Elements of the Cause of Action for Abandonment
All the following five elements have to be present for a patient to possess 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 didn't arrange for care by another appropriate skilled health care provider.
4. The health care provider should have reasonably foreseen that injury to the patient would arise from your termination of the care (proximate cause).
5. The patient actually suffered harm or loss as a result of the discontinuance of care.
Physicians, nurses, as well as other health care professionals have an ethical, and a legal, duty to prevent abandonment of patients. The health care professional carries a duty to give his / her patient all necessary attention as long as the case required it and should not leave the patient inside a critical stage without giving reasonable notice or making suitable arrangements for the attendance of another.
Abandonment with the Physician
When a physician undertakes treatment of a patient, treatment must continue before the patient's circumstances will no longer warrant the treatment, problems and the patient mutually accept to end the treatment with that physician, or the patient discharges problems. Moreover, the physician may unilaterally terminate the partnership and withdraw from treating that patient as long as he or she provides the patient proper notice of her or his intent to withdraw plus an opportunity to obtain proper substitute care.
In the home health setting, the physician-patient relationship won't terminate merely want . patient's care shifts in their location from the hospital for the home. If the patient is constantly on the need medical services, supervised medical, therapy, or other home health services, the attending physician should be sure 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 from the hospital will continue unless it is often 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 patient when the patient is discharged in the hospital to the home. Failure to follow along with through on the part of the physician will constitute the tort of abandonment if your patient is injured consequently. This abandonment may expose the doctor, the hospital, and the home health agency to liability for your 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 while it's being delivered by the home health provider, unless problems intends to continue to supervise that home care personally. Even more important, in the event the hospital-based physician arranges to get the patient's care assumed by another physician, the sufferer must fully understand this variation, and it should be carefully documented.
As supported by case law, the types of actions that will result in liability for abandonment of an 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 by the physician to the patient that this physician will no longer treat the sufferer
• refusal of the physician to respond to calls or to further attend the person
• the physician's leaving the person after surgery or neglecting to follow up on postsurgical care.
Generally, abandonment doesn't happen if the physician responsible for the patient arranges for any substitute physician to look at his or her place. This change may occur because of vacations, relocation of the physician, illness, distance from your patient's home, or retirement in 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 in most cases not find that abandonment has occurred. Even the place where a patient refuses to spend the money for care or is struggling to pay for the care, the doctor is not at liberty to terminate the connection unilaterally. The physician must still make a plan to have the patient's care assumed by another or give a sufficiently reasonable time period 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, as the care rendered with the home health agency is supplied pursuant to a physician's plan of care, whether or not the patient sued the physician for abandonment due to the actions (or inactions of the home health agency's staff), the doctor may seek indemnification through the home health provider.
ABANDONMENT With the NURSE OR HOME HEALTH AGENCY
Similar principles to people who apply to physicians sign up for the home health professional and the home health provider. A house health agency, as the direct provider of care to the homebound patient, might be held to the same legal obligation and duty to supply care that addresses a person's needs as is problems. Furthermore, there may be both a legitimate and an ethical obligation to remain delivering care, in the event the patient has no alternatives. A moral obligation may still exist on the patient even though the home health provider has fulfilled all legal obligations.
When a home health provider furnishes treatment to a patient, the duty to carry on providing care to the individual is a duty owed from 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 won't have a duty to continue offering the same nurse, therapist, or aide on the patient throughout the treatment, so long as the provider will continue to use appropriate, competent personnel to provide the course of treatment consistently with the plan of care. In the perspective of patient satisfaction and continuity of care, it may be in the best interests of the property health provider to try to provide the same individual practitioner towards the patient. The development of an individual relationship with the provider's personnel may improve communications as well as a greater degree of trust and compliance for the patient. It should assistance to 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, your home health provider is still equipped with a duty to provide want to the patient, unless the patient 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 determine the reasons regarding the dismissal, to detect "problem" employees, and to ensure no incident has brought place that might give rise to liability. The home health agency should continue providing want to the patient until definitively told not to do so by the patient.
Dealing with THE ABUSIVE PATIENT
Home health provider personnel may occasionally encounter an abusive patient. This abuse mayor might not be a result of the medical condition for which the care is being provided. Personal safety of the individual health care provider should be paramount. When the patient pose an actual physical danger to the individual, they should leave the premises immediately. The company should document from the medical record the facts 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. Whether or not this 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 should also immediately notify the patient and the physician the provider will terminate its relationship using the patient and that an alternative provider for these services must be obtained.
Other less serious circumstances may, nevertheless, lead your home health provider to discover that it should terminate its relationship with 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, by providing illegal drugs or providing non-covered services and equipment and billing them as something more important), or consistently noncompliant patients. Once treatment methods are undertaken, however, the house health provider is usually obliged to continue providing services prior to the patient has had a reasonable opportunity to obtain a substitute provider. Precisely the same principles apply to failure of an patient to pay for the help or equipment provided.
As medical professionals, HHA personnel should have training concerning how to handle the difficult patient responsibly. Arguments or emotional comments needs to be avoided. If it becomes clear that the certain provider and patient will not be compatible, a substitute provider should be tried. Should it appear how the problem lies using the patient and that it is necessary for the HHA to terminate its relationship with all the patient, the following seven steps must be taken:
1. The circumstances should be documented in the patient's record.
2. Your home health provider should give or send directions to the patient explaining situations surrounding the termination of care.
3. The letter must be sent by certified mail, return receipt requested, or another measures to document patient delivery of 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 Four weeks is sufficient.
5. In the event the patient has a life-threatening condition or even a medical condition that might deteriorate even without the continuing care, this disorder should be clearly mentioned in the letter. The need of the patient's obtaining replacement home healthcare should be emphasized.
6. The sufferer should be informed in the location of the nearest hospital emergency department. The sufferer should be told either 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 copy of the letter ought 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, a person's case should be thoroughly discussed together with the home health provider's risk manager, an attorney, medical director, and also the patient's attending physician.
The inappropriate discharge of a patient from medical care coverage by the home health provider, whether as a result of termination of entitlement, lack of ability to pay, or other reasons, might also lead to liability for that tort of abandonment.
Nurses who passively the stand by position and observe negligence by a physician or other people will personally become accountable towards the patient who is injured due to that negligence... [H]ealthcare facilities in addition to their nursing staff owe an unbiased duty to patients past the duty owed by physicians. When a physician's order to discharge is inappropriate, the nurses is going to be help liable for following an order that they knew or should be aware of is below the standard of care.