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Patient Abandonment - Home Healthcare

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Elements of the Cause of Action for Abandonment

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

1. Healthcare treatment was unreasonably discontinued.

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

3. Medical care provider did not arrange for care by another appropriate skilled medical doctor.

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 individual actually suffered harm or loss on account of the discontinuance of care.

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

Abandonment from the Physician

When a physician undertakes treatments for a patient, treatment must continue before patient's circumstances no longer warrant the treatment, problems 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 as long as he or she provides the patient proper notice of her or his intent to withdraw and an opportunity to obtain proper substitute care.

In your house health setting, the physician-patient relationship will not terminate merely want . patient's care shifts in their location from the hospital for the home. If the patient will continue to need medical services, supervised medical care, 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 even an 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 is often formally terminated by notice to the patient and a reasonable attempt to refer the patient to another appropriate physician. Otherwise, problems will retain his / her duty toward the individual when the patient is discharged through the hospital to the home. Failure to follow through on the part of health related conditions will constitute the tort of abandonment if the patient is injured therefore. This abandonment may expose health related conditions, the hospital, and the home health agency to liability for that tort of abandonment.

The attending physician inside 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 even though it is being delivered through the home health provider, unless the physician intends to continue to supervise that homecare personally. Even more important, if the hospital-based physician arranges to offer the patient's care assumed by another physician, the patient must fully understand this transformation, and it should be carefully documented.

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

• premature turmoil the patient by the physician

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

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

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

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

Generally, abandonment doesn't occur if the physician to blame for the patient arranges for the substitute physician to take his or her place. This variation may occur because of vacations, relocation from 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 with the patient's special conditions, if any, 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 not able to pay for the care, health related conditions is not at liberty to terminate their bond unilaterally. The physician must still make a plan to have the patient's care assumed by another in order to give a sufficiently reasonable period of time to locate another prior to ceasing to provide care.

Although a lot of the cases discussed concern the physician-patient relationship, as pointed out above previously, the same principles apply to all health care providers. Furthermore, since the care rendered from the home health agency is given pursuant to a physician's plan of care, whether or not the patient sued health related conditions for abandonment due to actions (or inactions of the house health agency's staff), problems may seek indemnification from the home health provider.


Similar principles to people who apply to physicians affect the home health professional along with the home health provider. Your house health agency, because the direct provider of want 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 health related conditions. Furthermore, there may be both the best and an ethical obligation to keep delivering care, when the patient has no alternatives. A moral obligation may still exist towards 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 remain providing care to the patient is a duty owed through the agency itself instead of by the individual professional who may be the employee or the contractor from the agency. The home health provider won't have a duty to continue supplying the same nurse, therapist, or aide to 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. From your perspective of patient satisfaction and continuity of care, it might be in the best interests of the home 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 plus a greater degree of trust and compliance for the patient. It should help alleviate many of the problems that arise in the health care' setting.

If your patient requests replacing of a particular nurse, therapist, technician, or home health aide, the house 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 would be wise to follow up on such patient requests to ascertain the reasons regarding the dismissal, to identify "problem" employees, and to ensure no incident has had place that might produce liability. The home health agency should continue providing choose 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 might 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. If the patient pose an actual danger to the individual, he or she should leave the premises immediately. The provider should document within the medical record the facts surrounding the inability to complete the treatment for that visit as objectively as you can. Management personnel should inform supervisory personnel with the home health provider and should complete an internal incident report. Whether it appears that a criminal act has taken place, such as a physical assault, attempted rape, or other such act, this act must be reported immediately to law enforcement agencies. The home care provider must also immediately notify both patient and the physician how the provider will terminate its relationship with the patient and that an alternative provider for these services must be obtained.

Other less serious circumstances may, nevertheless, lead the home health provider to determine 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 interrupt the law (for example, by offering illegal drugs or providing non-covered services and equipment and billing them as something different), or consistently noncompliant patients. Once treatment solutions are undertaken, however, the property health provider is normally obliged to continue providing services before the patient has had a reasonable opportunity to obtain a substitute provider. The identical principles apply to failure of a patient to pay for the assistance 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 which a certain provider and patient will not be compatible, a replacement provider should be tried. Should it appear that this 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. Instances should be documented within 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 ought to be sent by certified mail, return receipt requested, or another measures to document patient receiving the letter. A copy from the letter should be put in the patient's record.

4. Whenever 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 perhaps a medical condition that might deteriorate without continuing care, this issue should be clearly stated in the letter. Require the patient's obtaining replacement home health care should be emphasized.

6. The person should be informed with the location of the nearest hospital emergency department. The patient should be told to either go to the nearest hospital emergency department in case there is a medical emergency or to call the local emergency number for ambulance transportation.

7. A duplicate of the letter needs to be sent to the patient's attending physician via certified mail, return receipt requested.

These steps should not be undertaken lightly. Before such steps are taken, the patient's case should be thoroughly discussed with the home health provider's risk manager, legal services, medical director, along with the patient's attending physician.

The inappropriate turmoil a patient from health care coverage by the home health provider, whether due to termination of entitlement, being unable to pay, or other reasons, might also lead to liability for the tort of abandonment.

Nurses who passively the stand by position and observe negligence with a physician or anyone else will personally become accountable on the patient who is injured because of that negligence... [H]ealthcare facilities as well as their nursing staff owe an independent duty to patients after dark duty owed by physicians. Whenever 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.