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Patient Abandonment - Home Medical care

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Elements of the Cause of Action for Abandonment

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

1. Health care treatment was unreasonably discontinued.

2. The termination of medical 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 needs to have reasonably foreseen that harm to the patient would arise through the termination of the care (proximate cause).

5. The individual actually suffered harm or loss due to the discontinuance of care.

Physicians, nurses, along with other health care professionals have an ethical, in addition to a legal, duty in order to avoid abandonment of patients. Medical care professional has a duty to give his / her patient all necessary attention providing the case required it and should not leave the patient in the critical stage without giving reasonable notice or making suitable arrangements for the attendance of another.

Abandonment through the Physician

When a physician undertakes treating a patient, treatment must continue before patient's circumstances not warrant the treatment, the physician and the patient mutually agree 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 if he or she provides the patient proper notice of his / her intent to withdraw with an opportunity to obtain proper substitute care.

In the house health setting, the physician-patient relationship doesn't terminate merely because a patient's care shifts in their location from the hospital for the home. If the patient will continue to need medical services, supervised healthcare, therapy, or other home health services, the attending physician should ensure 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 even 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 make an effort to refer the patient to a different appropriate physician. Otherwise, health related conditions will retain his / her duty toward the individual when the patient is discharged in the hospital to the home. Failure to follow through on the part of problems will constitute the tort of abandonment in the event the patient is injured therefore. This abandonment may expose the doctor, the hospital, and the home health agency to liability for that tort of abandonment.

The attending physician within the hospital should make sure that a proper referral was created to a physician who will be accountable 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, when the hospital-based physician arranges to offer the patient's care assumed by another physician, the person must fully understand this variation, and it should be carefully documented.

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

• premature launch of the patient by the physician

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

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

• refusal of the physician to respond to calls or to further attend the individual

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

Generally, abandonment doesn't happen if the physician accountable for the patient arranges for the substitute physician to adopt his or her place. This change may occur because of vacations, relocation with the physician, illness, distance in 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 in which a patient refuses to pay for the care or is not able to pay for the care, problems 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 as well as to give a sufficiently reasonable time frame to locate another ahead of ceasing to provide care.

Although the majority of the cases discussed concern the physician-patient relationship, as pointed out previously, the same principles sign up for all health care providers. Furthermore, for the reason that care rendered from the home health agency is provided pursuant to a physician's plan of care, get the job done patient sued the physician for abandonment due to the actions (or inactions of your home health agency's staff), health related conditions may seek indemnification through the home health provider.


Similar principles to those that apply to physicians apply to the home health professional and the home health provider. Your house health agency, since the direct provider of care to the homebound patient, could possibly be held to the same legal obligation and duty to supply care that addresses a person's needs as is the doctor. 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 on the patient even though the home health provider has fulfilled all legal obligations.

Each time a home health provider furnishes treatment to a patient, the duty to keep providing care to the sufferer is a duty owed by the agency itself rather than 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 for the patient throughout the treatment, so long as the provider is constantly use appropriate, competent personnel to give the course of treatment consistently with the plan of care. From the perspective of patient satisfaction and continuity of care, it can be in the best interests of the home health provider to try and provide the same individual practitioner on the patient. The development of an individual relationship with the provider's personnel may improve communications and a greater degree of trust and compliance by the patient. It should assistance to alleviate many of the conditions arise in the health care' setting.

In the event the 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 choose to the patient, unless the sufferer also specifically states he or she no longer desires the provider's service. Home health agency supervisors must always follow up on such patient requests to determine the reasons regarding the dismissal, to detect "problem" employees, and to ensure no incident has taken place that might bring about liability. The home health agency should continue providing care 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 will not be a result of the medical condition that the care is being provided. Personal safety of the people health care provider should be paramount. If your patient pose an actual physical danger to the individual, they should leave the premises immediately. The provider should document within the medical record the facts surrounding the inability to complete treatments for that visit as objectively as is possible. Management personnel should inform supervisory personnel on the home health provider and will complete an internal incident report. If it appears that a criminal act has brought place, such as a physical assault, attempted rape, or any other such act, this act needs to be reported immediately to local law enforcement agencies. The home care provider should also immediately notify both the patient and the physician that this provider will terminate its relationship using the patient and that an alternate provider for these services ought to be obtained.

Other less serious circumstances may, nevertheless, lead the home health provider to ascertain 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 break the law (for example, through providing illegal drugs or providing non-covered services and equipment and billing them as something else), or consistently noncompliant patients. Once treatment is undertaken, however, the house health provider is often obliged to continue providing services until the patient has had a good opportunity to obtain a substitute provider. The identical principles apply to failure of your patient to pay for the assistance or equipment provided.

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

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

2. The property health provider should give or send a letter to the patient explaining the circumstances surrounding the termination of care.

3. The letter should be sent by certified mail, return receipt requested, or other measures to document patient delivery of the letter. A copy with the letter should be put into the patient's record.

4. Whenever possible, the patient should be given a particular period of time to obtain replacement care. Usually Thirty days 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 stated in the letter. The need of the patient's obtaining replacement home medical care should be emphasized.

6. The patient should be informed of the location of the nearest hospital emergency department. The patient should be told to either go to the nearest hospital emergency department in case of a medical emergency or 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 shouldn't be undertaken lightly. Before such steps are taken, the patient's case should be thoroughly discussed using the home health provider's risk manager, legal services, medical director, and also 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, might also lead to liability for your tort of abandonment.

Nurses who passively uphold and observe negligence with a physician or anyone else will personally become accountable to the patient who is injured as a result of that negligence... [H]ealthcare facilities along with their nursing staff owe an impartial duty to patients at night duty owed by physicians. When a physician's order to discharge is inappropriate, the nurses is going to be help liable for following a purchase that they knew or ought to know is below the standard of care.