home health professional and the home health provider. Your house health agency, as the direct provider of choose to the homebound patient, may be held to the same legal obligation and duty to offer care that addresses a person's needs as is problems. Furthermore, there may be both a legal and an ethical obligation to keep delivering care, if your patient has no alternatives. A moral obligation may still exist to the patient even though the home health provider has fulfilled all legal obligations.

When a home health provider furnishes treatment with a 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 might be the employee or the contractor of the agency. The home health provider won't have a duty to continue giving the same nurse, therapist, or aide on the patient throughout the procedure, so long as the provider continues to use appropriate, competent personnel to administer the course of treatment consistently with all the plan of care. From the perspective of patient satisfaction and continuity of care, it may be in the best interests of your home 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 and a greater degree of trust and compliance on the part of the patient. It should help to alleviate many of the issues 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 retains a duty to provide want to the patient, unless the person also specifically states he or she no longer desires the provider's service. Home health agency supervisors should follow up on such patient requests to discover the reasons regarding the dismissal, to identify "problem" employees, and to ensure no incident has gotten place that might produce liability. The home health agency should continue providing desire 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 may not be a result of the medical condition which is why the care is being provided. Personal safety of the individual health care provider should be paramount. Should the patient pose a physical danger to the individual, they should leave the premises immediately. The provider should document from the medical record the facts surrounding the inability to complete the therapy for that visit as objectively as possible. Management personnel should inform supervisory personnel on the home health provider and really should complete an internal incident report. When it appears that a criminal act has had place, such as a physical assault, attempted rape, and other such act, this act ought to be reported immediately to local law enforcement agencies. The home care provider must also immediately notify the patient and the physician that the provider will terminate its relationship using the patient and that an alternate provider for these services should be obtained.

Other less serious circumstances may, nevertheless, lead the property health provider to discover that it should terminate its relationship with a particular patient. Examples can include particularly abusive patients, patients who solicit -the home health provider professional to interrupt 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 treatment is undertaken, however, the home health provider is often obliged to continue providing services until the patient has had a reasonable opportunity to obtain a substitute provider. Precisely the same principles apply to failure of a patient to pay for the skills or equipment provided.

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

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

2. The house health provider should give or send instructions to the patient explaining situations surrounding the termination of care.

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

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

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

6. The person should be informed from the location of the nearest hospital emergency department. The individual should be told with the idea to go to the nearest hospital emergency department in the case of a medical emergency as well as to call the local emergency number for ambulance transportation.

7. A copy of the letter ought to 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 using the home health provider's risk manager, legal services, medical director, and 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, being unable to pay, or other reasons, can also lead to liability for that tort of abandonment.

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