Elements of the Cause of Action for Abandonment

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

CGHS card'

1. Medical treatment was unreasonably discontinued.

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

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

4. The health care provider needs to have reasonably foreseen that problems for 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, along with other health care professionals have an ethical, and a legal, duty in order to avoid abandonment of patients. The health care professional includes a duty to give her or his patient all necessary attention provided that the case required it and cannot leave the patient in a critical stage without giving reasonable notice or making suitable arrangements for the attendance of another.

Abandonment from the Physician

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

In your home health setting, the physician-patient relationship doesn't terminate merely must be patient's care shifts in their location from the hospital on the home. If the patient continues to need medical services, supervised medical care, therapy, or other home health services, the attending physician should be sure that he or she was properly discharged his or her-duties for the patient. Virtually every situation 'in which homecare is approved by Medicare, Medicaid, or an insurer will be one in which the patient's 'needs for care have continued. The physician-patient relationship that existed inside the hospital will continue unless it's been formally terminated by notice towards the patient and a reasonable try and refer the patient to a different appropriate physician. Otherwise, problems will retain his or her duty toward the individual when the patient is discharged from your hospital to the home. Failure to adhere to through on the part of the physician will constitute the tort of abandonment if your 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 within the hospital should be sure that a proper referral was designed to a physician who will be accountable for the home health patient's care even though it is being delivered by the home health provider, unless health related conditions intends to continue to supervise that home care personally. Even more important, when the hospital-based physician arranges to achieve the patient's care assumed by another physician, the sufferer must fully understand this change, and it should be carefully documented.

As based on case law, the kinds of actions that will lead to liability for abandonment of the patient will include:

• premature launch of the patient by the physician

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

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

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

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

Generally, abandonment doesn't happen 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 with the physician, illness, distance through the patient's home, or retirement in the physician. As long as care by an appropriately trained physician, sufficiently knowledgeable of 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 can not pay for the care, health related conditions is not at liberty to terminate the relationship unilaterally. The physician must still take steps to have the patient's care assumed by another in order to give a sufficiently reasonable stretch of time to locate another just before ceasing to provide care.

Although almost all of the cases discussed concern the physician-patient relationship, as pointed out previously, the same principles connect with all health care providers. Furthermore, because the care rendered through the home health agency is given pursuant to a physician's plan of care, set up patient sued problems 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 those who apply to physicians connect with the home health professional along with the home health provider. A house health agency, as the direct provider of choose to the homebound patient, could possibly be held to the same legal obligation and duty to provide care that addresses a person's needs as is the physician. Furthermore, there may be both a legal and an ethical obligation to keep delivering care, if your patient has no alternatives. An ethical obligation may still exist towards the patient even though the home health provider has fulfilled all legal obligations.

Each time a home health provider furnishes treatment with a patient, the duty to carry on providing care to the individual is a duty owed with the agency itself instead of 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 on the patient throughout the procedure, so long as the provider continues to use appropriate, competent personnel to administer the course of treatment consistently using 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 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 by the patient. It should help alleviate many of the problems that arise in the health care' setting.

If the patient requests replacement of a particular nurse, therapist, technician, or home health aide, the house health provider still has a duty to provide choose to the patient, unless the sufferer also specifically states she or he no longer desires the provider's service. Home health agency supervisors should follow up on such patient requests to look for the reasons regarding the dismissal, to detect "problem" employees, and to ensure no incident has taken place that might produce liability. The home health agency should continue providing want 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 is probably not a result of the medical condition which is why the care is being provided. Personal safety of the people health care provider should be paramount. When the patient pose a physical danger to the individual, they should leave the premises immediately. The company should document in 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 with the home health provider and should complete an internal incident report. Whether or not this appears that a criminal act has taken place, such as a physical assault, attempted rape, or another such act, this act must be reported immediately to law enforcement agencies. The home care provider also needs to immediately notify the patient and the physician that this provider will terminate its relationship with all the patient and that an alternative provider for these services should be obtained.

Other less serious circumstances may, nevertheless, lead the home health provider to find out that it should terminate its relationship with a particular patient. Examples can sometimes 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 solutions are undertaken, however, the home health provider is often obliged to continue providing services before patient has had a fair opportunity to obtain a substitute provider. Exactly the same principles apply to failure of an patient to pay for the assistance or equipment provided.

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

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

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

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

4. If at all possible, the patient should be given some period of time to obtain replacement care. Usually Thirty days is sufficient.

5. If the patient has a life-threatening condition or possibly a medical condition that might deteriorate even without the continuing care, this disorder should be clearly stated in the letter. Involve the patient's obtaining replacement home healthcare should be emphasized.

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

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

These steps mustn't be undertaken lightly. Before such steps are taken, the patient'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 medical coverage by the home health provider, whether as a consequence of termination of entitlement, lack of ability to pay, or other reasons, could also lead to liability for your tort of abandonment.

Nurses who passively uphold and observe negligence by a 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 unbiased duty to patients at night duty owed by physicians. Every time a physician's order to discharge is inappropriate, the nurses will probably be help liable for following a purchase order that they knew or should know is below the standard of care.


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